Hip Endoprosthesis

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Hip endoprosthesis surgery is a replacement of the dysfunctional joint with an artificial one. Often, the hip is damaged as the result of an illness or injury. The most common reason for hip endoprosthesis is a progressive hip arthrosis. 2020-03-12 Hip Endoprosthesis
All you need to now about Hip Endoprosthesis
Hip Endoprosthesis

Every third urban resident over 55 years has some signs of joint diseases. Often, a pain in the hip joint and limited mobility is considered as the age norm, and people do not worry about it. Only when the pain becomes intense and prolonged and causes the gait changes, it becomes clear that it is a time to see a doctor.

With any diseases of the hip joint, whether it is arthritis or arthrosis, there is a certain risk of disability. Of course, if the treatment is started timely and a patient is under constant supervision of experienced doctors, there is a good chance to keep the mobility of the joint long enough.

But it also happens that conservative treatment is unsuccessful, the patient gradually loses the ability to move normally, and hip endoprosthesis surgery seems the only reasonable option.

Arthrosis and osteoporosis are constant companions of elderly people, with women suffering from functional pathologies 2 times oftener than men. In the main, the both diseases are associated with age hormonal changes in the body and decrease in the synthesis of bone cells. With osteoporosis, the bones become brittle, whilst with arthrosis, joint cartilage thins out. Both these forms of joint dysfunction are not inflammatory.

The supply of a hip endoprosthesis is the most common supply of an artificial joint on the human body. It is currently performed around 220,000 times a year in Germany. The principle consists in an artificial replacement of the acetabular cup and the femoral head after the conservative, i.e. non-operative therapy has been exhausted. This is possible with different types and materials of prosthesis.

The chances of success of the artificial hip joint are high. A high level of satisfaction can be expected in around 95 percent of all cases. Regardless of this, this is a surgical intervention that should be discussed extensively between doctor and patient in each individual case. Because like any other surgical procedure, the hip endoprosthesis naturally has potential risks and complications. With a good indication (that is, the intervention is appropriate in the patient's individual disease situation) and an experienced surgeon, hip arthroplasty can be viewed as a low-complication procedure.


Destructive processes develop slowly, revealing themselves occasionally in attacks of sharp pain or difficulties to make usual movements, such as squatting, lifting, or turning. Gradually, the cartilage loses its elasticity and becomes thinner and thinner. Finally, the joint bones start rubbing against each other when walking, which leads to rapid deterioration of the joint surfaces. Excess weight, overloading the musculoskeletal system, makes the situation even worse.

An orthopedist can determine the degree of arthrosis or osteoporosis by the patient’s gait, but the final conclusions can be made only based on an X-ray or MRI scan. If conservative treatment cannot help to restore the joint ligament function, scheduled hip replacement is considered, as further development of the disease may lead to disability. Emergent hip replacement for elderly is often done in case of the femoral neck fracture.

The X-Ray or MRI scan clearly shows the degree of degenerative changes in the bones and articular cartilage, as well as types of deformities and other abnormalities that can be eliminated with surgery by replacing a damaged part of the joint with a prosthesis.

If your surgeon has concluded the surgery as the only effective method of treatment for joint degeneration, it is not that sad, as you may think first.

If the components of the joint are severely damaged, radical surgery is not recommended. Fragile bones and atrophied ligaments may not be strong enough to hold an endoprosthesis, which leads to further deterioration of the joint and can cause a trauma. Therefore, if your doctor finds the hip joint surgery possible and beneficial, it can be considered good news.

Contraindications to Hip Arthroplasty

There are a number of diagnoses that are absolute contraindications to joint surgery:

Relative contraindications to joint replacement surgery are functional chronic diseases in the stage of remission, neurosis, diabetes mellitus, bone and joint deformities, inclination to allergic reactions, and excess weight.

What Is an Endoprosthesis?

You should take your time when choosing an artificial hip joint, or endoprosthesis, as your quality of life after surgery depends on the properties of this medical device. But you have also another option: to choose the right clinic you can trust. Taking into account that German surgeons do not use materials of poor quality, you can minimize your risks. If you add to this high skill and experience of the doctors underlying their professional success, you will see why services of German orthopedists are in demand.

During the preparation for the surgery, a doctor will tell you which hip prosthesis can be used in every particular case and will explain the advantages and possible disadvantages of different designs. You will get comprehensive information about artificial joints used in the clinic and advice of an expert, which can help you to make a well-thought-out decision.

Modern hip endoprostheses are complex devices. “Eternal” artificial hip joint has not been invented yet, but today there are some high-end models on the market with lifetime 15-20 years or even more. There are also cheaper analogues, with lifetime about 5-10 years. An artificial hip joint with cementless fixation consists of a ball (head), a stem, a cup and, also, an insert. Endoprosthesis with cement fixation consists of the same elements, but acetabular component is solid and not divided into the cup and insert. Each of the elements has its own size range. During replacement surgery, a surgeon selects and inserts the appropriate size individually for every patient.

There are a few types of fixations of the artificial hip joint:

Depending on whether all the joint parts are replaced or not, there are total hip implants and partial hip implants.

The bearing is what provides rotation and movement in the artificial joint. The lifetime of the endoprosthesis depends on the type and quality of bearing materials.

Hip joint implants can be split into the following categories based on the bearing materials:

Hip Endoprosthesis

Same as with people’s faces, all of which different, there are no two identical joints in nature. Each person has specific anatomical features of the skeletal system, such as differences in size, shape and proportions of muscles, tendons and ligaments. That is why a number of sizes of implants are produced: a variety of models allows you to choose the option appropriate just for you. The ideal fitting of the implant stem and the joint is achieved by the femoral canal preparation.

A stem for cementless fixation has a rough surface, which allows the bone tissue to ingrow into the prosthesis. This type of prostheses is called a “press-fit” implant, which means the stem is simply inserted into the femoral canal after the preparation purposed to make it fitting to the prosthesis.

For cementless joint implants, titanium-based alloys with the best biocompatibility are used. The stem of the prosthesis is covered with calcium hydroxyapatite or another porous compound to accelerate the process of bone ingrowth into the artificial material.

All implant manufacturers have their own specifications to feature the prosthesis to the specific purposes. For better fitting in the bone canal, the stem can be finished with protruding elements, as pins and wings, and others. Selection of the stems is based on an X-rays scan. An orthopedist fits prepared femoral stem necks in order to choose the best one, meeting the femur morphology.

The stems may have cylindrical, conical or curved shape. As well as, their cross sections may be round or quadrangular. Whatever the implant design, it should meet the main task which is to ensure uniform distribution of load to the bone, along the length of the femoral canal and circumferentially.

A cup (socket) of the hip implant is a part of the prosthesis fixed in the acetabulum by a cement or cementless method. Acetabular component can be hemispherical or low profile (with a smaller bulge).

Low profile designs provide a wider range of movements, but, at the same time, they are less reliable at high loads, since low rims cannot prevent the dislocation of the femoral head from the endoprosthesis socket. In recent years, modernized designs have become widespread, in which the sides of the cup are strengthened.

The cement fixation cups are made of high molecular weight polyethylene; cementless sockets are made of an alloy of titanium with aluminum and niobium. The surface of the cementless cups is rough with a porous coating. There are also holes for fixing rods on the surface of the socket of hip implant.

Types of Hip Arthroplasty

Hip joint arthroplasty is an operation to replace a part of the joint with an artificial component (an implant). A variety of surgeries in this area can be divided into two groups: partial and total joint replacement. Hip hemiarthroplasty (partial replacement) is the replacement of the femoral head, while the acetabulum is kept. With total arthroplasty, both the acetabulum and femoral head are replaced.

The type of surgery treatment is decided by an orthopedic surgeon with consideration the following factors:

Older patients are more likely to have partial arthroplasty, since this type surgery is more sparing, and is not associated with excessive blood loss. But it has such disadvantage as a relatively short life of the endoprosthesis (5-6 years).

Total hip arthroplasty is a complex surgery. First, cartilage and subchondral bone tissue are removed and the joint surfaces are sawed, after which an implant is installed applying cement or cementless fixation. There are some disadvantages:

The main advantages are a long life of the implant and complete restoration of the joint functioning.

The method and surgical approach to the joint are selected during the preparation, taking into account several factors:

The surgical technique depends much on the chosen approach to the joint. The incision can be anterior, anterolateral, posterior, and combined.

Posterior approach – which is the most physiological and causes minimal damage to the soft tissues, nerves and muscles – is the most common for hip arthroplasty. It also reduces the probable damage to the outflow mechanism.

For secondary surgeries that are required in case of surgeon’s mistake, implant rejection or repeated trauma, longer incisions are normally used. Open access provides a better view of the femur. It can be a longitudinal straight incision, or curved cut.

After the incision is made, the surgeon gently pushes the muscles and fascia aside, opens the joint capsule, and performs a resection of the damaged fragments. Then, the femoral head is removed and the acetabulum is thoroughly cleaned (With the total arthroplasty, the acetabulum is removed together with the femoral head).

The next step is the femoral component fixation with metal rods or cement, and, then, testing the distal area of the artificial joint. If there are no any deviations, the surgeon treats the medullary canal where the implant stem is inserted, and the implant head is attached to the acetabulum (an artificial hemispherical cup). After the total or partial prosthesis is placed, the wound is sutured layer by layer, and drainage is inserted.

Cap prosthesis (McMinn hip)

The "Birmingham Re-surfacing Hip" developed by the English surgeon Derek McMinn consists of a cap with which the femoral head is crowned like a tooth. The cap has only one pin for anchoring, so that the medullary canal of the thigh does not have to be opened. In addition, the large diameter of the hip prosthesis ensures extensive luxation security. Even today, the bone-saving prosthesis with the right indication is still considered an ideal alternative for the treatment of younger, normal-weight patients without femoral neck deformity.

Short shaft prosthesis

Short stem prostheses are today considered to be as stable as classic long stem prostheses, but due to the shorter overall length, they can be better implanted through minimally invasive approaches. Thus, bone and soft tissue is saved, which facilitates subsequent revision surgery and favors a quick healing after hip surgery. In the medium term, experts see the short shaft prosthesis as the first choice, especially for the care of physically active patients with good bone quality.

Normal stem prosthesis

The standard stem prosthesis is the gold standard of hip prosthetics. The lifetime of modern implants is considered to be very good, but relatively much bone is sacrificed during implantation. However, due to its universally good properties, it is especially the first choice for older patients who can expect this

Hip prosthesis to be optimally cared for life.

Complications After Surgery

Complications after hip arthroplasty are rare, but you should be aware of the possible consequences, among which the most likely are:

After hip surgery, the patient is under constant monitoring by a medical team, so the risks of adverse effects are minimized. Today, surgery and recovery are performed according to the detailed step-by-step procedures, which reduces the likelihood of unforeseen situations.

Revision Endoprosthetics

Revision hip surgery is a secondary operation that is used in case of serious complications after implant placement, including:

Hip joint revision techniques are fundamentally different from those applied in the primary surgery. Hip joint replacement is carried out according to standardized protocols, but revision method is decided individually every time and every surgery is unique.

A complicating factor is a significant loss of bone tissue surrounding the endoprosthesis. The surgeon must remove the cement joint, clean the articular surfaces, and, then, install new implant components.

With the development of total purulent process, it is not always possible to perform joint restoration with an implant, since sepsis spreads quickly to soft tissues and organs. Fortunately, purulent infection is an extremely rare complication after surgery. Basically, revision is possible to eliminate all defects appeared after primary surgery.

Surgery Satisfaction

According to statistics, hip joint replacement surgery mostly has positive reviews. Patients are satisfied with the results. When performing surgery in relatively young age and without concomitant diseases, functioning of the hip joint can be fully restored. You can walk and even exercise, avoiding overloading the artificial joint. Active sports are contraindicated. There are also some unsatisfactory results after hip arthroplasty. Most often they happen in old age, if there are any concomitant pathologies. The patients' feedbacks show disappointment with the surgery results in 20% of patients who had hip joint replacement.

About Implants for Hip Endoprosthesis

BIOLOX®. Patient information on hip joint implants

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Worldwide, surgeons rely on pink BIOLOX®delta ceramics.

Even the color gives the surgeon the certainty of using hip implants of the highest quality and safety for his patients from CeramTec.

BIOLOX®delta is the only ceramic with 15 years of successful clinical experience and more than 8 million sold components.

Materials for hip joint implants

Different components made of different materials.

Today's endoprostheses consist of various components of modular hip joint systems.

There are the following pairings:

The pan housing (metal shell) used in the pelvic bone is equipped with a pan insert. The socket insert represents a joint surface of the endoprosthesis. The ball head, which is connected via the prosthesis socket with the thigh, forms the counterpart. Ball head and socket insert thus form the so-called sliding pair and rub against each other when moving.

Cup insert and ball head are available in different materials. So can be selected in the cup inserts between ordinary polyethylene, highly crosslinked polyethylene or ceramic. The ball heads have a choice between metal and ceramic. In the sliding combination material combinations are possible.

Hip prostheses equipped with wear-resistant ceramics provide patients with high-quality care that allows them to regain a high level of quality of life over a long period of time. Ceramic has proven particularly useful in long-term use due to various advantages. Ceramic ball heads and cup inserts offer the best possible solution for active and younger patients as well as patients with metal allergy.

BIOLOX® high tech ceramic ball and socket inserts are available for most modular hip systems.

Actual Studies

Endoprosthetics: between aspiration and reality

Pain-free walking after hip joint replacement is no longer enough for most patients today, and many strive for extreme sports. But the load capacity and life of a hip prosthesis are - despite improvements - limits.

People's aspiration to stay mobile and fit for old age is increasing - even among patients with hip artificial joint replacement. Whether new material combinations, anchoring technology and the surgeons' know-how can meet these increased demands for longevity was the subject of a press conference of the German Society for Endoprosthetics in Frankfurt / Main. "About 95 percent of our patients are satisfied with their implants. We are challenged with the five percent with complications, "said Prof. Dr. med. med. Carsten Perka, Charité University Medicine, Berlin.

This does not only apply to patients who want to resume their normal running, swimming or cycling. "Rather, we are worried about the increased demands of patients who want to run marathons, practice yoga, do rock climbing and play football.

Such expectations are not impossible thanks to biomechanical findings, says Perka. "The ability to anchor, the sliding partners used, and the ability to model the 'normal' motion patterns of a hip joint have found their way into the latest generation of implants." However, the patient also needs to understand where the limits of an artificial hip joint are in terms of stress and longevity , Patient education in advance, which cleaned up with exaggerated expectations and illusions, was therefore necessary. Because: "An endoprosthesis, which lasts a lifetime, will not exist."

Two sliding pairs

That the life of an artificial joint depends not only on the choice of material, but also crucially on the skill of the surgeon, stressed. habil. Michael M. Morlock, Director of the Institute of Biomechanics at the Technical University of Hamburg-Harburg. Problems with implants that required revision were more likely to be due to the surgeon's approach and patient's behavior than to the design or material of established prostheses. Problems often occur at the interface with bone or other implant components, Morlock says.

For a few years, two pairs of sliding bearings have been established as standard: Ceramic head plus ceramic shell and the plastic shell with ceramic or metal head. These pairings guaranteed a correspondingly large mobility of the artificial joint. According to Morlock, the cement-free installation of the joint, which offers advantages for young patients, has also become established. Titanium is mainly suitable for the shaft and not for sliding mating. A ceramic head was less susceptible to corrosion than metal heads, which needed to be put on very carefully. Polyethylene is decreasing as a material for joint replacement.

The robot-based approach is currently being used reluctantly because a robot can only work rigidly in precisely defined milling paths. "But because the bone is a moving material, a rigid milling path is inappropriate," Morlock explained. In a separate study of 60 patients who received classic or robot-supported hip implants, the latter would have hobbled after the procedure, because the robot has also milled muscles.

Morlock, however, was convinced that robot-assisted surgery would enter a new era in five to ten years.

The expert emphasized the importance of movement for an hip endoprosthesis on the one hand, but also warned against exaggeration: "Moderate movement promotes, too much harm", so his motto. Complications would be due to premature wear on the metal parts, as by ion-particle release, the corrosion is promoted.

Morlock pointed out another problem: Due to the high expectations and price pressure for implants, new products would be launched on the market, even though there was no long-term clinical experience. Over the last decade, this approach would have resulted in an increased incidence of complications (implant fracture, dislocation, infections), revisions, and global compensation of over five billion euros in a handful of novel designs.

Morlock therefore advocated "establishing approaches that will allow new types of products to be safely launched onto the market in the future, to enable innovation in the first place." Results from other countries showed that further improvements in the longevity of artificial joints are not primarily due to Product innovation, but by addressing three factors, namely:

Choose a Doctor for Hip Endoprosthesis

Hip Endoprosthesis Videos

Latest News in Hip Endoprosthesis

New technology allows more movement


How much exercise is allowed without the hip prosthesis loosening or the joint dislocating? Innovative prosthesis materials, diverse implant models and differentiated, gentle surgical techniques mean that a much more active lifestyle is possible. This is what the German Society for Endoprosthetics says.

Patients should discuss the desired types of sport with their surgeon before the procedure, then the best possible procedure can be selected with regard to the future stresses. Regular, moderate exercise helps treat numerous diseases and ailments. "That is why we recommend our patients with a replacement joint to be physically active for at least one hour every day," says University Professor Dr. med. Carsten Perka, Secretary General of AE and Medical Director of the Center for Musculoskeletal Surgery, Clinic for Orthopedics and Trauma Surgery at the Charité Berlin. This is all the more true since 27 percent of adults gained weight during the corona pandemic.

To date, exercise has been linked to premature wear and tear and other prosthetic problems. Wear particles could trigger an inflammatory reaction around the implant with loosening and the artificial joint would have to be replaced prematurely, so the assumption. As a result, many patients would rather have exercised too little. But endoprosthetics has developed over the past 20 years.

In hip arthroplasty, today's preferred use of modern, highly cross-linked polyethylene or new types of mixed ceramics as a cup replacement allows a much more active lifestyle without having to fear increased loosening rates and complications. "Just like the ceramic, highly cross-linked polyethylene shows extremely low wear rates in the load simulator," says Perka. "We can therefore assume that adequate exercise will not increase the risk of abrasion-induced loosening."

"Activities that lead to an even, albeit intensive, load on the prosthesis, such as slow jogging, cycling, cross-country skiing - so-called" low-impact "sports - are therefore certainly unproblematic," continues Perka. This also applies to alpine skiing. According to the orthopedist and trauma surgeon, however, you should have mastered it before the operation. "Because here it is important to maintain muscular control of the hip joint at all times. To be on the safe side, we also recommend choosing slopes below the level of difficulty before the operation."

Yoga, ballet or rowing require a maximum range of motion. "Here we can now select an operation access that leaves the particularly stressed tissue structures around the joint intact. The insertion of an extra-large artificial joint head gives us additional security." Joint sockets with a tripolar joint pairing ("double mobility") have only been on the market for a few years. With this combination, even extreme joint positions do not lead to a dislocation of the prosthesis. "Here we still have to wait for long-term data to determine whether these new joint pairings achieve the same long-term results as hip prostheses with normal head inlay situations even under the most intense mechanical stress," admits Perka.

"We have to adapt our recommendations with regard to physical activity after implantation of a hip prosthesis and now not only clearly allow moderate sport, but recommend it," summarizes Professor Dr. med. Karl-Dieter Heller, AE President and Chief Physician of the Orthopedic Clinic at the Duchess Elisabeth Hospital in Braunschweig. Only "stop-and-go sports" such as ball sports, extreme endurance loads and sports with intensive body contact can still significantly shorten the durability of the hip prosthesis.

Department of Endoprosthetics and Hip Surgery


We'll get you up and running again. At the Clinic for Endoprosthetics and Hip Surgery at the Vivantes Humboldt-Klinikum in Berlin, we are exclusively concerned with surgery on the large joints, especially the hip endoprosthesis.

Treatments according to the latest methods

This reflects the fact that as a patient you can best benefit from innovations, improvements and experience in hip arthroplasty when offered by specialists with a high degree of expertise. Achieving this expertise in the hip arthroplasty in the increasingly larger and more complex field of hip surgery only succeeds when focusing on a sub-area. We offer you this expertise, coupled with long clinical experience exclusively in hip arthroplasty surgery. We operate with state-of-the-art procedures using minimally invasive techniques and contemporary hip implants.

In addition to primary hip arthroplasty, we also perform standardized replacement surgery. In addition, joint-retained procedures such as arthroscopy or corrective surgery in case of misalignments belong to our daily operations. Always in exchange and in close cooperation with the other clinics of our department, we always offer you the best possible care options.

Minimal invasive hip TEP

In the surgical technique has changed a lot in recent years. It is thus possible to perform the implantation of artificial hip joints via a very small access with the help of special instruments while preserving the muscles close to the hip joint. You benefit from a faster mobilization and a cosmetically excellent result due to the small skin incision. Most hip prostheses are introduced minimally invasively.

Gentle hip endoprosthesis in young patients


A hip endoprosthesis is almost only older people, many think that. But about 16 percent of patients are younger than 60 years. Statistically, therefore, they are facing several replacement operations by the end of their lives. In order to achieve maximum durability of the first implant, the AE - German Society of Endoprosthetics recommends a particularly gentle procedure for first intervention in otherwise healthy patients. It consists of a minimally invasive surgery and the use of a non-cemented short or straight stem prosthesis. The combination of femoral head and sliding cup should each consist of ceramic or ceramic and ultra-high crosslinked plastic (HXPE). Experts at a press conference in the run-up to the 19th congress of the AE on 30 November 2017 in Hamburg will discuss which empirical values ​​exist and for whom this approach is appropriate.

With around 233,000 procedures, the implantation of a hip endoprosthesis was among the ten most common operations in 2016. Almost 37,000 of the patients were younger than 60 years. "These patients often suffer from congenital misaligned joints, circulatory disorders, have suffered accidental injuries or a rheumatic disease that has destroyed the articular cartilage of their hip joint," explains Prof. Dr. med. Karl-Dieter Heller, Secretary General of the AE.

Especially hip endoprosthesis for younger people should withstand the demands of everyday life for as long as possible. But there is still no material that comes close to the resilience and performance of the natural joint. Experience has shown, however, that hip prostheses last on average more than 15 years, sometimes 25 years.

"That's why we do everything we can to ensure a long service life for the first prosthesis," says Prof. Heller, the chief physician of the Orthopedic Clinic at the Duchess Elisabeth Hospital in Braunschweig. Particularly gentle here is a minimally invasive procedure: The muscles are not replaced by the bone, but completely spared. This is made possible by modern storage techniques and instruments. As a result, the surgical trauma is lower and rehabilitation is faster. Only the scar of the maximum twelve centimeters long skin incision remains. However, this method requires much experience on the part of the surgeon. Patients should inquire accordingly.

A short shaft prosthesis helps to "save" valuable bone substance in the thighbone: "For the daintier implant compared to normal bone, we need to remove less bone during implantation. As a result, we have more bones available for anchoring the replacement prosthesis in the event of subsequent interchangeable surgery, "explains Heller. Short stem prostheses are especially popular in Germany. However, they would only be used for about ten years. Since long-term results are missing so far, many surgeons still rely on decades of proven, but slightly longer straight dentures.

Since younger patients are on average more active than older patients, material wear is possible faster. For this reason, the topics of prosthesis wear and abrasion are central here, since abrasion particles can lead to prosthetic loosening. "We therefore recommend the pairings of ceramic ceramic and modern abrasion-reduced plastic (ultra high cross-linked polyethylene (HXPE)) with ceramics in younger patients for the femoral head and cup, as they produce the least amount of wear particles," says Heller.

With a hip endoprosthesis joint a normal active everyday life as well as the moderate exercise of sports such as skiing, running, swimming, golfing, cycling, hiking and Nordic walking is possible again. But the load capacity and life of a prosthesis are - despite significant improvements over previous dentures - limits. "It is important to us that our patients understand where the boundaries of an artificial joint are", emphasizes Prof. Dr. med. Henning Windhagen, President of the AE and Director of the Orthopedic Clinic of the Hannover Medical School (MHH) in the Diakovere Annastift. If you are unsure about what is allowed for sports, it is better to ask your orthopedist first.

Health tip: The hip joint prosthesis


New and gentle surgical procedures ensure that patients are mobile again faster.

The implantation of a hip joint endoprosthesis in a hip joint arthrosis is still the most successful surgical procedure, despite the success rate by far in medicine, despite the recurring "horror stories" in the tabloid press.

It is always impressive to see which quality of life, especially for younger patients, is reimbursed - regardless of whether the prosthesis was used as a result of degenerative or accidental wear on the hip joint. Also in veterinary medicine, the hip joint endoprosthesis has prevailed - especially in dogs. There are now decades of experience with total hip arthroplasty and the implants are so mature and reliable that hardly any further innovations are expected here.

Thus, the improvement of operational planning and technology for the further optimization of the surgical results is increasingly coming to the fore. In recent years, minimally invasive approaches to the hip joint have become increasingly popular due to the sparing of the hip musculature, lower postoperative pain, and associated shorter hospital stays. While usually the access to the hip joint takes place mainly from the outside of the hip joint, in a few centers slowly a new minimally invasive approach from the front to the hip joint is established.

In addition to the small skin incision, the anterior approach protects the hip-hugging musculature even better than the lateral access, so that patients recover much faster from their surgical intervention. They are thus faster mobile and less pain. This leads to a significantly shorter hospital stay. In some clinics, this procedure is already offered as a day surgery.

Despite all the euphoria, it should be borne in mind that even with minimally invasive technology, the implantation of a hip endoprosthesis still represents a major surgical intervention and thus a stationary stay for the safety of the patient and the surgical outcome is used. In any case, this new front access allows the implantation of short stem prostheses, which are optimal for this approach. However, it is also possible to use the conventional hip total endoprostheses available on the market by means of an appropriate surgical technique.

Nevertheless, it can not be used in all cases. In particular, when changing a relaxed total hip endoprosthesis or accompanying fractures, anatomical features, intraoperative complications and in very obese patients, the lateral access to the hip joint continues to be the better and, above all, safe procedure. Therefore, an individual consultation of the patient is still the alpha and omega in the surgical treatment of hip osteoarthritis.

Current highlight: First day clinical hip endoprosthesis surgery in one day


A new hip in the morning and back home in the evening? This is possible thanks to the so-called AMIS procedure and the Rapid Recovery program. As the first medical doctor in Germany, Dr. med. med. Manfred Krieger, Specialist in Orthopedics and Traumatology in the Network of Specialists Rhein-Main, in cooperation with the GPR Health and Care Center Rüsselsheim, the modern surgery and rehabilitation procedure "Hip in a day". The advantages for the patients are obvious: they are better fit again and usually have less pain.

Hip in a day in the media

The media are also very interested in Dr. med. med. Manfred Krieger Germany's first applied AMIS process and the Rapid Recovery program. The contributions illustrate the procedure and accompanying a patient - during hip endoprosthesis surgery and one year later.

Benefits of this hip joint endoprosthesis surgery method

  • Protection of the existing muscles around the hip
  • Blood saving technique
  • medicines for blood loss (tranexamic acid)
  • Good pain therapy (infiltration)
  • No nausea (PONV prophylaxis)
  • hygiene prophylaxis (oral and nasal swab)
  • Showers with Hibiscrub
  • dispensing with catheter (bladder catheter, wound drainage)
  • Early energy intake (cola, ice cream in the recovery room)
  • First getting up in the recovery room
  • Physiotherapy every 2 hours
  • Discharge criteria fulfilled after 8 hours
  • Stair running before discharge

BGU Clinic Frankfurt provides information on osteoarthritis and hip endoprosthesis


More than 170,000 artificial knee joints and more than 200,000 artificial hip joints are used each year in Germany. Common cause is a joint wear, the so-called arthrosis. The BG Unfallklinik Frankfurt is launching a patient information event at the Main under the motto "Osteoarthritis and joint endoprosthesis". Head physician Prof. dr. Dr. Reinhard Hoffmann and his team inform in the conference center of the clinic, Friedberger Landstraße 430, 60389 Frankfurt am Main about osteoarthritis and the artificial hip endoprosthesis.

Osteoarthritis is widespread in Germany. Nearly half of all persons over the age of 65 suffer from the disease of wear, usually at the knee or hip.

"In addition to the age-related wear and tear of the articular cartilage, injuries, inflammation, incorrect or overstressing can trigger osteoarthritis," explains the medical director of the BG Unfallklinik, Prof. Dr. med. Dr. Reinhard Hoffmann. Those affected initially only have pain on exertion, and in advanced state also in rest. If conservative treatments such as physiotherapy can no longer relieve the pain, it makes sense to replace the damaged joint with an implant.

"Although artificial hip joint surgery is one of the routine procedures, choosing a hip endoprosthesis for the individual is often associated with uncertainty and anxiety. Comprehensive advice and information for our patients is therefore very important to us ", emphasizes the expert. In the patient information session, the instructors will inform about the preparation for the stay in the clinic, new surgical procedures, rehabilitation and living with an artificial hip joint.

In September 2015, the BG Trauma an Orthopedic Clinic in Frankfurt faced a first audit process defined by the endoCert initiative of the German Society for Orthopedics and Orthopedic Surgery (DGOOC). Following the recommendation of the experts and approval of the certification body, the BG Trauma Clinic is certified as the endoprosthetics center for maximum care, especially for the hip endoprosthesis.

This recognition underscores the high medical, surgical, nursing and rehabilitative quality of treatment at the BG Unfallklinik Frankfurt am Main under strict objective criteria. The designation EndoProthetikZentrum of the maximum supply for the hip endoprosthesis is u. a. after the performed operations and the high requirements of the criteria catalog. The aim of the certification is to improve the post-operative morbidity and mortality of our patients and to provide patients with an orientation opportunity to help them decide on the BG Trauma Clinic as a specialized specialist clinic.

Hip endoprosthesis in the BG Clinic Frankfurt

A specialized team carries out the entire range of primary and alternative hip endoprosthesis.

Only the highest quality implants for hip endoprosthesis with long-term proven materials and material combinations are used. If required, special and special prostheses are implanted to partial or full hip endoprosthesis (e.g., short-shaft hip, "female knee", hypoallergenic implants, partial or full thigh endoprosthesis). In appropriate cases, implantation may be performed at the hip using minimally invasive technique (MIS).

A study has shown that femoral and knee endoprostheses can serve more than 25 years


8 out of 10 knee prostheses and 6 out of 10 hip prostheses currently have a service life of 25 years or more. In developed countries the endoprosthesis of hip and knee joints is one of the most frequently performed surgeries. In Germany, every year more than 400,000 patients have a hip or knee joint prosthesis implanted. Many patients before surgery ask about the service life of the prosthesis.

Jonathan Evans from Bristol Medical School and his staff analyzed data of case series and patient registers to answer this question. The results of the analysis of case series are considered less reliable, since they are often based on the experience of individual centres. This easily leads to a biased selection (patients with good initial risks are selected) or the publication of distorted information (the preferred publication of positive results). Formed in recent years in many countries, the registers of joint endoprosthesis prevent the occurrence of such distortions, as they tend to include all patients.

In fact, the results of the analysis of case series were better than the data of the registers. What concerns hip joint prostheses, British scientists, when analyzing case series, found out that up to 77.6% (with a 95% confidence interval from 76.0 to 79.2) have a 25-year service life. According to the register of joint endoprosthesis, 57.9% have a 25-year service life. With a 95% confidence interval from 57.1% to 58.7%, an accurate forecast is made (this, of course, does not exclude the fact that sometimes premature endoprosthesis is required because of infections and/ or loosening). The most important limitation for Evans’s calculations is that the 25-year data is based just on one patient register (from Finland).

Hip prosthesis: Prosthetic Model More Important Than Surgical Method


The joint endoprosthesis increases the quality of life of patients. Complications can occur if the surgical method does not fit the implant. The latter is more important for long-term success.

The implantation of knee or hip joints is considered routine by experts. On average, orthopedists used about 230,000 hip endoprostheses in 2016. The joint endoprosthesis frees the patient from pain, increases the quality of life and ensures mobility into old age. Most often, a total endoprosthesis of the corresponding joint is made. Around 40% of endoprosthetic hip operations fall into the 70-79 age group; Women are affected twice as often as men. Hip endoprosthesis is considered one of the most common and successful operations ever. Nevertheless, there are always failures. These are estimated to be more common in artificial knees at 20%. In hip endoprosthesis, there are also at least two out of every hundred patients who are dissatisfied with the long-term post-procedure.

Sometimes the prosthesis relaxes, sometimes it comes to infections. A not uncommon reason for a failed implantation is that in patients the prosthetic model does not fit the surgical method. For a long-term success, according to the current state of knowledge, the implant model plays a greater role than the surgical method. The German Society of Endoprosthetics (AE) therefore advises not to prioritize the operation method, but to give priority to an optimally suitable implant.

Many patients want a minimally invasive approach (MIS). And in fact, studies available to date prove benefits, especially in the first six weeks after surgery. After a year at the latest, however, examinations no longer show differences between MIS and the classic open procedure. The keyhole technique comes with tiny cuts in skin and soft tissues. In MIS, surgeons use the natural gaps between the muscles to get to the hip joint. "We push muscles, tendons, vessels and nerves aside as far as possible, instead of severing them as usual and then suturing them again," explains Professor Dr. med. Dieter C. Wirtz, Medical Director of the Clinic and Polyclinic for Orthopedics and Traumatology at the University Hospital Bonn.

According to the specialist, MIS also protects important nerve receptors at the tendon-bone and tendon-muscle transition. The mechanoreceptors provided depth sensitivity and thus gait stability and balance. "If these structures remain intact during prosthesis implantation, patients can begin their rehabilitation sooner after the procedure," says Wirtz.

Minimally invasive hip endoprosthesis may sound uncomplicated, but it is not suitable for every patient. "The hip joint geometry has to fit, the patient should not be too muscled or too obese," explains the member of the AE presidency. At the same time, especially the prosthesis model must be carefully selected. Minimally invasive access is associated with limited vision. "Being able to carry out the individual surgical steps with the necessary care always has priority." Summary of the expert: The surgical method should be chosen so that the hip endoprosthesis does not cause long-term discomfort. If patients bring with them the individual requirements for a minimally invasive, muscle-sparing procedure, this should also be chosen. But rather promises the classic open surgery long-term success must be open surgery. "The aim of every surgeon should be to operate as gently as possible," confirms Wirtz.

Patient Comments

I am very satisfied with my two hip endoprostheses "installed" by Prof. Dr. Thorey. Now I can finally get fit again!
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Natalia S.
On 11/25/21 I got a hip prosthesis from Dr. Penner. From the first meeting to the final meeting, I felt that I was in very good hands with him. The surgery went well too. On the day of the operation I was able to put full weight on my leg in the evening and walk alone with forearm support. After 3 days I was discharged from the hospital. My recovery was quick and uneventful. Even in rehab, it was confirmed to me that my hip prosthesis is very good.
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Genadijs Jan
In March 2021 I had an endoprosthesis implanted in my hip joint. The surgery was uncomplicated and successful. Thanks to Prof. Heers I am pain free again. He is a very good, friendly and competent doctor who I can only recommend.
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Claudia R.
Very good information about the possibilities immediately created a good basis of trust. The surgery (hip endoprosthesis on the right) went very well (small scar) and I had to get up on the day of the surgery. All employees were mostly very attentive and helpful. After about 4 weeks I can already walk without crutches. Thanks very much!
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Abubakar Said
I had two total hip replacements installed by Dr. Haas. Everything went smoothly and I felt in good hands. I think the AMIS method used is great.
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