An artificial hip joint, also referred to as a hip prosthesis (hip TEP), is a medical solution for people with severe hip joint diseases such as osteoarthritis or after traumatic injuries. Although this intervention helps many patients to improve their quality of life, it is essential to be aware of the potential risks and to be comprehensively informed. This article details the main risks of an artificial hip joint and highlights the benefits of short-stem prostheses in minimizing these risks.

Why is comprehensive education so important?

Comprehensive patient education plays a crucial role in the success of hip replacement surgery. A well-informed patient typically has realistic expectations, knows the necessary postoperative behaviors, and can actively contribute to a positive healing process. Studies show that patients who are well-informed about the procedure, risks, and rehabilitation have fewer fears, are more motivated postoperatively, and achieve better overall results.

Benefits of good patient education:

• Reduction of anxiety and uncertainty: Those who know what to expect can mentally prepare better for the surgery and subsequent rehabilitation.
• Better postoperative cooperation: Patients who are informed about physiotherapeutic measures, movement restrictions and the correct handling of the prosthesis can actively participate in their healing process.
• Avoiding complications: By knowing risk factors such as infections, dislocations, or thrombosis, patients can consistently implement preventive measures.
• Long-term therapeutic success: Those who load their hip prosthesis correctly and adhere to the recommendations of doctors and physiotherapists will benefit in the long term from better function and longevity of the prosthesis.

The education should therefore not only include information about the surgical procedure itself, but also about the optimal preparation, rehabilitation and long-term handling of the artificial hip joint. The doctor-patient dialogue is an essential part of the treatment process, as well-informed patients suffer less frequently from complications and are overall more satisfied with the treatment outcome.

General risks of an artificial hip joint (Hip TEP)

1. Infections

One of the most serious complications after the implantation of an artificial hip joint is infection. Although modern sterile techniques minimize the risk, there is still a possibility of infection in the surgical area. Such infections can be superficial or deep and often require intensive medical treatment, including further surgical interventions.

Types of infections:

• Early infection: Occurs within the first six weeks after surgery. Symptoms include redness, swelling, and pus formation at the surgical site.
• Late infection: Can occur months or years after implantation and is often more difficult to diagnose.

Treatment options:

• Antibiotic therapy
• Operative wound cleaning
• Replacement of the Prosthesis

2. Thrombosis and Embolism

Surgery on the lower half of the body, especially on the hip, increases the risk of blood clots forming in the veins, known as thrombosis. If such a clot breaks loose and travels to the lung, it can lead to a potentially life-threatening pulmonary embolism. Therefore, careful thrombosis prophylaxis after surgery is essential.

Preventive measures:

• Taking blood-thinning medications
• Wearing compression stockings
• Early Mobilization

3. Dislocation

One possible complication of an artificial hip joint is dislocation, i.e., the femoral head slipping out of the hip socket. This typically occurs in the first few months after surgery when the surrounding muscles are not yet sufficiently stable. Dislocations are very painful and usually require treatment in a clinic.

Causes of dislocation

• Unfavorable Movements: Particularly rotational movements or strong bending of the hip can cause the femoral head to dislocate from the socket.
• Weak musculature: In the first few months after surgery, the muscles may not yet be able to stabilize the prosthesis sufficiently.
• Misalignment of the Prosthesis: If the prosthesis is not optimally positioned, this can increase the risk of dislocation.
• Inappropriate prosthesis selection: Some models have a higher risk of dislocation than others.

Prevention and treatment

• Avoidance of Critical Movements: Patients should avoid certain movements such as crossing their legs or strong bending.
• Physiotherapy: Targeted strengthening exercises can stabilize the muscles and reduce the risk of dislocation.
• Optimal Prosthesis Selection: Modern implants with larger head diameters and short stem prostheses have a lower risk of dislocation.
• Surgical Repositioning: If dislocation occurs, the prosthesis usually needs to be repositioned under anesthesia. In rare cases, further surgical intervention is necessary.

4. Injury to nerves and blood vessels

During the implantation of an artificial hip joint, surrounding nerves and blood vessels can be injured. Such injuries are rare, but can lead to significant discomfort.

Possible consequences of nerve damage

• Numbness or tingling in the operated leg
• Muscle weakness, especially when lifting the leg
• Permanent nerve damage in rare cases

The sciatic nerve is particularly at risk as it runs in close proximity to the surgical site.

Prevention

• Careful surgical technique: Experienced surgeons minimize the risk through precise procedures.
• Neuromonitoring: In some clinics, electrical signals are used during surgery to monitor nerve function.

Injury to Blood Vessels

Vascular injuries can lead to severe bleeding. In rare cases, a blood transfusion or surgical vascular repair is required.

5. Heterotopic Ossification

Heterotopic ossification refers to an undesirable bone formation in soft tissues around the artificial joint. This can lead to limited mobility and pain.

Causes

• Inflammatory reactions after surgery
• Traumatic tissue damage during implantation
• Genetic predisposition

Symptoms

• Tissue hardening
• Limitation of mobility
• Pain in the affected area

Treatment

• Medicinal Therapy: NSAIDs (non-steroidal anti-inflammatory drugs) such as Ibuprofen or special medications like Bisphosphonates can inhibit bone formation.
• Physiotherapy: Regular exercise can reduce stiffness.
• Surgical removal: If the ossification is highly pronounced, it can be surgically removed.

6. Prosthesis loosening and wear

Over time, wear or loosening of the implant can occur. This can have both mechanical and biological causes.

Causes of prosthesis loosening

• Abrasion particles: Abrasion of plastic, metal or ceramic components can lead to an inflammatory reaction that breaks down the bone.
• Bone loss (osteolysis): Inflammatory processes can cause the bone around the prosthesis to deteriorate.
• Mechanical stress: Incorrect loading or inadequate anchoring can loosen the prosthesis.

Symptoms of prosthesis loosening

• Pain in the hip or groin
• Feeling of instability when walking
• Limited mobility

Treatment

• Conservative Therapy: If the wear is only minimal, physiotherapy can help strengthen the surrounding musculature and thus increase stability.
• Revision surgery: In cases of severe loosening or pain, replacement of the prosthesis is necessary.

Benefits of short-stem prosthesis for risk minimization

The short-stem prosthesis represents a modern variant of hip replacement and offers specific advantages that can contribute to minimizing the risks mentioned above.

Bone preservation

One of the biggest advantages of the short stem prosthesis is the preservation of bone tissue. Since the stem is shorter, less bone material is removed, which is particularly beneficial for younger patients, as this facilitates the possibility of a future revision surgery.

Faster recovery

Thanks to the minimally invasive surgical technique used in the implantation of short stem prostheses, patients often benefit from a faster recovery. This leads to shorter hospital stays and a quicker return to daily life.

Lower risk of dislocation

Due to the improved stability of the hip joint when using short-stem prostheses, there is a lower probability of dislocations or luxations after surgery. This increases the safety and confidence of patients in the new joint.

Preservation of bone density

The short stem prosthesis stresses the bone very close to the hip joint, which contributes to the preservation of bone density. A stable, solid bone reduces the risk of fractures and other complications.

Reduced risk of heterotopic ossifications

Through the soft-tissue-sparing implantation technique and the lower bone loss when using short-stem prostheses, the risk of forming heterotopic ossifications can be reduced. This contributes to better postoperative mobility.

Conclusion:

An artificial hip joint can significantly improve quality of life, but also carries risks. Careful patient education and the choice of a suitable prosthesis, such as a short-stem prosthesis, can help minimize complications. Those who prepare well for the operation, consistently undergo rehabilitation, and pay attention to a healthy lifestyle can extend the durability of their prosthesis and benefit from a pain-free life in the long term.