German clinics perform all kinds of joint surgery: arthroscopic surgery, endoprosthetics etc. According to the statistics, one in three people complains of joint pain. In fact, a lot of factors can cause serious joint pains. Geneticist or metabolic disorder are the possible reasons for joint diseases as well as unhealthy diet, bad ecology, absence of physical exercise and lack of time as an excuse to visit a doctor.
Flexible and mobile joints often characterize young healthy body. Unfortunately, joints tend to age with time and, as a result, start troubling potential patients. Oftentimes, chronic pain and joint stiffness are the reasons why people have to deny themselves many leisure activities. One would think that only simple household activities cause difficulties. However, these problems are usually secondary symptoms to some other diseases. Therefore, if a patient has some kind of discomfort or crunching, he should visit a doctor as soon as possible to resolve the problems by using minimally invasive practices. Annually German clinics carry out just over 500 000 joint surgeries.
When is joint replacement necessary? Who needs joint replacement? In what cases can the surgery be postponed? These questions are often asked by patients who suffer from joint pain and other stiffness. The most common cause, in which the patient has to consider joint replacement, is the advanced form of osteoarthritis (degenerative disease, which causes the cartilage decay) or rheumatoid arthritis (chronic inflammatory disease). In younger patients, a common cause of hip replacement is aseptic necrosis of the femoral head, caused by insufficient blood supply as well as trauma, dysplasia (congenital disorders). The joint (hip or knne joint) needs to be replaced with an artificial one in some severe cases of the immune diseases such as systemic lupus erythematosus, psoriasis, ankylosing spondylitis etc.
Thus the main objective of the operation is to remove pain and stop the pathological process which can no longer be managed with the conservative methods of treatment (drugs, physiotherapy). In addition, nonsteroidal anti-inflammatory drugs may lead to the development of serious complications of the gastrointestinal tract disorders. Chronic administration of steroid drugs for the treatment of rheumatic diseases may cause bone destruction and only worsen the situation.
If for this or that reason the joint replacement is impossible to perform, the specialists in Germany conduct the surgical fixation of joints (it refers to hip, ankle or wrist joints). Such a procedure is called arthrodesis and implies a merging of two bones on both sides of the joint. The operation is that the bone implant or bone is removed from another part of the body and interposed between the two bones to be spliced.
For a tight fit the special metal plates, screws and wires are used. After some time the bones and the joint between them become stronger and more resilient. Moreover, after this operation the pain usually disappears and the life quality improves.
Another alternative is osteotomy arthroplasty - surgical restoration of the normal position of the joint by removing the damaged portion of the bone and tissue with subsequent fixation with titanium screws. The purpose of this operation is to establish joint in a proper position and to help redistribute weight more evenly.
The operation is that the bone implant or bone is removed from another part of the body and interposed between the two bones holding the joint. For a tight fit using special metal plates, screws, wires and special fix constructions are used. After some time the bones which have undergone arthrodesis become tightly connected, so that the joint becomes stronger and more resilient.
If you look for joint replacement surgery or joint condition diagnosis, don’t look further than Germany. More than 600 000 patients each year undergo joint replacement surgery in Germany. The quality of arthroplasty here is second to none. The quality management of joint replacement surgery is performed by the leading German university clinics and state institutions. After surgery, the patient gets a full rehabilitation at affordable price and, as a result, can immediately return to everyday life, and even engage in physical exercise.
If you are unsure, where to carry out the operation of endoprosthesis: in Germany or in one of the local hospitals, some facts in favor of German clinics may persuade you:
Firstly, Germany uses implant materials solely from the most reputable manufacturers. All the materials are thorougly tested. This is extremely important because the quality of the prosthesis is crucial for the successful joint replacement
Secondly, the endoprosthesis in Germany is conducted on the top technical level. With the help of computer technology each patient can get the implant tailored to his/her individual characteristics. Thirdly, joint replacement in Germany is successfully performed for more than four decades, which means that German doctors enjoy the extended experience in carrying out such operations.
Moreover the price for joint replacement surgery is not higher than in the USA or Canada. If you have questions concerning the methods of joint replacement, please do not hesitate to call us.
The methods used in joint replacement depend on the diagnosis and, therefore, on the causes for the disruption of musculoskeletal apparatus. Diagnostics include an X-ray and a computer tomography, which help to estimate the damage degree and determine what type of endoprosthetics is required for the patient: a partial or a full. The patient's general condition, their age, concomitant diseases are also taken into consideration when selecting the prosthesis size and type.
A joint replacement surgery is performed when traditional medication and physiotherapy were proven ineffective. The improvement of joint replacement methods has reached such a level that patients no longer need a special rehabilitation.
The orthopaedic clinics in Germany perform hip, elbow, knee, shoulder, and other joint replacements. The main task of these operations is to restore the normal functioning of the joint and to eliminate the pain.
The types of joint arthroplasty differ in the way the prosthetic is attached to the bone. The replacement operation with cemented fixation utilizes special glue. This technique is considered to be outdated because it does not provide a reliable connection.
Usually the uncemented fixation of endoprosthetics is used. The method is extremely reliable because of the porosity of the prosthetic material. Over time, the bone tissue grows into its pores and securely holds the endoprosthesis.
Given the degree of joint damage and the general clinical picture, the prosthetics of different configurations are used depending on the case. Among other things, one should take into account that any artificial joint has a certain lifespan, so over time it may need to be replaced. There are four main types of hip replacement operations.
The stem of most hip endoprostheses is made of titanium alloys or cobalt and chromium based alloys. Prostheses stems have different shapes and are often covered with porous material allowing the bone tissue to grow into the endoprosthesis.
The endoprosthesis head is made of ceramic materials or cobalt or chromium based alloys. The head surface is thoroughly polished in order to achieve effortless sliding inside the cup component of the endoprosthesis. Metal, ultra high molecular weight polyethylene or reinforced by metallic elements polyethylene are used for the cup component. Depending on the required implant size, the total weight of all components of the endoprosthesis can be around 400-500 g (0.9-1.1 lbs).
All the materials have following common characteristics:
In order to be able to fully adapt the endoprosthesis to the body and weight of the patient, each endoprosthesis element is manufactured in different sizes.
Here are some examples of the most commonly used hip prostheses:
There are many types of implants and the ways they are installed. What brands and designs will be used by your doctor depends on many factors, including:
The doctor must describe the type of the selected implant and prosthetic technology that will be used to replace the knee joint. You decide whether to accept it or not.
Most likely that one of the following procedures will be proposed:
This type of knee joint arthroplasty is widely used, as this low-invasive approach can significantly reduce the recovery period.
Advantages of the technology:
For a long time this procedure was considered a "golden standard" for the treatment of gonarthrosis and the knee joint replacement in older persons (60 years and older). It is also used to treat younger patients.
According to clinical studies, after the full knee joint replacement in patients up to 50 years, 9 out of 10 implants remain functional after a decade; for elderly patients (60 years and older), the probability is about 95%. 1-1.5% of all operations per year fail. So the probability that the implant will serve for a long time is quite high.
At the end of the rehabilitation course following the installation of the knee joint prosthetics, most patients cease to limp, feel stiffness, are able to walk for a long time and to have recreational activities (travel, swimming, cycling).
This surgery implies cutting one of the bones and the redistribution of the walking load on the parts of the knee unaffected by arthritis. This procedure allows to postpone the replacement arthroplasty, but it still will be needed in the future.
Osteotomy has a number of drawbacks:
There are several methods to attach an endoprosthesis to bones:
This design of a knee joint endoprosthesis implies fitting of metallic components into plastic elements. This ensures smooth motions and minimizes wear.
The tibial component in these models has a raised surface where the internal pin sits. The pin is firmly placed in a special slot on the femur. To ensure that the endoprosthesis components are firmly fixed to the bone, the posterior cruciate ligament shall be removed.
The smooth co-operation of the components mimics the function of the removed posterior cruciate ligament: preventing the hip bone from sliding forward along the surface of the tibia bone while the knee is bent.
With this implant it is possible to save the posterior cruciate ligament of the knee. Such endoprostheses have no central pin on the tibial component and its corresponding slot on the femur. Such implants are suitable for patients whose posterior cruciate ligament is in satisfactory condition, able to provide sufficient stabilization of the knee joint.
In case of a total knee joint replacement, massive implants are used to replace the ends of the femur and tibia bones. If only one part of the knee joint is damaged, small implants (partial, or unicompartmental implants) that replace the damaged area can be used.
Mobile-bearing (rotating platform) knee joint implants consist of three components. This allows the endoprosthesis to simulate a real joint function. The presence of a rotating platform gives the plastic element inside the metal liner of the tibial component some rotation possibility. This design allows patients to rotate their knee inwards and outwards.
In comparison to other endoprostheses, implants with a rotating platform require more support from the soft tissue (ligamentous apparatus of the knee joint). Often, when the soft tissue is underdeveloped or weak displacement of the endoprosthesis occurs. Endoprostheses with a rotating platform usually cost more than other types of implants.
The results of clinical studies do not clearly reveal that the implants with a rotating platform serve longer, more effectively reduce pain, or improve the function of the knee joint.
Most patients receive an endoprosthesis with a fixed bearing. This type of implants have the polyethylene element of the tibial component firmly attached to the metal liner beneath it. The femoral component glides along the cushioning surface.
If the patient is too active, or suffers from obesity, the endoprosthesis with a fixed bearing wears out faster. This process is accompanied by endoprosthesis loosening and joint pain.
Endoprosthesis loosening is the main reason for artificial joints failure. For young and active patients and for obese and overweight patients, doctors recommend the knee joint implants with a mobile bearing or a rotating platform. Such implants serve longer and wear out slower.
The elbow joint replacement is performed quite rarely. Due to the complexity of its structure it is difficult to select a prosthetic that would fully mimic its function.
There are total and unicompartmental or partial elbow prostheses. A total joint replacement is more advantageous for older patients. Partial replacement of only the head of the ulna can be performed in younger patients.
Constructively there are two types of artificial elbow joints:
There are some other constructive options, such as partially or fully coupled systems.
The systems can also be divided into partial and total (TER) implants.
Though the need for a full elbow prosthetic is very rare. A more sparing option is a partial prosthetics, placed directly on the affected joint area. Because the elbow is a "coupling" consisting of several simple joints, only one of them usually gets replaced, most often the humeroulnar joint.
The choice between the coupled and the uncoupled systems depends not only on the degree of joint damage, but also on the condition of the ligamentous apparatus. If the ligaments are also affected, a special prosthetic stabilization is required, so the linked system is implanted. The patient's age, his or her general condition and, above all, the state of the bone tissue are also taken into account.
In this case it means resurfacing prosthetics: the damaged sections of the cartilage layer are covered by a protective shell, that duplicates the shape of the corresponding joint element.
Usually the humerus joint head (the epiphysis at its lower end) or the ulna upper epiphysis are replaced this way. If both of them are affected the bilateral prosthetics of both joint elements is carried out. An uncoupled bilateral prosthetic is stabilized by elbow's ligaments, if they are healthy and functional.
Main indications for this type of prosthetics are severe secondary phase of arthrosis, unresponsive to conservative treatment, accompanied by severe pains. It is often the result of progressive rheumatoid arthritis in the elbow. We shall not exclude another underlying cause: consequences of a long-standing, incorrectly cured fracture of elbow bones.
The essential condition to install this system are healthy elbow ligaments.
This prosthetics scheme is especially suitable to young, physically active patients. The resurfacing prostheses better preserve the bone tissue of the joint. It allows the joint to serve for a long time after the surgery.
Such systems are used for bilateral prosthetics (of both the upper and lower part of the elbow joint), if the ligaments are also damaged. An uncoupled implant would be unstable in this case.
There are two degrees of articulation: partial and complete.
Semiconstrained coupled models have movable, hinged connection between the upper and lower prosthetic parts.
A completely coupled joint prosthesis has a rigid connection. This is a particularly stable system. An additional stability factor is the axial locking of both linked parts. They are fixed with long pins inserted into tubular bone cavities along their longitudinal axes. It is possible to make a prosthesis for all three joints that make up the elbow, which are particularly complex systems used if the whole elbow is damaged.
However, the patient should be aware that with such a complex device, the lifetime of a completely linked joint implants is not as long as it of the uncoupled systems. Therefore, this prosthetics scheme is optimal for older patients (65 years or more), leading not to a very active lifestyle.
There are two types of endoprostheses on a stem:
This endoprosthesis copies the natural shape, build, and biomechanics of the shoulder joint. The affected joint surfaces are replaced with similar artificial components. A sine qua non for anatomical endoprosthesis is the preservation of the elements of the rotational cuff, which stabilizes the joint pushing the prosthetic head into the glenoid cavity of the scapula, because the surface of the artificial shoulder joint is less than the size of the adjoining surface of the prosthetic head, which, on the one hand, increases the possible amount of motion in the joint and, on the other hand, increases the risk of dislocation of the endoprosthesis head.
The philosophy of this endoprosthesis is in the opposite location of its components. It means that the blade component has a hemispheric form (similar to the humeral head), and the shoulder component has a concave shape. In the case of degenerative changes of the shoulder rotator cuff, its thinning or rupture, gradually progressing arthrosis of the shoulder joint occurs, the shoulder bone gets cranially displaced (upwards, under the acromion) and the joint becomes unstable. This is when this kind of total endoprosthesis is needed.
The stem of the endoprosthesis can be fixed without cement (using the press-fit method, i.e. firm impaction) and with cement (the components are fixed to bone with bone cement). The choice of fixation type depends on a number of factors, such as the quality of the bone, the patient's age, the concurrent conditions, the anticipated activity after the operation and many others, and is made in each case individually.
Ankle joint prosthesis system does not have such a broad constructive diversity as, for example, artificial knee or hip joints. Due to the extremely complex "design" of the ankle joint its partial and multifarious prosthetics are impossible. In Germany, the only option available is total prosthetics.
Accordingly, all applicable systems are based on a single design decision: upper and lower protection for intra-articular surfaces and a "cushion" in-between serving for their soft interaction. Hence their general name: total ankle joint endoprosthesis.
All models of artificial ankle joints consist of three main parts:
While it is a total prosthesis, the method used is generally sparing, conserving a lot of bone tissue. There is no need to use long pins to stabilize the prosthetic parts. The protective plate on the hucklebone is secured with small pins. The basic fastening principle is a firm, anatomically calibrated clasping of the bone surface by a plate and special properties of the adjacent surface ensuring that it is covered by the bone tissue. Same principle is used on the top plate. The only fastener is the central pin (which is also short). Plus the effect of surface intergrowth.
The polyethylene core is not fixed. It glides freely between the plates, thus facilitating their mutual functional mobility relative to each other. However, the plastic part cannot slip from the clamp, and it is hampered by the stabilizer on the edge of the top plate. Thus, the solid parts of the prosthesis have an everlasting (in principle) liner: its surface properties are very close to the properties of a healthy joint cartilage.
The precise fitting of polyethylene and metal surfaces provides a reliable guarantee against the material attrition, improves the durability of the artificial joint. In addition, the polyethylene core optimizes the load distribution in the prosthetic zone, which also contributes to longevity. And allows the recipient of the prosthetic to walk, run, and even jump without hindrance.
Rehabilitation clinics in Germany specialize in various fields of medicine. Depending on the medical area, special treatment and therapeutic activities can be offered in Germany. The distinguishing characteristic of rehabilitation in Germany is a unique mountain climate, which has a beneficial effect on the organism helping to strengthen it.
Germany is the only country in Europe that has a unique and exemplary network of rehabilitation centers and institutions that are equipped according to the latest technology and follow strict quality standards. In 1,239 preventive and rehabilitation institutions of Germany with the total number of 171,000 beds for stationary stay, over 2 mln patients are treated annually.
Already on the first day after the joint surgery you will begin with a course of physical therapy, that is carried out under the constant supervision of medical personnel. You need to start moving that soon after the surgery in order to train and strengthen muscles and ligaments around the implant, as well as to prevent the formation of blood clots and vessel obstructions, which may develop as a result of a long bed rest. A good blood flow is also important for the rapid healing and growth of bone tissue around the implant. In addition, movement and feasible exercises will prevent the formation of too much connective tissue, which can limit the joint mobility.
If your hip or leg was replaced, within a few first weeks (in some cases up to six weeks) you will have to use crutches or an arena in order not to overload your leg. During the rehabilitation the use of the so-called continuous passive motion device is also sometimes prescribed. This programmable medical device looks like a training gear, but unlike it, it independently performs the right moves for you. This allows the patient to recover normally after the surgery and at the same time returning the mobility to the joint.
If you perform the rehabilitation activities prescribed by your doctor during the first days after the knee joint surgery, to the time of discharge (2-3rd day) you should be able to switch from the intake of strong painkillers to the usual ones, to stand up and sit down on your own, walk around 8 meters along a straight line and go up and down the stairs with the minimal use of crutches or other supporting devices.
If you had a surgery on an ankle joint (malleolus), in addition to physical training aimed to strengthen the muscles and maintain the blood flow, you may need to perform individually selected exercises, because after this surgical intervention problems with the correct positioning of the foot during walking often occur. After you are discharged from the hospital you may need to seek medical help in special clinics, that conduct rehabilitation in Germany for patients after various joint surgeries. The team of specialists who performed your joint replacement surgery will help you with the choice, as it is important to select the rehabilitation therapy that corresponds to the specifics of your case.
Approximately a year after the joint operation, you will need to return to the clinic for medical examination to check the results of the surgery and the subsequent rehabilitation. This will also allow your doctor to detect any changes and, if necessary, take measures to prevent the development of complications.
Subsequent regular inspections of the implant will be carried out every five years.
In three or four months you are going to fully recover and will be able to do sports again, but you should exclude the contact (martial arts, rugby and so on) and team (football, volleyball, basketball) types of sport. On the other hand swimming, biking or skiing are suitable for keeping your joints in a great shape without any extra load. You may also do golf, alpine skiing and tennis (with some restrictions). The general rule for all types of sports: you should choose the one you did before the operation, as learning new sports can lead to unnecessary stress and unwanted injuries.
The Johannesbad rehabilitation clinic and thermal complex in Bavaria is a medical facility that was certified twice. It has at its disposal a therapy center, that includes an integrated medical fitness center, as well as Germany's largest thermal spa. The rehabilitation/spa clinic is located in Bad Füssing and is surrounded by the wonderful natural and cultural landscape of Lower Bavaria, the picturesque Lower Inntal valley, directly at the border with Upper Austria.
Modern medicine is needed for treatment and recovery. The musculoskeletal disorders in most cases significantly change patient's life. In order to restore the functional ability of the musculoskeletal system as soon as possible, individual support, as well as consistent, constructive and adapted to the patient's features training are required. Rehabilitation orthopedic clinic in Johannesbad takes individual care of your health.
Rehabilitation and subsequent treatment of various diseases of the musculoskeletal apparatus:
In 1986 an outstanding German businessman Max Gruendich founded the clinic bearing his name, guided by some clear ideas. His desire was to create a place for "talking" or narrative medicine, designed to establish closer or more trustful relationships between the doctor and the patient.
A part of his concept was to create the most favorable environment for patients as the basis for the effective therapy and rapid recovery. The Bühlerhöhe hill became a perfect place for it.
The Max Gruendich clinic still retains the original idea of its founder and puts it in its medical practice. All this makes it a unique clinic.
The activity of the clinic is based on three important structural and functional elements: internal medicine with many departments and excellent specialists, the center of preventive diagnostics and the field of psychosomatic medicine.
In 2006, Max Gruendich clinic was successfully certified by the "Organization for cooperation in the field of health care transparency and quality" (KTQ), then it was recertified twice.
The Orthopedic department of the clinic offers a full range of services in the field of orthopedics, prevention, diagnosis and treatment of congenital or acquired, form or functional defects of the musculoskeletal system, bones, joints, muscles and tendons.
In the center of attention of the Orthopedics department of the Max Gruendich clinic is stationary rehabilitation of patients with disorders of the musculoskeletal system, mainly after such surgeries as hip replacement or knee replacement, as well as operations on spine.
Individual rehabilitation programs are carried out coordinated with patient therapy and training plan that is aimed to contribute to the fastest recovery and return to daily life.
For your convenience, German Medical Group offers you the most comprehensive information about the best doctors, costs and methods of joint treatment in Germany. We are mostly often asked questions related to joint replacement procedure, and, what is even more crucial, the cost of joint replacement in Germany.
|Arthroplasty procedures||Average surgery cost, EUR|
|Total hip joint replacement||6.000-9.000,-|
|Operative exploration in the presence of hip implants (no implant replacement needed)||8.000-11.000,-|
|Operative exploration in case the hip implant replacement needed||6.000-8.000,-|
|Total knee joint replacement including computer navigation methods||9.000-15.000|
|hip joint endoprosthesis, including navigation||about 11.000|
|Hip implant replacement included||13.000,-|
|Shoulder joint replacement||9.000,-|
|Ankle joint replacement||7.000-9.000,-|
|Joint correction||Treatment cost, EUR|
|Axis correction of thigh||9.000,-|
|Axis correction of lower leg||9.000,-|
|Correction of hallux malposition (Halluxvalgus)||4.500,-|
|Joint arthroscopy||Treatment cost, EUR|
|Hip joint arthroscopy (surgery on meniscus included)||4.500,-|
|Cartilage repair (cartilage transplantation included)||9.000,-|
|Plastic surgery of anterior or posterior crucial ligament||9.000,-|
Experts in pain therapy, physiotherapists and ergotherapists help patients through the rehabilitation process after replacement surgery. The program includes physiotherapy, massage, lymphatic drainage, heating, water gymnastics, and recommendations on diet.
German Medical Group company will help you to plan your treatment and stay in Germany in the slightest detail. We will be glad to advise you on your forthcoming treatment in Germany. Just call us!