Hip Replacement Surgery

Prices in Germany are normally 75% below the cost of hip replacement surgery in the US and are individually quoted. They include all medical expenses, the hospital stay, surgeon's fees, operation room fees, anesthesia, anesthesiologist's fees, medicine, nursing, semi-private room, meals, pre-op diagnosis, local phone and English TV.

What is Hip Replacement Surgery?

Hip replacement surgery involves the removal of head or capital of the femur and bone material of the socket and the placement of artificially constructed replacements. It is the most successful, cheapest and safest form of joint replacement surgery.

Please see our {moslink othermenu:Anterior Hip Replacement}anterior hip replacement surgery{/moslink} page for a less traumatic procedure.

What is the History of Hip Replacement Surgery?

The earliest recorded attempts at hip replacement surgery (Gluck T, 1891), which were carried out in Germany, used ivory to replace the femoral head (the ball on top of the thighbone).Use of artificial hips in hip replacement surgery became more widespread in the 1930s; the artificial joints were made of steel or chrome. They were considered to be better than arthritis but had a number of drawbacks. The main problem was that the articulating surfaces could not be lubricated by the body, leading to wear and loosening and hence the need to replace the joint again (known as revision operations). Attempts to use teflon produced joints that caused osteolysis and wore out within two years. Another significant problem was infection. Before the advent of antibiotics, hip replacement surgery on the joints carried a high risk of infection. Even with antibiotic treatments, infection is still a cause for some revision operations. Such infections are not necessarily caused at the time of the hip replacement surgery; they can also be the result of bacteria entering the bloodstream during dental treatment.

What does a Hip Replacement Surgery Look Like?

In this X-ray, the patient's right hip (on the left in the photograph) has been replaced, with the "ball" of this ball-and-socket joint replaced by a metal head that is set in the thighbone or femur and the socket replaced by a white plastic cup (clear in this X-ray)

What are the Modern Advances in Hip Replacement Surgery?

The modern artificial joint owes much to the work of John Charnley at the Manchester Royal Infirmary; his work in the field of tribology resulted in a design that completely replaced the other designs by the 1970s. Charnley's design consisted of 3 parts - (1) a metal (originally Stainless Steel) femoral component, (2) a Ultra high molecular weight polyethylene acetabular component, both of which were fixed to the bone using (3) special bone cement. The replacement joint, which was known as the Low Friction Arthroplasty, was lubricated with synovial fluid. The small femoral head (22.25mm) produced wear issues which made it suitable only for sedentary patients, but - on the plus side - a huge reduction in resulting friction led to excellent clinical results. For over two decades, the Charnley Low Friction Arthroplasty design was the most used system in the world, far surpassing the other available options (like McKee and Ring).

In 1960 a Burmese orthopedic surgeon, Dr. San Baw (29 June 1922 - 7 December 1984), pioneered the use of ivory hip prostheses to replace ununited fractures of the neck of femur (‘hip bones’), when he first used an ivory prosthesis to replace the fractured hip bone of an 83 year old Burmese Buddhist nun, Daw Punya. This was done while Dr San Baw was the chief of orthopeadic surgery at Mandalay General Hospital in Manadalay, Burma. Dr San Baw used over 300 ivory hip replacements from the 1960s to 1980s. He presented a paper entitled Ivory Hip Replacements for Ununited Fractures of the Neck of the Femur at the conference of the British Orthopedic Association held in London in September 1969. An 88% success rate was discerned in that Dr San Baw’s patients ranging from the ages of 24 to 87 were able to walk, squat, ride the bicycle and play football a few weeks after their fractured hip bones were replaced with ivory prostheses. Dr San Baw’s use of ivory was, at least in Burma during the 1960s, 1970s and 1980s (before the illicit ivory trade became rampant starting around the early 1990s) cheaper than metal. Moreover, due to the physical, mechanical, chemical, and biological qualities of ivory, it was found that there was a better 'biological bonding' of ivory with the human tissues nearby the ivory prostheses.

In the last decade, several evolutionary improvements have been made in the total hip replacement procedure and prosthesis. Many hip implants are made of a ceramic material rather than polyethylene, which some research indicates dramatically reduces joint wear. Metal-on-metal implants are also gaining popularity. Most implants are joined without cement; the prosthesis is given a porous texture into which bone grows. This has been shown to reduce the need for revision.

The latest developments are several competing Minimally Invasive Surgery (MIS) approaches such as the anterior hip replacement, which may result in far less soft tissue damage and a much quicker recovery. C.A.O.S (Computer Assisted Orthopedic Surgery) is also very up and coming. Computer assisted surgery is used to better navigate prosthetic implantation.

What Are Some of the Conditions that Lead to Hip Replacement Surgery?

The arthritis that often accompanies age is the primary reason for Hip Replacement Surgery, however younger people can experience trauma from accidents, congenital conditions and cancer, which can lead to the need for Hip Replacement Surgery

What Are Some of the Variations in Hip Replacement Surgery?

There are many variations in the approach the doctor uses to remove the old damaged hip in Hip Replacement Surgery. The approach can be posterior, lateral, or anterior or a combination of approaches, depending on the anatomy and condition of the patient. The anterior approach has become a favorite of patients and doctors, because it leads to a shorter recovery time, lower costs and shorter rehabilitation time. Older patients tend to have cemented prosthesis, whereas younger patients do not.

How Long will I be in the Hospital after Hip Replacement Surgery?

A 7 - 10 day stay is expected after Hip Replacement Surgery. During this time post-op evaluations are done as well as rehabilitation. Some patients require an additional week of rehabilitation due to slow progress.

Hip Resurfacing: An Alternative to Total Hip Replacement Surgery?

Another option for younger patients is hip resurfacing, where the end of the femur bone is capped with a metal ball and like the hip replacement a metal socket is pressed into the pelvis. The advantage of the resurfacing is that it preserves bone stock, which is a decided advantage if revision is needed.