Hip Replacement: Modern Minimally Invasive Hip Surgery for More Mobility and Quality of Life – Prof. Guido Saxler

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00:00:09: Expert Physicians Talk, health explained in an understandable way.

00:00:14: In this podcast channel we talk about selected medical topics – in collaboration with leading medical specialists.

00:00:23: The following content comes directly from the respective specialist and is presented by a digitally recorded voice.

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00:00:37: Guido Saxler, Director of the Department of Orthopaedics and Trauma Surgery at Rheinland-Klinikum in Dormegen located between the metropolitan areas of Cologne and Dusseldorf.

00:00:49: Professor Saxler is a renowned specialist in hip knee and spinal surgery.

00:00:55: Professor Sachsler around two hundred fifty thousand hip replacements are performed annually in Germany.

00:01:01: How do you explain this high number?

00:01:04: Ultimately here in Central Europe and especially in Germany We are seeing a demographic development.

00:01:10: As you know, we have an increasingly ageing population and the older we get The more degenerative diseases we develop.

00:01:18: This partly explains these numbers.

00:01:20: What is also important in Germany?

00:01:22: And I personally think this is excellent Is that there are no age restrictions for surgical procedures.

00:01:28: Anyone who requires surgery or medical care receives appropriate treatment.

00:01:34: In North Rhine West failure however... ...we're facing special situation.

00:01:38: fewer and fewer hospitals are allowed to perform joint replacement surgery.

00:01:43: Therefore, I believe that due the reduced number of providers The total number procedures in North Rhine-Westphalia may decrease In future.

00:01:51: Other federal states May follow this political development as well.

00:01:55: How did restriction come about?

00:01:58: The Ministry of Labour Health & Social Affairs in north Rhine Westphalia decided To focus on specialists Namely certified centres for Joint Replacement and spinal surgery.

00:02:10: These centres with high-case numbers were selected to provide this care.

00:02:14: In the past, for example hospitals only needed to perform fifty knee replacements annually To be authorised to provide these procedures.

00:02:22: Today The minimum is one hundred.

00:02:25: in the future the requirement For knee replacements will probably rise to at least one hundred fifty Procedures per year in order to remain certified as a provider.

00:02:34: Which conditions typically lead to hip problems?

00:02:39: Essentially, these are the classic joint diseases.

00:02:42: Degenerative conditions In the hip area.

00:02:45: this is referred to as coxarthrosis or hip osteoarthritis.

00:02:49: We also see changes after accidents that may damage and eventually destroy the hip joints.

00:02:55: Rheumatic diseases are another cause although thanks to modern medications classics severe rheumatoid cases of becoming less common.

00:03:03: we also encounter medication induced necrosis where the femoral head collapses.

00:03:08: However, this can also occur without medication.

00:03:11: Very rarely we still see post-infectious conditions diseases of the hip following bacterial infections though these have become uncommon.

00:03:20: How do you determine whether the hip is actually the source of the pain?

00:03:26: The process is always similar.

00:03:27: first We talk to the patient.

00:03:29: symptoms Can sometimes be non specific and radiating into the back knee or thigh.

00:03:35: Many patients report groin pain which has already quite characteristic.

00:03:40: We begin with a detailed medical history.

00:04:07: Often, based on the examination and medical history alone we already know whether this issue originates from the hip rather than back or knee.

00:04:15: Behind all of these lies a scoring system used by certified centres to determine where surgery may be indicated.

00:04:21: There is even point scale involved that we do not necessarily discuss every detail with patients.

00:04:27: Ultimately however we know exactly when patient stands.

00:04:31: Only afterward move onto imaging diagnostics.

00:04:34: In some cases we also perform diagnostic injections into the joint to exclude spine, knee or other causes.

00:04:40: Standard X-rays are usually already highly informative – occasionally MRI and CT scans are added.

00:04:51: The

00:04:54: goal of conservative therapy just like surgery is to reduce pain & improve walking and standing ability.

00:05:01: Conservative options include injections physiotherapy, acupuncture and oral pain medication.

00:05:08: In cases where osteoarthritis is not yet advanced patients may also receive hyaluronic acid injections.

00:05:15: as long as these treatments work well conservative therapy should continue.

00:05:20: muscle strengthening and exercise training are particularly valuable.

00:05:23: in my view patients should always pursue these measures before planned or anticipated surgery.

00:05:30: what types of prostheses exist and what are the advantages of an artificial hip joint?

00:05:37: The primary goal for a hip prosthesis is pain reduction, ideally complete pain relief.

00:05:42: Many patients eventually forget they ever had surgery.

00:05:46: Improved mobility also positively affects the entire body – diabetes, cardiovascular diseases mental health general well-being all benefit from increased activity.

00:05:57: So this approach is holistic helping patients return to movement quality life.

00:06:03: There are various prosthesis designs.

00:06:05: A centre like ours must adapt to each patient's anatomy.

00:06:09: Broadly speaking, we either fix prostheses using bone cement or implant them cement-free.

00:06:15: Cement free prostheses require extremely precise preparation of the implant bed so that patients' bones can grow directly onto their implants.

00:06:23: For younger patients short stem prostheses also available.

00:06:27: We use both cemented and cement free systems.

00:06:30: Nowadays we are less concerned about implants loosening over time.

00:06:34: More often, revision surgery becomes necessary because the implant breaks due to a fall.

00:06:40: True loosening has become increasingly rare which is excellent and reflects the remarkable engineering behind modern implants.

00:06:48: Could you briefly explain what loosening means?

00:06:52: Certainly!

00:06:53: We fix the implant to patient's bone Over-time.

00:06:56: The connection between implant & bone whether cemented or cement free can dissolve.

00:07:03: the bone withdraws from the implant, which may lead to pain in the groin or femur.

00:07:07: In such cases revision surgery with modular prosthesis systems becomes necessary.

00:07:13: Large centres like ours routinely perform everything from minimally invasive procedures to complex revisions.

00:07:20: This is also why it's beneficial to undergo surgery at a centre capable of managing complications and revision procedures.

00:07:26: Often we do not need to replace the entire prosthesis sometimes only the cup or stem and having access to all compatible systems is very advantageous.

00:07:37: What materials are used for the implants?

00:07:41: Cemented implants are typically made from cobalt chromium molybdenum alloys.

00:07:45: Cement-free implants are generally titanium vanadium alloys.

00:07:49: Our knee implants also feature titanium nitride coatings, to minimise allergy risks.

00:07:54: Implant materials today Are extremely sophisticated And highly reliable.

00:08:00: For moving surfaces we use ceramics.

00:08:03: Modern ceramic heads are incredibly durable.

00:08:05: If I threw one against the wall, the wall would break before the ceramic headwood.

00:08:10: In The Hip Ceramic components usually articulate against polyethylene.

00:08:14: Today's ultra-highly crosslinked polyethylene produces minimal wear.

00:08:18: Some versions even contain vitamin E to improve longevity.

00:08:22: according to registry data Ceramic on ceramic bearings is still available but of becoming less common because modern Polyethylene performs exceptionally well and offers greater comfort.

00:08:35: Ceramic-on-ceramic implants can sometimes squeak or click, which is rarely the case with ceramic polyethylene combinations.

00:08:47: Fortunately risks have become extremely low because specialised centres perform high volumes of procedures – everyone knows exactly what to do!

00:08:55: Nevertheless, risks remain.

00:08:57: Postoperative swelling can cause blood clots in veins Thrombosis which may travel to the lungs and cause pulmonary embolism.

00:09:05: We prevent this using thrombosis medication, either injections or tablets.

00:09:10: Infection is another classic complication – some infections appear much later as so-called low grade infections.

00:09:17: During surgery bones can fracture and nerves can be injured.

00:09:20: These are among major complications that occur.

00:09:24: Your centre uses modern minimally invasive techniques.

00:09:28: How do these procedures work?

00:09:30: And who they suitable for?

00:09:34: In my opinion, minimally invasive surgery is suitable for virtually every patient.

00:09:38: Many centres use a direct anterior approach.

00:09:41: We used the ALMIS approach or a modified ALMS approach An anterolateral minimally-invasive technique.

00:09:49: With this approach we bluntly separate muscles rather than cutting through them.

00:09:53: This preserves muscle tissue and promotes faster recovery.

00:09:57: Whether surgery is performed from front or on the antero lateral side Patients are generally in very good hands at specialised centres.

00:10:05: The aim is always to preserve the surrounding musculature as much as possible.

00:10:10: How long does rehabilitation take after hip surgery?

00:10:15: This depends greatly on patient's condition before surgery.

00:10:18: Well trained patients generally recover faster than less fit individuals and younger patients often recover more quickly then older ones.

00:10:26: However, early post-operative course is fairly similar for most patients.

00:10:31: Patients are mobilised very quickly, sometimes on the same day.

00:10:35: And many are allowed full weight-bearing immediately due to surgical technique and implant stability.

00:10:41: Patients usually stay in hospital between three or six days.

00:10:45: during this time they learn walk safely climb stairs regain independence.

00:10:50: physiotherapy intensifies during second week transitioning from gate training movement training lymphatic drainage help reduce swelling.

00:10:59: patients receive waterproof dressings and can shower immediately.

00:11:04: We want them to return to everyday life as quickly as possible, rather than feeling sick.

00:11:09: Many patients stop using crutches relatively quickly although this varies individually.

00:11:14: we generally recommend crutches initially to reduce the risk of falls.

00:11:19: Most patients are surprised by how quickly recovery progresses.

00:11:23: What can people do to avoid reaching a point where surgery becomes necessary?

00:11:27: That

00:11:29: is difficult question because genetics play major role.

00:11:33: Unfortunately, we cannot escape poor genetic predispositions.

00:11:37: However patients can still do a great deal themselves.

00:11:40: Maintaining good muscle strength is extremely important.

00:11:43: Many well-trained patients experience osteoarthritis symptoms much later or sometimes hardly at all.

00:11:50: Obesity is another major issue especially in Western societies.

00:11:54: We know that excess weight significantly increases the likelihood of joint disease.

00:11:58: What challenges you currently see in hip surgery?

00:12:01: And what does the future look like?

00:12:05: We are increasingly treating older patients with more complex medical conditions.

00:12:09: Therefore, specialised centres need excellent interdisciplinary support.

00:12:14: Here we work closely with cardiology and other surgical departments because older patients often come with multiple health issues.

00:12:21: This is probably the biggest change that we have seen over the past ten years.

00:12:26: At the same time hip replacement surgery has reached an extremely high level.

00:12:30: Implant related problems are becoming increasingly rare thanks to improved certification processes and technological advancements over the past two decades.

00:12:40: Where is technology heading?

00:12:42: Will AI play a role?

00:12:45: Technologically, we are already introducing robotic surgery – these are assistive systems combined with navigation technologies.

00:12:52: I also believe that we will increasingly use virtual reality in revision surgery.

00:12:58: With VR headsets & pre-operative CT scans We can reconstruct joints even more precisely.

00:13:05: Soon we will also be able to perform intra-operative, three D imaging directly during surgery.

00:13:11: To better assess our results immediately.

00:13:13: whether AI itself will directly intervene During operations remains uncertain but assistive systems Will certainly continue improving because of the enormous growth in data processing capabilities Especially with future technologies like quantum computing.

00:13:28: The technologies I mentioned are already here today and will continue helping centers improve quality In the future.

00:13:35: Who can contact your centre?

00:13:39: We are open to all patients and all insurance providers, whether statutory or private.

00:13:45: Patients are willing to travel long distances if they feel that you're in good hands... ...and trust the overall treatment environment.

00:13:51: It is important a centre also manages complications Whether cardiac, abdominal vascular or intensive care related.

00:14:00: In my view this comprehensive infrastructure is extremely important especially as patients grow older.

00:14:05: We want to treat patients at the highest possible safety standard.

00:14:24: For more comprehensive and detailed information concerning the topic of medical specialists, please visit us online at primomedico.com.

00:14:42: Join again next time when we return with our popular segment which is called Medicine for Your Ears.