Joint Endoprosthesis

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Joint Endoprosthesis
Joint Endoprosthesis
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Joint endoprostheses

Joint endoprostheses are usually used for osteoarthritis, which is associated with pain and restricted mobility. The insertion of a joint endoprosthesis may also be necessary in the case of bone or joint damage, for example due to broken bones, torn ligaments or joint malpositions.

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  • How are joint endoprostheses used?
  • What complications can arise?
  • Whom can I ask?
  • How will the costs be reimbursed?

How are joint endoprostheses used?

The operation can be performed using epidural or spinal anesthesia or under general anesthesia. The doctor decides which form of anesthesia is used for each patient individually. The decision is made depending on the type of intervention and any accompanying illnesses of the patient.

In many cases, joint endoprostheses are used in a minimally invasive manner. The minimally invasive procedure is muscle-friendly and large incisions in the skin can be avoided. As a result, healing is usually faster than with a joint replacement using a large incision.

After opening the joint, damaged tissue is removed. The artificial joint is then fixed to the bone with “bone cement” or pressed onto the bone surface with high pressure. A combination of both technologies is also possible (hybrid technology). In addition, part of the artificial joint can be anchored in a long bone (e.g. thigh bone or shin bone). Depending on the affected joint and the extent of the joint damage, only the joint surfaces or additionally the stabilizing ligaments (e.g. cruciate and collateral ligaments of the knee joint) can be replaced.

After careful hemostasis, a drain is placed to drain off wound fluid. Finally, the wound is closed and a compression bandage is applied. The drainage can be removed after a few days if there are no complications.

Note The function of an endoprosthesis can decrease after a few years. Then the prosthesis may have to be replaced.

What complications can arise?

Post-operative pain

Pain in the affected joint after the operation can usually be treated well with painkillers and usually regresses again after healing and sufficient muscle building. However, some patients continue to need pain medication after the operation. Depending on the affected joint, it takes between three months and a year for the final therapeutic success to occur. However, this success also depends on regular exercise training.

Infections

As with any surgical procedure, despite maintaining high standards of hygiene before, during and after the procedure, there is a risk of infection. If the affected joint is very warm, painful and reddened after the operation, or if a fever occurs, the attending doctor must be contacted as soon as possible. Joint infections must be recognized and treated particularly quickly, as they can lead to life-threatening inflammations or inflammatory reactions (osteomyelitis - inflammation of the bone marrow or sepsis - "blood poisoning").

In the event of an infection in the area of ​​the prosthesis immediately after the operation, the surgical wound is reopened and inflamed tissue is removed (debridement). The joint is then rinsed, the mobile (moving) parts of the artificial joint are changed and a drain is put in place to allow infectious wound fluid to escape. Antibiotics are also given. Before the first administration of antibiotics, the doctor takes wound fluid from the infected joint and has a germ determination carried out. In this way, the antibiotic treatment can be adapted to the pathogen after the examination results have arrived. If this means that the infection cannot be adequately combated or there is a so-called late infection (see below), the fixed parts of the prosthesis must also be removed.After the inflammation has healed, a new prosthesis can then be inserted in most cases. An infection can also occur months or years after the installation of a joint endoprosthesis (late infection) if pathogens (mostly bacteria) enter the artificial joint via the bloodstream.

Note When creating a joint endoprosthesis, an antibiotic against bacterial infections is administered as a precaution before or during the operation.

Bleeding

When inserting joint endoprostheses, profuse bleeding can occur, which may make it necessary to administer blood. Seldom has to be operated again to stop bleeding.

thrombosis

The risk of developing a thrombosis is increased after a joint endoprosthesis has been placed. Therefore, the patient receives heparin for at least two weeks after the operation, for example as a thrombosis prophylaxis ("blood thinning").

Aseptic inflammation

Plastic or cement abrasion during joint movements can trigger a non-infectious inflammatory reaction in the affected joint. This can lead to loosening of the prosthesis.

Nerve damage

When severing nerves, nerve pain or sensory disturbances (e.g. numbness or tingling sensation in the skin) can result. These usually resolve on their own after a while. Destruction of nerve tissue leading to muscle paralysis occurs very rarely.

Material incompatibility

Modern materials that are used for the production of joint endoprostheses rarely cause intolerance reactions or allergies. In these cases the prosthesis must be removed. There is also the option of using special allergy prostheses.

Periarticular calcifications

Calcifications of connective tissue in the vicinity of the prosthesis can be avoided by taking anti-inflammatory drugs (anti-inflammatory painkillers) or, under certain circumstances, treated with glucocorticoids or X-rays. They rarely have to be removed surgically.

Wrong positioning

Joint endoprostheses must be precisely positioned, otherwise pressure and tension will be exerted on the structures that surround the joint (e.g. bones or ligaments). This can damage them. In addition, this can result in incorrect strains that can affect the entire musculoskeletal system.

Loosening of the prosthesis

If the prosthesis is not positioned precisely enough or not sufficiently fixed or if it is subjected to excessive stress, the prosthesis can loosen in the surrounding bone tissue. This can lead to pain, bone damage, and joint instability.

Periprosthetic fractures

Prostheses are made of solid material. If the prosthesis is not perfectly positioned or cemented in place, if falls frequently or if there is osteoporosis, the bone tissue in which the prosthesis is fixed can break.

Whom can I ask?

Joint prosthesis operations are carried out by specialists in orthopedics or traumatology (trauma surgery). Examinations and consultations before a joint prosthesis operation can be carried out by a resident specialist or at an outpatient clinic.

How will the costs be reimbursed?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

  • Right to treatment
  • Visit to the doctor: costs and deductibles
  • What does the hospital stay cost?
  • Prescription fee: This is how drug costs are covered
  • Rehabilitation & cure
  • Aids & remedies
  • Health Professions AZ

and via the online guide to reimbursement of social insurance costs.

For certain non-drug treatments (e.g. physical therapy), approval from the health insurance company is required.

Prostheses and walking aids (e.g. crutches) are requested via a medical aid prescription. Depending on the health insurance provider, patient co-payments are provided for in the settlement. Further information can be found under: Aids and remedies.

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