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Hip Replacement for Hip Osteoarthritis (coxarthrosis)

Hospital Neuwerk Moenchengladbach

9.2/10
location_onGermany, Moenchengladbach

Department of Adult and Pediatric Orthopedics, Traumatology

The Department of Adult and Pediatric Orthopedics, Traumatology offers the modern diagnostics and treatment of the entire range of musculoskeletal diseases. The department's field of ​​competence includes the treatment of injuries of varying severity. The therapeutic options cover both conservative measures and surgical interventions, which are mainly performed using sparing minimally invasive techniques. The treatment concept is based on the comprehensive approach – from the use of conservative methods to physiotherapeutic procedures the day after surgery.

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Catholic Clinic Koblenz-Montabaur

10/10
location_onGermany, Koblenz

Department of Adult and Pediatric Orthopedics, Traumatology, Endoprosthetics

According to the prestigious Focus magazine, the Department of Adult and Pediatric Orthopedics, Traumatology, Endoprosthetics ranks among the top German medical facilities specializing in the treatment of orthopedic diseases! The department offers comprehensive diagnostics, surgical and conservative treatment of all musculoskeletal disorders in adults and children. Also, the department provides an outpatient rehabilitation. The field of endoprosthetics is marked by the endoCert certificate, which indicates high treatment standards. The focus is also on the treatment of injuries of varying severity, including in elderly patients.

Academic Hospital Brothers of Mercy Munich

10/10
location_onGermany, Munich

Department of Orthopedics and Traumatology

According to the Focus magazine, the Department of Orthopedics and Traumatology ranks among the top medical facilities in Germany in the treatment of musculoskeletal diseases! The department offers the full range of diagnostics and treatment of all acute and chronic diseases and injuries of the musculoskeletal system. The main goal of the department’s doctors in the treatment of each patient is the restoration of normal mobility and the elimination of painful sensations. The department has about 140 beds for patient hospitalization. The department’s doctors provide their first-class medical services to more than 4,000 inpatients every year. The Maximum Care Endoprosthetics Center (EPZmax) and the certified Trauma Center are part of the department as well.

Academic Municipal Hospital Karlsruhe

9.8/10
location_onGermany, Karlsruhe

Department of Adult and Pediatric Traumatology, Hand and Orthopedic Surgery

The Department of Adult and Pediatric Traumatology, Hand and Orthopedic Surgery offers the full range of services in these medical fields. Specialization covers the conservative and surgical treatment of injuries and degenerative changes of the extremities, joints, pelvis and spine. The surgical interventions are performed using both classic open, and minimally invasive, endoscopic method. The department performs more than 6,000 surgical procedures every year. It has 90 beds and treats about 3,000 inpatients and 20,000 outpatients annually.

Vitos Orthopedic Clinic Kassel

9.2/10
location_onGermany, Kassel

Department of Adult and Pediatric General Orthopedics, Trauma Surgery

The Department of Adult and Pediatric General Orthopedics, Trauma Surgery offers the full range of diagnostics and treatment of musculoskeletal pathologies. The specialization covers joint replacement surgery, foot and hand surgery, shoulder surgery, treatment of rheumatic joint lesions, treatment of injuries, sports orthopedics, treatment of orthopedic problems in children and adolescents, as well as pain therapy. The key to successful clinical practice is the highest professionalism and unique experience of the department's medical team combined with the very latest infrastructure and advanced equipment.

University Hospital Ulm

9.2/10
location_onGermany, Ulm

Department of Adult and Pediatric Orthopedics

According to the Focus magazine, the Department of Adult and Pediatric Orthopedics ranks among the top German departments specializing in joint replacement surgery! The department covers the full range of conservative and operative therapy in diseases of the musculoskeletal system, including the special pain therapy in the case of these pathologies, emergency treatment and long-term care for the patients with paraplegia. The department offers many sparing minimally invasive techniques, advanced navigation systems for high-precision interventions.

University Hospital Frankfurt am Main

10/10
location_onGermany, Frankfurt am Main

Department of Adult and Pediatric Orthopedics, Special Orthopedic Surgery and Rheumatic Orthopedics

According to the Focus magazine, the Department of Adult and Pediatric Orthopedics, Special Orthopedic Surgery and Rheumatic Orthopedics ranks among the top German medical facilities specializing in the treatment of orthopedic diseases in adults and children, as well as in hip surgery! The department offers the full range of medical services in these medical fields. It carries out both diagnostics and treatment of patients of all age groups, including very elderly patients, with various musculoskeletal diseases. The therapeutic options include both conservative and surgical treatment methods. The department is distinguished by high professionalism of doctors, advanced infrastructure and invaluable experience in the field of its specialization, due to which it occupies leading positions in the European medical arena and guarantees an optimal treatment result.

Charite University Hospital Berlin

9/10
location_onGermany, Berlin

Department of Adult and Pediatric Orthopedics, Traumatology

According to the Focus magazine, the Department of Adult and Pediatric Orthopedics, Traumatology ranks among the top German medical facilities in the field of its specialization! It offers the full range of conservative and surgical treatment of musculoskeletal diseases. The department's priorities include knee and hip surgery, including endoprosthetics, spinal surgery, shoulder and elbow surgery, surgical oncology of the musculoskeletal system and the treatment of injuries of varying severity. With an annual number of more than 8,000 inpatients, the department has the status of one of the largest and most reputable in the field of its competence.

University Hospital Heidelberg

9.8/10
location_onGermany, Heidelberg

Department of Adult and Pediatric Orthopedics, Traumatology

According to the Focus magazine, the Department of Adult and Pediatric Orthopedics, Traumatology ranks among the top German departments specializing in endoprosthetic joint replacement! The department offers the full range of services in the field of diagnostics and treatment of all diseases of the musculoskeletal system. In addition to surgical treatment, a number of effective conservative treatments are available in the department, for example, physiotherapy, occupational therapy, therapeutic exercise. The highly qualified doctors who have a rich experience and outstanding treatment results take care of the patients' health. 

University Hospital Würzburg

9.2/10
location_onGermany, Würzburg

Department of Traumatology, Hand Surgery, Plastic and Reconstructive Surgery

The Department of Traumatology, Hand Surgery, Plastic and Reconstructive Surgery covers the whole range of services in these focuses. The department specializes in joint replacement, treatment of tumors of the musculoskeletal system, endoscopic treatment methods for spinal injuries, arthroscopic treatment of joints, etc. The department is also a recognized Center for Sports Orthopedics.

University Hospital Carl Gustav Carus Dresden

9.1/10
location_onGermany, Dresden

Department for Adult and Pediatric Orthopedics, Trauma Surgery

According to Focus magazine, the Department of Adult and Pediatric Orthopedics, Trauma Surgery ranks among the top German departments specializing in joint replacement surgery! The department offers the full range of diagnostics, conservative and surgical treatment of diseases, injuries of the musculoskeletal system. The department is the certified Center for Endoprosthetics (more than 1,000 primary joint replacement operations yearly), which also specializes in particularly complex clinical cases. In addition, the department has won the status of the Trauma Center of interregional significance, certified in accordance with the standards of the German Trauma Society.

University Hospital Rechts der Isar Munich

9.8/10
location_onGermany, Munich

Department of Adult and Pediatric Orthopedics, Sports Medicine

The Department of Adult and Pediatric Orthopedics, Sports Medicine offers the full range of services in these fields. The department deals with the treatment of all diseases of the musculoskeletal system: bones, joints, muscles, ligaments and tendons. The highly specialized medical team of the department applies only modern diagnostic and therapeutic methods in its practice, while the long experience of doctors guarantees first-class surgical and conservative treatment.

University Hospital Tuebingen

9.2/10
location_onGermany, Tuebingen

Department of Adult and Pediatric Orthopedics

The Department of Adult and Pediatric Orthopedics offers the full range of modern diagnostics and treatment of diseases, deformities of the musculoskeletal system in patients of all age groups. The priority task of all specialists of the department is to preserve the mobility of the patient and improve the quality of his life. In the field of surgical treatment, the main focus is on joint arthroplasty, resection of musculoskeletal tumors, as well as surgical correction of spinal defects and pathologies. In addition, the department specializes in the treatment of sports injuries.

University Hospital Muenster

9.8/10
location_onGermany, Muenster

Department of General Orthopedics and Orthopedic Oncology

The Department of General Orthopedics and Orthopedic Oncology offers the full range of conservative and surgical treatment of all musculoskeletal diseases. The department ranks among the largest medical facilities of this kind in Germany, as well as among the specialized authoritative departments for the treatment of bone and soft tissue tumors in the European medical arena. The treatment is carried out both on an outpatient and inpatient basis, including the outpatient operations. In addition to its successful clinical activities, the department is proud of its productive research work, which has given birth to many innovations in orthopedics, for example, the department's specialists have patented the very latest prosthetic systems, particularly in the field of orthopedic oncology.

University Hospital Bonn

9.2/10
location_onGermany, Bonn

Department of Orthopedics and Traumatology

According to the Focus magazine, the Department of Orthopedics and Traumatology ranks among the top German departments specializing in joint replacement surgery! The department specializes in the diagnostics and treatment of all diseases and injuries of the musculoskeletal system. The therapeutic options include both conservative and surgical treatments. The department has 5 modern operating rooms, which meet stringent hygienic standards and a high technological level (for example, 2D and 3D X-rays, navigation systems, surgical microscopes, etc.). Also, it is possible to perform operations on an outpatient basis.

University Hospital Jena

8.9/10
location_onGermany, Jena

Department of Adult and Pediatric Trauma, Hand, Reconstructive Surgery

The Department of Adult and Pediatric Trauma, Hand, Reconstructive Surgery offers all modern surgical interventions in these medical fields. The department specializes in the treatment of patients with polytrauma, pelvic surgery, endoprosthetics, cancer, reconstructive surgery and hand surgery. The department has 62 beds for inpatient treatment and 3 high-tech operating rooms for both planned and emergency operations. The prestigious certificates of the Interregional Trauma Center of the German Society of Traumatology and the EndoCert certificate testify to the outstanding quality of medical services.

Coxarthrosis (arthrosis, arthritis, osteoarthrosis, osteoarthritis) is a degenerative lesion of the hip joint. In most cases, this is age-related wear out. Less commonly, joint degeneration can be caused by trauma or dysplasia (congenital underdevelopment). So far, medicine cannot offer reliable methods on how to restore the patient's own joint. Therefore, the main treatment for severe arthritis is hip replacement. You can undergo this operation abroad, in one of the best orthopedic clinics in the world. Booking Health will find the most suitable hospital and organize your trip.

Content

  1. Who may need hip replacement for coxarthrosis?
  2. What types of endoprosthetics can be performed?
  3. What types of endoprostheses can be used?
  4. Preparation for surgery
  5. How is the surgery performed?
  6. After surgery
  7. Revision hip replacement
  8. Surgery outcomes
  9. Treatment in European hospitals with Booking Health

Who may need hip replacement for coxarthrosis?

 

Hip osteoarthritis always progresses. In different patients, this occurs faster or slower, but the outcome of the pathology is the same: the formation of ankylosis, namely, a completely immobile joint.

The symptoms become more severe at the stage 3-4, so there is a need for hip replacement. Patients suffer from chronic pain that cannot be controlled with conservative therapy. One limb becomes shorter than the other one, which not only interferes with walking, but also badly affects the spine and other joints of the lower limb, primarily the knee.

Disability and chronic pain are the main reasons why patients decide to undergo hip replacement. This operation is recognized as the best in the world in terms of improving the quality of life. In the vast majority of cases, it helps achieve a successful outcome.

Hip replacement is the most common orthopedic surgery. In developed countries, tens of thousands of such interventions are performed every year. Coxarthrosis is the most common indication for hip replacement. Less commonly, such operations are performed for joint inflammation, dysplasia, hip fracture, avascular necrosis of the femoral head.

Cost of hip replacement surgery is from €11,783. You can find prices for other therapeutic options and hip rehabilitation on the Booking Health website.

According to indications, total and partial hip replacement surgeries are used in hip coxarthrosis.

The best hospitals for surgical treatment of hip osteoarthritis in Europe are:

  1. University Hospital Rechts der Isar Munich
  2. University Hospital of Ludwig Maximilian University of Munich
  3. University Hospital Ulm
  4. University Hospital Frankfurt-am-Main
  5. Vitos Orthopedic Clinic Kassel

What types of endoprosthetics can be performed?

 

Hip replacement can be either partial or total. In the first case, the joint is only partially replaced. It consists of two components: femoral and acetabular (acetabular cup prosthesis). When performing partial replacement, doctors replace only the femoral component. However, the patients with coxarthrosis usually require a total hip replacement.

According to the number of operations performed, hip replacement can be primary or revision (repeated, secondary). In most cases, European doctors perform a single surgical procedure. The prosthesis is implanted reliably, very accurately, and therefore the risk of loosening or infection is minimal. In recent years, the quality of endoprostheses has improved: they can serve for decades without a need to be replaced. Most patients suffering from hip osteoarthritis are people over 70 years old. Therefore, the implanted artificial joint serves lifelong.

According to the method of fixing the endoprosthesis, hip replacement for arthritis can be cement and cementless. The cementless method is mostly used – the spongy component of the prosthesis gradually grows into the bone. This process is called osseointegration. Nonetheless, in case of osteoporosis, artificial prostheses do not fuse well, so they are reliably fixed with cement.

What types of endoprostheses can be used?

 

Endoprostheses for hip replacement consist of a femoral and pelvic component. The femoral component is a stem, which imitates a part of the femur, with a neck and head. This head is placed in the pelvic component of the prosthesis – the cup. A liner is located between them. Different components of the endoprosthesis can be made of different materials – their combination is called a sliding pair or friction joint. The liner is usually made of polyethylene.

In most cases, it is possible to select the most suitable endoprosthesis for the patient from standard sizes. In Europe, the method of computer selection is used from tens of thousands of options.

In the most complex cases of arthritis, in bone defects and significant deformation of the acetabulum, the endoprosthesis has to be made individually. It is 3D printed. Special computer programs take into account the quality and quantity of the remaining bone tissue, set the required configuration of the pelvic component of the endoprosthesis, the location of the screws, and help the specialists plan surgery.

Individual endoprostheses are the most reliable, comfortable and functional, but when using them, the cost of treatment increases. The need to use individual components of prostheses usually arises in traumatic arthritis.

Preparation for surgery

 

Preparation for hip replacement surgery involves undergoing tests and creation of favorable conditions for postoperative recovery.

It is advisable to prepare the body for the upcoming intervention. This will help make it more safe. A month before hip replacement, it is worth quitting smoking, as it impairs blood supply, increases the risk of infectious complications, and slows down the restoration of bones and soft tissues.

Excess weight is bad for the surgery results, as it often becomes the main cause of the development of arthritis. Overweight and obesity are determined by body mass index (BMI). To calculate it, you need to take your weight in kg and divide by your height squared (in meters). An index of up to 25 is considered normal. An index from 30 means obesity of the first degree. If the BMI is over 40 (grade 3 obesity), you may not have surgery at all.

If you have weak arms, take up sports. It is worth strengthening the muscles for several months before surgery. These muscles will bear the main load in the first 2 months after hip replacement.

You will be consulted by a rehabilitation therapist immediately before the operation. He will teach you how to use crutches or a walker in advance. You will practise walking without straining the operated limb. The doctor will teach you how to sit up, sit down and stand up correctly.

Take a shower the night before your surgery. Do not eat anything after 6 p.m., and do not drink anything after midnight.

How is the surgery performed?

 

The hip replacement surgery does not cause any discomfort to the patient. It is performed under general anesthesia, so there is no even minimal pain. The operation usually takes 1 to 2 hours. In complex cases, it may take longer.

The joint destroyed by arthritis is permanently removed. An artificial prosthesis is implanted in its place. The acetabulum of the pelvis is drilled out and an artificial cavity (cup) is implanted in it, which is fixed with screws or cement. On the other hand, the femoral component is placed, which becomes a continuation of the patient's own femur. If possible, the doctors use a short stem of the endoprosthesis to preserve as much of the patient's own bone tissue as possible.

Upon the completion of surgery, the doctor sutures the wound. It leaves the drains – the tubes through which blood and lymph drain. This is carried out to prevent the accumulation of fluid in the surgical area.

After surgery

 

Immediately after surgery, the patient stays in the Intensive Care Unit. He receives symptomatic, supportive, pain therapy. Drugs are used to reduce the risk of infectious and thromboembolic complications. The leg is in the abduction position. A roller is placed between the legs.

The activation of the patient is allowed within a day after the operation. The first bandaging is performed during this period. For two days, the intestines do not work well, so the patient has to follow a sparing diet. He can walk on the third day, but he will have to use additional support devices.

In the first days after surgery, the patient can only sleep on his back. When turning on the unoperated side, a roller should be pressed between the legs. The legs are bent at the knees and a roller is placed between the knee and ankle joints. The patient should already do exercises while lying in bed during the first days, but he should avoid sudden movements, too strong (more than 90 degrees) bending not only at the hip joint but also at the knee joint of the operated limb. Rotational movements are undesirable.

The stitches are usually removed after 2 weeks. Sometimes they do not have to be removed: the threads gradually dissolve on their own.

The patient needs to stay 1-2 weeks in the hospital. The maximum load on the operated leg is possible within one and a half to two months. The patient then needs to increase it gradually. In the first days after surgery, the affected leg is not loaded at all. After a week, the load is allowed up to 15% of the body weight, after 3 weeks – up to 50%.

In replacement surgery, methods of fast-track rehabilitation after hip replacement become more common. Trials show that it not only reduces the recovery period and hospital stay, but also reduces the risk of some complications. The method was developed in Denmark, but then became widespread in Europe and America.

According to the fast-track protocol, the patient is activated within a few hours after surgery. This is possible due to spinal anesthesia instead of general anesthesia. Upon the completion of surgical procedure, infiltration anesthesia is additionally used. In the postoperative period, low molecular weight heparins and compression hosiery are used to prevent thromboembolism, which, in addition, prolongs the effect of infiltration anesthesia. To relieve pain, nonsteroidal anti-inflammatory drugs are prescribed, and, if necessary, opiates. Physiotherapy starts the next day. Patients stay in the hospital only 5-7 days after hip replacement.

The rehabilitation period takes up to 6 months, but already 1 month after fixation with cement and 2 months after cementless fixation, the maximum load on the operated leg and walking without crutches is possible. The main methods of rehabilitation are therapeutic exercises, physiotherapy, massage. Exercises play a major role in 2-3 weeks after surgery, when soft tissues heal.

Revision hip replacement

 

Approximately 10-15% of patients require repeated hip replacement. This operation is technically more complex than the primary one, and often gives unfavorable functional outcomes. Prostheses for hip replacement are often more expensive, and for some patients they have to be made individually, further increasing the cost of treatment. In the best European hospitals, even a revision hip replacement is successful in most cases.

Here are the main reasons why the patient may need a revision joint replacement surgery after hip replacement:

  • Infectious complications are the most common reason for early surgery. If possible, sanitizing operations can be performed to eliminate the inflammation foci, but the prosthesis can be preserved. In case of infectious complications, even several operations may be required, since a new artificial joint cannot always be implanted immediately after removing the old one.
  • Loosening of the endoprosthesis. The more accurately it is implanted, the lower the risk of one or both components loosening. The risk also depends on the quality of the prosthesis and the level of physical activity of the patient.
  • Dislocation of the prosthesis can be repaired. Operations are performed for irreducible or recurrent (re-developing) dislocations.
  • Other reasons include wear of a polyethylene liner, dissolution of bone tissue, injuries with mechanical damage to the prosthesis, periprosthetic fractures, tumors, ossification foci, etc.

The two main reasons are infection and aseptic loosening of the endoprosthesis – they account for 40-45% of cases. The percentage of infection is maximal in the first year after the primary replacement, but then rapidly decreases. In the long term, especially 10 or more years after hip replacement surgery, the reason for revision operations is usually loosening of the prosthesis.

If the artificial joint wears out, its parts need to be replaced. In 20% of cases, the doctor changes only the femoral component, in 40% of patients – the acetabular (pelvic) component, and in another 40% of cases, the total hip replacement is performed.

Surgery outcomes 

 

The efficiency of hip replacement is about 97% in the best hospitals. Chronic pain completely disappears in patients, limb function restores. They can lead an active lifestyle with virtually no restrictions. Even the most severe types of arthritis can be successfully treated with this surgery.

Hip replacement is the most successful surgery as compared to other types of large joint replacement. Patients are more often completely satisfied with the results of the intervention, while the implanted prostheses serve for decades and usually do not require any replacement.

Treatment in European hospitals with Booking Health

 

To undergo treatment in European hospital, please use Booking Health services. On our website, you can see the cost of treatment in different hospitals, compare prices and book a medical care program at a favourable price.

Please contact Booking Health specialists to undergo treatment in European hospital. Here is what we will do for you:

  • We will choose the best European hospital, whose doctors specialize in hip replacement surgery.
  • We will help you overcome the language barrier and establish communication with your attending physician.
  • We will reduce the waiting time for the medical care program and book a doctor's appointment on the most convenient dates.
  • We will reduce the price. The cost of treatment in European hospitals will be decreased due to the lack of additional coefficients for foreign patients.
  • We will take care of all organizational issues: documents for entering the country, transfer from the airport, hotel, interpreter, etc.
  • We will prepare a program and translate medical documents. You do not have to undergo previously performed diagnostic procedures, which you have already had.
  • We will provide communication with the European hospital upon the completion of your medical care program.
  • If necessary, we will organize additional diagnostic tests and treatment in European hospitals.
  • We will buy medicines abroad and send them to your native country.
  • We will help you keep in touch with a European hospital after a joint replacement surgery.

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

Authors: Dr. Nadezhda IvanisovaDr. Sergey Pashchenko




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