German Centre for Orthopaedics
The German Centre for Orthopaedics at the Waldkliniken Eisenberg is a nationally and internationally renowned clinic for the treatment of orthopaedic diseases of the knee joint.
We predominantly treat patients with wear-related disorders (osteoarthritis of the knee), inflammatory rheumatic knee disorders (rheumatoid arthritis), but also limited damage to the cartilage and bone (osteonecroses).
Naturally, we also care for patients with all other congenital or acquired diseases of the knee joint, with complications after the implantation of knee replacements, as well as tumour patients. Apart from this, we support patients with fractures resulting from accidents and sports injuries and their long-term effects.
We implanted 727 knee replacements and performed 175 revisions on artificial knee joints at the German Centre for Orthopaedics in 2018.
Osteoarthritis of the knee (or knee osteoarthritis) refers to signs of wear in the knee joint: Progressive destruction of the cartilage occurs, later including the joint surfaces and bone.
It is mostly elderly people who suffer from this disease – as the years go by, the layer of cartilage recedes and the bones rub directly against each other. Younger people can also suffer from osteoarthritis of the knee, the causes usually having to do with excessive strain on the joint, prior joint damage due to accidents, or malalignment of the joints. Patients often complain of walking difficulties, as well as pain when bending and putting weight on the knee.
The treatment of knee osteoarthritis primarily depends on the severity of the disease: In the early stage, drug therapies are accompanied by physical measures (for example physiotherapy) help to alleviate the symptoms.
If the damage is more severe, arthroscopy may be beneficial: In this sparing, minimally invasive intervention, the surgeons remove fragments of joint cartilage and smoothen the remaining surfaces. This operation can reduce the pain and postpone the need for joint replacement.
In some cases, a corrective osteotomy may be sensible: In the case of so-called axial malalignments (knock knees or bandy legs) the cartilage is only subject to wear in the so-called primary load-bearing zones. If the leg axis is adjusted operatively, these load-bearing zones change. The healthy area of cartilage in a different part of the joint interior now takes over the articular function – the painful, arthritic area is now relieved.
If the cartilage layer has been completely destroyed, doctors recommend an artificial knee joint – particularly in patients of advanced age. This low-risk operation can restore the weight-bearing capacity of the knee and help the patient regain a pain-free life.
“Rheumatism” is a collective term for various different inflammatory diseases of the locomotor system. If a joint is affected, inflammations of the joint mucosa occur, which later damage the joint cartilage.
In the knee joint, painful swellings and redness occur and the joint ligaments are damaged. Over the further course, joint destruction and increasing instability or restriction of mobility occur. Rheumatoid arthritis is the most common inflammatory-rheumatic disease.
A life-long anti-inflammatory drug therapy of the underlying rheumatological disease in combination with physical measures is often necessary in order to alleviate painful inflammations and preserve joint function.
If the inflammation persists or if the joint damage Is too far advanced, an operation may be the most sensible decision: As a joint-sparing method, removal of the inflamed joint mucosa may be beneficial. If large areas of the joint cartilage have been destroyed, doctors recommend the implantation of a knee replacement.
Analogously to femoral head necrosis bin the hip joint, osteonecrosis of the knee joint involves the locally limited death of bone tissue below the joint cartilage – the necrotic focus is cut off from the blood supply.
The localised necrosis occurs in the knee joint in adolescence (osteochondrosis dissecans) or in adulthood as segmental necrosis of the thigh bone (necrosis of the femoral condyle).
If the necrotic focus is shed into the joint, free joint bodies occur that can cause painful impingement symptoms when the knee joint is moved. Defects on the joint surface lead to pain and swelling and, over the further course and without treatment, result in the development of knee osteoarthritis in adulthood.
Depending on the extent of the joint damage, doctors suggest joint-sparing methods such as the drilling and refixation of the detached bone fragment or cartilage or bone grafts. In adulthood and in the late stage, the implantation of an artificial knee joint must be considered.
German Centre for Orthopaedics
Leading experts in arthroplasty
At the German Centre for Orthopaedics, Dr. Markus Heinecke and his team have developed concepts to improve the rate of infection and the surgical outcome in knee arthroplasty.
For many years, the German Centre for Orthopaedics at the Waldkliniken Eisenberg has belonged to the pioneers in the field of arthroplasty and is constantly working on achieving even better results. In the field of knee arthroplasty, the team led by the managing senior physician Dr. Markus Heinecke has set new standards.
The treatment strategies applied in Eisenberg are aimed at infection prophylaxis and improvement of the surgical outcome. And the best thing about this: Studies have shown that Dr. Markus Heinecke and his team achieve the desired effects with their methods.
In the Knee Department at the German Centre for Orthopaedics, drainage tubes are no longer placed and tourniquets are not applied.
“Operation without a tourniquet shows that we have a better control over bleeding and the patients have fewer complaints in the area of the thigh, where the tourniquet is usually applied,” explains Dr. Heinecke.
At less than one percent, the infection rate at the Waldkliniken Eisenberg is already below the national average of one to three percent. In order to further minimise the risk of infection and get it as close as possible to zero, the specialists in Eisenberg place importance on continuous treatment with antibiotics. The patient already receives the first dose 30 minutes before the operation. If the operation lasts more than two hours, a second dose of antibiotics is to be given.
“The most important thing is to adjust the dose to the patient’s weight in order to achieve the desired effect,” says Dr. Heinecke. Apart from this, the patient receives medication for blood coagulation before the operation,” so that we can reduce blood loss and postoperative haematoma formation,” explains the senior physician.
After the operation, vancomycin is administered. This antibiotic is deposited directly into the joint. “The advantage is that it remains and acts there for a while,” explains Dr. Heinecke. “In a study, we were able to show that our already very low infection rate could be reduced even further. It must be noted that this antibiotic cannot be used in the implantation of partial prostheses, as we have demonstrated that it is toxic for cartilage.”
Also in the case of aseptic revision of prostheses, i.e. in patients whose prosthesis has loosened or is no longer stable, treatment with antibiotics for five days produces better results.
The decisive advantage: If a specific bacterium is identified in a tissue sample, the antibiotic can be adjusted according to the antibiogram, and that without any gaps. “The patient has received an antibiotic from the first day onwards, which means that there is a very good chance that the infection can be overcome. This would not be the case if we only started administering the antibiotic after three days, as bacteria produce biofilm from the first day on,” says Heinecke.