The Roland Clinic - maxillary endoprosthetics center
The Roland Clinic as a competence center for the musculoskeletal system focuses with its four specialist centers on complaints and diseases that restrict your freedom of movement. In order to help you as a patient to achieve a better quality of life, in addition to specialist medical expertise, we rely on state-of-the-art diagnostic and therapeutic procedures - both inpatient and outpatient.
What is a maxillary endoprosthetics center?
Since the end of 2012 clinics have been certified by the German Society for Orthopedics and Orthopedic Surgery (DGOOC) - either as endoprosthetics center or as endoprosthetics center of maximum care. For this the special certification system "EndoCert" was developed.
The Roland Clinic has decided to be certified as a maximum arthroplasty center (EPZmax) and thus to meet the highest requirements of the DGOOC.
When the knee joints need to be replaced
In case of extreme wear in the knee, we will choose the right therapy for you. Depending on the nature of the disease, the severity of the present knee joint arthrosis, the bone structure and the age of the patient, there are different treatment options. Every year, we provide around 700 patients with artificial knee replacement at the Roland Clinic.
For each patient we select the individually fitting knee endoprosthesis (articular joint) from a variety of possibilities (for example partial or total endoprostheses, cemented and cementless joint replacement, etc.). Every endoprosthesis that we implant, we adapt in advance planning by computer technology exactly to your needs. This ensures a high degree of accuracy of fit - indispensable for an optimal fit and a long life of the artificial joint.
Cement-free titanium implants with a ceramic sliding couple have proven to be particularly reliable with long service lives. If possible - and this needs to be carefully examined from patient to patient - we refer to this form of knee joint replacement. Especially for younger patients, we often recommend endoprostheses that require as little bone material as possible for anchoring, so that a possible change of the joint replacement can later be carried out gently.
We only work with endoprostheses that have been tried and tested over the long term and with which we have had good experience. Thereby technical innovations, such as e.g. new materials and surgical procedures, always considered. The highest priority at all times is the patient safety and quality of results, which we scrutinize with every innovation.
The Center for Endoprosthetics, Foot Surgery and Rheumatoid Orthopedics of the Orthopedic Clinic Markgröningen has 80 inpatient beds and performs about 2,500 surgeries per year. The focus of the center is in arthroplasty, where about 800 hip endoprostheses, 870 knee endoprostheses, 60 shoulder endoprostheses and 20 ankle prostheses are implanted per year.
The artificial joints are implanted using state-of-the-art, minimally invasive, tissue-conserving surgical techniques that select small accesses and protect the soft tissues as best as possible. Here, the center has established itself as an international reference center.
Osteoarthritis, i. Morbid wear on the articular cartilage is the most common cause of knee pain and is becoming increasingly important in joint damage, even at a younger age. If the cartilage in the knee joint wears off, this is a process that can not be undone. Hyaline cartilage, which protects the bone at the condyle, is unable to heal itself if damaged. The increased wear of the cartilage leads to direct bone-to-bone contact. The consequences of osteoarthritis on the knee ("gonarthrosis") are severe pain during exercise. The painless walking distances are getting shorter. Finally, even in dormancy severe pain. At the same time, the mobility and stability of the knee joint are getting worse. The cause is often a malposition of the legs. For example, X or O legs strain the knee joints one-sidedly. But even accidents or the sports injuries mentioned above are the cause of the wear.
Double sled / joint replacement: The bicondylar knee replacement (resurfacing) is for patients whose knee joint is variously damaged. In the case of completely destroyed knees, it is also possible to implant surface knee endoprostheses with mobile parts ("mobile bearing") in younger and active patients in order to imitate the most "physiological" movement possible.
In the replacement of the knee prosthesis, it is necessary to secure a new prosthesis again safely in the bone and to obtain a stable, well-movable knee joint. In this case, usually modular revision prostheses with different degrees of coupling and different components for bone fixation or for bone defect reconstruction must be selected or combined individually depending on the bone and soft tissue situation.
Case study - Knee replacement
In a 64-year-old female patient, an external O-leg of an external knee total endoprosthesis implantation resulted in a malposition in the thigh. During preoperative diagnosis, a simultaneous periprosthetic infection is detected. In a first operation, the old prosthesis is first removed and an antibiotic-releasing placeholder is used. Furthermore, systemic antibiotics are given to treat the infection. After 14 days, the patient is first mobilized home on two forearm crutches. Four weeks later, a new axle-guided prosthesis is implanted and the thigh axis is simultaneously corrected by a changeover. Due to the earlier infection, six weeks are again given antibiotics. The patient can be mobilized quickly under full load and leaves the clinic again after 14 days.
Knee endoprosthesis: complications due to too many kilos
Overweight patients with a knee endoprosthesis are at an increased risk of complications from a body mass index (BMI) of about 30. They often suffer from wound healing disorders and infections and need to be re-operated more often. From a BMI of 40, the risk of complications increases exponentially. Therefore, the AE - German Society of Endoprosthetics recommends to reduce the body weight for planned prosthesis implantation as long as possible before the procedure. Even better, however, would be to maintain normal weight throughout life, according to the AE. Because too many kilos are one of the main causes of painful arthrosis of the knee joint. Patients are often unaware of this relationship.
Every year around 169,000 knee endoprosthesis are used in Germany. Some of these interventions could be prevented by losing weight. Because: "Being overweight on the knee joints and is one of the main reasons for osteoarthritis," says Prof. Dr. med. Karl-Dieter Heller, Secretary General of the AE and chief physician of the Orthopedic Clinic at the Duchess Elisabeth Hospital in Braunschweig. In addition, the higher the BMI, the faster the painful joint wear progresses. "In overweight, knee osteoarthritis often occurs at a young age," says the specialist in orthopedics and trauma surgery. Even five kilos overweight doubled the risk of developing knee arthrosis, in which the cartilage in the joint wears off.
Over 65 percent of men and more than 50 percent of women between the ages of 18 and 79 are overweight in Germany, according to figures from the Robert Koch Institute. Obesity refers to a BMI of over 25 - that is, a body weight of more than 25 kg / m2 - as obese, who has a BMI over 30. A quarter of adults are obese. The proportion of overweight and obese patients who receive a knee endoprosthesis also increases accordingly. But with the fullness of the body also increases the risk of surgery: "Obesity is often associated with multiple diseases, such as cardiovascular problems in combination with diabetes," says Heller. These underlying diseases weaken the organism and make it more susceptible to complications such as infections. In addition, operative access to the joint, ie the incision size and depth, is greater in the case of obesity and the situation is more confusing. "The precision of the surgical procedure may be impaired," says Heller. A particularly common and lengthy complication are wound healing disorders: "The fat layer is less well supplied with blood and thus also the overlying skin. As a result, the wound edges are undersupplied and can die, so that the wound may no longer close - the breeding ground for infections is thus laid, "Heller continues.
"We therefore recommend our patients to lose weight before a planned prosthetic surgery and do something for general fitness," says Prof. Dr. med. Florian Gebhard, President of the AE and Medical Director of the Department of Trauma, Hand, Plastic and Reconstructive Surgery at the University Hospital Ulm. For untrained obese are very suitable as electric bikes. They protect the joints and help with hills and longer distances. And he adds, "We also advise keeping the new weight for a while before surgery." Because in the phase of losing weight, the risk of complications is also increased.
Despite the risks mentioned above, overweight patients up to a BMI of about 40 benefit from a knee endoprosthesis. "But before that, all conservative options, such as physiotherapy and pain therapy, must be exhausted," emphasizes Heller. Only after that, together with the patient, the pros and cons of an operation should be carefully weighed. If a knee endoprosthesis is unavoidable, Heller advises all, but especially strongly obese patients to go for the procedure in a certified endoprosthetics center (EndoCert certification of the German Society of Orthopedics and Orthopedic Surgery (DGOOC)). And if the surgery is over, it is one of the homework of the patient, the weight regularly to control and stay active: Because the artificial joint benefits from less kilos and well-trained muscles.