Hip joint surgery
When is the optimum time?
The reduction in quality of life caused by advanced hip osteoarthritis is different for each person. The decision in favour of surgery must be right for you. You decide when the time is right for you to have an artificial hip joint. Unfortunately, the wear and tear on cartilage caused by osteoarthritis is increasing exponentially. This means that hip pain and restricted movement will increase over time, increasing insecurity and therefore the risk of falling, unless the problem can be at least partially stabilised at an initial stage through targeted muscle strength development. The more pain you have, the less you want to use your muscles. This is a vicious circle, because it weakens the muscles. Unfortunately, muscles also break down much faster than they are trained.
How is a hip joint operation planned?
Every hip operation is planned individually by the surgeon before the operation. This requires a current X-ray of the pelvis with a reference sphere (usually a 2.5 cm metal sphere). With the help of this reference sphere and a corresponding planning programme, the size of the hip stem and socket can be precisely and individually determined on the corresponding X-ray image.
How can I prepare for the procedure?
Before the operation, you can also do a lot to ensure that the operation is successful and that you can get back on your feet quickly after the artificial hip joint has been fitted.
The most important prerequisite is that you are 100 per cent convinced that now is the right time for you to have an artificial hip joint and that you feel well looked after and understood by your doctor. Only together can a good result be achieved.
Healthy lifestyle and training
An unhealthy lifestyle (especially smoking) and being overweight can affect the chances of recovery. Heavy smokers usually have poorer blood circulation and wound healing. Being overweight puts additional strain on the joints and makes mobility and recovery training after the operation more difficult.
In preparation for the operation, we recommend that you continue to move and train your hip joints despite the pain - because the stronger your muscles and the better your mobility before the operation, the quicker you will be back on your feet. It takes at least three times as long to build up muscles as it does to break them down. Good nutrition with high-quality proteins also promotes muscle development. Physiotherapy before the operation can support this and prepare you for the time after the operation.
Strengthening the immune system
As several studies have already shown, strengthening the immune system with sufficient vitamins and proteins before and after the operation is extremely important in order to minimise the complication rate. Well-tolerated nutritional supplements are used for this purpose.
Our skin is our natural protection against the outside world and is colonised by many skin bacteria. These do not normally cause any damage, but can lead to infections if the skin is damaged and the immune defence is weakened. We therefore advise our patients to cleanse their entire body themselves with a special washing lotion for five days before the operation and to disinfect the skin area to be operated on with appropriate disinfectant wipes. These measures significantly reduce skin bacteria and lower the risk of infection.
Check-up at the family doctor and dentist
We also recommend a check-up with your family doctor so that anaemia, bleeding tendencies or cardiological problems can be ruled out or, if necessary, treated before the operation. As all these measures have a positive effect on the outcome of the operation, we specifically advise our patients on these points before a major operation, such as an artificial knee or hip joint (information sheet, counselling, product recommendations, etc.).
We also recommend that you have your teeth checked and, if necessary, restored by a dentist before a major joint replacement operation. Dental hygiene (DH) is also recommended before the operation. After the operation, you should not go to the dentist or to the DH for at least three months in order to avoid possible infections.
How does a hip prosthesis operation work?
For an operation to implant an artificial hip joint using the newer minimally invasive, tissue-sparing technique from the front to be a success, a general anaesthetic is necessary to guarantee optimal muscle relaxation.
1. visualisation of the hip joint
In the minimally invasive, tissue-sparing surgical approach to the hip joint from the front, an approx. eight centimetre long skin incision is made below the outer groin. The stabilising hip muscles are gently pushed to the side and the affected hip joint is exposed. The anterior joint capsule is then removed and the diseased hip joint, worn down by osteoarthritis, is revealed.
2. removal of the femoral head
The worn femoral head and part of the femoral neck are then separated from the femur with a saw and removed. Depending on which stem model is used, more or less bone is removed from the femoral neck. Once the worn femoral head has been removed, the joint socket is clearly visible.
The new artificial hip joint is then reconstructed.
3. preparation of the acetabulum and its replacement
The acetabulum is prepared using special reamers in different sizes. The special hip reamers in different sizes are used to remove old capsule and cartilage tissue from the natural acetabulum until bone tissue with a good blood supply is visible again. The size is checked using fluoroscopy (X-ray during the operation). The well-perfused bone tissue ensures that the new artificial hip socket is firmly anchored. This is followed by the insertion of the new definitive acetabulum and the corresponding inlay as a cartilage replacement.
4. preparation of the femur and insertion of the stem
The femur is a tubular bone. It has a sturdy bone cortex (cortical bone) on the outside. The hollow interior of the femur (medullary cavity) is soft and filled with delicate bone balls (cancellous bone). This interior is then treated with special shank rasps in different sizes. If the hold and size are good, which is again checked under X-ray, the next step is a trial reduction of the hip. This involves checking how stable the hip is and which movements could cause it to dislocate. If the muscle tension is too low and the hip joint can therefore easily dislocate, either the femoral head is lengthened or the stem is enlarged, even if this can lead to a lengthening of the leg. The stability of the new hip joint is more important than achieving a symmetrical leg length. Once everything has been checked and verified, the trial parts are removed and the final parts of the new hip prosthesis are inserted. If the bone quality does not permit cementless anchoring, the new artificial stem must be cemented in.
5 Reduction of the new artificial hip
Once the new acetabular cup, the cup insert and the stem have been inserted and the final femoral head has been fitted in the correct size and length, the artificial hip joint is repositioned. This restores the mobile connection between the stem and cup. After another functional check, the new hip joint is x-rayed to check the final position of the artificial hip joint.
6. close to the skin
At the end of the operation, any existing bleeding is stopped and a drainage tube is inserted into the joint to drain off any future blood accumulation. The surgical wound is then sutured in layers and covered with a sterile silicone dressing.
How long does the hospitalisation last and what happens afterwards?
You will be hospitalised for about five days after the operation. If a drainage tube has been inserted, it will be removed the next day. On the first postoperative day, the clinic will start internal physiotherapy with gait training. You should only put partial weight on the operated hip using walking sticks for about six weeks in order to protect the soft tissue and encourage the bone to grow into the new cementless artificial hip joint. The walking sticks give you security and help people to be more careful towards you. If the new hip has been cemented, it can be fully loaded the very next day. Nevertheless, we still recommend walking sticks for at least 14 days in these cases.
As the anterior capsule of the hip joint was partially removed during the operation, you must not turn the operated leg outwards, cross it or straighten it for six weeks. This is to prevent a possible dislocation of the hip joint. Dislocation of the hip, also known as hip luxation, is an emergency and fortunately very rare. It usually occurs as a result of tripping, getting stuck with the operated leg or performing an incorrect movement. If this happens, the leg can no longer be moved or loaded, and the leg immediately shortens. In most cases, the hip then has to be repositioned under a short anaesthetic. However, subsequent operations may also be necessary if something breaks or collapses as a result of the dislocation or re-dislocation.
Illus. from left to right, operated hip marked with white adhesive tape
Movements not permitted:
- Hyperextension of the operated hip
- Turning the operated leg outwards
- Crossing of the operated leg
- Turning the upper body to the healthy side
After six weeks, the joint capsule will have regenerated and the three prohibited movements will gradually be permitted again. You should also sleep on your back with a pillow under the back of your knees for six weeks. The stitches are removed after 14 days.
Physiotherapy lasting several weeks should begin immediately after hospitalisation. Most patients organise themselves so that they come to our physiotherapy two to three times a week. Of course, you can also look for a therapist near your place of residence. We are happy to issue appropriate prescriptions. Some health insurance companies also cover inpatient rehabilitation or a cure. This should be clarified in advance and only planned once the costs have been approved. If help with household chores is desired or necessary, this can be organised through Spitex. We will be happy to help you with the organisation.
What are the possible risks and complications?
The use of an artificial joint is a routine procedure for experienced specialists. Artificial joints have been tested and developed for many years and the corresponding surgical techniques have been constantly optimised and refined. In most cases, very good results can be achieved without any detours. However, you must be aware that although you are receiving an artificial joint as a replacement for your natural joint, it remains a foreign body that can also cause you problems.
Every operation harbours risks and something unexpected can happen at any time. The complication rate for a first operation is relatively low at one per cent. However, the risk increases with each subsequent operation. Good health and a healthy lifestyle help to minimise the risks. We differentiate between general complications that can occur during any operation (e.g. infections, blood clots, nerve/muscle/vascular injuries, post-operative bleeding, wound healing disorders or sensory disturbances on the skin) and specific complications that can occur during surgery on the artificial hip joint. These include
- Early loosening of the anchoring of the artificial hip joint to the pelvis (socket) or thigh (stem) with possible suspicion of a particular infection
- Dislocation of the joint (luxation) with injury to the joint and/or the anchorage
- Difference in leg length, axial misalignment and rotation errors of the leg
- Restriction of movement due to scarring and adhesions or incarceration of tissue
- Allergy to cement and/or prosthesis material
The risks are low for an initial operation, but then increase with each subsequent operation. A complication may mean that you have to have another operation. In a good clinic, you will be closely monitored so that a quick response can be made in the event of complications.
Frequently asked questions
What happens if a broken hip is not operated on?
If an osteoarthritic hip is not operated on, the typical symptoms such as movement and load-dependent pain as well as restricted movement increase more and more. This increase is not linear, but exponential. The hip joint becomes increasingly stiff and climbing stairs, getting in and out of the car, putting on socks or shoes and cutting toenails become insurmountable hurdles. In addition, gait instability and the risk of falling increase, making walking aids (walking stick, rollator) necessary. The resulting postural rest puts more strain on other joints, which in turn can lead to further complaints. The limping gait and the relieving posture can lead to increased back pain. Due to the increasing pain, additional painkillers have to be taken, which in turn put a strain on the stomach, liver, kidneys or gastrointestinal tract over a longer period of time. If the pain and restricted movement increase to such an extent that your quality of life is significantly impaired, you should have these complaints checked out by a specialist.
How long does an artificial hip joint last?
Nowadays, an artificial hip joint lasts around 20 years. The lifespan of the artificial hip joint can be shortened by infections, chronic overloading, wear and tear and abrasion of metal and polyethylene, allergies to the artificial hip joint and its possible anchoring (cement), an increase in osteoporosis and thus a decrease in the bony anchoring of the hip prosthesis.The lifespan of the artificial hip joint can be shortened by infections, chronic overloading, wear and tear and abrasion of metal and polyethylene, allergies to the artificial hip joint and its possible anchoring (cement), an increase in osteoporosis and thus a reduction in the bony anchoring of the hip prosthesis, as well as falls resulting in bone fractures.
How resilient is an artificial hip joint?
After the operation, an artificial hip joint can theoretically be fully loaded. If the anchoring form is carried out with cement, the artificial hip joint is firmly attached to the bone thanks to the cement, which allows the artificial joint to bear full weight immediately. However, most hip prostheses are inserted without cement up to a certain age. This means that the bone cells must first migrate to the surface of the artificial hip joint and slowly ossify with it. This ossification takes about six weeks. This creates a natural firm anchorage. Theoretically, a cementless artificial hip prosthesis can also be fully loaded immediately. However, in order to ensure that the hip prosthesis grows in and ossifies sooner, we recommend taking the weight off it for approx. six weeks. This also protects the soft tissues and allows a safe gait to be trained.
How often can you get a new hip?
A hip prosthesis can be replaced several times if necessary. In most cases, more artificial material must be used to achieve good anchoring. This means that
z. This means, for example, that the artificial hip stem becomes longer. A hip revision is a major operation. It requires thorough assessment and good planning. The more often a hip prosthesis has to be revised, the more complex the operation and the higher the risk of complications such as infections. Reconstruction also takes longer.
How long is the incision during hip surgery?
In the minimally invasive and tissue-sparing approach to the hip joint from the front, an approx. eight centimetre long skin incision is made below the outer groin. The important thing is not the length of the incision, but that the stabilising hip muscles are not cut through afterwards, but gently pushed to the side in order to expose the anterior hip joint capsule and the defective hip joint. This eight-centimetre incision is sufficient to insert the new artificial hip joint without damaging the tissue. Because this technique means that no muscles are injured, there is significantly less pain and blood loss after the operation. The rapid convalescence means that the quality of life can be improved quickly and significantly.
Book a consultation appointment
We guarantee rapid, expert clarification and advice as well as treatment using the most modern methods.
PD Dr Andreas L. Oberholzer is a recognised expert in hip complaints and has extensive experience in the field of artificial hip joints.
Book your appointment directly online here or call us on +41 44 388 16 16. You are also welcome to come to us for a second opinion.
PD Dr Andreas L. Oberholzer
FMH specialist in orthopaedics and trauma surgery. Areas of specialisation: Knee, hip and foot surgery.