Degenerative diseases of the hip joint (coxarthrosis, arthrosis)

The symptoms listed below should make you consider your daily physical activities, to see if preventative measures need to be taken or if treatment may be necessary.

• A feeling of fatigue after longer walks is often the first indication of an existing condition. There is no pain yet, but you are increasingly feeling the need to take a break.
• The progressing joint degeneration eventually causes a pulling sensation, a feeling of pressure, mild pain in the groin area, thighs or knee joints.
• In the next phase, you will experience pain while walking longer distances, walking on uneven ground or while climbing stairs.
• Pain after periods of inactivity is a typical symptom: When standing up after long sitting or when getting up in the morning, your first few steps are often painful and you always feel initial stiffness.
• At later stages, you may experience resting pain and/ or night pain.
• The more pain you experience, the more you will try to avoid painful movements. As a consequence, your muscles become tense and shorten as you adopt an unnatural posture, continuously bending your hip and causing the joint capsule and ligaments to shrink. Ultimately, the range of motion of your hip joint decreases and movement becomes painful.

Advanced osteoarthritis strong

Anamnesis – comprehensive and thorough

The first step is anamnesis, i.e. the systematic analysis of your medical history. In this process, your current state of health, your living environment, your case history (e.g. organic diseases), particular risk factors as well as genetic (hereditary) risks are evaluated. The following questions are typical:

• What are the symptoms, when did they start and how often do they appear?
• What seems to cause the symptoms (physical exertion, sports)? How can they be alleviated?
• Have you tried self-treatment (home remedies)?
• What did your physician prescribe (medication, physical therapy)?
• Do you have any other conditions, including non-orthopaedic ones?
• What medication do you take regularly?

This is followed by thorough physical examination, in which we ascertain joint swellings, mobility, stability, pressure and pain during movement of the affected joint and the neighbouring joints, in addition to height, weight, posture, misalignment of limbs and spine, nervous disorders and blood supply. The results usually yield a first diagnosis, which will then be confirmed, if necessary, using additional imaging techniques, and/or distinguished from similar signs and symptoms.

Physiotherapy:
Individualised physical therapy is combined with easy-to-understand instructions for self-treatment, to alleviate your discomfort, stabilise your cartilage and strengthen your muscles, helping you to significantly improve your mobility.

Additional Physical Therapy:
The usage of heat, cold, ultrasound or electrotherapy complements the treatment. These techniques promote blood flow and thus improve joint nourishment.

Antiphlogistics (anti-inflammatory medication):
Anti-inflammatory therapies, also referred to as antiphlogistics, are our first choice for all medical conditions of the musculoskeletal system. In addition to their anti-swelling and anti-inflammatory effect, their active ingredients also relieve pain in different strengths. The side effects of these medications particularly affect the stomach and kidneys (e.g. Ibuprofen, Diclofenac, Indometacin).

Cartilage-building supplements:
Gelatines, Chondroitin sulfate and glucosamine sulfate are supplements with scientifically proven efficacy. However, treatment over a period of six to twelve weeks is necessary to achieve the desired effect.

Pure analgesics (pain medication):
Pure analgesics do no treat the cause of arthrosis. Although they relieve pain, they have no effect on the inflammatory processes in the body (examples: (e.g. Paracetamol, Metamizol, Tramadol).

The goal of our treatment is always to preserve your natural hip joint for as long as reasonably possible, and only replace it by an endoprosthesis (artificial implant, Greek endo= inside the body, prosthesis = artificial) when there is no other option. If you have coxarthrosis, however, you should not wait “until the last minute“, but rather see us for a consultation in time. There may still be the possibility of preservation treatment.

In any case, the correction of misalignments is a prerequisite for the long-term success of any preservation procedure, because in conditions where the original, healthy cartilage was overloaded, new cartilage will not be able to survive, either.


Osteotomy procedures: correction of misalignments

Congenital and acquired deformities can be corrected more easily at an early stage, i.e. during childhood. In young adults suffering from hip pain, VDRO = varus-derotational osteotomy (three-dimensional realignment surgery of the femur) and/or pelvic surgery may be necessary. Improved alignment and weight distribution in the hip joint helps slow down joint degeneration. Of course, such a surgical procedure needs to be carefully planned. Stabilisation is achieved using special plates and screws.

Until the bone has fully healed after approx. twelve weeks, the joint will have moving stability, but only limited weight-bearing stability. Therefore, the patient will have to rely on crutches for the rehabilitation period of twelve weeks. This surgery is performed in cases where an endoprosthesis can still be delayed by 5 years or, ideally, 10 years.

In Germany, approx. 200,000 artificial hip joints are implanted annually. Endoprostheses, surgical instruments and minimally invasive surgery techniques (= surgery where only a very small portion of surrounding tissue is injured) are continuously enhanced, thereby extending the service life of artificial joints considerably. As a result, artificial joints have now also become an option for younger and physically active patients. Today, a well-implanted total hip replacement lasts about 15 years and enables you to lead a pain-free life. One or even several revision surgeries are possible.


When is the right time for hip replacement?

Your pain is becoming more severe, even when resting and at night. The mobility of your hip joint is deteriorating and your pain-free walking distances are becoming shorter. Previous treatment measures no longer help and your quality-of-life is significantly affected. In this case, you should consult your physician or directly talk to us.

The cap implant is the smallest endoprosthesis, and therefore the one where the least amount of bone needs to be removed. The damaged cartilage is removed from the head of the femur and a metal cap similar to a dental crown is attached the head of the femur. Its counterpart is a metal cup, which is inserted without the use of cement into the acetabulum after the cartilage has been removed.

Its advantages include very little friction between the two metal parts, excellent manoeuvrability and a very large head of the implant, which significantly reduces the risk of hip dislocation. Therefore, this implant is particularly suitable for physically active and often younger patients. However, good bone density is a prerequisite, because otherwise there is the risk of femoral neck fracture. One disadvantage is that, despite minimal friction, metal ions are released which may become enriched in the bodies of patients with hepatic or renal disorders.

In order to implant a standard endoprosthesis, the damaged head of the femur is removed together with the femoral neck, i.e. healthy bone tissue. For a short-shaft endoprosthesis, only the head of the femur needs to be removed, and the implant is anchored in the remaining femoral neck without the use of cement. The implant is smaller and more bone is preserved. Therefore, this represents a suitable alternative to a standard implant, especially for younger and physically active patients, who may require several replacement revision surgeries in the course of their lives. However, there are no reports on long-term results available yet. Osteoporosis is a clear contraindication for this procedure, as is the case with any other cementless implant type.