An artificial hip joint, also known as a total hip replacement (THR), is a medical solution for people with serious hip joint conditions such as osteoarthritis or following traumatic injuries. Although this procedure significantly improves the quality of life for many patients, it is essential to be aware of the potential risks and to receive comprehensive information. This article details the main risks of an artificial hip joint and highlights the advantages 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, understands the necessary postoperative behaviors, and can actively contribute to a positive recovery. Studies show that patients who are well-informed about the procedure, its risks, and rehabilitation experience less anxiety, are more motivated postoperatively, and achieve better overall outcomes.

Advantages of good education:

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

Therefore, patient education should include not only information about the surgical procedure itself, but also about optimal preparation, rehabilitation, and long-term management of the artificial hip joint. The doctor-patient dialogue is an essential component of the treatment process, as well-informed patients experience fewer complications and are generally more satisfied with the treatment outcome.

General risks of an artificial hip joint (total hip replacement)

1. Infections

One of the most serious complications after hip replacement surgery is infection. Although modern sterile techniques minimize the risk, the possibility of infection in the surgical area still exists. 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
• Surgical wound cleansing
• Prosthesis replacement

2. Thrombosis and embolism

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

Preventive measures:

• Taking blood-thinning medication
• Wearing compression stockings
• Early mobilization

3. Luxation (dislocation)

A possible complication of an artificial hip joint is dislocation, or the slippage of the femoral head from the hip socket. This occurs primarily in the first few months after surgery, when the surrounding muscles are not yet sufficiently strong. Dislocations are very painful and usually require hospital treatment.

Causes of a dislocation

• Unfavorable movements: Especially twisting movements or strong bending of the hip can cause the femoral head to pop out of the socket.
• Weak muscles: In the first few months after surgery, the muscles are not yet able to sufficiently stabilize the prosthesis.
• Malposition of the prosthesis: If the prosthesis is not optimally positioned, this can increase the risk of dislocation.
• Inappropriate choice of prosthesis: 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 bending sharply.
• Physiotherapy: Targeted strengthening exercises can stabilize the muscles and reduce the risk of dislocation.
• Optimal choice of prosthesis: Modern implants with larger head diameters and short-stem prostheses have a lower risk of dislocation.
• Surgical repositioning: If a dislocation does occur, the prosthesis usually needs to be repositioned under anesthesia. In rare cases, a further surgical procedure is necessary.

4. Injury to nerves and blood vessels

During hip replacement surgery, 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 occurs in rare cases.

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

prevention

• Meticulous 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

Injuries to blood vessels can lead to severe bleeding. In rare cases, a blood transfusion or surgical repair of the vessel is necessary.

5. Heterotopic ossification

Heterotopic ossification refers to unwanted bone formation in the soft tissues surrounding the artificial joint. This can lead to restricted movement and pain.

causes

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

Symptoms

• Hardening of the tissue
• Restriction of mobility
• Pain in the affected region

Treatment

• Drug therapy: NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen or specific medications such as bisphosphonates can inhibit bone formation.
• Physiotherapy: Regular exercise can reduce stiffness.
• Surgical removal: If the ossification is severe, it can be surgically removed.

6. Prosthesis loosening and wear

Over time, the implant may wear out or loosen. 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 break down.
• Mechanical stress: Incorrect loading or insufficient anchoring can loosen the prosthesis.

Symptoms of a prosthesis loosening

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

Treatment

• Conservative therapy: If the wear and tear is minimal, physiotherapy can help strengthen the surrounding muscles and thus increase stability.
• Revision surgery: In cases of severe loosening or pain, the prosthesis needs to be replaced.

Advantages of short-stem prostheses for risk minimization

The short stem prosthesis represents a modern variant of hip joint replacement and offers specific advantages that can help minimize the risks mentioned above.

Bone preservation

One of the greatest advantages of short-stem prostheses is the preservation of bone tissue. Because the stem is shorter, less bone material is removed, which is particularly beneficial for younger patients as it facilitates the possibility of future revision surgery.

Faster recovery

Thanks to minimally invasive surgical techniques 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 everyday life.

Lower risk of dislocation

The improved stability of the hip joint when using short-stem prostheses reduces the likelihood of dislocations or luxations after surgery. This increases patients' safety and confidence in their new joint.

Maintaining bone density

The short-stem prosthesis places stress on the bone very close to the hip joint, which helps maintain bone density. Stable, strong bone reduces the risk of fractures and other complications.

Reduced risk of heterotopic ossification

The soft tissue-sparing implantation technique and the reduced bone loss associated with short-stem prostheses can lower the risk of heterotopic ossification. This contributes to improved postoperative mobility.

Conclusion:

An artificial hip joint can significantly improve quality of life, but it also carries risks. Thorough patient education and the selection of a suitable prosthesis, such as a short-stem prosthesis, can help minimize complications. Those who prepare well for the surgery, consistently follow rehabilitation, and maintain a healthy lifestyle can extend the lifespan of their prosthesis and benefit from a pain-free life in the long term.