Prof. Dr. med. habil. Klaus-Peter Günther is a leading authority in the field of hip surgery and hip endoprosthetics. As Managing Director of the University Center for Orthopedics, Trauma & Plastic Surgery at the University Hospital Carl Gustav Carus Dresden, he combines medical expertise with innovative approaches in the treatment of joint diseases. His medical focus is particularly on complex hip endoprosthetics, revision endoprosthetics and joint-preserving hip surgery.
The center headed by Prof. Dr. Günther has been awarded the distinction of a maximum care endoprosthetics center, a certification that guarantees the highest standards in endoprosthetic care. This recognition reflects the excellent quality of treatment provided by experienced and certified surgeons such as Prof. Dr. Günther. As a senior main surgeon, he is attested outstanding professional competence. In his clinical work, Prof. Dr. Günther devotes himself to the entire spectrum of hip surgery. This includes primary and revision endoprosthetics for various complications, arthroscopic procedures for hip impingement and malalignment as well as realignment surgery and pelvic osteotomies. His approach is characterized by a high degree of precision, state-of-the-art surgical techniques and patient-oriented care.
Prof. Dr. Günther's scientific commitment is reflected in his numerous publications and many years of research activity. His work focuses on healthcare research into hip joint replacement and the epidemiology of degenerative joint diseases. His research work provides important impetus for the further development of orthopaedic and endoprosthetic medicine. As Chair of Orthopaedics at the Technical University of Dresden, Prof. Dr. Günther plays a central role in training the next generation of doctors. At the same time, he is involved in specialist societies, review boards and commissions, which underlines his influence on the further development of the specialist field. Thanks to his contribution, the University Hospital Carl Gustav Carus Dresden is one of the most highly regarded clinics in Germany and sets standards in orthopaedic and trauma surgery care. As an outstanding physician, Prof. Dr. Klaus-Peter Günther stands for excellence in science and patient care.
The editorial team of the Leading Medicine Guide was able to speak with Prof. Dr. Günther about the current possibilities of joint-preserving hip surgery.
Joint-preserving hip surgery offers innovative approaches to treating diseases and injuries of the hip joint without having to replace it with a prosthesis. The aim is to preserve the natural function and structure of the hip joint as far as possible while relieving pain and improving the patient's mobility. These procedures play a particularly important role in younger patients and those with early stages of degenerative joint disease. By using minimally invasive techniques, precise diagnostics and modern surgical procedures, misalignments can be corrected, damage repaired and, in many cases, the long-term health of the hip joint ensured.
In order to determine whether a patient is suitable for joint-preserving hip surgery, a detailed and step-by-step diagnosis is required.
This begins with a detailed medical history, in which the patient's symptoms are asked in detail. Pain intensity, localization and progression, as well as functional limitations and the effects on everyday life play a central role. The patient's medical history, for example previous injuries, operations or previous illnesses such as hip dysplasia or osteoarthritis, are also carefully recorded. The clinical examination of the hip joint provides further important information. The doctor checks the mobility of the joint, looks for restricted movement or painful blockages and tests specific stress situations that may reveal hip impingement or dysplasia. Muscular weaknesses, instabilities or incorrect loading are also recorded, as they are often accompanying symptoms of an underlying joint problem.
“There must be evidence of a deformity of the hip joint in order to even consider joint-preserving surgery. The patient must have symptoms, otherwise they would not go to the doctor, and the deformity must be verifiable. Furthermore, there must be no significant hip osteoarthritis and the patient should be young or middle-aged. Patients over the age of 50 are reluctant to undergo hip joint preservation surgery. The three most important deformities of the hip joint are: “dysplasia”, in which the hip has a poor roof. This is usually a congenital deformity, a so-called maturation disorder of the hip joint, in which the hip roof is too small, too short or too slanted and therefore cannot withstand a load. The second major block of disease is “impingement” - the bumping of the hip joint. There are two subtypes here: so-called camshaft impingement, in which the femoral head, which should actually be round, has a small bulge that bumps against the hip socket. Then there is the pincer impingement, in which the acetabulum is too overlapping and the femoral head bumps against it during end movements. The third group includes other deformities such as rotational defects of the femur,” explains Prof. Dr. Günther at the beginning of our conversation.
Modern imaging techniques in the diagnosis and surgical planning of the hip joint.
“The basis of diagnostic imaging is always an X-ray of the pelvis and the affected hip joint. As a rule, this is supplemented by an MRI, whereby in these cases a special MRI is carried out with radial sequences and, if necessary, with contrast medium and a measurement of the rotation of the thigh. This is part of the standard diagnostic procedure. In certain cases, the diagnosis is supplemented by a CT scan, although this is not the primary imaging method. Once the patient's findings have been confirmed by imaging, an appropriate operation can be planned,” says Prof. Dr. Günther about the diagnostic measures.
MRI is particularly valuable as it enables detailed visualization of soft tissue structures such as cartilage, labrum and tendons. It helps to identify damage or abnormalities such as labral tears, cartilage damage or inflammatory changes. In addition, MRI can detect subtle changes that indicate early stages of degenerative disease or mechanical overload. CT, on the other hand, provides a high-resolution image of the bony structures of the hip joint. It is useful for precisely assessing malalignments such as femoroacetabular impingement (FAI) or hip dysplasia. Three-dimensional reconstructions allow complex anatomical relationships to be visualized, which enables precise surgical planning. This information can be particularly helpful when performing osteotomies or other bony corrections in order to carry out the procedure precisely and safely.
Minimally invasive techniques are increasingly preferred in joint-preserving hip surgery, as they offer numerous advantages over conventional open procedures.
“There are different procedures depending on the condition. Impingement operations can often be performed using arthroscopy alone. However, there are also procedures that are arthroscopically assisted, in which a small incision is made to open the joint and the arthroscope is also inserted for endoscopy. This combined technique is used by around a third of surgeons in minimally invasive procedures in Germany, while the other two thirds perform impingement surgery using arthroscopy alone. However, if the patient has hip dysplasia, it is not possible to perform minimally invasive surgery - a so-called pelvic realignment operation is usually required. Although this is increasingly performed in a tissue-sparing manner, it is a major procedure. Other procedures involving a pelvic realignment cannot be performed using a minimally invasive approach either. An incision has to be made and the bone cut, which is then rejoined with a plate and secured with nails,” explains Prof. Dr. Günther.
The main advantages of minimally invasive techniques are faster postoperative recovery, less pain and a lower complication rate. As the surrounding muscles and soft tissue are largely spared, the stability of the joint is maintained and patients can return to everyday activities more quickly. The risk of scarring and infection is also reduced.
As a special center for endoprosthetics, the University Hospital Carl Gustav Carus Dresden has a particularly high level of expertise and performs around 120 conversion operations per year.
The long-term treatment outcomes of joint preservation surgery and hip endoprosthetics depend heavily on the patient's individual starting situation, including age, activity level and severity of joint disease.
"Joint-preserving procedures, such as hip arthroscopy or osteotomies, aim to preserve the natural anatomy of the hip joint and optimize the mechanical loads. “Long-term results naturally depend on the underlying disease, the quality of treatment and the extent of the deformity at the time of surgery. In most cases, the implantation of an artificial hip joint can be avoided or delayed. However, if the damage is already advanced and conservative treatment is no longer sufficient, an artificial hip joint is necessary. All procedures, whether joint-preserving or with an artificial hip joint, have a survival rate of at least 80-90% over the first 10 years if selected and performed correctly. The success rate for joint-preserving surgery is only a few percentage points lower than the success rate for an artificial hip joint, although the option of an artificial hip joint is still available if joint-preserving surgery is not successful,” explains Prof. Dr. Günther.
While joint-preserving measures support natural joint function and eliminate the risk of complications caused by foreign material, endoprostheses offer a definitive solution for serious joint diseases. The choice between the two approaches therefore depends not only on the current joint situation, but also on the patient's long-term expectations and needs.
Prof. Dr. Günther comments on the recovery time for patients undergoing both procedures: “Here, too, it depends on what was done. As a rule, patients who have undergone realignment surgery need around three months to return to normal everyday activities, while patients who have had an arthroscopy procedure to remove a small bulge can move normally again after around four to six weeks."
The long-term success of joint-preserving hip surgery depends on several factors relating to both the surgical procedure and post-operative management.
People who have a low joint load and relatively stable bone structures before surgery are more likely to have a successful recovery and a good long-term result. Another important success factor is the surgeon's technique. Choosing the right surgical technique based on the patient's individual anatomy can optimize the load on the joint and minimize the likelihood of complications. Early mobilization, targeted physiotherapeutic measures and the avoidance of overloading during the healing phase make a decisive contribution to the long-term stability of the joint. Patients themselves can make an important contribution to optimizing the result by following the post-operative instructions, practicing physiotherapy regularly and improving their physical condition through targeted exercises. The aim is to strengthen the muscles around the hip joint, which promotes joint stability and reduces the risk of re-injury. In addition, it is advisable to avoid being overweight, as additional pressure on the joint can impair healing and the lifespan of the joint. Patients should also pay attention to a balanced diet to support bone health and promote the healing process.
“Rehabilitation depends very much on the type of operation. If a patient has undergone pelvic or thigh realignment, they can only bear partial weight for six weeks with the help of crutches and can then slowly build up their weight-bearing. In the case of arthroscopic bead removal, weight-bearing is possible immediately in some cases or after one to two weeks. If procedures such as cartilage transplants are performed, the recovery period is slightly longer at six to eight weeks. However, it is generally the case that all patients are able to stand on their feet independently on the day of the operation,” says Prof. Dr. Günther on the recovery times for patients, and with this we conclude our conversation.
Many thanks, Professor Dr. Günther, for the valuable information on endoprosthetics!
