Endoprosthetics: endoprostheses hip – knee

Modern arthroplasty

About 50 years ago, doctors implanted the first modern-style hip joint endoprostheses. They consisted of an acetabular cup, a head thigh shaft and were anchored in the bone with the help of so-called “bone cement”, an acrylic resin. In the early 1980s, the first artificial knee joints were implanted, shoulder and ankle joints followed. Today, endoprosthetic surgeons in Germany annually provide about 230 000 patients with an artificial hip joint and about 170 000 patients with an artificial knee joint. The overwhelming majority are very satisfied with the result of the intervention – over years and decades. The expected average lifespan of an artificial joint can now be estimated at at least 15 years; significantly longer lifetimes are the rule rather than the exception. The main benefit in the vast majority of cases is the achieved freedom from pain. The newly acquired mobility is the biggest benefit for the quality of life reported by patients. The surgical technique as well as the components and materials used for joint implants have evolved rapidly. The initially used stainless steel has given way to new alloys and the metal titanium, the plastic used (polyethylene) is of higher quality, and for the femoral head the manufacturers process almost exclusively ceramics. The surgical approaches have become gentler, the cuts smaller, the rehabilitation after the procedure is faster.

Endoprosthetics knee (artificial knee joint, knee prosthesis)

Which knee prosthesis is the right one?

The human knee joint is a highly complex mechanical construct. Four bones meet here: thighs, tibia and fibula and the kneecap. Together they form – functionally speaking – three joints: the inner and outer joint between thigh and lower leg and the joint between thigh and kneecap. All partial joints can be at least theoretically replaced individually by artificial joints.

a) Slide prosthesis – one-sided (unicondylar) resurfacing. The sled prosthesis replaces only part of the knee joint. It is usually used when one-sided wear of the joint has been detected.

b) Knee joint total endoprosthesis or knee TEP: complete (bicondylar) resurfacing. – The total endoprosthesis completely replaces the joint. Prerequisite is basically that the ligamentous apparatus of the knee is fully maintained and functional.

c) Axially guided knee joint endoprosthesis. It is used when the two other prosthetic variants would not lead to the required stability of the knee joint. The Achs-guided knee joint endoprosthesis is also suitable for unstable lateral or cruciate ligaments.

d) Custom artificial knee joint – Individually shaped prostheses are available in different variants. You should u. a. take into account the specificities of the female knee joint. u. a. First, there are special prostheses for women, which should take into account the geometric requirements of the female knee joint. “Tailored” prostheses are exactly the anatomical specifications
adapted to the individual patient. Whether they actually last longer and / or work better has not yet been statistically proven.

Endoprosthetics hip (hip replacement, hip prosthesis)

a) Total hip arthroplasty (Hip TEP) – This total endoprosthesis is used in most patients. Its components are thigh shaft, acetabulum and condyle.

b) Hip Resurfacing (Cap Prosthesis, McMinn Prosthesis) – Instead of implanting a femoral stem, the surgeon can only crown the damaged hip joint head. However, this method is rarely used.

c) Duo-Head Prosthesis of the Hip Joint – In (usually older) patients with femoral neck fracture, the insertion of a duo-head prosthesis may be appropriate, replacing only the femoral head. This procedure shortens the operation time.

Endoprosthetics shoulder (artificial shoulder joint)

a) For the partial or complete replacement of the shoulder joint different systems are possible. Both the partial joint replacement (hemiprosthesis, only the articular surface of the humeral head) and the total endoprosthesis (TEP) with head and socket have their proven fields of application. The choice of prosthesis depends not only on joint damage but also on the condition of the surrounding tissue (rotator cuff), the age of the patient and the quality of the bone.

b) Total Endoprosthesis of the Shoulder Joint (Shoulder TEP) – In shoulder TEP, orthopedic surgeons use anatomical systems on the one hand. Head and socket are replaced here if both articular surfaces are severely affected. Musculature, d. H. the rotator cuff must be intact for this prosthesis. Because long prosthetic stems complicates the later replacement of a prosthesis, the trend is toward using shorter stems.

In terms of numbers, the older patients – and this age group of patients – are the largest – the inverse systems, a special feature of shoulder arthroplasty. Here head and pan are “reversed”. The head is fixed on the shoulder blade and the pan on the upper arm. Thus, this shoulder prosthesis type is based on the damage pattern and not on the original anatomy of the shoulder. The results of these surgeries are good, even if the arthrosis is already advanced or the surrounding muscular cuff of the shoulder joint is no longer intact. In addition, orthopedists use special fracture prostheses, for example, if it has not been able to reconstruct the shoulder joint in a complicated upper arm fracture from the fragments.

A knee prosthesis is the (partial or complete) replacement of a human knee joint with an artificial joint. Endoprostheses are used to -. B. by osteoarthritis – worn joints or joint parts to be replaced with state-of-the-art, fully functional replica. Premium physicians can offer different models of prostheses to their patients, depending on the functional condition of the affected joint (especially the ligamentous apparatus), the age and health status of the patient.

How important the hip joint is for everyday life, patients often notice only when the movements are limited by an injury or illness. Due to its central position in the body, this special joint is indispensable for the fulfillment of many areas of life. If the full functionality of the hip joint is no longer possible by other healing methods, a hip prosthesis can be the solution. Premium doctors have special knowledge in the field of endoprosthetics because of their specialization. So they can choose between different models, materials and surgical options for a hip joint prosthesis together with the patients. This enables a premium supply at all times.

Injuries, illnesses or signs of wear can damage a shoulder joint. If neither conservative treatments promise a cure success or joint-preserving operations no longer contribute to the relief of the discomfort, the implantation of a shoulder prosthesis may be necessary. This restores the painless mobility of the shoulder joint. In order to counteract a long-term suffering, it is advisable to consult one of the specialized premium physicians, who will inform you about a possible procedure and treatment alternatives.

Our specialists for this area

ARCUS Sports Clinic Pforzheim

OCM Orthopedic Surgery Munich – Hip and Knee Munich

Center for Musculoskeletal Surgery (CMSC) Charité Berlin Berlin

Orthopedic University-
clinic Ulm at the RKU Ulm

DIAKOVERE Annastift Hannover

ORTHOPARC Clinic Cologne

Center for Orthopedics and Traumatology of the St. Elisabeth Group Herne

OUC University Center for Orthopedics and Traumatology Dresden Dresden

Dr. Alexander Rosenthal Bochum

Prof. Dr. med. Christoph Lohmann Magdeburg

Klinikum rechts der Isar Munich

Sports Clinic Ravensburg Ravensburg

Asklepios Clinic Bad Griesbach Bad Griesbach

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Christina Cherry
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