Hip Replacement Surgery in Germany
In 2007, The Lancet journal named hip replacement surgery the 'surgery of the century'. It is widely regarded as the surgical procedure with the greatest impact on a person’s quality of life. Consequently, it is one of the most common surgeries in developed countries. In 2022, for example, around 255,000 artificial hip joints were implanted in Germany. A large number of these operations were carried out on patients from abroad who came to Germany to receive better medical treatment.
When is a hip replacement necessary
Most hip replacement surgeries are performed to treat coxarthrosis, also known as osteoarthritis or hip joint arthritis. Less commonly, such surgeries are performed to treat femoral neck fractures following severe trauma, osteomyelitis (bone infection), autoimmune inflammation or cancer. In summary, hip replacement surgery is performed when the joint is severely and irreversibly damaged.
The German Society for Orthopaedics and Traumatology (DGOU) has set out the following criteria in its guidelines for surgery to treat osteoarthritis:
- Joint pain limits patients’ daily activities and reduces their quality of life.
- Optimal conservative treatment does not sufficiently alleviate pain after approximately three months.
- X-rays confirm the diagnosis.
- The treating physician and the patient have jointly considered all the pros and cons of surgery.
Therefore, the decision to operate cannot be based solely on radiographic criteria (i.e. the stage of osteoarthritis). The primary goal of surgery is to improve the patient’s quality of life. Accordingly, people decide on joint replacement based on the reduction in quality of life that pain and limited mobility cause.
Causes of joint degeneration
Coxarthrosis is the term used to describe the degeneration and destruction of the joint due to a degenerative-dystrophic process. Osteoarthritis may have an identifiable cause:
- Hip dysplasia.
- Trauma.
- Rheumatoid arthritis.
- Asseptic necrosis of the femoral head.
- Ankylosing spondylitis.
- Previous injuries.
In such cases, secondary osteoarthritis is diagnosed, and it may have a specific name depending on the cause: for example, post-traumatic or dysplastic osteoarthritis.
Characteristics of these conditions include:
- Development at a younger age.
- More complex joint replacement cases.
- A greater need for high-tech procedures, such as 3D printing of customised acetabular components for joint replacement in cases of significant post-traumatic acetabular deformation.
Idiopathic or primary osteoarthritis, which develops without any obvious cause, is more common. It is essentially age-related wear and tear of the joint.
The main patient group consists of elderly people. Consequently, the average age of patients undergoing hip replacement surgery is 70 years. Up to 90% of hip replacement operations are performed for primary coxarthrosis.
Types of hip replacement surgery
Hip replacement surgery can be either partial or total. In a partial replacement, only the femoral component is replaced. In a total hip replacement, also known as total hip arthroplasty, both the femoral and acetabular components are replaced.
Total hip replacement is performed in the vast majority of cases. Partial replacement is only carried out in rare cases, mainly on patients with a femoral neck fracture provided there are no degenerative changes in the acetabulum. However, femoral neck fractures usually occur in older age, when a person already has signs of osteoarthritis. Therefore, even with this injury, orthopaedic surgeons generally prefer to perform a total hip replacement.
A total hip replacement consists of three parts:
- An artificial acetabulum (cup) with a plastic (polyethylene) or ceramic liner.
- An artificial ceramic femoral head.
- A femoral stem, which is approximately 15 centimetres long and fixed within the femur.
In Germany, high-quality endoprostheses are used that are capable of lasting for decades without needing replacement. Most patients will only require one operation to have an artificial joint fitted in their lifetime.
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Methods of hip prosthesis fixation
Doctors use two methods to fix hip prostheses:
- Cemented: the prosthesis is fixed in place using cement.
- Cementless: the prosthesis is pressed into the bone and then fuses with it.
Cementless hip prostheses are standard practice for over 80 per cent of patients in Germany, provided there is no severe joint deformity and the bone quality is good. The prosthetic stem, which is fixed in the femur, and the acetabular cup are made of well-tolerated titanium alloys. A ceramic and polyethylene bearing pair is usually used for the head and liner.
Cemented prostheses are used if the bone quality is poor (for example, due to osteoporosis) or if anatomical features preclude cementless fixation. In such cases, the endoprosthesis components are fixed using bone cement.
How is a hip replacement performed
The operation is carried out under epidural or general anaesthesia. Various surgical techniques are used in hip replacement surgery. The two main types are conventional and minimally invasive techniques.
Conventional surgery: Access to the joint is gained via a 15–25 cm incision. The damaged bone material is removed and the bone is prepared for the implant. The surgeon prepares the pelvic and femoral bones for this using special drills and rasps.
Possible surgical approaches:
- Posterior – the most common approach, which provides an excellent view of the joint and a low risk of nerve damage.
- Anterior – technically more complex, but better at preserving muscle tissue. It offers a lower risk of prosthesis dislocation, thereby reducing post-operative limitations.
- Anterolateral – this approach is rarely used, but some surgeons prefer it because it causes minimal damage to the joint capsule and the posterior hip rotator.
Minimally invasive surgery. Similar to the conventional approach, but performed through a smaller incision (8–10 cm). This results in less damage to the muscles. However, the surgical field is not clearly visible, so the surgeon requires intraoperative X-rays and navigation systems.
Advantages of the minimally invasive technique:
- Shorter hospital stay, possibly down to 1–2 days.
- An easier early rehabilitation period.
- Better aesthetic results.
- Lower risk of prosthesis dislocation due to muscle preservation.
This method is not suitable for all patients. If you are interested in minimally invasive surgery, we can help you find a suitable clinic for hip joint treatment in Germany. Following an examination, we will be able to determine whether minimally invasive surgery is feasible in your case.
After surgery
It is important to start moving around again as soon as possible after the procedure. It is best to take your first steps with your new hip replacement on the day of the operation. This activity helps the prosthesis parts to settle into the bone and integrate more effectively. On the other hand, early mobilisation prevents complications such as thrombosis, oedema, and lymphoedema. Furthermore, patients' quality of life improves and they are able to go to the toilet unaided.
Rehabilitation following joint replacement surgery in Germany can be undertaken as an inpatient or outpatient. The surgical wounds will have healed within about two weeks, and after six weeks, you will no longer need to use crutches.
To avoid dislocation of the prosthesis, you must not cross your legs, turn your leg inwards too sharply or bend it beyond 90 degrees for the first 3 months. After this period, the tissues will have become sufficiently strong and most restrictions will be lifted. Over 70% of prosthesis dislocations occur within the first month after surgery, with an overall incidence of 1–3% following hip replacement.
Results of joint replacement surgery
The main results of joint replacement surgery in Germany are as follows:
- In over 90% of patients, joint pain disappears completely and limb function is restored. Although a small number of patients experience residual symptoms, their condition improves significantly compared to before the operation.
- After surgery and rehabilitation, patients can resume physical activities such as labouring, sports, dancing, cycling and skiing. They can return to an active lifestyle.
- The ten-year survival rate for joint replacements performed in Germany is 95%, and the twenty-year rate is 85%.
Germany employs the latest techniques aimed at improving treatment outcomes for complex cases and minimising trauma, including minimally invasive surgical approaches, innovative prosthesis designs, customised prostheses, 3D printing, computer-assisted navigation, robotic surgery and accelerated rehabilitation protocols. You will receive safer and more reliable treatment here.
Submit an enquiry on our website to choose a German clinic for a hip replacement and experience the many advantages of German healthcare.
FAQ
What preparation is required before hip replacement surgery?
- It is advisable to achieve a healthy weight, build up the muscles in your hips, body and arms through physical exercise, and treat any underlying health issues. Following a medical examination, you will receive personalised recommendations on how to prepare for the operation.
How long does a hip replacement operation take?
- Usually 1–2 hours, but up to 3 hours in complex cases.
How long does rehabilitation take after a hip replacement?
- Most patients feel well again after three months. However, you will only be permitted to put full weight on the joint after 12 months.
Sources: https://www.heliosgesundheit.de/magazin/news/02/hueftprothese/#:~:text=Die%20H%C3%BCftendoprothese%20besteht%20immer%20aus,TEP%20oder%20H%C3%BCft%2DTEP).
https://www.ndr.de/ratgeber/gesundheit/Hueft-TEP-Alles-Wissenswerte-fuer-die-Hueft-OP,huefte260.html
https://www.ncbi.nlm.nih.gov/books/NBK507864/
