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Particularly the cam type impingement and the combined types, which occur in more than 80 % of impingement cases, rapidly cause progressive degenerative changes of the joint. In terms of osteoarthritis as well as impingement, the patients come to us with varying imaging findings and an individual clinical appearance. Thus, the treatment options are very diverse. Beside a joint replacement and a conservative approach, hip arthroscopy can also be a successful treatment, especially in cases of low and moderate osteoarthritis and the clinical appearance of an hip impingement. This article provides an overview of current conservative therapies and the possibilities using hip arthroscopy. In addition, this article provides an overview of essential preoperative findings and the associated potential for success. [ABSTRACT FROM AUTHOR]

In the present study, the question was examined whether spinal anesthesia or general anesthesia is more suitable for older individuals undergoing hip surgery. The multicenter, randomized study included 1599 cases of hip fractures, of which 795 received spinal anesthesia and 805 received general anesthesia. No significant difference was found in the primary endpoint, consisting of death or inability to walk independently 60 days after the operation. The frequency of postoperative delirium was also comparable. The study shows that general anesthesia does not pose a significant risk for older individuals and they should be given the choice between different anesthesia options. [Extracted from the article]

Preclinical testing - clinical application: Total hip arthroplasty has become one of the most successful procedures in orthopedics. This has been made possible through continuous improvement of the implant systems and materials accompanied by an improvement in preclinical testing and the legal framework. A further improvement in results can only be achieved if the two other decisive factors for the success of an operation are also included: intensive education and training of the surgeons combined with education and awareness of the patients. Risk assessment: The introduction of new concepts always bears the risk of new unforeseen failure mechanisms, which cannot always be prevented by established preclinical testing. This requires the careful introduction of new concepts into clinical application, combined with a standardized failure analysis, in order to reduce the number of problem cases in the worst case situation. [ABSTRACT FROM AUTHOR]

Background: The optimal time to perform endoprosthesis of hip fractures in the elderly is still under discussion. CRP as an objective marker of postoperative inflammatory reaction should give an indication if early or late surgery is favored. Methods: CRP values from 122 patients with no complications after hip arthroplasty of femoral neck fractures were analyzed in context with the time between the trauma and the operation. Results: In early surgery within 24 h after trauma the CRP values were significantly lower than in delayed surgery. Conclusion: The lower postoperative inflammatory reaction after early surgery of hip fractures provides a better outcome when treated with arthroplasty. [ABSTRACT FROM AUTHOR]

Because of the considerable progress achieved in alloplastic hip joint replacement, very few indications for arthrodesis remain, for instance loss of the stabilizing muscles in the hip. The possibilities for total hip arthroplasty are not only limited to the generally accepted standard procedures, but should also take individually customized tumor prostheses into consideration including partial pelvis replacement as well as fallback options using a saddle prosthesis and combinations of alloplastic implants and corrective osteotomy. Pelvic support osteotomy represents a convincing functional alternative particularly for younger patients after bacterial coxitis in early childhood with corresponding loss of the femoral head and neck. Further options consist of Girdlestone resection arthroplasty and ultimately hip disarticulation. After hip arthroplasty accompanied by subsequent complaints in the neighboring joints the indication for reorienting de-arthrodesis should be assessed on an individual basis. Relevant examples are presented for all of the procedures and surgical techniques mentioned. [ABSTRACT FROM AUTHOR]

Approximately 18,000 hip revision procedures of the acetabular component are performed annually in Germany with rising incidence. The aims of acetabular revision are reconstruction of the anatomic hip center, reconstruction of bone stock, cement-free primary stability of the revision implant in autochthonous bone and permanent secondary integration. Precise planning of the revision surgery is necessary with analysis and classification of the bone defects and reconstruction following a concise therapeutic concept. Cup loosening without bone loss as well as segmental bone defects can usually be reconstructed with standard implants. Cavity defects, especially the common craniolateral defects, require the implantation of oval cups or augments to achieve anatomic reconstruction of the hip center. Combined segmental and cavity defects can be reconstructed using oval cups with craniolateral plates, whereas acetabular discontinuity requires stable fixation within the iliac wing by means of an intramedullary stem combined with an extramedullary plate. Middle and long term survival greater than 90% can be realized with the use of this therapeutic concept. [ABSTRACT FROM AUTHOR]

Infections occur in 0.5–5% of cases after implantation of an endoprosthesis and represent one of the most severe complications of artificial joint replacements. Approximately 300,000 primary implantations for hip and knee prostheses are carried out in Germany annually with a corresponding number of early and late infections. This means that approximately 4,000–6,000 cases are to be expected annually. Periprosthetic infections normally lead to a significant loss of function and quality of life for patients and the complex remediation is costly. Therefore, preventive measures, such as perioperative prophylaxis with antibiotics, maintaining highly sterile conditions during operations and an expedient selection of patients are of substantial importance. The basic principles of an adequate restoration include identification of the pathogen, local eradication of the infection mostly after removal of the prosthesis, pathogen-oriented systemic and local antibiotic therapy and finally re-implantation of the revision prosthesis under infection-free conditions. The standard procedure for revision surgery is a two-phase replacement with maintenance of an infection-free interval before renewal of the prosthesis. The use of single-phase or multi-phase strategies, as well as the selection of cemented or cement-free revision, varies between centers as a definitive evaluation is not yet available. The most important parameters for successful treatment of periprosthetic infections have been identified as the earliest possible diagnosis, radical surgical cleansing with an adequate antibiotic therapy and successful restoration has been reported in approximately 80% of cases. Because of the complex therapy regime, treatment in specialized centers is generally recommended especially under the aspect of a demanding patient monitoring. [ABSTRACT FROM AUTHOR]