JOINT RESTORATION AND ARTHROPLASTY IN GERMANY – Prof Dr med Oliver Hauschild
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Prof. Dr. med. Oliver Hauschild is an expert in orthopedics and trauma surgery whose clinical career began more than 20 years ago. His main clinical interests include joint preservation surgery, primary and revision knee and hip arthroplasty, and orthopedic surgical oncology.
Prof. Hauschild's primary goal is to restore the patient's own joint, and he actively practices joint preservation techniques. If clinically indicated, the medical team successfully performs minimally traumatic arthroplasty. Modern techniques allow arthroplasty to be performed without compromising quality of life, even in young and physically active individuals.
Prof. Hauschild now treats patients at the Park-Clinic Weissensee Berlin, and as of 2019, he is the Head Physician of the Department of Adult and Pediatric Orthopedics, Trauma Surgery, Spinal Surgery and Foot Surgery. This is a maximum care Center for Joint Replacement Surgery with professional endoCert certification. In the interview, the professor tells us about the methods of joint restoration, indications for joint replacement surgery, and conditions for its success.
Good afternoon, Prof. Hauschild! Thank you for taking the time to give us an interview today.
My name is Oliver Hauschild. Since 2017, I have been the Head Physician of the Department of Orthopedics and Trauma Surgery at the Park-Clinic Weissensee in Berlin. I am a specialist in orthopedics and trauma surgery, with additional qualifications in the fields of special trauma surgery and special orthopedic surgery.
I graduated from the University of Freiburg, after which I worked for 15 years at the University Hospital Freiburg.
Prof. Hauschild, could you please tell us how many patients from abroad come to you for treatment per year?
Due to the coronavirus pandemic and the military operations in Ukraine, the number of foreign patients has decreased significantly. Before the coronavirus pandemic, I consulted outpatients once a week, including online consultations. One third of these patients eventually underwent surgical treatment with me.
What countries do patients come to you from?
Most of my patients come from post-Soviet states. But I also have patients from North Africa and Arab countries.
Prof. Hauschild, with what diseases do patients most often seek medical help from you?
Most patients come with hip and knee arthrosis as well as degenerative spinal diseases.
What treatment methods for knee arthrosis do you use?
We offer a full range of treatments for degenerative knee diseases, including cartilage lesions, ranging from cartilage repair to cartilage transplantation.
We perform surgical interventions for the placement of mini-implants and total joint replacement surgery. Corrective osteotomies on young patients with arthritis and X- and O-shaped leg deformities, in whom cartilage tissue cannot be restored, are performed in our department with great success.
Prof. Hauschild, could you please tell us about the treatments you use to postpone joint replacement surgery?
The choice of treatment method depends on the stage of the disease. We use joint preservation treatments that allow for cartilage tissue restoration. Cartilage cell transplantation is the most advanced procedure of this kind, and even large cartilage defects can be corrected with this method.
The technique includes two consecutive interventions: the first is the harvesting of autologous cartilage cells with their subsequent cultivation, and the second is the transplantation of the resulting biological material. The organization of such a treatment for patients from abroad is a rather difficult task, but practice shows that with a competent approach to planning, it is quite feasible.
Our department also offers one-stage cartilage replacement surgeries, in particular corrective osteotomies. The essence of the operation is to correct the axis of the lower limb by dissecting the bone and placing a special plate in the required position. This allows for normalizing load distribution on the lower limb and eliminating pressure on the damaged part of the cartilage, thereby providing pain relief. This treatment option is suitable for patients of almost all ages. Corrective osteotomies can also be performed on patients with severe arthrosis. In addition, this operation is an alternative method of arthroplasty for young patients and patients who plan to do sports in the future.
When is arthroplasty the only treatment option?
Arthroplasty is the last-line treatment for degenerative joint diseases in our department. I cannot tell you exactly when the so-called "point of no return" occurs, but usually the patient's clinical condition and his complaints are a guideline: the patient suffers from manifestations of arthrosis even at rest, he has to take painkillers daily, he can only move with a cane, his mobility deteriorates, and he cannot cope with daily activities on his own. In my opinion, in this case, arthroplasty should be considered because it is obvious that other treatment methods will no longer yield a good result.
Prof. Hauschild, have there been any cases in your clinical practice where patients from abroad came to you after a failed arthroplasty?
Of course. One of the key areas of our work is revision arthroplasty. Despite the long service life of prostheses, which is about 20 years for the hip joint and about 15 years for the knee joint, they still cannot serve the patient for a lifetime. Over time, the elements of the artificial joint wear out, and revision joint replacement surgery is needed.
However, the main problem that patients come to us with is infectious joint lesions. Some infections are difficult to treat, so a patient has little or no chance of recovery without surgery and appropriate antibiotic therapy.
What are the most common complications in patients who have had arthroplasty? How can these complications be prevented?
It should be kept in mind that knee and hip arthroplasty procedures have their own specifics. The most common complication is infection with bacteria that normally live on the skin and protect the body from harmful microbes. As soon as the surgeon makes a skin incision during the intervention, bacteria enter the surgical field.
If it is surgery on the soft tissues, this is not a serious problem, but when it comes to foreign materials, such as an endoprosthesis, a hundred times fewer bacteria may cause inflammation.
As soon as bacteria enter the artificial joint after its placement, they multiply and quickly form a so-called shield that protects them from antibiotics. In such cases, it is often necessary to remove the prosthesis.
The most important measure for the prevention of infections, in addition to injections of antibiotics immediately before surgery or an hour before surgery, is the treatment of the patient's body with a special solution, which begins to be applied a few days before surgery. We regularly carry out such preventive measures in our department.
Another typical complication of artificial hip joint implantation is the incorrect positioning and displacement of prosthesis elements. A surgical technique and a surgical approach play a decisive role in the absence of complications. We use a minimally invasive anterior approach in our department, so any displacement of the prosthesis is extremely rare in our practice. Improper positioning and instability of the endoprosthesis usually lead to artificial joint dysfunction, so we use a navigation system that allows us to position the elements of the prosthesis as accurately as possible, thereby leveling the risk of complications.
How are patients prepared for surgery in your department?
First of all, a patient receives comprehensive information about the possible options for surgical treatment, its expected results, and the rules for preparing for a particular operation. The next preventive measure, as I have already said, is the treatment of the patient's body with a special solution.
It goes without saying that various methods for reducing blood loss are used during the surgical intervention. Due to this, when performing primary knee and hip arthroplasty, we almost always manage to avoid blood transfusions, which in turn helps reduce the risk of severe complications.
Prof. Hauschild, what kind of surgical techniques do you use when performing hip replacement surgery? What is special about such operations in your department?
The key feature is that joint replacement surgery is performed in our department using sparing minimally invasive techniques. The main advantage of this surgical technique is a miniature skin incision. At the same time, the main feature is that we can form a surgical approach without any damage to the anatomical structures, removing only the joint capsule and the affected area of the bone. In our experience, when using such sparing surgical techniques, patients experience less pain at the stage of early rehabilitation.
And, as I said, we attach great importance to the precise positioning of all elements of the artificial joint in order to prevent serious complications.
How would you rate joint replacement surgery performed using minimally invasive techniques? What are the benefits of such operations in comparison with classical arthroplasty? What patients are the candidates for such operations?
I routinely perform such surgical interventions, so I am convinced that this is an excellent treatment option. Primary hip replacement surgery certainly provides excellent results. The patients in our department are satisfied with the brilliant results of hip replacement surgery. Moreover, the surgical approach chosen by the specialist does not affect the success rate.
At an early stage of arthrosis, patients, however, recover faster when the operation is performed using minimally invasive techniques. Such surgical interventions guarantee minimal blood loss, and by maintaining the integrity of the muscular apparatus during primary arthroplasty, revision surgery in the future will also allow for long-term results.
What patients are the candidates for such operations?
Based on my experience, these are suitable for almost all patients. Such operations are usually performed even in overweight patients with complex comorbidities. From a technical point of view, they are certainly somewhat more complex, but they give a good result.
The only group of patients for whom such treatment may be contraindicated are those who have previously undergone open hip surgery. In my opinion, it is advisable for them to perform arthroplasty using the same surgical approach.
How do endoprostheses differ? Can the choice of one or another endoprosthesis affect the effectiveness of treatment?
In this case, you need to understand the specifics of knee and hip replacement surgery. In general, we can say that all endoprostheses approved for sale in Germany have excellent functionality, so it is more important to pay attention to the selection of a surgeon than an endoprosthesis. However, there are also some differences.
When performing hip replacement surgery, the difference, first of all, is in the method of fixing the prosthesis, that is, cemented or cementless fixation. Cemented fixation of the endoprosthesis is usually indicated for patients with severe destructive processes in the bone tissue. As a rule, these are elderly patients. The use of cemented endoprostheses in patients with severe bone defects virtually eliminates any complications after surgery because the success of fixing the prosthesis does not depend on the initial quality of the bone tissue. This is due to the fact that special cement fills the space between the endoprosthesis and the bone, ensuring its reliable fixation.
As for young patients, we can use special miniature rods for hip arthroplasty. These are implanted only in the femoral neck, thanks to which surgeons manage to preserve bone tissue volume as much as possible. If a patient requires revision arthroplasty, and young patients usually have to resort to a second operation during their lifetime, then cemented prosthesis fixation will be the only option for revision surgery.
At the same time, it is very important to choose a suitable "friction couple" for a particular joint. It is absolutely advisable that the head of the artificial joint be made of ceramic and the insert be made of high-density cross-linked polyethylene. It is these "friction couples" that we prefer in our department because they guarantee the maximum service life of the prosthesis.
These are mini-implants for the correction of localized cartilage lesions in elderly and middle-aged patients (see video). And these are customized implants manufactured considering the MRI scans, with the use of which we achieve excellent results (see video). And this is a knee endoprosthesis with a plastic insert (see video). Its yellowish color indicates that it is made of high-density, cross-linked polyethylene. Polyethylene is impregnated with vitamin E, which ensures minimal wear of the endoprosthesis.
As for knee replacement surgery, we choose one of several implants, focusing on the type of knee lesions. If one part of the knee joint is affected, the best solution will be to replace only that part by performing partial knee replacement surgery. Partial knee replacement surgery allows for the preservation of the integrity of the ligamentous apparatus, due to which a significantly better range of motion in the knee joint can be achieved compared to total hip replacement surgery.
However, even if the patient does not have any lesions in the lateral ligaments of the knee joint but more than one affected area is identified, he is a candidate for total knee arthroplasty. If the lateral ligaments are damaged or the patient has large bone defects, it is possible to implant a fully constrained and hinged artificial joint when a part of the thigh is connected to a part of the lower leg.
What type of endoprosthesis would you recommend to patients?
I personally would recommend the most sparing treatment that best suits the patient's individual needs. Of course, it is necessary to discuss all possible treatment options with the patient, but when planning joint replacement surgery, the patient's needs must be taken into account. In no case should you be limited to one treatment option, for example, arthroplasty, because of the patient's young age.
Joint replacement surgery should not be performed on patients with severe bone defects. The same applies to partial joint replacement surgery. I believe that providing the patient with all the possible information about treatment options is important, and this approach is very appealing to patients. But, of course, if the patient has severe movement restrictions, then the only treatment option is still joint replacement surgery. It is therefore very important for me to take into account the smallest nuances.
In our department, we use endoprostheses from a German manufacturer with solid experience in this field. The choice of the manufacturer is also a decisive criterion for me because, as I said at the very beginning of our conversation, the service life of the endoprosthesis should be 15-20 years, and I can guarantee this only when using products that have been on the market for a long time.
Some patients are afraid of joint replacement surgery. Could you please provide any arguments to reassure them?
In my opinion, there is no reason to be afraid of such an operation because it is routine and always carefully planned. This is, however, a major operation and is not indicated if a person has just had a slight pain in the knee for a week.
I can reassure patients by telling them about the potential benefits of joint replacement surgery. When deciding to perform an operation, I assess the patient's clinical case and his potential risks. I think about how we can minimize these risks. I explain to the patient what will happen during the operation. However, as with any other operation, some worries undoubtedly do exist. In our department, we always strive to provide the patient with comprehensive information about how exactly the operation will be performed and thereby dispel his fears of the intervention.
But there is one thing that is absolutely disappointing for my team and me. It is when the patient hesitates about the operation, as a result of which the subsequent surgical intervention becomes technically more complex with a higher risk of complications. I always advise patients not to delay the operation if it is required and not to complicate the task for the surgeon.
What advice would you give to patients who are candidates for arthroplasty but have not yet decided where exactly to undergo the operation?
In fact, it is quite difficult to reliably find out where exactly the patient will receive quality treatment. According to the data from the registers, the results of arthroplasty differ depending on which surgeon performs the operation and at which hospital it is done.
If we talk about the complications of operations and the level of patient satisfaction, Germany has an advantage: there is a special certification system at German hospitals that involves the issuance of a quality certificate by external independent audit organizations. Certification includes an assessment of organizational and structural processes as well as treatment outcomes. Hospitals that have received such a certification have the status of the Center for Arthroplasty, and if they meet the highest standards of medical care, they receive the certificate of the Maximum Care Center for Arthroplasty.
Our hospital is certified as the Maximum Care Center for Arthroplasty. Certification as a Center for Arthroplasty in Germany is a kind of guarantee of high treatment success rates. The hospitals that have such certificates perform many operations, and many patients come here, which indicates a high level of patient satisfaction and their desire to undergo surgery at this medical facility. In addition, this certification indicates that the hospital employs a team of surgeons with extensive experience in the field of arthroplasty. The patient thus understands that it is a certified center that offers top-quality joint replacement surgery.
Prof. Hauschild, thank you very much for the informative interview! I wish you all the best!
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