Minimally Invasive Hip Replacement - Expert Interview with MUDr. Pavol Pavelka, MHBA

Dr. Pavol Pavelka is an experienced specialist in orthopedics and trauma surgery with a particular focus on hip and knee joint replacement. As chief physician at the Endoprosthetics Center at St. Vinzenz Clinic in Pfronten, Allgäu, he is committed to modern, patient-centered medicine of the highest standard. With his thorough training in Prague and Germany, as well as his rapidly completed residency, Dr. Pavelka specialized early on in complex surgical procedures.

His particular focus is on minimally invasive hip arthroplasty—including the AMIS technique—as well as complex primary and revision knee surgeries. In his leadership role, Dr. Pavelka is responsible for the medical and organizational quality of the EndoProthetikZentrum, which is renowned far beyond the region for its high standards. Under his leadership, state-of-the-art technologies and minimally invasive procedures are employed, specifically designed to restore patients’ mobility and significantly improve their quality of life.

Regular certifications by the independent quality assurance program EndoCert confirm the center’s outstanding structures, processes, and outcomes, while also documenting Dr. Pavelka’s consistent commitment to medical excellence. Beyond his clinical work, Dr. Pavelka brings valuable business management expertise to the center’s leadership through his master’s degree in Health Business Administration. This enables him to act responsibly not only medically but also organizationally and strategically. As an expert recognized by EndoCert, he is also authorized to audit other endoprosthetics centers in Germany and contribute to quality assurance in the field of endoprosthetics.

Dr. Pavelka impresses not only with his professional expertise but also with his patient-centered approach. The individual patient and their unique needs are always at the center of his work. With a deep understanding of the medical, technical, and human aspects of his discipline, he combines precise surgical techniques with personal care, thereby creating a foundation of trust that ensures successful treatment. Through his combination of medical expertise, business acumen, and human empathy, Dr. Pavelka embodies modern orthopedic care at the highest level.

The editorial team of the Leading Medicine Guide learned more about minimally invasive hip replacement during a conversation with Dr. Pavelka.

The hip plays a central role in our mobility and quality of life. As one of the largest and most heavily loaded joints in the human body, it enables us to perform basic movements such as walking, sitting, or climbing stairs. Over the course of a lifetime, however, wear and tear, injuries, or conditions such as osteoarthritis can lead to painful limitations. When conservative treatment methods no longer provide sufficient relief, an artificial joint replacement—known as an endoprosthesis—may be necessary to restore mobility and permanently eliminate pain.

Severe wear and tear of the hip joint, which ultimately requires a hip replacement, usually develops over a long period of time and can have various causes. 

“The most common causes of hip joint wear and tear requiring a hip replacement are osteoarthritis—particularly primary coxarthrosis—and post-traumatic osteoarthritis following accidents or fractures. Other causes include secondary osteoarthritis resulting from inflammation, such as rheumatoid arthritis or hip dysplasia, as well as congenital malformations or genetic predispositions. Over the course of years, these conditions lead to the destruction of the cartilage in the hip joint and impair patients’ mobility and quality of life. “In some cases, direct implantation of hip prostheses is indicated following accidents involving unfavorable femoral neck fractures—despite the presence of residual cartilage—if the risk of poor fracture healing due to osteosynthesis is too high and the joint has already sustained significant prior damage,” explains Dr. Pavelka at the beginning of our conversation.

In addition to these medical factors, lifestyle and external influences also play an important role. Being overweight places a constant strain on the hip joints beyond normal levels, which can accelerate cartilage wear. Similarly, certain occupations or sports involving heavy physical exertion or frequent lifting and carrying of heavy loads can contribute to premature joint wear. In some cases, genetic predisposition also plays a role, particularly when there is a family history of osteoarthritis.

Before deciding on a surgical procedure such as hip replacement, there are a variety of conservative treatment methods available that aim to relieve symptoms, maintain mobility, and slow the progression of joint wear. 

These non-surgical measures are primarily used when symptoms are still at a moderate stage and quality of life has not yet been severely impaired. “Conservative treatment methods for osteoarthritis include a variety of therapies aimed at relieving pain and improving the quality of life for those affected. These methods include, among others, physical therapy to support mobility and muscle strength, as well as medication for pain management. Nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain relievers are used to reduce symptoms. In addition, injections such as cortisone (an anti-inflammatory agent), hyaluronic acid (which, simply put, helps lubricate the joint), or PRP (platelet-rich plasma, derived from the patient’s own blood and designed to promote healing). Weight loss can also be beneficial, as less body weight reduces the strain on the joints. Furthermore, orthopedic aids such as crutches or special shoes are used to protect the joints and support mobility. These conservative measures are often very effective in the early stages of osteoarthritis and can noticeably relieve symptoms. In the advanced stages of the disease, however, when joint wear is more pronounced, these methods become less effective and can no longer adequately control the pain. “In such cases, when severe pain persists despite all conservative therapies and joint mobility is severely limited, a hip replacement may become necessary,” explains Dr. Pavelka, adding:

“To assess whether a hip replacement is an option, objective criteria have been introduced, such as the EKIT checklist (EKIT stands for ‘Evaluation of Cartilage Damage, Communication, Information, and Treatment Planning’), which enables a systematic assessment of the situation. Nevertheless, the decision to undergo joint replacement is primarily one that the patient makes after being fully informed and weighing the pros and cons of surgery with their doctor.”

The limits of conservative treatment methods are reached when, despite consistent application over an adequate period of time, sufficient pain relief can no longer be achieved, mobility is severely restricted, and everyday activities such as walking, getting dressed, or climbing stairs become a challenge. At the very latest when quality of life has significantly deteriorated and those affected feel increasingly limited in their independence, surgical treatment should be considered. Even if imaging techniques such as X-rays reveal advanced osteoarthritis with significant joint damage, joint replacement is often the most medically sensible option. The goal is to permanently eliminate pain and restore as natural a range of motion as possible through the timely implantation of a hip prosthesis.

Individual factors such as age, activity level, and existing comorbidities play a decisive role in determining whether and when a hip prosthesis should be implanted. The decision to perform joint replacement surgery is not made solely on the basis of X-ray findings, but is always considered in the context of the patient’s overall health and personal situation.

Dr. Pavelka comments: “Individual factors such as age, activity level, and comorbidities are decisive for the choice of implant and the fixation method. In younger, more active patients, the hip prosthesis is implanted cementlessly to promote biological bonding and osseointegration, which maximizes the implant’s lifespan. For older patients or those with comorbidities such as diabetes or cardiovascular disease, the risks and benefits of the surgery must generally be carefully weighed. Above a certain age or in cases of specific femoral bone shapes, the prosthesis stem is often cemented, which reduces the risk of revisions, such as those caused by femoral fractures. In the past, there was a tendency to be cautious about indicating hip replacement in young patients due to concerns about potential prosthesis failure and the need for revisions. Today’s modern implants continue to show good and very good results even after well over 15 years in some cases, as long as bone quality is maintained. High-quality materials and proper implantation technique are essential for the long-term durability of the prostheses.”

The use of an artificial hip joint generally has a very positive effect on patients’ long-term quality of life and mobility. 

With a successful surgery and a good healing process, the hip joint’s range of motion can be largely restored, making everyday activities such as walking, climbing stairs, or putting on shoes possible again—pain-free and independently.

“In 2007, the implantation of a hip prosthesis was named the ‘Operation of the Century’ in the renowned medical journal *The Lancet*—a title that many patients we see daily in our practice can attest to. In most cases, the implantation of an artificial hip joint leads to a significant improvement in quality of life and mobility. Patients experience significant pain relief and restored mobility, which enables them to resume activities such as walking, cycling, and even participating in sports. “Long-term studies show that patient satisfaction with hip replacements is high, and many patients lead more active and pain-free lives after surgery,” Dr. Pavelka explains.

Minimally invasive hip surgery offers a number of advantages over the conventional technique that can have a significantly positive impact on the healing process, pain levels, and patients’ mobility. 

“Minimally invasive hip surgery offers several advantages over the traditional technique: fewer tissues and muscles are cut, leading to faster healing, less postoperative pain, and a quicker return to mobility. Patients often experience a shorter hospital stay and a sooner return to daily activities. The AMIS (Anterior Minimally Invasive Surgery) method is a specialized form of minimally invasive hip surgery in which access to the hip is gained through an anterior approach without cutting through the major muscle structures. This technique allows for faster tissue healing and mobilization. Specialized instruments are required, and the implants are designed specifically for this surgical technique. “I performed my first hip replacement using this approach in 2010 with Professor Dr. Haaker in North Rhine-Westphalia. Since then, I have used this technique for primary procedures almost without exception,” says Dr. Pavelka, adding that in rare cases, an alternative approach may also be appropriate: 

“The minimally invasive technique is suitable for most patients. Factors such as obesity, shortened thigh muscles, previous hip surgeries, or specific hip joint anatomies can make the approach more difficult, but not impossible. For patients with severe bone changes or those requiring an additional procedure (e.g., metal removal), an alternative approach may be more appropriate. A detailed preoperative examination and imaging are crucial for determining whether a minimally invasive technique, such as the AMIS method, will yield the best results in this case.”

In addition to physical conditions, pre-existing conditions and comorbidities also play a role in the decision-making process. Patients with certain health issues, such as circulatory disorders or neurological conditions, may be at higher risk for complications, which must be taken into account when selecting the appropriate procedure. In principle, however, all patients benefit from a minimally invasive surgery, regardless of any comorbidities. Furthermore, the surgeon’s experience plays a crucial role, as the AMIS method requires a high degree of precision. Not every surgeon offers this technique, and the surgeon’s experience with minimally invasive procedures significantly influences the outcome.

The minimally invasive approach to hip replacement has gained considerable importance in recent years, as it offers many advantages for both the patient and the surgeon.

“The minimally invasive approach poses a greater challenge for the surgeon, as access to the hip is more limited and the surgical view is less direct. This requires precise surgery and a high level of experience on the part of the surgeon to position the implant correctly. The advantage is that the muscles and soft tissues are subjected to less trauma, but the procedure is technically more demanding. The surgeon often has to work in a more confined space, which makes visualization more difficult. However, with computer-assisted preoperative planning, intraoperative imaging, and experience with this method, excellent, reproducible results can be achieved,” emphasizes Dr. Pavelka, adding:

“The AMIS approach spares the soft tissues, as no muscles need to be transected, leading to faster healing and less postoperative pain. Statistically speaking, this is the approach with the lowest postoperative dislocation rate. The approach is intermuscular and interneural, which means that even when the muscle gap is widened, no motor nerve branches are compromised. These anatomical advantages result in a low dislocation rate and more stable postoperative healing. “Nothing then stands in the way of surgical success and patient satisfaction.” With these positive prospects, we conclude our conversation.

Thank you very much, Dr. Pavelka, for this in-depth overview of minimally invasive hip replacement!