Surgical treatment
If you reach a point where conservative treatment does not lead to any improvement, then you should consider surgery. One of the most popular procedures is total hip replacement. There is another option for younger patients and for patients under 65 years is hip resurfacing to preserve the bone and to restore the natural joint feeling and function. In this case, only the damaged cartilage will be replaced.
More than 5 million people suffer from osteoarthritis of the hip joint. More than 90% of those over the age of 65 suffer from this problem. Our doctors have decades of experience in using modern surgical methods. In addition to the high-quality skill in implanting artificial joints, we offer high-quality implants with excellent medical care.
Implanting the “appropriate” artificial hip joint requires a specialized orthopedic surgeon with years of experience and extensive knowledge of high technology in the medical field. The degree of osteoporosis and the patient’s personal circumstances play a major role.
Non-cemented hip prostheses are ideal for patients between the ages of 65 and 80 years. Taperloc hip stems are mostly used. It is a titanium stem that has proven itself over thirty years. Also included a socket containing a titanium shell.
Cemented prosthetic hip implants have proven to be one of the safest methods for elderly patients. This method has been developed over 50 years ago. Cemented hip endoprostheses are mainly performed for those over 80 years of age. It is characterized by providing immediate and unrestricted stability to elderly patients even in cases of imperfect bone (such as osteoporosis, bone aging). This surgical procedure is also characterized by a low rate of bleeding.
The studies have shown that more than 97% of these implants still work after 10 years, and 90% after 20 years.
Hip arthroscopy sometimes called a “keyhole surgery,” is a minimally invasive procedure in which an orthopedic surgeon uses an arthroscope to examine the inside of the hip joint. This procedure allows the surgeon to diagnose the cause of hip pain or other problems in the joint. Some hip conditions may also be treated arthroscopically. To perform arthroscopic hip surgery in these cases, the surgeon makes additional small incisions to create access points for various arthroscopic needles, scalpels, or other special surgical tools.
Hip impingement
Hip impingement describes a mechanical conflict, through which the normal motion play in the hip joint is disturbed and the femoral neck strikes the front rim of the socket. This leads to blocking of the hip during certain movements.
Definition
Femoroacetic impingement or hip impingement is an acquired malformation of the hip, which is one of the most common causes of coxarthrosis. The cause is bony attachments on the femur and/or on the acetabulum. Through these bony attachments impingement of the thigh bone and the bony margin occurs with movement especially during hip flexion.
Repeated impingement repeatedly squeezes intervening structures such as articular cartilage and the cartilaginous lip (labrum).
Hip impingement describes a mechanical conflict, through which the normal motion play in the hip joint is disturbed and the femoral neck strikes the front rim of the cup. This leads to blocking of the hip during certain movements.
Possible causes are deposits on the femoral head in question which cause it to lose its round shape (CAM impingement). On the other hand, the acetabulum can also be twisted too much or unfavourably so that it extends too close to the joint. This disorder is also known as pincer impingement. A combination of both (so-called mixed impingement) is the most common cause. The changes in shape described cause the transition from the femoral head to femoral neck to strike the joint socket and the labrum running around the socket (joint lip). The more often such an impact occurs and the higher the speed and force involved (in certain sports, stooping, working while sitting, driving), the sooner the articular cartilage and/or the rim or the labrum are damaged. This causes the joint to become inflamed and causes pain. Over time, this mechanism can lead to hip arthrosis.
Symptoms
Similar to osteoarthritis, patients with hip impingement complain of hip pain in the groin area (at the front and at the side of the hip joint), which occurs initially especially during and after exercise. Deep sitting can also trigger the typical pain. Patients also often notice limited mobility of the hip joint. Later sufferers complain of severe pain during prolonged sitting and walking short distances. Blockage is already clearly noticeable at this stage.
Diagnosis
In addition to the medical history (anamnesis) a physical examination is important at the start. During the examination, the doctor will perform a so-called provocation test. Two movements are performed simultaneously, which causes the typical groin pain. If the suspicion is confirmed, an X-ray is taken to see if the symmetry between the femoral head and the socket is present. Bony elevations are also clearly visible on the x-ray. For more detailed imaging of the soft tissues, a CT would be the method of choice.
Conservative treatment
Conservative therapy aims to alleviate hip pain and favourably influence the further course of the disease. Physiotherapeutic treatment to improve mobility is used in particular. Drug and anti-inflammatory treatment is also advised. Electrotherapy can also relieve the initial symptoms. Since this is a “mechanical problem” surgery is necessary in most cases.
Surgical treatment
If pain already exists while sitting and large bony attachments are present, they cannot be remedied through exercise but only removed by a hip operation. This can usually be done by an experienced hip specialist in a minimally invasive manner using keyhole surgery (hip arthroscopy). Hip arthroscopy is a relatively new surgical procedure. The most common disease in which hip arthroscopy is performed is hip impingement.
With arthroscopy, the exact extent of the damage can be determined and, if possible, corrected immediately during the exploration. As part of this procedure, a joint lip can be re-attached to the socket edge, a deformed condyle, socket or femoral neck removed and adapted or a femoral neck can be re-modelled. The aim is that after treatment pain-free movement of the joint will be possible again, and the degeneration processes, which were caused by the impingement of the hip joint, are slowed down or prevented.
Hip arthroscopy is performed on a so-called “extension table” in the supine position. Access to the joint is via 2-4 small cuts on the thigh of about 1 cm in length. A camera and the respective working tools are then introduced. Now, the structures of the hip can be viewed and treated under 2.3x magnification. The operation takes between 30 and 90 minutes.
Rehabilitation – Time and methods
The rehabilitation depends on whether bone has been removed during hip arthroscopy or if cartilage damage has been treated. If this is the case, only a partial load is initially recommended. Waling aids are then recommended for about 10 days. Walking training, stair climbing etc. are incorporated as soon as possible in the rehabilitation program. The aim of the physiotherapeutic treatment is also to correct the improper stress levels arising due to the restriction in movement over the past months and years. Hip-friendly sports such as swimming or cycling can be resumed as early as 6 weeks after surgery.
Periprosthetic fractures
The use of an artificial hip or knee joint is now one of the standard orthopaedic operations. A periprosthetic fracture may, however, occur during an accident. In technical terms this refers to the fracture of the bone in which the prosthesis is anchored.
Definition
Implants of artificial hip or knee joints are among the most common operations in Germany. This results in an increased number of periprosthetic fractures in accidents. Increasing life expectancy and the increase in sports and leisure activities intensify this. The causes of these fractures in the vicinity of a prosthesis are primarily falls in the home environment of the patient, but also traffic or leisure accidents, uncontrolled falls as a result of secondary diseases, and additional burdening due to the loosening or changing of inserted prostheses.
Symptoms
Risk factors include bone density reduction (osteoporosis), dissolution of bone tissue (osteolysis) as a result of inflammation or tumours, damage to the bone (cortical perforation), and mechanical overstressing of loose prostheses.
The type of periprosthetic fracture is as diverse as the causes. With artificial hip joints, fractures of the femur occur below the shaft of the prosthesis, in the area of the prosthesis socket and multiple fractures or debris fractures occur in the region of the shaft. The periprosthetic fractures in the artificial knee joint usually occur above the implant in the femur (supracondylar femur fracture); fractures of the lower leg bone (tibia), however, are less common.
Diagnosis
For the best possible therapy (and to avoid postoperative complications) a preoperative analysis is necessary. It is sufficient to take a normal x-ray for simple fractures. For complex fractures, however, computerised tomography (CT) should be used.
Conservative treatment
Conservative therapy is dispensed with in this type of fracture or is an exception. Conservatively, a fracture could only be treated at a magnitude of category 1 and a fracture angle less than 30 degrees. Only the pain therapy is conservative.
Surgical treatment.
At EMERALD AVENUE MEDICAL CLINIC IN DUBAI pursue several goals in the event of a periprosthetic fracture. First and foremost is the acute pain therapy to relieve the pain of the patient. The second goal is the correction of the fracture and the restoration of the proper anatomical conditions. Targeted post-operative pain therapy, early mobilisation of the patient, the fastest possible healing and support for healing through special physiotherapy are further steps.
There are special implants for hip and knee surgery as well as other special materials for the treatment of a periprosthetic fracture. These include various special plates, special screws, wires and titanium tapes, with which the fractures are fixed. These procedures use a combination of these materials and prosthesis replacement techniques.
The duration of the operation is usually around 2 hours.
Rehabilitation – Time and methods
Following the surgery, periodic checkups and targeted physiotherapy are important. In most patients, full mobility is restored within 8-12 weeks.
Replacement operation
Artificial hip joints are usually very safe and durable. Nevertheless, they can become loose for a variety of reasons. When this happens an operation to replace the prosthesis is often necessary. The replacement of the hip prosthesis is more complex than the first implantation. But you are in good hands in our clinics: Thanks to many years of experience with replacement surgery, the specialist team in or department of hip arthroplasty offers you security for this technically demanding operation.
Definition
The most common reason for a replacement operation is loosening of the artificial hip joint. This loosening can be generally differentiated into septic or aseptic loosening. Aseptic loosening is more common. After insertion of an artificial hip joint, this can lead to increased abrasion of the sliding component due to incorrect loading. These abrasion products then cause a loosening of the previously incorporated prosthesis components. Likewise, changes in the tissue, circulatory disorders or mechanical stress can loosen the anchoring of the artificial hip joint in the bone. Incorrect implantation by inexperienced surgeons should also be mentioned here.
Septic loosening is caused by bacterial infections that damage the bone and tissue surrounding the artificial hip joint, thereby loosening the prosthesis. If the wearer of an artificial hip joint has complaints such as inguinal, hip or leg pain, it must be clarified whether they are caused by the artificial hip joint or other diseases.
Symptoms
Loosening of the prosthetic is barely noticeable in the early stages and hardly causes any problems. But the loosening of the socket can later cause inguinal problems. The situation is different with the prosthesis stem. In this case, pain will be felt relatively quickly in the thigh. Start-up pain under stress is also typical. Such pain often radiates to the knees. If the leg lengths are different it means the hip prosthesis has sunken into the medullary region of the bone. Metal abrasion in metal-to-metal prostheses can cause neurological symptoms due to the released metal particles. Worsened kidney function may be an indicator here.
Diagnosis
The exact extent of bone damage is determined via the preoperative X-ray checks, and a precise plan is made regarding which prosthesis is to be implanted in which size. A CT image of the hip prosthesis can better show a spatial representation of the bone around the prosthesis. Since special surgical issues cannot be predicted with certainty during a replacement operation at the hip, the necessary special implants are always available in most of our clinics.
Conservative treatment
Conservative therapy is not used with this type of diagnosis. Only the pain therapy is conservative.