Every surgical incision must heal again. And this healing process works best when the cuts are short and only made where there is no other option. To insert a new hip joint, the incision on the hip is usually much shorter these days, says Dr. Florian Friedrich from the Schön Clinics in Rendsburg and Eckernförde. In the early days of endoprosthetics, the incision was twice as long. In numbers: Today the scar is usually eight to eleven centimeters long, whereas it used to be at least 15 to 20 centimeters.
Stay in hospital significantly shorter
Friedrich is the medical director of endoprosthetics. He and his colleagues insert around 700 artificial hip, knee and shoulder joints every year. These are not just planned procedures to replace a worn joint with an artificial one. The doctors also treat fractures near the joints and replace artificial joints.
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The 44-year-old doctor began his medical studies at a time when conventional surgical methods were increasingly being replaced by minimally invasive ones. Today they are standard, which has many advantages: patients are often back on their feet the day after the operation, complications after an operation are low at well under one percent and hospital stays are significantly shorter: a maximum of one week instead of three weeks.
Dr. Florian Friedrich, medical director of the Joint Center at the Schön Clinic: “We often know down to the millimeter which prosthesis we need.”
Photo: Michael Staudt
This is also made possible by the fact that many incisions have become unnecessary, for example in the case of an artificial hip joint: “The minimally invasive procedure is particularly characterized by the fact that the muscles and soft tissues are no longer cut deep on the way to the joint, but are kept aside,” says Friedrich. This also eliminates a major reason for the high blood loss with the conventional method. Since the muscle tissue is particularly well supplied with blood, the likelihood that blood reserves will be needed increases with every injury in this area. “Today a blood transfusion is an absolute exception.”
The size of the prosthesis is determined exactly beforehand
What does the minimally invasive method mean for the surgeon? “The learning process is long, the method requires more effort and requires great caution,” says Friedrich, “but the result is worth it.” Precise preliminary planning based on x-ray images helps. A computer program helps determine the perfect prosthesis. “We often know down to the millimeter which prosthesis we need.” During the operation, adjustments are made and, if necessary, adjusted. The prostheses have a special surface coating that allows for easy ingrowth.
In order to achieve an optimal result, sawing and hammering are carried out in the operating room. Dr. Friedrich: “It’s purely a craft. But of course we don’t use hardware store tools, but medical saws and hammers that are sterile.” First, the femoral neck is severed, then the damaged old femoral head is removed. In its place comes the first part of the prosthesis, a socket with a polyethylene insert. After this is implanted, the shaft is prepared.
In the operating area of the Schön-Klinik Rendsburg: Dr. Florian Friedrich and his colleagues have a navigation system at their disposal that enables precise positioning of the prosthesis. This system is used in knee operations.
Photo: Michael Staudt
Once this has happened, a test with sample parts follows. This determines whether the installation will be stable so that the joint cannot dislocate. The leg length must also be correct.
If the surgical team is satisfied with the test run, the original prosthesis is unpacked and implanted. The operating area is then thoroughly rinsed to ensure a high level of germ protection. “We also check whether there has been any small bleeding anywhere.” If everything is OK, it will be sewn up.
The type of anesthesia is determined individually
The type of anesthesia depends on the medical requirements, but also on the wishes of the respective patient. General anesthesia is just as established as spinal anesthesia, although you can still be given a sleeping pill to block out the noises and conversations in the operating room. “The anesthesia colleagues advise the patients.” The surgeons also discussed the patients in detail during consultation hours. It will be checked whether the operation is actually necessary and the risks will be explained.
“The hip operation takes around 45 to 60 minutes. “This is where our experience pays off; we do it practically almost every day,” explains the doctor. The patients benefit from this. Dr. Florian Friedrich: “An extremely high level is very satisfied with the result.” This is also for Dr. Friedrich’s greatest motivation: “Being able to help patients live a pain-free life is always a great joy for everyone involved.”
