German Centre for Orthopaedics
Hip diseases such as osteoarthritis of the hip joint, femoral head necrosis and hip dysplasia are the main areas of focus in our department, along with artificial hip replacement. The operation is planned specifically to meet the anatomical requirements of each individual patient.
At the German Centre for Orthopaedics, we implanted 1,053 total hip replacements and performed 164 revisions in 2018.
Apart from this, we support patients with fractures resulting from accidents and sports injuries and offer the entire spectrum of diagnostics: Beside standard examinations, such as X-rays, ultrasound, MRI and bone density measurements, we also have a gait analysis laboratory.
Necrosis refers to the pathological death of tissue cells. In the case of femoral head necrosis, the blood supply to the head of the femur is insufficient, parts of the femoral head are destroyed, and this can lead to the collapse of the surface of the head over the course of the disease.
The disease is thus accompanied by a circulation disorder of the femoral head, the cause of which is often unclear. Patients who suffer from femoral head necrosis are often younger than patients with osteoarthritis, with symptoms not occurring until relatively late and ultimately leading to pain upon weight-bearing on the hip.
BIf an operation is necessary, the doctors try to preserve the joint for as long as possible, especially in younger patients. Drilling of the femoral head is aimed at improving blood circulation in the affected area and relieving oedema, the necrosis is excavated, and the defect is augmented with bone to prevent the head from collapsing.
The use of modern surgical methods can markedly increase accuracy here. Blood circulation can also be improved by administering appropriate medication. If the joint-sparing measures are not successful, the implantation of an artificial hip joint is often unavoidable.
Hip dysplasia is a congenital malformation of the hip joint, which is already diagnosed and treated in newborn babies and infants.
In this condition, the hip socket in the pelvic bone is steeper than normal, which means that it cannot completely cover the femoral head. This results in an unphysiological load distribution in the hip joint. It may remain undetected for a long time in childhood and adolescence and only in later years lead to restricted mobility (limping, gait disorder), leg shortening and pain in the hip joint.
In the case of an early diagnosis in childhood, orthopaedic specialists can treat hip dysplasia successfully with conservative measures or joint-sparing operations (pelvic osteotomy) – for this reason, ultrasound examination of the hip joints is part of the statutory U3 paediatric check-up in Germany to ensure the early detection of dysplasia.
This is important: Untreated, hip dysplasia can lead to osteoarthritis of the hip (dysplastic hip osteoarthritis) in adulthood. Then – depending on the age and findings – we recommend either a joint-sparing operation (pelvic or femoral osteotomy) or joint replacement (implantation of a hip prosthesis).
Patients with congenital hip dysplasia require special attention. The dysplasia often results in a shortening of the leg, a pelvic misalignment or a limping gait pattern. This may have an effect on the entire musculoskeletal and locomotor apparatus.
If the joint is worn from many years of incorrect mechanical loading, often the only option remaining is to implant an endoprosthesis. This can bring an alleviation of the symptoms and achieve an improvement in functionality. However, the anatomy is often strongly altered and the bone quality is reduced.
Therefore, special care must be taken in the operation. Each patient with dysplastic osteoarthritis requires individual surgical planning and performance. The specialists in our clinic are particularly well acquainted with this clinical picture as a result of their many years’ experience in the treatment of patients with dysplastic hip osteoarthritis. We will be glad to support you with our specialist advice!
Hip osteoarthritis (osteoarthritis of the hip joint) belongs to the most common forms of osteoarthritis: When standing and walking, the hip is subjected to loads many times our body weight, which is why symptoms of wear occur more often here than in the joints of the upper limbs (shoulder, elbow).
Wear usually starts in the upper part of the joint and gradually continues over all articular surfaces: A progressive destruction of the cartilage surface of the hip socket and femoral head occurs – until they finally articulate "bone on bone". Patients who suffer from hip osteoarthritis mostly complain of pain when starting to move and pain upon weight-bearing, which increases during the day and may also radiate into the hip and knee joint.
Over the course of the disease, the intensity of the symptoms increases over months and years and may be followed by restricted mobility and compensatory limping. In the early stage, we can treat hip osteoarthritis with medication and targeted physiotherapeutic measures.
If osteoarthritis of the hip is more pronounced, an artificial hip joint is often the only remaining, but promising means with which to relieve the patient’s pain and enable them an active life.
Various different types of hip replacement are available to us, depending on the requirement and the stage of the disease.
The revision of endoprostheses requires a particularly high degree of experience. If revision surgery of an artificial joint is necessary, the surgeon is confronted by a special situation each time. No individual case is identical to another.
Regardless of whether a cup or stem has to be replaced, or whether a joint infection is involved. Our doctors analyse the case step by step and will be able to offer you an appropriate solution. Special implants are often necessary, which can be combined according to the principle of a building-block approach.
Both the respective materials and the respective “know-how” are available at the Waldkliniken. If necessary, custom-made components or special implants are available at short notice.
A quick return to fitness
Active people want to return to their everyday life quickly after an operation. Therefore, we place importance on minimally invasive surgical techniques.
Apart from this, you have access to a gait analysis laboratory at the German Centre for Orthopaedics. Here, in complex cases, we can precisely determine the movement patterns, enabling us to make a precise diagnosis as well as evaluate the outcome of therapy.
The Chair for Orthopaedics of the Friedrich-Schiller University of Jena at the Waldkliniken Eisenberg has been working since 1998 on the further development of the minimally invasive implantation of hip prostheses. This method has advantages for the patients particularly in the early phase after the operation. It generally provides a marked reduction of pain and more rapid mobilisation.
In the “MIS technique”, the doctor only opens up a very small approach to the hip joint. In particular, this means that the surrounding muscles are not detached. Rather, the surgeon advances through an anatomical gap in the muscles to reach the joint.
Advantages of this method are a quicker return to weight-bearing and more rapid mobilisation, with a lower analgesic requirement. Already on the day after the operation, our physiotherapists help the patients with exercises to achieve as physiological as possible a gait pattern. The positive result: Patients achieve a fluid gait pattern and can often do without walking aids after just a few weeks. In addition, the shorter scar is a pleasant optical result.
Minimally invasive hip surgery is above all ideal for younger working professionals or elderly patients who want to get back on their feet quickly. This method is not suitable for patients with prior operations, deformities of the bones and scarring, as well as those who are strongly overweight. The intervention is also not advisable for musclebound and large-boned patients. Our doctors consult with them to decide on the best approach.
Instrumented gait analysis makes it possible for our medical professionals and scientists to exactly record the movements of human subjects.
In contrast to the subjective assessment of the gait pattern, in which doctors or physiotherapists observe the patient, the computer-assisted variant supplies exact, three-dimensional data on the gait pattern (e.g. velocity, step length, loading, among others) that are not or are only partially detectable with the naked eye – an objective assessment is provided.
Normal walking on a level surface is analysed in the laboratory with measurement devices (walking distance approx. 10 metres, ideally with 10 repetitions). For this purpose, spherical reflective markers are attached to the body at defined anatomical points with double-sided adhesive tape before the measurement.
Special infrared cameras, which are connected to a computer, register the movement of these markers in space. This makes it possible to record the range of movement of the joints of the lower limbs and, by means of measurement platforms installed in the floor, determine the loads acting on the ankle, knee and hip joints. Movements of the pelvis and, if necessary, of the upper body can also be determined.
The patient benefits twofold: On the one hand, the findings are supplemented before therapy and a more precise diagnosis is rendered and, on the other, repeated gait analyses enable the doctors to check the success of therapy after the intervention. Gait analysis is used especially within the context of scientific studies.