Prof. Dr. med. Fritz Thorey is a world-renowned expert in hip surgery, knee surgery, hip replacement, knee replacement, sports surgery, sports traumatology and sports orthopedics. His outstanding expertise and impressive experience, with around 800 operations per year, have earned him numerous awards and honors. His skills are particularly sought after in hip and knee arthroplasty. The ATOS Clinic Heidelberg is internationally renowned, not least due to the prestigious “IZO – International Center for Orthopedics”. Here, Prof. Dr. med. Fritz Thorey stands out in particular as an expert in joint replacement surgery. Expectations regarding mobility and sporting activity have changed significantly in recent years, and Prof. Dr. Thorey has played a key role in this. Patients who require a joint replacement today often aspire to more than just the ability to walk pain-free. The editorial team of the Leading Medicine Guide spoke to Professor Dr Thorey specifically on the subject of hip replacement to find out what options are available to affected patients.
Prof. Dr Fritz Thorey has already seen numerous patients who, with prostheses, have developed sporting ambition and devoted themselves to extreme sports. Prof. Dr. Thorey’s impressive medical achievements are the result of his early enthusiasm for orthopedics and trauma surgery during his medical studies, as well as his intensive focus on the field of endoprosthetics. In Heidelberg, he is constantly refining his methods of minimally invasive and muscle-preserving endoprosthetics. This enables even patients with advanced hip and knee osteoarthritis to lead a pain-free, mobile and active life.
However, Prof. Dr Thorey is not only an experienced specialist but also a tireless researcher. He is constantly optimizing medical procedures, such as the use of bone-preserving implants, bearing surfaces in the hip and knee joints, robot-assisted endoprosthetics and customized implants. His team supports him in driving forward innovations in orthopedic surgery and sports medicine. Despite his impressive experience, Prof. Dr Thorey ensures that his operations never become routine. Every year, he performs around 800 procedures, some of which are complex, always with a watchful eye and a commitment to further optimizing medical procedures.
Hip joint problems are usually caused by cartilage degeneration.
Cartilage loss in the hip can be caused by various factors that lead to damage or loss of cartilage tissue. With increasing age, cartilage naturally wears down as the body’s ability to produce new cartilage decreases. This age-related cartilage loss is known as degenerative joint disease or osteoarthritis.
Frequent and repeated strain or overuse of the hip can also lead to premature cartilage degeneration. This can occur in people working in certain occupations that require repetitive movements, or in athletes who place excessive strain on their hips. Injuries such as fractures, dislocations or cartilage damage caused by trauma can affect the cartilage in the hip and lead to accelerated degeneration. Similarly, inflammatory conditions such as rheumatoid arthritis or hip joint inflammation can damage the cartilage and accelerate its degeneration.
And last but not least, congenital malformations or misalignments of the hip, such as hip dysplasia or femoroacetabular impingement (FAI), can lead to uneven stress on the cartilage and promote its degeneration. We would now like to take a closer look at the latter factor and discuss it with Professor Dr Thorey.
Femoroacetabular impingement (FAI)
“Femoroacetabular impingement (FAI) is caused by abnormal bone growth formations on the joint surfaces of the femoral head (femur) and/or the hip socket (acetabulum). These abnormal bony growths can prevent the femoral head and the hip socket from moving smoothly, causing them to collide or ‘get stuck’ against each other during movement (impingement). There are three types of FAI. In the so-called cam type, the femoral head is not perfectly round, but slightly flattened or irregularly shaped. This can lead to restricted movement. In the pincer type, the hip socket overlaps too far over the femoral head, which can lead to restricted mobility. In the mixed type, both the cam and pincer types are present,” explains Prof. Dr Thorey at the outset of our conversation, adding: “The diagnosis of FAI is usually made through a combination of clinical examinations, imaging techniques such as X-rays or MRI, and, if necessary, an arthroscopic examination of the hip joint. This makes it possible to assess the structure of the hip joint more accurately and to identify abnormal shapes or bone changes.”
Femoroacetabular impingement (FAI) vs. hip dysplasia
FAI (femoroacetabular impingement) and hip dysplasia are two different conditions affecting the hip joint. Femoroacetabular impingement is an abnormal shape of the hip joint in which either the head of the thigh bone (femur) or the hip socket (acetabulum) is not correctly formed. This restricts the normal mobility of the hip joint and can lead to pain and damage to the surrounding tissue structures. FAI can be caused by genetic predisposition or acquired factors. Hip dysplasia is a congenital malformation of the hip joint in which the hip socket is underdeveloped. As a result, the femoral head does not fit properly into the hip socket, which can lead to instability and an increased susceptibility to dislocation. Hip dysplasia often occurs at birth or in early childhood.
“In FAI, there is a collision between the femoral head and the hip socket during certain movements, which can lead to pain, inflammation and potentially damage to the articular cartilage, the labrum (hip joint rim) or the surrounding tissue. In hip dysplasia, the hip joint is unstable because the femoral head is not correctly positioned in the hip socket. “This can lead to premature wear of the joint cartilage, hip pain, restricted movement and the development of osteoarthritis,” explains Prof. Dr Thorey, outlining the differences.
Patients come to Professor Dr Thorey when their hip is already causing them pain.
“The initial symptoms of FAI can vary, but typically pain occurs in the groin or hip area. The pain can worsen with certain movements or activities, such as walking, running, bending over or sitting for long periods. If left untreated, FAI can lead to further damage to the hip joint, such as the development of hip osteoarthritis, which is why treatment as soon as possible is recommended,” explains the hip and knee specialist.
With regard to treatment options for FAI, there are both conservative and surgical options. The choice of treatment depends on the severity of the symptoms, the extent of structural changes and the patient’s individual needs. “Taking non-steroidal anti-inflammatory drugs (NSAIDs) can help to relieve pain and inflammation, and targeted exercises to strengthen the surrounding muscles and improve mobility can also be helpful. In addition, corticosteroids can be injected, which may provide temporary pain relief. Ultimately, however, surgery is usually the final option. In a minimally invasive procedure, a tiny camera (arthroscope) is inserted into the hip joint via small incisions. Abnormal bone structures can be corrected, inflamed tissue removed and, if necessary, the labrum of the hip joint repaired. In advanced cases where other measures are not sufficiently effective, a hip replacement may be necessary,” explains Prof. Dr Thorey, outlining the treatment options.
Many people are very apprehensive about hip surgery
Of course, it is never a pleasant prospect when surgery is on the cards. But people are often particularly sensitive when it comes to the hip – after all, the hip is not a small bone, and one might imagine the procedure to be particularly daunting. Here, Prof. Dr Thorey can reassure patients: “Fortunately, for some time now we have been able to perform hip surgery using minimally invasive techniques. In this context, minimally invasive primarily means that the muscle tissue is spared during the operation, which in turn leads to a faster recovery for the patient. As a rule, a patient who has undergone surgery is at least able to stand on their feet on the very day of the operation. That used to be unthinkable! Patients often spent the first three weeks confined to their hospital beds,” says Prof. Dr Thorey encouragingly.
There are several steps that anyone can take to protect the cartilage in the hip and promote the overall health of the hip joint.
“Regular, low-impact exercise, such as swimming, cycling or yoga, can boost blood circulation, strengthen the muscles and improve joint stability. This helps to relieve pressure on the hip joints and keep the cartilage healthy. Being overweight can also increase the strain on the hip joints and lead to faster wear and tear of the cartilage. Every kilo counts! I often explain to patients that they should imagine carrying a box of water. That weighs about 8 kilos. So if those 8 kilos are missing, that’s quite a lot.
A balanced diet with sufficient intake of vitamins, minerals and antioxidants can help keep the cartilage healthy. Dietary supplements can be helpful. The main focus here is on the active ingredients glucosamine and chondroitin, which are said to help maintain cartilage. But as always, what we take from nature is ultimately the best. “He who heals is right, as the saying goes,” explains Prof. Dr Thorey, adding: “Excessive strain on the hip joints, such as standing for long periods, heavy lifting or high-intensity training, can of course also lead to cartilage wear.
It is important to take breaks, avoid putting excessive strain on the hips and listen to your body. Whether training or carrying out everyday activities, it is important to ensure your movements are gentle on the joints. Avoid excessive jumping, hard landings or abrupt twisting movements that could strain the hip joints, and also ensure good posture to avoid unnecessary pressure on the hip joints.” It is important to note that while these measures can support the health of the hip joints, they cannot prevent all types of hip problems or conditions.
Top-class care at the ATOS Clinic in Heidelberg
“We have the advantage of being able to offer maximum specialization within the ATOS Clinic. I myself, for example, only operate on hips and knees. I perform around 500 hip operations and around 300 knee operations every year. Doctors and specialists from various fields, such as orthopedics, radiology, physiotherapy and rehabilitation, work closely together to ensure comprehensive and individually tailored treatment. The patient’s well-being is the focus, and great importance is placed on individual consultation, information and care. Treatment is carried out in close consultation with the patient to achieve the best results,” explains Prof. Dr Thorey, outlining the advantages of the ATOS Clinic in Heidelberg.
“As far as research and progress are concerned, there is certainly still room for improvement. We can already grow cartilage, but it doesn’t work quite so well for the hip, as it’s really difficult to grow femoral heads,” notes Prof. Dr Thorey, before enthusiastically recounting the story of his oldest patient to date. “My oldest patient was 97 years old, but had a biological age of perhaps 73. He was a sprightly chap, ran 10 kilometres every day and was simply fit. I gave him a new hip; he was back on his feet after five days and only needed outpatient rehabilitation. It’s great to see something like that! So it’s important to look after your own fitness and general health – then you always have the best options,” concludes Prof. Dr Thorey.
Professor Dr Thorey, thank you very much for these fascinating insights!
