Orthopaedics in Germany

Orthopaedic oncology:

• CT-guided biopsy;
• bone and soft tissue tumours;
• joint replacement for tumours;
• treatment of spinal injuries and disorders with minimally invasive and endoscopic techniques;
• treatment of injuries of the hand and their sequelae;
• reconstructive surgery after complex limb injuries, including bone and soft tissue reconstruction and nerve grafting;
• reconstructive joint surgery, primarily of the knee, ankle and shoulder joints (arthroscopy and joint replacement);
• integrated rehabilitation programmes;
• management of periprosthetic infections by simultaneous removal of the old prosthesis and implantation of a new one (one-stage prosthesis exchange: the old implant is removed and the new one fitted during a single operation);
• joint surgery, including primary replacement of the hip, knee and shoulder joint;
• minimally invasive surgery;
• cartilage therapy, including autologous chondrocyte implantation using the matrix-induced autologous chondrogenesis technique;
• arthroscopic surgery of the shoulder, knee, ankle and elbow joints;
• therapy and surgery of the cartilage and the cruciate ligament;
• joint-preserving knee surgery;
• axis correction;
• foot surgery;
• bone lengthening and deformity correction;
• treatment of pseudarthrosis (non-union);
• orthopaedics that preserves joint mobility;
• malunited and non-united bone fractures;
• sequelae of complex fractures of the limbs, spine and pelvis and of complex joint injuries;
• spinal cementation (kyphoplasty and vertebroplasty);
• septic orthopaedics;
• spinal surgery and spinal orthopaedics;
• orthopaedic rheumatology;
• sports medicine;
• orthopaedic oncology (soft tissue and bone tumours);
• revision surgery to replace hip, knee and shoulder prostheses
• complete or total joint replacement);
  
• a wide range of modern implants for primary and revision arthroplasty (modern implants including short-stem prostheses, ceramic tribological pairings, Oxinium);
• implantation of custom-made iFit® prostheses from ConforMIS®;
• the full
  range of biological reconstructions, for example for joint replacement in tumour disease, partial replacement of the pelvis and so on;
• hemiarthroplasty (unipolar replacement) of the hip joint;
• treatment of infectious inflammation of the joints, including artificial joints;
• surgical debridement of infected joints;
• radiofrequency ablation of the spine;
• outpatient operations (for example, minimally invasive carpal tunnel release);
• acupuncture;
• trigger point therapy (osteopathy);
• chirotherapy (manual therapy);
• physiotherapy:
• non-contact hydromassage baths;
• spinal traction (TESI traction system);
• ultrasound therapy;
• extracorporeal shock wave therapy (ESWT);
• magnetic field therapy;
• laser therapy.
• kinesiology taping;
• treatment of osteoarthritis with hyaluronic acid preparations;
• treatment of osteoarthritis and other injuries of the muscles, tendons and ligaments with autologous
• conditioned plasma (ACP);
• treatment of osteoporosis (osteology);
• professional fitting of orthopaedic insoles;
• medical training therapy;
• special therapeutic exercise in the postoperative period.

Spinal surgery:

• intervertebral disc replacement and disc surgery;
• degenerative diseases;
• spinal deformities (scoliosis, kyphosis, spondylolisthesis);
• fractures;
• tumours and inflammation.

Operations that preserve mobility in the knee and hip joint:

• pelvic osteotomy;
• treatment of subacromial impingement syndrome;
• surgery to correct deformities of the joints and bones;
• arthroscopic and minimally invasive joint surgery;
• bone and cartilage transplantation.

Shoulder surgery:

• treatment of subacromial impingement syndrome;
• rotator cuff of the shoulder;
• shoulder instability.

Foot and ankle surgery:

• forefoot surgery;
• the Achilles tendon;
• corrective osteotomies and arthrodesis;
• bone and cartilage transplantation;
• diabetic foot.

Paediatric orthopaedics:

• hip joint disorders in children;
• foot deformities;
• patellar dislocation;
• axis correction;
• surgical leg lengthening.

Orthopaedic oncology:

• CT-guided biopsy;
• bone and soft tissue tumours;
• joint replacement for tumours.

Specialised (minimally invasive) spinal procedures:

• periradicular therapy (PRT), transforaminal and facet joint injections;
• radiofrequency therapy, denervation (pulsed and non-pulsed);
• epidural catheter therapy, neurolysis;
• intradiscal catheter therapy (IDET, decompression catheter, nucleoplasty, Dekompressor);
• denervation (methylene blue).

Specialised (minimally invasive) joint procedures:

• lavage of the joint cavity with distension of the joint capsule;
• needling;
• pulsed radiofrequency therapy;
• denervation;
• infiltration (hyaluronic acid, PRP therapy using platelet-rich plasma, Orthokine autologous blood therapy).

Treatment of headaches and migraine:

• denervation of the occipital nerve and the facet joint;
• Botox therapy;
• infiltrations;
• acupuncture.

• coxarthrosis (hip osteoarthritis);
• ankle joint injuries;
• knee joint injuries;
• shoulder joint injuries;
• skeletal deformities;
• bone cancer;
• paraplegia;
• paediatric orthopaedics;
• non-union (pseudarthrosis) of the femur;
• degenerative diseases of the bones, cartilage and joints;
• impingement syndrome (compression of the shoulder rotators) and rotator cuff tears;
• spinal disorders;
• herniated intervertebral disc;
• sports injuries;
• treatment of osteoarthritis (gonarthrosis, coxarthrosis, osteoarthritis of the shoulder and ankle joints);
• interventional pain therapy;
• frozen shoulder syndrome (adhesive capsulitis);
• rheumatism;
• osteoporosis;
• foot deformities, including hallux valgus;
• paediatric orthopaedics;
• spinal canal stenosis;
• treatment of sacroiliac joint pain;
• treatment of nerve pain (neuropathic pain).

Hip replacement:

• primary total replacement (for fracture, osteoarthritis and necrosis of the femoral head);
• secondary total replacement / revision arthroplasty (for loosening of the prosthesis, after infection, or in cases of pronounced bone defects of the femur or pelvis);

Knee replacement:

• primary unicompartmental (partial) replacement for osteoarthritis;
• primary total replacement for osteoarthritis;
• repeat total replacement (after an unsuccessful primary
• replacement, loosening of the prosthesis, after infection or in cases of pronounced bone defects of the femur or lower leg).

Osteoarthritis

One of the most common causes of joint pain and restricted joint movement is natural wear and tear.

This wear often results from a combination of several causes. After a consultation with the doctor, a physical examination and imaging diagnostics (ultrasound, X-ray, magnetic resonance imaging, computed tomography), most patients are first advised to undergo conservative treatment. Fitting an artificial joint to reduce or eliminate the pain is the last step offered to the patient, when conservative treatment has proved ineffective.

Replacement of the large joints is a priority field of German orthopaedics. The implants and models used are selected for each patient according to their individual data. German specialists work exclusively with the world's leading manufacturers and with the most modern and reliable implants. Their aim is to bring patients back to everyday life and to improve it.

A variety of implants is used for hip replacement, including short-stem prostheses. They are fixed without cement, although everything depends on the quality of the bone. Sometimes partially cemented prostheses are implanted and, in very rare cases, fully cemented components.

Knee replacement covers both partial resurfacing of the joint surface (the "sledge" prosthesis) and complete resurfacing of the joint surface with axial stabilisation (the "linked" or constrained prosthesis).

The stay in the hospital department is usually 8-12 days. This is followed by 3 weeks of inpatient or outpatient rehabilitation.

Revision arthroplasty

Artificial joints, however, are also subject to wear or loosening depending on the various loads placed on them (body weight, sport, activity, occupational strain, bone quality, concomitant diseases, injuries, the quality of the first implantation). As life expectancy increases and the number of people living with joint implants grows, the number of patients in our department with worn artificial joints and other bone tissue defects is rising noticeably.

This creates a need for partial or complete replacement of the implants, which often involves highly complex operations, including building up and stabilising the bone defect by means of bone grafting, using additional constructs with special modular components, titanium augments, and support plates and cups.

Compared with standard primary joint replacement, revision operations are as a rule more difficult and complex and carry a higher risk of complications, which is why they should be performed before bone defects develop. Here, too, timely surgery is the key to success.

Range of conditions:

• fractures of the spine;
• instability of the ligaments and discs in various segments of the spine;
• post-traumatic curvature of the spine;
• tumour disease of the spine.

Methods of treating spinal disorders:

• conservative treatment with physical exercise;
• dorsal techniques (internal fixation, decompression surgery);
• ventral techniques (minimally invasive thoracoscopic reconstruction and stabilisation of the vertebrae from TH3 to L3);
• kyphoplasty.

Surgical treatment of spinal disorders includes:

• microdiscectomy for a lumbar disc herniation;
• minimally invasive selective bony decompression for stenosis of the lumbar spinal canal;
• dorsoventral stabilisation and bony decompression for multisegmental stenosis of the lumbar spinal canal;
• treatment of osteoporotic spinal fractures using special minimally invasive stabilisation techniques (kyphoplasty of the vertebral bodies);
• minimally invasive dorsal stabilisation with additional cementation where necessary;
• minimally invasive dorsal stabilisation of the spine for spinal metastases that threaten its stability.

The orthopaedic clinics and departments treat:

• degenerative disorders of the lumbar spine, by conservative and surgical methods;
• osteoporotic fractures of the thoracic and lumbosacral spine; spinal damage caused by tumours.

If conservative therapy proves unsuccessful, surgical treatment is indicated. Today, spinal operations are among the standard forms of medical treatment. The decision to operate is explained by the doctor in detail and accurately on the basis of the clinical picture and the results of radiological examinations, with a full description of the course of treatment and of the possible risks associated with the operation.

Microdiscectomy

Microdiscectomy is indicated in acute forms of lumbar radiculopathy (sciatica) with a clinically confirmed dermatomal pattern, combined with possible neurological deficits (motor and sensory), and in chronic pain syndrome. A diagnosis of "herniated intervertebral disc" requires radiological examination. In our department the standard method is open microsurgery performed with an operating microscope. To minimise complications during the operation, the patient is placed in a special perioperative position. The stay in the hospital department for this procedure is usually 5-7 days. After the operation certain rules of behaviour must be observed; the patient is informed about them in advance.

Minimally invasive selective bony decompression and stabilising operations on the lumbar spine

Another cause of lumbar sciatica may be degenerative lumbar stenosis of the spinal canal (narrowing of the spinal canal). If conservative therapy has proved ineffective, surgical treatment using selective bony decompression (widening of the spinal canal) is possible.

In most cases these operations are performed minimally invasively, using an operating microscope and special positioning cushions.

Where existing multisegmental lumbar stenosis of the spinal canal has led, through wear, to instability of the spine, selective bony decompression is often not sufficient. In such cases multisegmental decompression is combined with stabilisation of the spine using internal fixation, with additional reinforcement of the ventral (anterior) column by an intracorporeal cage (a spacer between the bodies of adjacent vertebrae). Thanks to an optimised surgical workflow and the appropriate instruments, anterior stabilisation can in most cases be achieved from the dorsal side (from the back) within a single operation.

Arthroscopic surgery of the shoulder joint:

• stabilisation after shoulder dislocation;
• reconstruction of the acromioclavicular joint;
• surgical treatment of compression of the shoulder rotators (subacromial decompression;
• resection of the acromioclavicular joint) in subacromial impingement syndrome.

Open operations on the shoulder joint:

• reconstruction of the rotator cuff;
• stabilisation after shoulder dislocation;
• displacement osteotomy of the proximal humerus;
• reconstruction of the acromioclavicular joint;
• tenodesis of the tendon of the long head of the biceps;
• stabilisation of fractures of any kind in the shoulder region.

The foot is a highly complex structure: hard-wearing and stable, flexible and at the same time sensitive. Although it consists of many individual elements, the foot is able to transmit information quickly and precisely about the surface it is resting on when we walk or stand. Among the most common conditions are deformities of the metatarsus and the toes. These are not only a cosmetic defect but are also very painful. Foot surgery therefore aims to restore the natural, pain-free function of the foot.

Common conditions of the metatarsus

The most common conditions are deformities of the metatarsus and the toes, such as hallux valgus and hallux rigidus. Hallux valgus deformities are not only a cosmetic defect but are also very painful. As a rule, hallux valgus is accompanied by progressive osteoarthritis, which can be halted by foot surgery. In most cases the joint can be preserved during hallux valgus surgery.

Common types of deformity such as claw toe, splayfoot, plantar fasciitis and Haglund's deformity can today be treated with comparatively gentle surgery.

Types of corrective surgery and postoperative treatment

Hohmann procedure

Indication for surgery: rigid claw toe or hammer toe deformity.

Principle: resection of the heads of the proximal phalanges of the lesser toes and temporary fixation with a Kirschner wire.

Postoperative treatment: a special orthopaedic shoe to offload the forefoot (the so-called "Frankfurt shoe") is worn for 2 weeks, after which the wire and the sutures are removed.

Weil osteotomy

Indication for surgery: metatarsalgia.

Principle: shortening and elevating osteotomy of the metatarsal head, fixation with a snap-off screw.

Postoperative treatment: a special orthopaedic shoe to offload the forefoot (the so-called "Frankfurt shoe") is worn for 4 weeks; the sutures are removed after 14 days.

Chevron procedure / chevron osteotomy

Indication for surgery: hallux valgus with a stable first tarsometatarsal joint and an intermetatarsal angle between the first and second metatarsals of less than 15°.

Principle: V-shaped osteotomy of the head of the first metatarsal with lateral displacement and possible plantarisation, fixation with compression screws.

Postoperative treatment: a special orthopaedic shoe to offload the forefoot (the so-called "Frankfurt shoe") is worn for 6 weeks; the sutures are removed after 14 days.

"Scarf" osteotomy / Scarf osteotomy

Indication for surgery: hallux valgus with a stable first tarsometatarsal joint and an intermetatarsal angle between the first and second metatarsals of more than 15°, mainly juvenile hallux valgus.

Principle: Z-shaped osteotomy of the shaft of the first metatarsal with lateral displacement and possible plantarisation, fixation with cortical screws.

Postoperative care: a special orthopaedic shoe to offload the forefoot (the so-called "Frankfurt shoe") is worn for 8 weeks; the sutures are removed after 14 days.

Akin osteotomy / open wedge osteotomy

Wedge osteotomy of the proximal phalanx of the great toe in mild hallux valgus. Indication for surgery: hallux valgus with a stable first tarsometatarsal joint and an intermetatarsal angle between the first and second metatarsals of more than 15°, mainly juvenile hallux valgus.

Principle: V-shaped osteotomy of the shaft of the first metatarsal with a lateral wedge cut through the cortical bone in order to correct the intermetatarsal angle, fixation with an angular stable plate.

Postoperative care: a special orthopaedic shoe to offload the forefoot (the so-called "Frankfurt shoe") is worn for 8 weeks; the sutures are removed after 14 days.

Corrective arthrodesis of the first tarsometatarsal joint / Lapidus arthrodesis

Indication for surgery: hallux valgus with an unstable first tarsometatarsal joint and an intermetatarsal angle between the first and second metatarsals of more than 15°.

Principle: arthrodesis of the first tarsometatarsal joint with reduction into the anatomical position, fixation with an angular stable plate.

Postoperative care: a special orthopaedic shoe to offload the forefoot (the so-called "Lüneburg shoe") is worn for 8 weeks; the sutures are removed after 14 days.

Cheilectomy

Indication for surgery: grade I osteoarthritis of the first metatarsophalangeal joint

Principle: wedge resection of the exostosis at the metatarsophalangeal joint of the great toe

Postoperative treatment: the sutures are removed after 14 days

Hemiprosthesis of the head of the first metatarsal

Indication for surgery: grade I-II osteoarthritis of the first metatarsophalangeal joint

Principle: hemiprosthesis of the head of the first metatarsal

Postoperative treatment: a special orthopaedic shoe to offload the forefoot (the so-called "Lüneburg shoe") is worn for 8 weeks, the sutures are removed after 14 days, and early mobility exercises are performed to preserve joint movement.

Arthrodesis of the metatarsophalangeal joint of the great toe

Indication for surgery: grade II-III osteoarthritis of the first metatarsophalangeal joint.

Principle: arthrodesis of the first metatarsophalangeal joint, fixation with 2 crossed compression screws.

Postoperative treatment: special orthopaedic footwear to offload the forefoot (the Lüneburg shoe) is worn for 8 weeks; the sutures are removed after 14 days.

Outpatient hand surgery covers, alongside minor elective procedures such as:

• treatment of nerve compression syndromes;
• treatment of tenosynovitis;
• treatment of Dupuytren's contracture;
• wrist arthroscopy;
• denervation operations and others.

also the surgical treatment of injuries requiring urgent intervention. These include, for example, simple fractures of the fingers and metacarpals, and damage to joint capsules, ligaments, tendons and so on.

Wrist joint:

• arthroscopic surgery of the wrist joint;
• displacement osteotomy of the distal radius;
• stabilisation of any fracture of the hand skeleton;
• tendon surgery;
• soft tissue surgery.