The synonymous in further meanings
artificial hip joint, total hip joint prosthesis (THP), hip joint artificial limb, total hip prosthesis, total hip replacement, HEP, TEP, HTEP, hip arthroplasty, hip replacement, hip joint arthrosis, a joint substitute, hip joint substitute, hip operation, hip joint operation, McMinn artificial limb, cap artificial limb, short shaft artificial limb
English: hip prosthesis.
Definition
The name total hip joint prosthesis stands for "artificial hip joint". The artificial hip joint is based on the human hip joint and therefore consists of the same parts in principle.
If a hip artificial limb will be implanted, you replace the socket of the hip of the pelvis by a socket artificial limb (= "artificial socket"). The femoral head and the femoral neck itself are being replaced by the artificial limb shaft with an artificial femoral head on top.
There is the possibility of fixing the mentioned components in the bone either with or without bone cement.
There is also the possibility of implanting a so-called hemi- artificial limb. In this case only the femoral neck and the femoral head are being replaced artificially- the socket of the hip is, however, not being replaced.
Age
As a rule, the clinical manifestation of a hip arthrosis has to be established between the 50th and 60th years of life. In most cases a hip arthrosis does not remain restricted to only one side and therefore frequently appears predominantly on both sides.
Sex distribution
With regard to the appearance of a hip arthrosis and connected to that the implantation of a total hip prothesis the sex-specific relationship is 1,5:1 (women: men).
Frequency
Approximately 120,000 artificial hip joints are being implanted all over Germany (= inserted) every year. Since the number of the hip joint implantations increased continuously within the last few years, the implantation operation has developed into a "routine operation" by now. Since the number of the hip joint implantations rises, the number of the changing operations is also increasing. It amounts by Anno (per annum) meanwhile to approx. 10,000
Cause
- Socket of the hip
- Femoral head
- Femoral neck
- used up joint cavity
As a rule, such an operation becomes necessary if the wearing- out on the hip joint is very far advanced. Such a based on coxarthrosis (derived from the Latin word: "coxa" (= hip)) always implies a painful change in the area of the hip joint which arises due to the diseased joint cartilage wear- out.
Depending on original cause one distinguishes in the area of the coxarthrosis between:
Primary coxarthrosis and the secondary coxarthrosis.
You always talk about a primary coxarthrosis, if one cannot name any obvious causes for the emergence.
You talk, however, about a secondary coxarthrosis, if the illness is based on another illness or was caused by it. These causal illnesses can be circulation disorders (e.g. Perthes' disease or the idiopathic hip head necrosis) or dysplasia of the hip, for example.
Among other things, reasons for a hip joint arthrosis might be:
Inflammations (at, for example, rheumatic illnesses / rheumatism / rheumatoid arthritis), (chronic) overstraining or injuries, but also innate malformations.
Every false straining, or every illness, which causes a long lasting false straining (pre- arthrotic deformity), also injuries in the area of the joint structures as a consequence of accidents (e.g. fractures of the femoral neck within older people) or movability above range in the area of joints can have a negative effect and therefore influencing the hip joint function negatively durably.
Overweight is regarded as unfavorable influencing with regard to the emergence and the course of a disease of a hip arthrosis.
You find further information about the emergence of a hip joint arthrosis at hip arthrosis.
Indication
The indications for the implantation of a hip artificial joint:
The following table shows the probability for the indication of a hip joint replacement at present illness. Therefore in approximately 60% of all cases of present primary coxarthrosis such an operation becomes necessary.
Primary coxarthrosis 60%
Rheumatoid arthritis 7%
Fractures and contortions, particularly the fracture of the neck of the femur 11%
Aseptic bone necrosis 7%
Other indications 9%
Revisions / repeated surgery 6%
Risk factors
As already mentioned above, there are different risk factors which increase the emergence of a coxarthrosis. Some essential factors shall be listed followingly once again. You can find further information about some illnesses. Simply click on the corresponding link.
- innate malpositions (e.g. dislocation of the hip, Perthes` disease, epiphysiolysis capitis femoris) which were not corrected in the age of a small child.
- Over- and false straining at work or in the sports
- Inflammation of joints (for example at rheumatic illnesses),
- Fractures (particularly: fracture of the femoral neck)
- Overweight (no arthrosis risk factor as such. Overweight has an accelerating effect on the progressing of arthrosis, though ).
- Lack of exercise
- dissimilar long legs
- Idiopathic necroses (loss of bone mass as a result of an insufficient circulation in result of injuries (traumata)).
- Bone tumors
Clinic
The anamnesis (questioning of the medical history) is operated at different levels. At first, the family history is analyzed with regard to heaped, early arthroses or rheumatic illnesses. An anamnesis of one's own also seems important to be able to distinguish between a primary and secondary arthrosis. Whether hip joint illnesses or operations have already taken place in the past, whether there are metabolism illnesses or the pains extend also at other joints are of interest in the context of the case history of one's own.
The arthrosis appears mainly in the form of pain in the inguinal region and buttocks area, they can radiate from the hip joint up to the thigh or even to the knee joint, though. Pains are also conceivable in the area of the lumbal spinal column.
Furthermore patients frequently complain about attempt-, finish-, or load pains which then can extend in more advanced stages up to resting pain, which primarily appear at night.
Due to the movement restrictions typical of the coxarthrosis, which can be explained by the malposition of the hip joint and tense muscle, the quality of life of the patient can be limited very strongly. Everyday, "normal" movements can be very difficult again and again: The maximum way of walking is reduced, the putting on of shoes and stockings can also become difficult.
The picture above on the right shows how the intraoperative results of a coxarthrosis represent themselves. The femoral head and the socket of the hip are freed from cartilage, that is why the bone in these areas is “naked”.
Diagnosis
Making the diagnosis is carried out after case history (families, own case history), physical examination (localization of pain) with an additional reassuring by x-rays of the concerned hip side. In the context of a movement check of the hip joint flection, extension, inside- and outside rotation as well as abduction and adduction are checked. At existing coxarthrosis the inner rotation in the hip joint is extremely restricted, because of muscle shortening the complete leg seems shortened.
Forecast
With most patients a good to a very good long time result can be achieved by a hip joint prosthesis. The pain alleviation in combination with a considerably improved movability and with that a considerable increase of the quality of life have a positive effect.
The operative intervention in the case of hip joint near fractures, which according to tendency happen very frequent with older people, causes a stabilization of the hip joint and promises a fast mobilisation instead of a long-week confinement to bed without operation.
The life time of the artificial joints are restricted. As a rule, a changing operation must on an average be carried out after 12 to 18 years. The word "average" already implies deviations in the two directions. So single artificial joint models can last considerably longer, the life time of the artificial joint can also considerably be found below the average, though. There are several factors which can negatively influence the life time of the artificial joint. So the artificial limb can be loosened by osteoporosis or "material abrasion" by accidents, overloads, already after few years, for example. A changing operation then becomes a necessity.
How you can imagine yourself, however, such changing surgeries can not be carried out permanently. This means that they should be avoided if possible, but in any case delayed for a long time. All factors which could draw such a loosening with themselves should be avoided. Particularly the strong overstraining of the artificial hip joint by lifting heavy loads, executing joint shaking sports, should be avoided.
At present, the research is working on the development of so-called "abrasion free" materials. "Best result conditions" can therefore be spoken of sooner or later on the part of the material. The patient then only must help by appropriately correct behavior to be able to reach even considerably better forecasts.
Sports
Problem: Uncontrollable movements!
There are sports which are suitable for people with artificial joints, conditionally suitable or unsuitable. The classification is dependent on the frequency of so-called critical movements. As a rule, one understands extreme movements, such as strong rotations, compressions, movements of the leg, by such critical movements to the body to or cross over leg positions (= adduction). Especially the mentioned movements can cause a luxation (= dislocation) of the artificial hip joint / hip prothesis. Under circumstances therefore a renewed operation can become necessary.
Therefore sports, whose straining is established particularly in the speed and stamina area, which it still can come to permanent changes of direction under circumstances are unsuitably. Most ball sports cannot exclude such critical movements because it comes to uncontrollable movements particularly in the contact with an opponent (man against man) again and again. Ball sports like baseball are an exception. Martial arts, setback games (tennis, squash, ...), belong to a further group of unsuitable sports, as well as bolt sports, alpine skiing and many more. You should ask your attending doctor whether and to what extent he can approve "your" previous kind of sport. He can individual assess what is the best for you.
Just with regard to the kind of sport "alpine skiing" just mentioned the experts argue. There are supporters, however also strict opponents. Since it is, however, necessary to avoid critical movements and falls, one can hold tight: as a rule, experienced skier, who have been skiing for many decades, can ski relatively harmless with artificial joints, particularly if you avoid journeys on mogul slopes and in deep powder snow and if you are restricted to prepared slopes. However, the risk is enormously high in case falls occur.
What do I have to take into account at the choice of the kind of sport?
Like it is already mentioned above it is of enormous importance that sports with a great shock load are being avoided. Also sports with abrupt movements have to be avoided.
There are still no studies, which sports could cause a possible loosening of the artificial joint till now. There are studies which examined tennis particularly with regard to the artificial limb loosening, though. Summarizing it can be said that a minimal increased loosening rate could be stated. Since the tennis sports as such implies an improved musculature in the appropriate hip area, though, the advantages and disadvantages lifted themselves against each other, seen statistically. The playing in a group of 4 persons in tennis proved to be particularly positive since the damaging starts and stops were reduced.
Therapy
You can find more information about the surgery, complications, artificial joint models and loosening signs on the next page!!!!
You will find information about the following topics soon:
- The artificial hip joint surgery
- Complications of the artificial hip joint surgery
- the pressure disk prosthesis
- Short shaft artificial joint
- the McMinn- artificial joint
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