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 Dresden University of Technology. 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 Managing 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 techniques, and corrective measures for misalignments and joint problems.
His department has been recognized as a Center of Excellence for Endoprosthetics, guaranteeing the highest quality and standards of care. As senior lead surgeon, Prof. Dr. Günther personally performs the relevant endoprosthetic procedures, thereby ensuring first-class care for his patients. His clinical and scientific specialisms include complex hip arthroplasty, healthcare research on joint replacement and joint-preserving hip surgery. As Chair of Orthopedics, he trains future medical professionals and is actively involved in various professional societies.
With numerous specialist publications and many years of experience, Prof. Dr Günther makes a significant contribution 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 find out more about hip replacement and the options available for joint-preserving surgery, so they spoke to the hip specialist Prof. Dr Günther.
Hip osteoarthritis is a degenerative joint disease that is often associated with pain, limited mobility and a reduced quality of life. In advanced stages, hip replacement surgery may be necessary to restore the joint’s functionality. However, a prosthesis is not always the only solution – particularly 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 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 down joint wear. “Conservative treatment options are now also included in the guidelines of the professional societies for the use of artificial hip joints, known as S3 guidelines (which have the highest scientific quality). Therefore, before surgery is performed, various conservative measures must be assessed and exhausted. These include drug therapies combining painkillers and anti-inflammatory drugs such as diclofenac, ibuprofen and so-called COX-2 inhibitors (non-steroidal anti-inflammatory drugs). Another key component is physiotherapy and exercise therapy to strengthen the body, improve mobility and build muscle strength. These two central elements must have been thoroughly assessed before an artificial hip joint is implanted. Another important point is providing the patient with information and advice. The better informed the patient is, the more successful the treatment will be. Discussions about the various treatment options are therefore of the utmost importance. This also includes discussions about optimizing body weight. This is because patients who are overweight (with a BMI of over 30) should reduce their weight; while this is difficult with painful joints, 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 the use of an artificial hip joint. The higher the BMI, the greater the risk profile. Following weight loss, patients are advised on occupational and leisure activities. Activities involving impact (such as most ball sports) should be avoided, while gliding and impact-free movements (such as swimming or cycling) are preferable. The use of a walking aid or walking stick is also discussed with the patient as a means of support to relieve pressure on the affected leg. “All these conservative measures must be assessed and tested over a period of three months before a hip replacement is considered as a treatment option,” explains Prof. Dr Günther at the start 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, while hip replacement involves the implantation of an artificial hip prosthesis to replace the damaged joint. Various factors are decisive for patients who are suitable candidates for joint-preserving measures. Prof. Dr Günther explains: “Joint-preserving surgery is primarily suitable for younger patients (generally not over 40–50 years of age) and for patients who do not yet have significant osteoarthritis. There is a classification of osteoarthritis stages based on X-ray images, with grades 1–4 distinguished. Joint-preserving surgery is only an option for grades 1–2. A prerequisite for joint-preserving surgery is that there must be corresponding damage that can be repaired. This includes, for example, hip dysplasia, where a surgical realignment can be performed, or hip impingement, where deformities of the femoral head and acetabulum can be corrected. “In patients with severe grade 3–4 osteoarthritis and in 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 patients where conservative treatment has been exhausted, patients very often benefit from the implantation of a hip prosthesis. When correctly indicated, 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 surgery 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 endoprosthetics is concerned, three major themes can be identified. Firstly, implant materials and designs have improved. Among other things, this involves greater wear resistance of the bearing surfaces. For example, ultra-high-molecular-weight polyethylene is usually used for acetabular cups and ceramic for femoral heads, but ceramic-on-ceramic bearing combinations are also possible. Bone-sparing short stems are also becoming increasingly common. The second major point is a tissue-sparing surgical technique that has developed over the last 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 insert an endoprosthesis. The third major area 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, information programs for patients, which are provided prior to surgery. For example, there is also an informative film shown for educational purposes, and pre-operative physiotherapy is provided. Of great importance are an optimized form of anesthesia and pain management in coordination with the anesthesiologist. Furthermore, avoiding the use of a urinary or wound catheter after the operation promotes faster mobilization and thus recovery. Blood-saving measures during the operation and the patient getting up early after the operation also speed up recovery. All of this contributes to greater patient satisfaction, less pain and a shorter hospital stay, which can gradually be reduced to 3–4 days. In some clinics, there is an emerging trend toward outpatient endoprosthesis surgery, similar to that seen in Anglo-American and Scandinavian countries. ‘This development will also become increasingly prevalent in Germany,’ explains Prof. Dr Günther, before going on to discuss the durability of the implants:
“Thanks to significantly improved wear properties, the durability of the implants has now increased considerably. 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 further factors. Firstly, there is the potential for infection of the artificial joint; secondly, mechanical complications (such as dislocation); and thirdly, bone fractures (for example, a femoral fracture). These factors may occur immediately after the insertion of an artificial joint, but also later on, and may then necessitate 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 MRI nor CT is required for the diagnosis of hip osteoarthritis alone (especially as the latter also involves additional radiation exposure). An X-ray is generally sufficient for decision-making in hip osteoarthritis and determining the indication. In joint-preserving surgery, an MRI is performed beforehand to classify the often complex deformities and enable surgical planning,” explains Prof. Dr Günther.
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 joint surgery that are supposed to result from this have not yet been conclusively proven. In any case, the use of a robot incurs additional costs, and the duration of the operation is often longer due to the necessary pre-settings of the robot. Radiation exposure may also be higher if a CT scan is required when using a robot. Regardless of the fact that clinics also use robotic assistance to attract patients, I believe it makes sense to further investigate the potential applications and benefits of robotic technology. This concerns not only examining how the placement accuracy of implants can be improved, but above all the long-term effect on durability and patient satisfaction. It is therefore entirely legitimate to consider robotic technology in order to further optimize the future conditions for successful endoprosthesis procedures. “However, robotic technology is not yet necessary for routine use,” Prof. Dr Günther points out critically.
Lifestyle factors play a key role in the prevention of hip osteoarthritis and can have a significant influence on whether or not someone develops the condition over the course of their life.
Weight management, physical activity and diet are the main areas on which patients can focus to reduce the risk of hip osteoarthritis and promote the health of their joints. “Osteoarthritis is always multifactorial. This includes, for example, genetic predisposition. There is nothing that can be done to prevent this. However, other risk factors can be addressed through preventive measures. This starts with parents having an ultrasound scan of their child’s hips after birth to check the quality of the joints. If so-called hip maturation disorders are detected, these can then be treated appropriately. In the case 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 wear and tear of the cartilage. Patients can manage their weight through a balanced diet and regular physical activity involving gliding movements that are beneficial for the hips (e.g. cycling, swimming). A diet rich in fruit, 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 can highly recommend here. For example, it also describes how eating certain types of fish can help protect against osteoarthritis. There are also various articles on the subject of the hip available there,” recommends Prof. Dr Günther regarding the options for prevention. In addition to these lifestyle factors, patients should also take care to avoid hip injuries by warming up properly before sport and physical activities and wearing protective equipment where appropriate.
The best care at Dresden University Hospital!
“Here at Dresden University Hospital, we perform a very high number of joint-preserving operations and also have a high caseload of joint replacement surgeries, around 1,000 per year. Of these, around 400 are performed due to wear and tear, around 200 due to femoral neck fractures, and the remainder due to necessary revision surgery,” emphasises Prof. Dr Günther. A revision operation on the hip or knee 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 operations 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 pressing need to ensure that patients are treated in facilities which, in terms of both sufficiently high case numbers and other structural requirements, promise the best possible outcomes. This is also required under the current hospital reform. Repeated calculations show that the consistent implementation of minimum case numbers in joint replacement surgery can reduce mortality and complication rates. At the same time, relevant clinics should be certified for joint replacement surgery in order to maintain the highest possible standard of care.” We conclude our conversation with this wish and outlook.
Thank you very much, Professor Günther, for this informative conversation!
