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The Hip Joint

Learn more about the anatomy and damage of a hip joint, the fixation of an artificial hip joint and what happens before the surgery.

Anatomy: How is the Hip Joint Structured?

The hip joint is made up of two bony sections:

  • femoral head: globular end of the femoral neck
  • acetabulum: cup-like cavity in the pelvis bone

When in a healthy condition, both joint surfaces are covered with a layer of joint cartilage that acts as a kind of shock absorber. It helps to distribute and reduces the forces which act upon the hip joint. This surface is lubricated by synovial fluid. The synovial fluid enables smooth movements of the bones and reduces friction. The fixed joint capsule forms an envelope around the hip joint.

Stability and Movement Thanks to Ligaments and Muscles
It is the bony structure which makes this joint so stable: The femoral head rests securely in the amply sized concave acetabulum. The hip joint is also reinforced by strong ligaments. The joint is surrounded by strong muscles which help protect it and allow a powerful movement of the legs.

Illustration: Anatomy of the hip joint

What Happens Before the Surgery?

Physical Examination – where Does it Hurt?

The doctor will first examine your pelvis, both hips, spine and legs and, when doing so, will palpate various muscles and bone structures. He will then perform a few movement tests in order to gain an impression of the mobility of the hip joint. He further examines the pain caused when the hip joint is moved in different directions, for example adduction, abduction, rotating, bending and stretching. At the same time, the doctor also examines to see if there is a difference between the length of the legs.

Patient Assessment – Your Personal Medical History

Your doctor will first ask you to give details of your complaints. He will want to know where it hurts and where the pain radiates to. He will also ask about the intensity of the pain, its duration and any factors which intensify or ease the discomfort.

X-ray – Focus on Your Hips

Using the X-ray image, the doctor is able to recognise the changes caused by coxarthrosis: the intra-articular space between the acetabulum and the femoral head is either no longer uniform, is narrower or indeed is no longer visible. The bone structure of the femoral head and acetabulum appears irregular and altered whilst in very advanced stages the sections of the joint are deformed.

Preoperative Discussion – Your Chance to Ask any Questions

On the day before the surgery, the surgeon will usually talk to you in detail about the planned procedure. He will explain the surgical method and the type of prosthesis to be used. The prosthesis model selected depends on the nature of your bones, your body weight and your level of physical activity. The surgeon will have normally decided beforehand which prosthesis model and type of fixation to use on the basis of your X-ray and data.
In the majority of cases, the surgeon will also ask you about your state of health on the day before the surgery. Do not hesitate to inform your doctor of any complaints which you consider minor, such as colds and skin infections, even if you are not asked. Although harmless, these illnesses need to be cured before a surgical intervention.
The anaesthetist will also talk to you on the day before the surgery to explain the potential risks involved with the anaesthesia. He will perform a few minor examinations; he is particularly interested in your heart and lung functions and any possible allergies. He will then talk to you about the type of anaesthesia to be used.

Autologous Blood Donations – Find out More!

Under certain circumstances, large amounts of blood may be lost when performing a hip prosthesis surgery. A blood transfusion then becomes necessary. An autologous blood transfusion using the patient's own blood which was donated at an earlier date, essentially rules out the risk of infections such as Hepatitis C and HIV.
As a rule, there is sufficient time between the diagnosis and the hip prosthesis surgery (around two to six weeks) to discuss this issue with your attending doctor. Use this opportunity to ask about the option of an autologous blood donation.