Hip Osteoarthritis (Coxarthrosis). Treatment in Germany

Coxarthrosis is one of the most common orthopedic diseases and the main indication for hip replacement. The disease develops in people over 40 years old and leads to complete joint destruction by the age of 70-80. You can undergo diagnostics, conservative therapy and surgical treatment of coxarthrosis in Germany. Booking Health will help you reduce the cost of treatment and organize your trip.

Content

1. What is coxarthrosis?
2. Conservative treatment
3. Non-drug therapy
4. Drug therapy
5. Surgical treatment
6. How is replacement surgery performed?
7. Primary and revision replacement
8. Recovery after treatment
9. Why is it worth undergoing treatment in Germany?
10. Treatment in Germany with Booking Health

What is coxarthrosis?

Hip osteoarthritis is a degenerative disease caused by the destruction of cartilage and the subchondral bone, which is located underneath. The disease is essentially a gradual "wear and tear" of the joint, which occurs with age. The rate of development of pathology depends on the number of the following factors:

• Body weight.
• Level of physical activity.
• Structure of the musculoskeletal system.
• Lifestyle, nutrition, metabolism, etc.

Coxarthrosis is manifested by chronic pain syndrome. The range of motion of the damaged joint gradually decreases. The function of its pulling backwards suffers first. Then the possibilities of rotation of the joint are reduced. A person spares a sore leg when walking, and therefore muscle atrophy on the affected side gradually occurs.

The disease is diagnosed with the use of medical imaging methods. They allow the doctors to see the signs of joint destruction even prior to the onset of the very first symptoms.

The main diagnostic method is X-ray. It is less informative than CT or MRI, but still, in most cases, X-ray examination is sufficient not only to make a diagnosis, but also to determine the stage of pathology. Most people go to the doctor after the onset of symptoms, when the destruction of the joint is obvious and clearly visible on the images.

When planning surgical treatment, computed tomography is often used. This method allows the doctors to examine the joint and surrounding tissues in all details.

Conservative treatment

The conservative treatment can be drug and non-drug therapy. Its goal is to slow down the development of coxarthrosis, relieve pain and other symptoms, as well as improve the function of the limb. However, there are no treatment methods, which can restore the destroyed hip joint.

Non-drug therapy

Non-drug therapy is more effective. Unlike drugs, it allows the doctors to slow down the progression of the disease and delay the need for replacement surgery. Non-drug therapy is aimed at eliminating excessive load on the hip and strengthening the body's ability to carry this load.

The therapy has the following purposes:

• Limb unloading. The patient can use a cane, crutches, or orthoses. The special orthopedic shoes are often chosen to compensate for differences in the length of the patient's limbs.
• Muscle strengthening. For this purpose, special training is used, as well as cuff traction for the lower leg. The procedure is effective only at the early stages. The doctors use weights, which are gradually increased to build muscle. The specialists increase not only the weight, but also the duration of its use – up to several hours a day.
• Weight loss. It allows the patient to reduce pain, relieve the joint and improve its function (increase the range of motion). It has been proven that weight loss reduces the symptoms of coxarthrosis and improves the quality of life. However, there is no evidence that weight loss slows down the degeneration of articular cartilage.
• Lifestyle correction. The patient is advised to avoid physical activity, joint injuries, overheating and hypothermia. Lifestyle adjustments are also aimed at achieving and maintaining body weight targets.

Many non-drug procedures are used for symptomatic purposes. These may be physiotherapy, gymnastics, reflexology, acupuncture and others. The effectiveness of most techniques has not been proven. None of these treatment methods slows down the development of hip osteoarthritis.

Drug therapy

The main classes of drugs used for coxarthrosis are:

• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Chondroprotectors.
• Glucocorticoids.
• Opiates (narcotic analgesics).

NSAIDs are the main group of drugs. These medicines are taken by most people with coxarthrosis. However, they are all unsafe: 1% of people have gastrointestinal or other haemorrhages, which require hospitalization. The incidence of minor haemorrhage, which are insensitive or accompanied by mild abdominal pain, is even higher. Therefore, the doctors try to minimize the doses of drugs and the frequency of their administration, complementing the effect with non-drug measures.

At the initial stages of the disease, NSAIDs are usually taken on demand. That is, in cases where hip pain occurs or increases. This usually occurs after exertion, while after rest, the painful sensations disappear.

The course of the early stages of osteoarthritis can be undulating. The hip joint periodically becomes inflamed – reactive synovitis develops. During these periods, painkillers are used. When the symptoms of synovitis subside, medications are not used.

Chondroprotectors are a group of drugs with an unproven effect. These are components of animal cartilage. Some tests demonstrate a moderate symptomatic effect in knee osteoarthritis, but in coxarthrosis, the use of chondroprotectors is usually useless. These drugs are not used in Europe.

Glucocorticoids are strong, but very harmful drugs for the body, and therefore they can be used only in extreme cases. For osteoarthritis, they are used in short courses. They can sometimes be injected into the joint.

Opiates are powerful analgesics. The need for them arises only at the advanced stages of arthrosis. Grade 3-4 osteoarthritis is usually treated with replacement surgery, and therefore opiate therapy is provided only to those for whom this surgery is contraindicated.

Surgical treatment

In the twentieth century, a large number of operations were used for the treatment of hip osteoarthritis: stabilizing, decompressive, tropostimulating, corrective surgeries. As a result of these surgical interventions, movement in the joint was limited, friction decreased, the length of the limbs was restored, etc. However the effect of these operations was short, so they were almost completely abandoned in Europe.

Hip replacement (endoprosthetics) is the only effective surgical treatment. All other methods are considered inappropriate.

Hip replacement has the following benefits:

• It solves the problem of hip osteoarthritis once and for all.
• High efficiency – on average, 90%, and in the best German hospitals – up to 98%.
• Low probability that a second operation will be required in the future – on average, 15-20%, and in Germany only 10% of patients need repeated interventions, and they are generally performed more than 10 years after the first operation.
• Low risk of complications.
• Quick pain relief.

The recovery of patients is even faster than after many organ-preserving surgeries. Depending on the fixation technique of the endoprosthesis, a person can maximally load the operated leg and walk without crutches already after 1-2 months.

How is replacement surgery performed?

The patients with coxarthrosis undergo total hip replacement. This means that the doctors replace not only the femoral, but also the acetabular (pelvic) part of the joint.

The surgical procedure is performed under general anesthesia. Spinal anesthesia can also sometimes be used. The duration of the surgical intervention is 1-2 hours. The doctor removes the patient's own joint and implants the components of the artificial joint in its place.

Orthopedists use two methods for endoprosthesis fixation:

• Cement.
• Cementless.

The cementless method is often used for hip replacement. The components of the artificial joint are pressed into the bone and fixed with screws. They are fused gradually with the patient's own tissues.

However, in elderly patients and in concomitant osteoporosis, the choice can be made in favor of cement. After "gluing" the artificial joint, the person is activated earlier and can load the operated leg earlier. This is important to reduce the risk of bone fractures near the prosthesis and to reduce the risk of complications caused by long-term decrease in the patient's mobility.

Primary and revision replacement

If a patient with coxarthrosis is operated on for the first time, such an operation is called primary hip replacement. If a person is operated with a previously implanted endoprosthesis, this is a secondary or revision hip replacement. The need for it arises infrequently. The better the hospital, the lower the risk that a second surgery will be required in the future.

Revision replacement is usually more complex than the first one. The operation takes longer and is more expensive. The surgical intervention is technically more complex and often gives unsatisfactory results.

During the first year after the primary hip replacement, the most common cause of revision surgery is infectious complications. This reason is the most unfavorable prognostically. Many patients will not have even one, but several operations, long-term conservative therapy and rehabilitation. Infection may develop even in the long term after replacement, but its risk gradually decreases.

Five years or more after primary hip replacement, the leading cause of revision surgery is aseptic loosening of the endoprosthesis. It is damaged due to wear and tear, technical errors during the implantation, or damage to the patient's bone tissue. Surgery for aseptic loosening involves the replacement of one or both components. In 60% of cases, the physician replaces only the femoral or only the acetabular part of the artificial joint.

Recovery after treatment

After surgery, complete restoration of the musculoskeletal structures affected by the disease and surgery takes at least 3-4 months. On average, the maximum function of the limb can be achieved after 6 months.

Rehabilitation begins at the hospital, where the patient undergoes hip replacement. From the very first day, the patient can get out of bed. He receives pain therapy, antibiotics, and anticoagulants. Most of the exercises are performed while lying in bed, and then standing next to it, using special devices.

Doctors in Europe use fast-track rehabilitation protocols. They involve early activation of the patient, training self-care, walking, sitting, getting up, basic household skills. With an uncomplicated postoperative period, discharge is possible within 4-7 days after hip replacement.

The high-quality early rehabilitation is especially important for the elderly and those weakened by concomitant diseases. It allows the person not only to improve the functional results of coxarthrosis treatment, but also to reduce the risk of complications.

A week later, minor loads on the operated leg are allowed. The load is gradually brought to the maximum. The most dynamic stage of rehabilitation begins in about a month. With the help of exercises, the patient can fully restore the function of the limb. The rehabilitation in Europe takes place in well-equipped Rehabilitation Centers. The high-quality rehabilitation ensures not only strong thigh muscles and maximum range of motion, but also the complete absence of pain.

Why is it worth undergoing treatment in Germany?

Germany offers advanced medicine. In terms of the quality of rehabilitation, this country holds a leading position even among other developed countries.

There are several reasons why it is worth undergoing coxarthrosis treatment in Germany:

• Safe operations with minimal risk of complications.
• The efficiency of replacement surgery for coxarthrosis in the best hospitals reaches 98%.
• Affordable cost of treatment: here it is lower than in many other developed countries.
• High-quality care, concomitant and symptomatic therapy, comfortable conditions in hospitals.
• Rehabilitation based on a fast-track type of the program.

After the operation, you can undergo rehabilitation treatment in one of German Rehabilitation Centers in order to quickly return to a full-fledged and active life.

Treatment in Germany with Booking Health

To undergo treatment of coxarthrosis in Germany, please use the Booking Health services. On our website, you can find the cost of treatment in different German hospitals and compare prices. Please enter the name of the disease in the program, select a treatment method, and you will receive a list of hospitals where you can get medical care. By default, they are sorted by rating, but sorting by other parameters is also possible.

Please contact the Booking Health specialists to undergo treatment in Germany. Here are our benefits for you:

• We will choose the best hospital whose doctors specialize in hip replacement for coxarthrosis.
• We will help you overcome the language barrier, establish communication with the German hospital and your attending physician.
• We will reduce the waiting time for the medical program and book a doctor's appointment on the most suitable dates for you.
• We will reduce the price. The cost of treatment in Germany will be decreased due to the lack of additional coefficients for foreign patients.
• We will take care of all organizational issues: our intermediary commits to meet you at the airport and accompany you to the hospital. We will provide you with interpreting services, help you prepare the documents, book a hotel and airline tickets.
• We will elaborate the medical care program and translate medical records into German. You do not have to undergo previously performed diagnostic tests.
• We will provide communication with the hospital after the treatment in Germany.
• We will organize additional medical examinations, treatment in Germany or rehabilitation, if necessary.
• We will buy medicines in Germany and forward them to your native country.
• We will help you keep in touch with the hospital  after your treatment in Germany.

Booking Health makes treatment in Germany easier, faster and cheaper. We will fully organize your trip, and you will only have to focus on restoring your health.

Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko