Current highlight: First day clinical hip replacement surgery in one day
A new hip in the morning and back home in the evening? This is possible thanks to the so-called AMIS procedure and the Rapid Recovery program. As the first medical doctor in Germany, Dr. med. med. Manfred Krieger, Specialist in Orthopedics and Traumatology in the Network of Specialists Rhein-Main, in cooperation with the GPR Health and Care Center Rüsselsheim, the modern surgery and rehabilitation procedure "Hip in a day". The advantages for the patients are obvious: they are better fit again and usually have less pain.
Hip in a day in the media
The media are also very interested in Dr. med. med. Manfred Krieger Germany's first applied AMIS process and the Rapid Recovery program. The contributions illustrate the procedure and accompanying a patient - during hip replacement surgery and one year later.
Benefits of this hip joint replacement surgery method
- Protection of the existing muscles around the hip
- Blood saving technique
- medicines for blood loss (tranexamic acid)
- Good pain therapy (infiltration)
- No nausea (PONV prophylaxis)
- hygiene prophylaxis (oral and nasal swab)
- Showers with Hibiscrub
- dispensing with catheter (bladder catheter, wound drainage)
- Early energy intake (cola, ice cream in the recovery room)
- First getting up in the recovery room
- Physiotherapy every 2 hours
- Discharge criteria fulfilled after 8 hours
- Stair running before discharge
BGU Clinic Frankfurt provides information on osteoarthritis and hip replacement
More than 170,000 artificial knee joints and more than 200,000 artificial hip joints are used each year in Germany. Common cause is a joint wear, the so-called arthrosis. The BG Unfallklinik Frankfurt is launching a patient information event at the Main under the motto "Osteoarthritis and joint replacement". Head physician Prof. dr. Dr. Reinhard Hoffmann and his team inform in the conference center of the clinic, Friedberger Landstraße 430, 60389 Frankfurt am Main about osteoarthritis and the artificial knee replacement or hip replacement and replacement surgery.
Osteoarthritis is widespread in Germany. Nearly half of all persons over the age of 65 suffer from the disease of wear, usually at the knee or hip.
"In addition to the age-related wear and tear of the articular cartilage, injuries, inflammation, incorrect or overstressing can trigger osteoarthritis," explains the medical director of the BG Unfallklinik, Prof. Dr. med. Dr. Reinhard Hoffmann. Those affected initially only have pain on exertion, and in advanced state also in rest. If conservative treatments such as physiotherapy can no longer relieve the pain, it makes sense to replace the damaged joint with an implant.
"Although artificial hip joint surgery is one of the routine procedures, choosing a hip replacement for the individual is often associated with uncertainty and anxiety. Comprehensive advice and information for our patients is therefore very important to us ", emphasizes the expert. In the patient information session, the instructors will inform about the preparation for the stay in the clinic, new surgical procedures, rehabilitation and living with an artificial hip joint.
In September 2015, the BG Trauma an Orthopedic Clinic in Frankfurt faced a first audit process defined by the endoCert initiative of the German Society for Orthopedics and Orthopedic Surgery (DGOOC). Following the recommendation of the experts and approval of the certification body, the BG Trauma Clinic is certified as the endoprosthetics center for maximum care, especially for the hip endoprosthesis.
This recognition underscores the high medical, surgical, nursing and rehabilitative quality of treatment at the BG Unfallklinik Frankfurt am Main under strict objective criteria. The designation EndoProthetikZentrum of the maximum supply for the hip endoprosthesis is u. a. after the performed operations and the high requirements of the criteria catalog. The aim of the certification is to improve the post-operative morbidity and mortality of our patients and to provide patients with an orientation opportunity to help them decide on the BG Trauma Clinic as a specialized specialist clinic.
Hip endoprosthesis in the BG Clinic Frankfurt
A specialized team carries out the entire range of primary and alternative hip endoprosthesis.
Only the highest quality implants for hip endoprosthesis with long-term proven materials and material combinations are used. If required, special and special prostheses are implanted to partial or full hip replacement (e.g., short-shaft hip, "female knee", hypoallergenic implants, partial or full thigh replacement). In appropriate cases, implantation may be performed at the hip using minimally invasive technique (MIS).
Hip Endoprosthesis At Obergöltzsch Hospital
At Obergöltzsch Hospital, a particularly gentle procedure for the implantation of hip prostheses is successfully used. In Germany, doing pioneering work.
First of all, experience has been gained at the Obergöltzsch Hospital before the innovation was presented. Since September 2013, Dr. Holger Freitag has been using a so-called minimally invasive surgical procedure when inserting hip prostheses. Since then he has carried out around 100 successful operations of this kind in Rodewisch. "The layman sees above all the small cut," says Dr. Friday (52). But the crucial thing about the new method is that the hip muscles can be completely preserved. "This is always extremely impressive for me as a surgeon," admits the orthopedist, who is based in Auerbach and works as a consultant in Obergöltzsch. The procedure is more complicated than the usual one and therefore takes longer and requires some experience. The has Friday: According to his own calculation, he has implanted about 2100 hip prostheses over the past 22 years.
In the conventional procedure, the muscles are affected, but this usually heals quickly, as the orthopedic admits: "The problems arise in the second intervention." This is often due after more than ten years, when the joint prosthesis begins to wear out. And as more and more younger people get artificial hip joints, more than two surgeries are often necessary - in which the previous procedure, the muscles are attacked each time again. Especially in these cases, the gentle process should be effective. But of course, all patients benefit from the painless and rapid rehabilitation - many can go without supports after four or five days. The procedure should be offered after the good experience of "an ever-larger patient group".
After hip surgery quickly mobilized by A.M.I.S technique- Health Forum Blaubeuren
The subject of hip replacement surgery is of great interest to many - the AMIS method even more so. In front of numerous listeners Dr. med. Frank Wirtz, Chief Physician of the Department of Orthopedics / Traumatology at the Blaubeuren site of the Alb-Donau Hospital, at the Health Forum on A.M.I.S - the special surgical technique that he has been successfully using for four years. He has already performed 660 surgeries and the patients are more than satisfied.
The hip joint is one of the most stressed joints of the body. In old age pain is often noticeable, the cause of which in many cases is the coxarthrosis - a wear of the cartilage between the socket and the femoral head. Congenital or inflammatory conditions such as rheumatism, injury or overstress can also damage the hip joint. All causes have one thing in common with pain: they severely limit daily life. If drug and physical therapies are no longer successful and the limitations are no longer tolerated, think about replacing the hip joint.
Today, high-quality titanium prostheses with ceramic or plastic gliding pairings are used, which remain wear-free for decades without significant abrasion and thanks to virtual adjustment on the X-ray image can be implanted with the highest degree of precision even before an intervention.
In previous conventional hip replacement implant surgery is operated on a laterally applied section. It is essential to cut the muscle lying above the joint or to release it from the bone. This "damage" often forces a long period of rest after the operation so that the muscles can recover or grow on the bone.
"It's not the prosthesis, but the way it's used," Dr. Wirtz, who has been successfully using the other, the A.M.I.S. technique (anterior minimally invasive surgery) for four years now. The leg to be operated is lowered by a special holder of the surgical table developed for this procedure during surgery and turned outwards. So it is possible to implant the hip prosthesis without severing muscles and vision. Utilizing the natural gap between two muscles on the front of the groin, the vessels and nerves are equally protected.
Advantages for the patients are obvious: less blood loss at the operation, significantly reduced risk of dislocation, less pain, early full load of the operated leg from the first day - after consultation with the doctor and under the supervision of a therapist - and a possible discharge from inpatient treatment between the 5th and 7th day. The early movement prevents a regression of the muscles, so that a stationary rehab is basically dispensable. In many cases it can be replaced by outpatient therapy - depending on the individual healing process.
The A.M.I.S. technique can be used for cementless as well as cemented hip prostheses, but also for the treatment of femoral neck fractures. Only very few clinics in Germany offer this surgical procedure and even as an experienced surgeon you have to go to school again. "We can therefore be very proud of this special knowledge and the successes in the operations of the past four years," says Wirtz.
Best quality of care for hip fractures in Germany: AOK examination places St. Antonius Hospital in first place
New measuring method examines stationary and post-stationary course
The chief physicians Oliver Heiber and dr. In fact, Ture Wahner has given its employer, the St. Antonius Hospital, first place in the middle of all hospitals in Germany - as far as the treatment of hip fractures is concerned.
The AOK has collected data from AOK patients on the quality of care using the specialized QSR measurement technique. It is interesting that the QSR procedure not only examined in-patient treatment, but also post-treatment treatment. Because a hospital naturally does not experience the course of the operated patient and therefore never learns how the recovery and rehabilitation course has developed.
Need: Sensitive handling of implants and time for advice
An endoprosthetic hip restoration uses an implant. The current proposal of the Federal Ministry of Health to provide more transparency in medical devices, welcome the chief physicians of the Department of Traumatology and Orthopedics very much. The endoprostheses that both use in a hip joint fracture are known to Dr. med. Heiber: "Here a very sensitive approach and a conscious choice are needed. Therefore, we only use proven implants from well-known manufacturers. The prostheses must be distinguished by their longevity and traceability. "The manufacturers must be reputable and long-term established in the market:" Your products must comply with current standards ", Dr. Ture Wahner.
In addition to impeccable endoprostheses, patients also need their will, some effort and support. To get back on their feet as quickly as possible, Heiber and Wahner have therefore established the info event "Get fit, join in!". Already in the run-up to the operation, the orthopedists, anesthesiologists and rehabilitation physicians provide valuable information on the entire topic of endoprosthetics - including a pragmatic walking-post training. To take the time as a doctor for a proper consultation of the patient before the operation - that too is a recipe of Germany's best accident surgical and orthopedic provider in terms of endoprosthetic hip care after fracture. He is sitting in Eschweiler Hospital.
A study has shown that femoral and knee endoprostheses can serve more than 25 years
8 out of 10 knee prostheses and 6 out of 10 hip prostheses currently have a service life of 25 years or more. In developed countries the replacement of hip and knee joints is one of the most frequently performed surgeries. In Germany, every year more than 400,000 patients have a hip or knee joint prosthesis implanted. Many patients before surgery ask about the service life of the prosthesis.
Jonathan Evans from Bristol Medical School and his staff analyzed data of case series and patient registers to answer this question. The results of the analysis of case series are considered less reliable, since they are often based on the experience of individual centres. This easily leads to a biased selection (patients with good initial risks are selected) or the publication of distorted information (the preferred publication of positive results). Formed in recent years in many countries, the registers of joint replacement prevent the occurrence of such distortions, as they tend to include all patients.
In fact, the results of the analysis of case series were better than the data of the registers. What concerns hip joint prostheses, British scientists, when analyzing case series, found out that up to 77.6% (with a 95% confidence interval from 76.0 to 79.2) have a 25-year service life. According to the register of joint replacement, 57.9% have a 25-year service life. With a 95% confidence interval from 57.1% to 58.7%, an accurate forecast is made (this, of course, does not exclude the fact that sometimes premature replacement is required because of infections and/ or loosening). The most important limitation for Evans’s calculations is that the 25-year data is based just on one patient register (from Finland).
What concerns knee replacement, researchers distinguish between total knee replacement (TKR) and single-radius knee replacement (SRKR). The register data shows a 25-year service life of the TKR for 82.3% (from 81.3 to 83.2%) and SRKR for 69.8% (from 67.6 to 72.1%). Based on this, knee joint prostheses have a longer service life than hip prostheses.
Hip prosthesis: Prosthetic Model More Important Than Surgical Method
The joint replacement increases the quality of life of patients. Complications can occur if the surgical method does not fit the implant. The latter is more important for long-term success.
The implantation of knee or hip joints is considered routine by experts. On average, orthopedists used about 230,000 hip endoprostheses in 2016. The joint replacement frees the patient from pain, increases the quality of life and ensures mobility into old age. Most often, a total replacement of the corresponding joint is made. Around 40% of endoprosthetic hip operations fall into the 70-79 age group; Women are affected twice as often as men. Hip replacement is considered one of the most common and successful operations ever. Nevertheless, there are always failures. These are estimated to be more common in artificial knees at 20%. In hip replacement, there are also at least two out of every hundred patients who are dissatisfied with the long-term post-procedure.
Sometimes the prosthesis relaxes, sometimes it comes to infections. A not uncommon reason for a failed implantation is that in patients the prosthetic model does not fit the surgical method. For a long-term success, according to the current state of knowledge, the implant model plays a greater role than the surgical method. The German Society of Endoprosthetics (AE) therefore advises not to prioritize the operation method, but to give priority to an optimally suitable implant.
Many patients want a minimally invasive approach (MIS). And in fact, studies available to date prove benefits, especially in the first six weeks after surgery. After a year at the latest, however, examinations no longer show differences between MIS and the classic open procedure. The keyhole technique comes with tiny cuts in skin and soft tissues. In MIS, surgeons use the natural gaps between the muscles to get to the hip joint. "We push muscles, tendons, vessels and nerves aside as far as possible, instead of severing them as usual and then suturing them again," explains Professor Dr. med. Dieter C. Wirtz, Medical Director of the Clinic and Polyclinic for Orthopedics and Traumatology at the University Hospital Bonn.
According to the specialist, MIS also protects important nerve receptors at the tendon-bone and tendon-muscle transition. The mechanoreceptors provided depth sensitivity and thus gait stability and balance. "If these structures remain intact during prosthesis implantation, patients can begin their rehabilitation sooner after the procedure," says Wirtz.
Minimally invasive hip replacement may sound uncomplicated, but it is not suitable for every patient. "The hip joint geometry has to fit, the patient should not be too muscled or too obese," explains the member of the AE presidency. At the same time, especially the prosthesis model must be carefully selected. Minimally invasive access is associated with limited vision. "Being able to carry out the individual surgical steps with the necessary care always has priority." Summary of the expert: The surgical method should be chosen so that the hip endoprosthesis does not cause long-term discomfort. If patients bring with them the individual requirements for a minimally invasive, muscle-sparing procedure, this should also be chosen. But rather promises the classic open surgery long-term success must be open surgery. "The aim of every surgeon should be to operate as gently as possible," confirms Wirtz.