Dr. Andreas Ottersbach is a recognized and highly specialized orthopedic surgeon with an international reputation, focusing on hip and knee joint replacement. As Chief Physician of the Orthopedic Clinic at the Oberwallis Hospital Center in Switzerland, he employs minimally invasive techniques and state-of-the-art procedures to implant prostheses with the highest precision while preserving surrounding tissue.
Particularly noteworthy is his pioneering work in Switzerland with the Rapid Recovery™ concept, which accelerates recovery processes after surgery and continuously optimizes workflows. His high level of specialization, especially in endoprosthetics, makes him a sought-after expert, both nationally and internationally. With his passion for innovative procedures, Dr. Ottersbach was a pioneer in introducing intraoperative digitization and navigation control for joint surgery in Switzerland. By utilizing advanced technologies such as the SPI system and infrared-based navigation techniques, he is able to precisely account for his patients’ individual anatomical conditions.
Under his leadership, the clinic in Brig has achieved above-average results in the Swiss implant registry, demonstrating the high quality of care and low revision rate. Dr. Ottersbach’s deep understanding of hip and knee joint anatomy enables him to treat particularly complex cases. He places great emphasis on minimizing hospital stays and recovery time for his patients through minimally invasive procedures. His innovative spirit and constant drive to improve surgical processes make him a leading expert in endoprosthetics.
The editorial team of the Leading Medicine Guide spoke with this specialist in knee endoprosthetics to learn more about patient safety and the optimization of treatment processes.
Knee endoprosthetics is a major advancement in modern orthopedics, offering patients with severe knee joint diseases such as osteoarthritis or rheumatoid arthritis an improved quality of life. In this procedure, the damaged knee joint is replaced with an artificial joint to relieve pain and restore mobility. Thanks to innovative techniques such as less invasive surgery and precise navigation, procedures today are safer and gentler, shortening recovery time and maximizing long-term treatment success. These advancements enable many patients to actively and painlessly return to daily life. Tools to enhance patient safety in knee prosthetics, such as computer-assisted navigation and intraoperative imaging, allow for precise implantation and reduce the risk of complications. Process optimizations, such as standardized treatment pathways and the Rapid Recovery™ concept, accelerate recovery and ensure consistent quality of care through clear protocols.
According to Dr. Ottersbach, computer-assisted navigation systems have made knee prosthetics safer by significantly improving precision during knee implant surgery. These systems work with infrared technology during surgery, eliminating additional radiation exposure for patients and medical staff. Furthermore, imaging techniques such as X-rays, CT scans, or MRIs can be used prior to surgery to determine leg axes or create a three-dimensional model of the knee. The latest developments even allow radiation-free MRI data to be converted into CT equivalents.
“At the Wallis Hospital, we use the Orthopilot system from Braun Aesculap for total knee replacement. I have actually been working with it for 25 years. Over that time, the hardware and software have been continuously improved, and the system has been an established method in orthopedic medicine for more than two decades. This ensures high consistency and safety due to ongoing refinements.
The major advantage of this system is that it not only considers leg axes but also ligament tension, allowing the surgeon at the end of the procedure to determine and achieve the best balance between leg alignment and ligament tension. Navigation provides the surgeon with a wealth of information, which is processed into an individual treatment plan by computer software. The surgeon can intervene with his experience to adjust or confirm the proposed alignments and prosthesis dimensions. Implementation is then carried out with high precision using infrared-based navigation technology. Other conventional systems often focus only on axes, without capturing or considering ligament tensions with such accuracy,” explains Dr. Ottersbach, adding further system specifications:
“The entire navigation is infrared-based, so it works without radiation, which is a significant advantage for patients and staff. Prosthesis sizes are determined through infrared measurements accurate to 0.2 mm. This provides crucial data on the most suitable prosthesis sizes with respect to width, depth, and height, as all three dimensions of the knee joint are captured.” With robotics, these navigation advantages are also utilized, though higher accuracy cannot be expected, since even without a “robotic saw” or “robotic saw holder,” the precision of bone cuts can be verified and adjusted until the desired outcome is achieved.
Important Procedures in the Operating Room
The “Team Time-Out” is an essential part of surgical safety measures across all disciplines and ensures patient safety even before surgery begins.
It is a structured checklist that ensures the entire surgical team—surgeons, anesthesiologists, and nurses—share the same information. Developed as part of the World Health Organization’s (WHO) “Surgical Safety Checklist,” it is mandatory in many countries and aims to minimize errors and complications in the operating room.
“This checklist must be followed as systematically as a pilot checks all systems before takeoff. The patient’s identity is confirmed, along with the correct surgical site, anesthesia method, and availability of the required prostheses. At the Orthopedic Department in Brig, this process is already digitized in real time. Using a foot pedal, the surgeon confirms the sequence of planned surgical steps on a monitor and checks off each action with a click. Preparation of necessary instruments and surgical access is also verified and confirmed step by step. Photos of critical surgical scenes are displayed on the monitor, making it easier for the scrub nurse to provide the required instrument at the right time. The SPI program (Surgical Process Institute Program), combined with the ‘Team Time-Out,’ ensures the highest possible patient safety,” explains Dr. Ottersbach.
Setting Up the Navigation
“For the patient, two transmitters are fixed with screws to the femur and tibia as reference points, which communicate with the navigation device. The device consists of two infrared cameras mounted on a stand with a monitor that displays the data the surgeon enters step by step during the procedure.
It works a bit like “painting by numbers”: The dimensions of the femur are measured from side to side, front to back, and top to bottom, and kinematic measurements help identify the hip and knee centers. At the end, a model of the leg with hip, knee, and ankle centers appears on the monitor, allowing real-time observation of leg alignment—whether straight, knock-kneed, or bowlegged. By applying counterpressure, the system shows in real time and by angle whether a correction is possible.
Without this technology, such precision would not be achievable. At the end of surgery, a digital surgical protocol is generated. We have also found that these systems improve teamwork and the surgical “flow.” Everything works like clockwork. And it doesn’t take long—about 70–75 minutes for navigated knee replacement, which is an excellent timeframe considering the increased patient safety,” notes Dr. Ottersbach.
Additional Measures to Enhance Patient Safety and Treatment Quality Before and After Surgery
Standardized protocols help identify and systematically eliminate potential sources of error. For example, they define which pain medications should be used and how to prevent postoperative complications such as infections and thrombosis. These structured approaches minimize risks that could disrupt recovery and ensure consistently high treatment quality. Overall, patients can return to daily life more quickly. A smooth treatment process, less postoperative pain, and shorter rehabilitation significantly improve patient satisfaction. Moreover, adherence to standardized protocols fosters trust in the care team, as patients see that their treatment is based on evidence-based and proven methods.
The Rapid Recovery™ concept has a major impact on postoperative rehabilitation for knee prosthetics, accelerating recovery, reducing hospital stays, and helping patients return to daily activities more quickly.
A key aspect of this concept is early mobilization, often on the day of surgery. This rapid activation is supported by less invasive techniques and optimized pain management, reducing risks of complications such as thrombosis or infection and promoting healing. Another essential factor is interdisciplinary collaboration between surgeons, anesthesiologists, physical therapists, and nurses, ensuring comprehensive patient care.
“I came to Switzerland in 2005 and shortly thereafter introduced navigation in Brig. The SPI program was implemented in our hospital in 2018, the first in Switzerland. I always try to identify and implement the most effective tools. With the Rapid Recovery concept, an evidence-based approach, we were pioneers in Switzerland as early as 2011. It is an interdisciplinary overall concept aimed at guiding the patient safely and quickly through surgery and ensuring the shortest possible recovery time, so the patient can return home quickly.
To give the surgery an even more relaxed atmosphere, we can sometimes arrange for the patient to walk into the operating room, emphasizing that they are not sick but simply receiving a replacement part. However, this is not a fixed part of the standardized procedure due to logistical reasons. The interdisciplinary approach is so successful because all caregivers involved participate. Another important component of Rapid Recovery is patient education. Each week, experienced surgical assistants give presentations on topics such as prosthetics for knees, hips, spine, and shoulders. Patients scheduled for surgery attend these lectures about two weeks before their own procedure.
An anesthesiologist explains the anesthesia methods, and the ward nurse informs patients about what to expect during their stay. Physical therapists also explain the necessary aids. This way, every patient knows exactly what to expect, enters the hospital with more confidence, and realizes they are not alone. All this provides patients with a strong sense of security,” emphasizes Dr. Ottersbach.
One of the key success factors of the Rapid Recovery™ concept is the significant reduction in hospital stays. Many patients can be discharged after just a few days thanks to optimized processes. Another sign of success is the rapid mobility achieved by patients in the first days after surgery, closely monitored and documented. At the same time, complication rates, especially infections or joint stiffness, are carefully tracked to document care quality, draw conclusions, and continuously improve.
“As for pain reduction after surgery, effective methods have been established for many years. For example, a larger amount of local anesthetic mixed with adrenaline is injected directly into and around the joint. This ensures that the patient is completely pain-free for the first 6–7 hours after surgery, allowing us to begin mobilization during this period. The physical therapist can already help the patient take their first steps without pain.
We also avoid drainage tubes, as they are no longer necessary with today’s gentler surgical methods. This initiates rapid recovery, complemented by a standardized pain management concept that is continuously adapted with new and tested medications—ideally avoiding opioids due to their side effects. We strive to keep patients active—for example, they receive ice cream in the recovery room, which not only brings joy but also provides short-term calories for extra energy during early mobilization.
Generally, patients go home on the third day after endoprosthesis implantation. This differs from Germany, where inpatient rehabilitation is nearly standard—about 90% of patients undergo inpatient rehab, which delays their return to normal life. At our clinic, we have reduced this figure to under 30%, allowing patients to return home more quickly and without compromising treatment outcomes. It truly creates a win-win situation for everyone,” says Dr. Ottersbach about this successful overall concept.
At the Oberwallis Hospital Center, more than 400 hip and knee prostheses are implanted each year, with Dr. Ottersbach personally performing over 200 of them.
Digital process management tools and standardization in the operating room play a critical role in preventing errors and improving patient safety, particularly in knee prosthetics.
A central element of these digital tools is real-time monitoring during surgery. By continuously collecting and analyzing data, potential problems can be identified early, helping to avoid errors.
“The success of this overall approach is reflected in the Swiss endoprosthetics registry, where our results in Brig are particularly strong for knee and hip prosthetics, especially regarding revision surgeries. Concerning anesthesia safety, brain activity is now monitored to ensure better supervision. However, most patients receive spinal anesthesia, which allows them to be awake yet pain-free if they prefer.
Some patients even wish to watch their own operation via a ceiling-mounted camera in the operating room, which can be discussed individually. We also offer a 3D headset for distraction. For those who prefer not to be aware of the procedure, general anesthesia is, of course, available,” says Dr. Ottersbach, highlighting at the end of our conversation:
“For the past two decades, we have voluntarily measured treatment quality by sending patients questionnaires, now also digitally, focusing on Patient Reported Outcome Measures (PROMS). These provide insight into functional outcomes and allow us to make fine adjustments as needed.”
Thank you very much, Dr. Ottersbach, for this in-depth look into your internal procedures and measures taken to ensure patient safety!
