Prof. Dr. med. habil. Klaus-Peter Günther is an outstanding orthopedic surgeon and hip specialist who works at the Carl Gustav Carus University Hospital in Dresden, part of the Technical University of Dresden. With his many years of experience and extensive expertise, he enjoys an excellent reputation in Saxony and beyond.
Prof. Dr. Günther specializes in particular in hip surgery and hip replacement. He is the Executive Director of the University Center for Orthopedics, Trauma, and Plastic Surgery in Dresden and leads a highly qualified team of specialists and orthopedic surgeons. Prof. Dr. Günther’s specific areas of treatment include primary joint replacement for diseases and the consequences of injuries, revision joint replacement for loosening and complications, arthroscopic procedures as minimally invasive treatments, and corrective measures for misalignments and joint problems.
His department has been recognized as a Maximal Care Endoprosthetics Center, which guarantees the highest quality and treatment standards. As the senior lead surgeon, Prof. Dr. Günther personally performs these endoprosthetic procedures, thereby ensuring first-class care for his patients. His clinical and scientific focus includes complex hip arthroplasty, health services research on joint replacement, and hip surgery aimed at preserving joint function. As a professor of orthopedics, he trains future medical professionals and is actively involved in various professional societies.
With numerous professional publications and many years of experience, Prof. Dr. Günther contributes significantly to the advancement of orthopedics and sets standards in hip surgery. His dedication and expertise have helped make the Carl Gustav Carus University Hospital in Dresden one of the best hospitals in Germany. The editorial team at Leading Medicine Guide wanted to learn more about hip replacement and the options available for joint-preserving surgeries, so they spoke with hip specialist Prof. Dr. Günther.
Hip osteoarthritis is a degenerative joint disease that is often accompanied by pain, limited mobility, and a reduced quality of life. In advanced stages, hip replacement surgery may be necessary to restore the joint’s function. However, a prosthesis is not always the only solution—especially in the early stages, joint-preserving hip surgery can offer alternative treatment options to promote the preservation of the natural hip joint and maintain mobility. Conservative (non-surgical) treatment methods are available throughout the entire course of the disease.
For patients with hip osteoarthritis, there are a variety of non-surgical treatment options that can help alleviate symptoms and improve quality of life.
Non-surgical approaches aim to reduce pain, improve mobility, and slow joint wear. “Conservative treatment options are now also included in the guidelines of professional societies for the use of artificial hip joints, known as S3 guidelines (which represent the highest scientific quality). Therefore, before surgery is performed, various conservative measures must be evaluated and exhausted. These include drug therapies combining pain relievers and anti-inflammatory medications such as diclofenac, ibuprofen, and so-called COX-2 inhibitors (nonsteroidal anti-inflammatory drugs). Another key pillar is physical therapy and exercise therapy to strengthen the body, improve mobility, and build muscle strength. These two central elements must have been thoroughly evaluated before an artificial hip joint is implanted. Another important aspect is providing the patient with information and counseling. The better informed the patient is, the more successful the treatment will be. Therefore, discussions about the various treatment options are of the utmost importance. This also includes discussions about optimizing body weight. Patients who are overweight (with a BMI of 30 or higher) should reduce their weight; while this can be difficult due to joint pain, it is possible thanks to effective conservative treatments and, in cases of extreme obesity, successful surgical options such as gastric sleeve surgery. Weight loss can reduce the complication rate associated with hip replacement surgery. The higher the BMI, the greater the risk profile. After weight loss, patients are advised on occupational and recreational activities. For example, high-impact movements (such as most ball sports) should be avoided, while gliding and low-impact movements (such as swimming or cycling) are preferable. The use of a walking aid or cane is also discussed with the patient as a means of support to relieve pressure on the affected leg. “All of these conservative measures must be evaluated and tested over a period of three months before a hip replacement is considered as a treatment option,” explains Prof. Dr. Günther at the beginning of our conversation.
The decision between joint-preserving measures and hip replacement in the treatment of hip osteoarthritis requires careful consideration of each patient’s individual circumstances.
Joint-preserving hip surgery aims to preserve the natural joint structure and extend the lifespan of the patient’s own hip joint, whereas hip replacement involves the implantation of an artificial hip prosthesis to replace the damaged joint. For patients who are candidates for joint-preserving procedures, various factors are decisive. Prof. Dr. Günther explains: “Joint-preserving surgery is primarily an option for younger patients (generally no older than 40–50 years) as well as patients who do not yet have significant osteoarthritis. There is a classification of osteoarthritis stages based on X-ray images, ranging from grades 1 to 4. Joint-preserving surgery is only an option for grades 1 and 2. A prerequisite for joint-preserving surgery is the presence of reparable damage. This includes, for example, hip dysplasia, where surgical realignment can be performed, or hip impingement, where deformities of the femoral head and acetabulum can be corrected. “For patients with severe osteoarthritis (Grades 3–4) and for older patients with advanced damage, joint-preserving surgery is no longer an option.”
In cases of advanced joint damage—particularly in middle-aged and older adults—and when conservative treatment has been exhausted, patients very often benefit from hip replacement surgery. When indicated appropriately, this procedure can relieve pain, improve mobility, and significantly enhance quality of life. Both joint-preserving hip surgery and hip replacement carry procedure-specific risks. In addition to the general surgical complications that can occur with any procedure, additional procedure-specific problems—such as progressive cartilage damage in joint-preserving surgeries and implant-related complications in hip replacement—can limit the outcome.
Over the past few decades, hip arthroplasty has undergone impressive development, with numerous innovative techniques and advances introduced to extend the lifespan of hip prostheses and improve postoperative outcomes for patients.
“As far as progress in hip replacement surgery is concerned, three major areas can be identified. First, implant materials and designs have improved. Among other things, this involves greater wear resistance of the bearing surfaces. For example, ultra-high-density polyethylene is typically used for acetabular cups and ceramic for femoral heads, though ceramic-on-ceramic bearing combinations are also possible. Bone-sparing short stems are also becoming increasingly common. The second major area is a tissue-sparing surgical technique that has developed over the past 10–20 years and is mastered and applied by approximately half of all surgeons in Germany. Thanks to less invasive surgical procedures, few or no muscles need to be cut to implant a hip replacement. The third major topic is accelerated and optimized recovery. Here, concepts are applied that are referred to by English terms such as “Fast-Track” or, more accurately, “Enhanced Recovery.” This includes, among other things, patient education programs provided prior to surgery. For example, an informational video is shown to educate patients, and preoperative physical therapy is provided. Of great importance are an optimized form of anesthesia and pain management coordinated with the anesthesiology team. In addition, avoiding the use of a urinary or wound catheter after surgery promotes faster mobilization and, consequently, recovery. Blood-saving measures during surgery and having the patient get out of bed early after surgery also accelerate recovery. All of this contributes to higher patient satisfaction, less pain, and a shorter hospital stay, which can gradually be reduced to 3–4 days. In some hospitals, following the example of Anglo-American and Scandinavian countries, there is an emerging trend toward outpatient endoprosthesis surgery. “This development will also become increasingly prevalent in Germany,” explains Prof. Dr. Günther, who also addresses the durability of the implants:
“Due to greatly improved wear resistance, the durability of the implants has now increased significantly. This has also been demonstrated in laboratory tests and long-term clinical studies. However, the need for implant replacement surgery may not only result from material wear but can also be attributed to three additional factors. First, there is the potential for infection of the artificial joint; second, mechanical complications (such as dislocation); and third, bone fractures (such as a femoral fracture). These factors can occur immediately after the placement of an artificial joint, but also later on, and may then necessitate a revision surgery. Taking into account a decreasing failure rate due to wear of the bearing surfaces, the survival rate of implants today is approximately 95% after 10 years and still 80–90% after 20 years.”
Advances in diagnostic imaging, particularly through techniques such as magnetic resonance imaging (MRI) and computed tomography (CT), have had a significant impact on the treatment of hip osteoarthritis and the planning of surgical procedures.
These imaging techniques provide a detailed view of the anatomical structures of the hip joint, including the cartilage, bones, soft tissues, and surrounding muscles. This enables orthopedic surgeons to make more precise diagnoses and, in particular, to classify complex deformities. “Neither an MRI nor a CT scan is required for the diagnosis of hip osteoarthritis alone (especially since the latter also exposes the patient to additional radiation). An X-ray is generally sufficient for making a decision regarding hip osteoarthritis and determining the indication for surgery. For joint-preserving surgeries, an MRI is performed beforehand to classify the often complex deformities and enable surgical planning,” Prof. Dr. Günther explains.
There are conflicting views regarding robot-assisted hip surgery.
“There is a tendency to overestimate the benefits of robotic assistance. The potential benefits for hip and knee surgeries that are supposed to result from this have not yet been definitively proven. In any case, the use of a robot incurs additional costs, and the duration of the surgery is often longer due to the necessary pre-calibration of the robot. Radiation exposure may also be higher if a CT scan is required when using a robot. Regardless of the fact that hospitals also use robotic assistance to attract patients, I believe it makes sense to further investigate the potential applications and benefits of robotic technology. This applies not only to examining how the placement accuracy of implants can be improved, but above all to the long-term effect on implant longevity and patient satisfaction. Therefore, it is entirely legitimate to consider robotic technology in order to further optimize the future conditions for successful joint replacement surgeries. “However, robotic technology is not yet necessary for routine use,” Prof. Dr. Günther points out critically.
Lifestyle factors play a significant role in the prevention of hip osteoarthritis and can have a considerable influence on whether or not someone will develop this condition over the course of their life.
Weight management, physical activity, and nutrition are the main areas patients can focus on to reduce their risk of hip osteoarthritis and promote joint health. “Osteoarthritis is always multifactorial. This includes, for example, genetic predisposition. You can’t prevent this. But for other risk factors, preventive measures can be taken. This starts with parents having an ultrasound of their child’s hips performed after birth to check the quality of the joints. If so-called hip maturation disorders are detected, they can then be treated accordingly. In cases of hip conditions that are considered risk factors for later hip osteoarthritis—such as hip dysplasia or hip impingement—one would assess whether joint-preserving surgery should be considered to slow the progression of osteoarthritis. And ultimately, of course, factors such as weight, exercise, and diet also play a role. Maintaining a healthy weight is crucial, as being overweight or obese can increase the risk of hip osteoarthritis. Excess body weight puts strain on the hip joints and can lead to accelerated cartilage wear. Patients can manage their weight through a balanced diet and regular physical activity that includes gliding movements beneficial for the hips (e.g., cycling, swimming). A diet rich in fruits, vegetables, whole grains, and lean protein—while limiting the consumption of sugary drinks, processed foods, and saturated fats—can help maintain or achieve a healthy weight. We know that a predominantly plant-based and Mediterranean diet is more beneficial for the joints than a high meat intake. Our Dresden Hip School offers a wealth of information on the topic of “lifestyle factors,” which I highly recommend. For example, it also explains that eating certain types of fish can help protect against osteoarthritis. There are also various articles on the topic of the hip available there,” recommends Prof. Dr. Günther regarding preventive measures. In addition to these lifestyle factors, patients should also take care to avoid hip injuries by warming up properly before sports and physical activities and wearing protective gear when appropriate.
Top-Notch Care at Dresden University Hospital!
“Here at Dresden University Hospital, we perform a very high number of joint-preserving surgeries and also have a high volume of joint replacement surgeries—approximately 1,000 per year. Of these, approximately 400 are performed due to wear and tear, approximately 200 due to femoral neck fractures, and the remainder due to necessary revision surgeries,” emphasizes Prof. Dr. Günther. A hip or knee revision surgery is a complex procedure that requires special surgical skills and a high level of expertise. It involves the careful removal of the old prosthesis, ideally without causing additional damage to the surrounding tissue, and the precise fitting of a new prosthesis. These surgeries are technically more demanding and take longer than the initial implantation, as they involve treating infections and stabilizing the new prosthesis. Surgeons must have a deep understanding of joint biomechanics and extensive experience to achieve the best results.
Regarding future developments in the field of hip arthroplasty, Prof. Dr. Günther notes: “We have a great need to ensure that patients are treated in facilities that promise the best possible outcomes, both in terms of sufficiently high case volumes and other structural requirements. This is also a requirement under the current hospital reform. Multiple calculations show that the consistent implementation of minimum case volumes in joint replacement surgery can reduce mortality and complication rates. At the same time, clinics performing joint replacement surgery should be certified to maintain the highest possible quality of care.” With this hope and outlook, we conclude our conversation.
Thank you very much, Professor Dr. Günther, for this informative conversation!
