Professor Dr. Michael Hirschmann is an internationally recognized expert in orthopedics and traumatology with particular expertise in knee surgery and knee endoprosthetics. As President of the Personalized Arthroplasty Society and a board member of leading specialist societies such as the German Knee Society and the European Society of Sports Traumatology, Knee Surgery and Arthroscopy, he shapes both research and clinical practice in his field. With over 450 scientific publications and numerous international awards, he has established himself as one of the leading experts on knee injuries and knee osteoarthritis.
Prof. Dr. Hirschmann has made a significant contribution to the development of personalized medicine in knee surgery and is setting innovative standards in knee arthroplasty. In particular, his concept of phenotyping and phenotype-based positioning of knee prostheses as well as the use of modern technologies such as 3D-printed prostheses and robotic assistance have ushered in a new era in individualized patient care. His approach enables more precise adaptation of prostheses to the specific needs of patients and makes a significant contribution to improving post-operative results.
In addition to his clinical work, Prof. Dr. Hirschmann is intensively involved in the further development of orthopedics and knee surgery. As head of the University Center for the Musculoskeletal System at Baselland Cantonal Hospital, he implements the close integration of research and practice and ensures that state-of-the-art orthopedic treatments are combined with holistic musculoskeletal rehabilitation. The combination of university knowledge and innovative technologies makes him a driving force for orthopedic care in the region and beyond.
The editorial team of the Leading Medicine Guide was able to speak with Professor Dr. Hirschmann and learned about exciting aspects of robot-assisted knee endoprosthetics and personalized medicine in knee prosthetics.
Robot-assisted knee endoprosthetics and personalized medicine are revolutionizing knee surgery and offering patients more precise and individualized treatment. By using the latest robotic technology, the positioning of knee prostheses is optimized, which can lead to better results and faster recovery. Combined with personalized medical approaches tailored to each patient's specific phenotype, this innovative technology enables customized care that significantly improves patients' quality of life. These advances offer new hope for patients with knee osteoarthritis and set new standards in orthopedic surgery.
Knee osteoarthritis and other degenerative knee diseases that require a knee prosthesis are usually caused by a combination of mechanical stress, biological degradation processes and individual risk factors.
“Knee osteoarthritis can basically be divided into two main types: primary and secondary osteoarthritis. Secondary osteoarthritis is usually caused by previous injuries or operations on the knee. It can also be caused by rheumatic diseases that damage the tissue in the joint and ultimately lead to osteoarthritis. The cause of primary osteoarthritis is less clear and is often described as mechanical wear and tear of the joint cartilage, which is usually caused by a misalignment of the knee. Such a misalignment can occur, for example, in the case of an axial deviation such as the bow leg, which places greater strain on the inner area of the joint and causes correspondingly greater wear and tear. With the knock-knee, on the other hand, it is the outer area of the joint that experiences more pressure. In many cases, these two main causes lead to osteoarthritis. Osteoarthritis of the knee is a very common condition, especially in people over the age of 60. According to estimates, 70 to 80 percent of people in this age group already have more or less pronounced knee osteoarthritis,” explains Prof. Dr. Hirschmann at the beginning of our conversation and continues:
“The first symptoms of osteoarthritis of the knee often lead those affected to see a doctor quickly, especially if they suddenly notice more swollen knee joints or pain on the inside or outside of the joint. It often only takes a few months between the onset of symptoms and the first visit to the doctor, with the symptoms usually occurring in a wave-like progression - initially they are more severe, then they improve again, only to increase again later. However, even if the symptoms initially become less severe, they continue to increase over time. Eventually, patients will want to seek treatment. At this point, there are still many ways to alleviate the symptoms without surgery. In addition to physiotherapy, which is an important part of treatment, injection treatments are also used. Common options include hyaluronic acid, cortisone and autologous blood therapy. In some cases, fatty tissue is also used, which is processed and re-injected into the affected joint to aid healing or relief."
Personalized medicine in knee endoprosthetics offers decisive advantages over standardized treatment methods, as it responds individually to the anatomical conditions, biomechanical requirements and specific needs of each patient.
“In traditional medicine, the focus is often on developing therapies and diagnoses that are suitable for a broad population group. This approach is based on the principle that one solution works for many people at the same time. In contrast, personalized medicine takes a different approach: it focuses on the specific needs of the individual patient. In orthopedics in particular, and especially in the implantation of knee prostheses, this represents a significant paradigm shift. In the past, standardized solutions were developed based on the average patient's needs. These standardized prostheses were often only roughly adapted to the patient's individual circumstances. Today, however, a new approach is being taken. Instead of applying blanket solutions, the patient's individual knee joint is analyzed and treated in detail. The prostheses are no longer made to a general standard size, but their positioning and design are increasingly tailored to the patient's specific anatomy. This individualized approach allows for much more precise and effective treatment. A particularly important part of this progress is the use of modern 3D printing technologies. With the help of 3D printing, both the prostheses and the necessary instruments can be manufactured with the highest precision and individually according to the patient's anatomical needs. These technologies offer the opportunity to create customized solutions that provide patients with a significantly better fit and functionality of the prostheses,” explains Prof. Dr. Hirschmann.
A key advantage lies in the precise selection of the knee prosthesis, which can be adapted exactly to the patient's natural joint shape and alignment using modern imaging techniques such as high-resolution MRI or CT scans. This not only achieves a better fit, but also ensures that the kinematics of the knee joint are as natural as possible. Another advantage is the optimized positioning of the prosthesis. Computer-aided planning procedures and robot-assisted surgery enable surgeons to perform the implantation with the utmost precision. This reduces the risk of malpositioning, minimizes wear on the prosthetic components and ensures even load distribution in the joint. This in turn can extend the durability of the prosthesis and reduce the need for revision surgery. While standardized knee prostheses are often manufactured and implanted according to general average values, personalized medicine can help to reproduce natural movement behaviour as accurately as possible and improve the quality of life of those affected in the long term.
Robot-assisted knee endoprosthetics represents a significant advance in orthopedics, as it enables exceptionally precise and customized implantation of knee prostheses.
Compared to conventional procedures, where the surgeon works manually using anatomical reference points, robotic surgery uses state-of-the-art imaging technologies, computer-aided planning and mechanized precision instruments to ensure exact placement and alignment of the prosthesis.
“With robotic assistance, doctors can measure the knee joint more precisely during the operation to ensure the best possible alignment and positioning of the prosthesis. Another important tool is the measurement of ligament tension curves, which is recorded individually for each patient during the operation. This technique makes it possible to restore a more stable knee joint. Robot-assisted knee surgery does not involve a robot performing the entire operation independently. Rather, it is a navigation system that helps the surgeon to position the prosthesis precisely and measure the ligament tension. The surgeon remains the one who performs the entire operation, while the robot merely serves as a precise aid. The advantage of this technology is that it increases the precision and accuracy of the operation,” says Prof. Dr. Hirschmann and adds:
“Patients are generally well informed about this technology, and many specifically opt for robot-assisted surgery because they are convinced that this method provides more accurate results. In practice, however, no technology is completely flawless, and it is emphasized that the surgeon must have a solid experience in knee prosthetics before using robotic technology. Only then can the surgeon correctly interpret and apply the robot-assisted data. Basic experience in knee prosthetics is therefore a prerequisite for being able to fully exploit the advantages of robot-assisted systems”.
Another advantage of the robot-assisted technique is that the surrounding tissue is spared. As the robot only removes the absolutely necessary bone material and soft structures such as muscles, tendons and ligaments are preserved as much as possible, this results in less trauma to the tissue. Compared to conventional methods, there is often less post-operative pain and mobility can be restored more quickly. In addition, robot-assisted surgery enables dynamic intraoperative adjustment. During the operation, the system can analyze the patient's individual ligament tension in different degrees of flexion and adjust the positioning of the prosthesis if necessary. This is particularly relevant in order to ensure natural joint movement and minimize the risk of instability or restricted movement.
Robot-assisted surgery is playing an increasingly important role in reducing the recovery time and improving the functionality of the knee joint after an operation.
“The length of the recovery period after robotic knee surgery varies depending on the patient, but generally patients experience faster rehabilitation and improved functionality of the knee joint. The time in hospital has been reduced in recent years due to advances in surgery, but the actual length of stay is also highly dependent on financial and organizational factors. A decisive factor for the durability of the prostheses lies in the precise positioning, which can be further optimized through the use of robot technology, which contributes to a potential extension of the service life of the prosthesis,” emphasizes Prof. Dr. Hirschmann.
“In my own professional practice, I have worked intensively with these advanced, robot-assisted systems for many years, gaining valuable experience that is of great importance to my work. These years of experience are crucial, as the true benefits of the technology can only be fully realized if the surgeon is very familiar with the systems and is able to use them in a targeted and precise manner. One particularly important aspect that I would like to emphasize at this point is the close connection between personalized medicine and robot-assisted surgery. This synergistic combination is key to significantly improving treatment outcomes. It is important to understand that robotic technology alone does not guarantee success. Rather, it is the precise and targeted application of these innovative technologies, together with the surgeon's in-depth experience, that creates enormous added value for patients. Only when both factors - the advanced technology and the surgeon's in-depth knowledge - are used in harmonious interaction can modern surgical techniques in knee prosthetics achieve their full effect. This leads to safer procedures and significantly better results, which sustainably improve the patient's quality of life. In this context, surgery not only becomes more efficient, but also significantly more precise and reliable,” Prof. Dr. Hirschmann makes clear at the end of our conversation.
Thank you very much for these interesting details, Professor Dr. Hirschmann!
