Endoprosthesis
Valeria Dahm is a freelance writer in the medical department. She studied medicine at the Technical University of Munich. It is particularly important to her to give the curious reader an insight into the exciting subject area of medicine and at the same time to maintain the content.
More about the experts All content is checked by medical journalists.An endoprosthesis is an artificial joint replacement. It is surgically implanted in place of a diseased joint and is usually made of metal, plastic or ceramic. It replaces parts of the joint or the entire joint. Read everything about the surgical procedure, how the endoprosthesis works and what risks it entails.
What is an endoprosthesis?
In endoprosthetics, diseased joints are replaced by endoprostheses. A distinction is made between the total endoprosthesis - or TEP for short -, which forms a complete new joint, and the hemiprosthesis, which only replaces parts of the joint. To ensure that the endoprosthesis is preserved for as long as possible, but at the same time tolerated by the body, it is made of metal, plastic (polymers) or ceramics. These materials can also be combined.
The connection between endoprosthesis and bone is called anchoring. The cemented endoprosthesis is the most common variant and is connected to the bone with the help of a special bone cement. The cementless endoprosthesis is first pressed into the bone and anchored by waxing. The hybrid endoprosthesis combines both types: one part of the endoprosthesis is cemented, the other part is attached without cement.
When do you make an endoprosthesis?
The endoprosthesis replaces joints of the hip, knee, shoulder, ankle, elbow and spine if these no longer fulfill their function or can only be moved to a limited extent. The reasons for this are:
- Osteoarthritis - wear and tear of the articular cartilage
- Rheumatism (rheumatoid arthritis) - chronic inflammation that can lead to joint destruction
- Malformations (dysplasias)
- Necrosis
- Fractures
- Joint stiffeners
- Replacement of an endoprosthesis
What do you do with an endoprosthesis?
The doctor will ask you in advance about previous illnesses, injuries, medication and allergies. He will examine the affected joint for mobility, stability and pain and explain the operation to you.In addition, a blood count and an X-ray, a computed tomography (CT) or a magnetic resonance imaging (MRI) will be done. The anesthetist will give you sleep and pain medication before the operation.
Surgical method
The surgeon reaches the joint via a skin incision, which is significantly smaller in the minimally invasive variant that is also used. The muscles are pushed to the side as gently as possible or carefully cut and the joint capsule that surrounds the actual joint is opened. Now the surgeon removes worn joint surfaces and articular cartilage. The remaining bones are prepared for the endoprosthesis with special rasps, burs and saws.
With the help of a trial implant, size, mobility and stability are checked. The endoprosthesis finally selected can now be connected to the bone with the help of so-called bone cement.
Cementless endoprostheses have a conical anchorage. This is knocked into the bone and fastened in this way. This is also called press-fit fixation. The cementless endoprosthesis is more likely to be used in younger patients, as their bone substance is even stronger and more stable.
A screw connection between the endoprosthesis and the bone is also possible.
Finally, the surgeon checks the correct fit and mobility of the endoprosthesis. An additional x-ray may be taken before he sutures the wound. A bandage protects the wound from infection.
Further information: knee replacement surgery
If you want to know how to do a knee replacement, read the article knee replacement.
Further information: Hip TEP
If you want to know how to do a hip replacement, read the article Hip replacement.
What are the risks of an endoprosthesis?
In addition to general surgical risks, specific complications can occur. These include:
- Bleeding
- Thrombosis
- Infections
- Injury to skin, muscles or bones
- Loosening of the endoprosthesis
- allergic reactions to components of the endoprosthesis
What do I have to consider after an endoprosthesis?
After implanting an endoprosthesis, you will usually stay in the hospital for one to two weeks. Physiotherapeutic follow-up treatment is started there on the first day after the operation. With the help of a structured plan, the muscles are built up and the mobility of the joint restored. In passive physiotherapy, a physiotherapist moves and mobilizes the joint without your active cooperation. In addition, you will independently perform exercises under the guidance and control of the physiotherapist.
The subsequent three to four weeks rehabilitation can take place either on an outpatient basis or in a special rehabilitation clinic. The function of the joint is restored and you learn how to move around your joints in everyday life and which sports and activities you can practice. Swimming, cycling and Nordic walking are particularly gentle on the joints. In order to avoid consequential damage, a weight control is also recommended.
Your doctor will carry out radiological checks and examinations at regular intervals so that any loosening of the endoprosthesis or late complications can be detected as early as possible. In the event of discomfort or pain, you should consult your doctor immediately.
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