Options for Joint-Preserving Hip Surgery: An Expert Interview with Prof. Günther

Prof. Dr. med. habil. Klaus-Peter Günther is a leading authority in the field of hip surgery and hip replacement. As Executive Director of the University Center for Orthopedics, Trauma, and Plastic Surgery at the Carl Gustav Carus University Hospital in Dresden, he combines medical expertise with innovative approaches to the treatment of joint diseases. His medical focus is particularly on complex hip arthroplasty, revision arthroplasty, and hip surgery aimed at preserving joint function.

The center, led by Prof. Dr. Günther, has been designated a Maximum-Care Arthroplasty Center—a certification that guarantees the highest standards in arthroplasty care. This recognition reflects the excellent quality of care ensured by experienced and certified surgeons such as Prof. Dr. Günther. As a senior lead surgeon, he is recognized for his outstanding professional expertise. In his clinical practice, Prof. Dr. Günther focuses on the full spectrum of hip surgery. This includes primary and revision joint replacement for various complications, arthroscopic procedures for hip impingement and malalignments, as well as realignment surgeries and pelvic osteotomies. His approach is characterized by a high degree of precision, state-of-the-art surgical techniques, and patient-centered care.

Prof. Dr. Günther’s scientific commitment is evident in his numerous publications and his many years of research. His work focuses on health services research related to hip replacement and the epidemiology of degenerative joint diseases. His research provides important impetus for the further development of orthopedic and endoprosthetic medicine. As Chair of Orthopedics at the Technical University of Dresden, Prof. Dr. Günther plays a central role in the training of the next generation of medical professionals. At the same time, he is actively involved in professional societies, review boards, and commissions, which underscores his influence on the further development of the field. Thanks to his contributions, the Carl Gustav Carus University Hospital in Dresden ranks among Germany’s most prestigious hospitals and sets the standard for orthopedic and trauma care. As an outstanding physician, Prof. Dr. Klaus-Peter Günther embodies excellence in both scientific research and patient care.

The editorial team of the Leading Medicine Guide spoke 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 goal is to preserve the natural function and structure of the hip joint as much as possible while alleviating pain and improving patients’ mobility. These procedures play a particularly important role for younger patients and those with early-stage degenerative joint diseases. Through the use of 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.

Determining whether a patient is a candidate for joint-preserving hip surgery requires a detailed, step-by-step diagnostic process. 

This begins with a thorough medical history, during which the patient’s symptoms are carefully assessed. Pain intensity, location, and progression, as well as functional limitations and the impact on daily life, play a central role in this process. The patient’s medical history—including previous injuries, surgeries, or pre-existing conditions such as hip dysplasia or osteoarthritis—is also carefully documented. The clinical examination of the hip joint provides further important insights. The doctor assesses the joint’s range of motion, looks for restricted movement or painful locking, and tests specific loading scenarios that may reveal hip impingement or dysplasia. Muscular weakness, instability, or improper loading are also assessed, as they are often accompanying symptoms of an underlying joint problem.

“There must be a demonstrable structural abnormality of the hip joint in order to even consider a joint-preserving procedure. The patient must be experiencing symptoms—otherwise, they wouldn’t go to the doctor—and the structural abnormality must be verifiable. Furthermore, there must be no significant hip osteoarthritis, and the patient should be young or middle-aged. In patients over 50, surgeons are cautious about performing hip-preserving procedures. The three most important structural abnormalities of the hip joint are: “dysplasia,” in which the hip has a poorly formed acetabulum. 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 stress. The second major category of conditions is “impingement”—that is, the hip joint rubbing against the surrounding structures. There are two subtypes here: so-called “camshaft impingement,” in which the femoral head—which should actually be round—has a small protrusion that rubs against the acetabulum. Then there is “pincer impingement,” in which the acetabulum extends too far and the femoral head rubs against it during end-range movements. “The third group includes other structural abnormalities, such as rotational malalignment 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. This is usually supplemented by an MRI, although in these cases a specialized MRI is performed using radial sequences and, if necessary, contrast medium, as well as a measurement of femoral rotation. This is part of the standard diagnostic workup. In certain cases, the workup is supplemented with a CT scan, though this is not the primary cross-sectional imaging modality. Once the patient’s findings are confirmed by imaging, an appropriate surgical plan can be devised,” said Prof. Dr. Günther regarding the diagnostic measures.

MRI is particularly valuable because it provides a detailed view of soft tissue structures such as cartilage, the labrum, and tendons. It helps 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 diseases 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 misalignments such as femoroacetabular impingement (FAI) or hip dysplasia. Three-dimensional reconstructions allow for the visualization of complex anatomical relationships, enabling precise surgical planning. This information can be particularly helpful in performing realignment osteotomies or other bony corrections with precision and safety.

In joint-preserving hip surgery, minimally invasive techniques are increasingly preferred because they offer numerous advantages over conventional, open procedures. 

“Depending on the specific condition, different procedures are used. Impingement surgeries can often be performed using arthroscopy alone. However, there are also arthroscopically assisted procedures in which a small skin incision is made to create a mini-incision in the joint, and the arthroscope is additionally inserted for visualization. This combined technique is used by about one-third of surgeons performing minimally invasive procedures in Germany; the other two-thirds perform impingement surgery using pure arthroscopy. If, on the other hand, the patient has hip dysplasia, minimally invasive surgery is not an option—in such cases, a so-called realignment procedure, specifically pelvic realignment, is usually required. Although this procedure is increasingly performed in a way that preserves tissue, it is still a major operation. Minimally invasive techniques also cannot be used for other procedures involving realignment. “In these cases, an incision must be made and the bone cut through; it is then reattached using a plate and secured with screws,” explains Prof. Dr. Günther.

The advantages of minimally invasive techniques lie primarily in faster postoperative recovery, less pain, and a lower complication rate. Since the surrounding muscles and soft tissues are largely spared, the stability of the joint is preserved, and patients can return to their daily activities more quickly. In addition, the risk of scarring and infection is reduced.

---

As a specialized center for endoprosthetics, the Carl Gustav Carus University Hospital in Dresden possesses a particularly high level of expertise and performs approximately 120 revision surgeries per year.

---

The long-term treatment outcomes of joint-preserving procedures and hip replacement depend heavily on the patient’s individual baseline condition, including age, activity level, and the severity of the joint disease.

Joint-preserving procedures, such as hip arthroscopy or realignment osteotomies, aim to preserve the natural anatomy of the hip joint and optimize mechanical loading. “Long-term outcomes naturally depend on the underlying condition, the quality of treatment, and the extent of the deformity at the time of surgery. In most cases, it is possible to avoid or delay the implantation of an artificial hip joint. However, if the damage is already advanced and conservative therapy is no longer sufficient, an artificial hip joint is necessary. All procedures—whether joint-preserving or involving an artificial hip joint—have a survival rate of at least 80–90% over the first 10 years when properly selected and performed. “The success rate for joint-preserving surgery is only a few percentage points lower than that for artificial hip replacement, although the option of an artificial hip replacement is still available if the joint-preserving surgery is unsuccessful,” explains Prof. Dr. Günther. 

While joint-preserving measures support natural joint function and eliminate the risk of complications from foreign materials, endoprostheses offer a definitive solution for severe joint diseases. The choice between the two approaches therefore depends not only on the current condition of the joint but also on the patient’s long-term expectations and needs.

Regarding patients’ recovery time for both procedures, Prof. Dr. Günther comments: “Here, too, it depends on what was done. As a rule, patients who have undergone a joint replacement surgery need about three months to return to their normal daily routine, while patients who have had arthroscopic surgery to remove a small bony spur can move around normally again after about four to six weeks.”

The long-term success of a hip-preserving surgery depends on several factors related to both the surgical procedure and postoperative management. 

People who have low joint stress and relatively stable bone structures prior to surgery are more likely to have a successful recovery and a good long-term outcome. Another important factor for success is the surgeon’s technique. Choosing the right surgical technique, based on the patient’s individual anatomical characteristics, can optimize the load on the joint and minimize the likelihood of complications. Early mobilization, targeted physical therapy, and avoiding excessive strain during the healing phase contribute significantly to the joint’s long-term stability. The patient can play a key role in optimizing the outcome by following postoperative instructions, regularly attending physical therapy sessions, and improving physical condition through targeted exercises. The goal is to strengthen the muscles surrounding 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 shorten the joint’s lifespan. Patients should also maintain a balanced diet to support bone health and promote the healing process.

“Rehabilitation depends heavily on the type of surgery. If a patient has undergone a pelvic or femoral realignment, they may only bear partial weight for six weeks while using crutches and can then slowly increase the load. In the case of arthroscopic bone spur removal, weight-bearing may be possible immediately or after one to two weeks. If procedures such as cartilage transplants are performed, the recovery period is somewhat longer, at six to eight weeks. “However, as a general rule, all patients are able to stand on their own two feet on the very day of the surgery,” says Prof. Dr. Günther regarding patients’ recovery times, and with that, we conclude our conversation.

Thank you very much, Professor Dr. Günther, for your valuable insights into joint replacement surgery!