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Hip Endoprosthesis – Total Hip Replacement Explained

A hip endoprosthesis is an artificial hip joint implanted to relieve chronic pain and restore mobility when the natural joint is severely damaged by wear or injury.

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Things worth knowing about "Hip Endoprosthesis"

A hip endoprosthesis is an artificial hip joint implanted to relieve chronic pain and restore mobility when the natural joint is severely damaged by wear or injury.

What Is a Hip Endoprosthesis?

A hip endoprosthesis – also known as a total hip replacement (THR) or hip arthroplasty – is a surgical implant that fully or partially replaces a damaged or destroyed natural hip joint. It is one of the most commonly performed and highly successful orthopedic procedures worldwide. The primary goals are to eliminate chronic pain, restore joint function, and significantly improve the quality of life of the patient.

Components and Types

A hip endoprosthesis typically consists of several components:

Femoral stem: Inserted into the thigh bone (femur) to anchor the implant.
Femoral head: A ball-shaped component that replaces the natural head of the femur.
Acetabular cup: Replaces the natural socket in the pelvis.
Liner (insert): A bearing surface between the ball and socket, made of polyethylene, ceramic, or metal.

Depending on the fixation method, prostheses are classified as:

Cemented prosthesis: Components are fixed using bone cement – commonly used in older patients with softer bone.
Cementless prosthesis: The implant surface allows bone to grow directly into it – preferred for younger, more active patients.
Hybrid prosthesis: Combines cemented and cementless fixation techniques.

Indications – When Is a Hip Endoprosthesis Used?

A hip replacement is recommended when conservative treatments such as physiotherapy, pain medication, and assistive devices no longer provide adequate relief. Common indications include:

Hip osteoarthritis (coxarthrosis): Advanced wear of the hip cartilage – the most frequent cause.
Femoral neck fracture: A break near the top of the thigh bone, often occurring in elderly patients after a fall.
Avascular necrosis of the femoral head: Death of bone tissue due to disrupted blood supply.
Rheumatoid arthritis: Inflammatory joint disease causing joint destruction.
Congenital hip deformities: Such as hip dysplasia leading to secondary arthritis.

Surgical Procedure

The procedure is performed under general or spinal anesthesia and typically takes 1 to 2 hours. The surgeon selects from several operative approaches:

Lateral approach: The classic access route through the side of the hip.
Posterior approach: Access from the back – widely used, provides excellent visualization.
Anterior approach (AMIS): A minimally invasive approach from the front that preserves muscle structures.

After removing the damaged joint, the prosthetic components are implanted and securely fixed. Modern minimally invasive techniques allow smaller incisions and promote faster recovery.

Rehabilitation and Follow-Up Care

Rehabilitation begins as early as the day after surgery, with the goal of gradually restoring full mobility:

Early mobilization with physiotherapy support from postoperative day 1
Gait training with forearm crutches for several weeks
Inpatient or outpatient rehabilitation at a specialized facility
Regular follow-up examinations including X-ray controls

For several weeks after surgery, patients are advised to follow movement precautions – such as avoiding hip flexion beyond 90 degrees – to minimize the risk of prosthetic dislocation.

Risks and Possible Complications

As with any surgical procedure, hip replacement surgery carries certain risks:

Infection of the implant or wound
Deep vein thrombosis or pulmonary embolism (preventable with anticoagulant therapy)
Prosthetic dislocation (luxation)
Leg length discrepancy
Loosening of prosthetic components (typically after many years)
Nerve or vascular injury (rare)

Longevity and Revision Surgery

Modern hip endoprostheses have a lifespan of 15 to 25 years or more. If a prosthesis becomes loose or wears out, a revision procedure is required. This surgery is technically more demanding than the initial implantation.

References

Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370(9597):1508-1519.
National Institute for Health and Care Excellence (NICE): Hip replacement – NICE guideline NG157. London, 2020. Available at: www.nice.org.uk
Kurtz S et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780-785.

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