Prof. Dr. Peter Schräder, Chief Physician and Medical Director of the Orthopedics and Traumatology Clinic at OrthoCentrum Jugenheim (OCJ), is an outstanding specialist whose expertise is valued far beyond the region. With a broad spectrum of specialties ranging from orthopedics and trauma surgery to pediatric orthopaedics and rheumatological and sports orthopedic treatments, he covers all areas of modern orthopedics. His expertise in knee and hip endoprosthetics and joint-preserving cartilage surgery stands out in particular.
His clinic in Seeheim-Jugenheim, idyllically situated in the Darmstadt-Dieburg district, enjoys an excellent reputation as a specialist clinic for mobility. Patients of all ages are treated individually and holistically here. Prof. Dr. Schräder attaches great importance to finding the best possible treatment for every disease of the musculoskeletal system - whether conservative or surgical. Thanks to state-of-the-art equipment and innovative treatment methods, such as minimally invasive procedures and high-precision navigation systems, his patients' mobility is restored as quickly as possible.
Prof. Dr. Schräder devotes particular attention to pediatric orthopaedics. His sensitive empathy and specialist knowledge create a trusting environment in which individual treatment plans are developed, especially for young patients. Whether it is a question of growth disorders, deformities or injuries, the focus is always on the best possible quality of life for the children - always in close consultation with the parents.
Prof. Dr. Schräder sets standards in adult medicine, particularly in the implantation of artificial joints. With around 1,200 endoprostheses for hip and knee joints, including replacement operations, the clinic is one of the leading centers in this field. The use of high-quality implants and tissue-sparing techniques ensures outstanding treatment success. Innovative approaches such as computer-assisted navigation guarantee optimal alignment of the prostheses, which improves functionality and significantly extends the service life of the implants.
Prof. Dr. Schräder also demonstrates his versatility in rheumatology and sports traumatology. With targeted, often non-surgical therapies, he alleviates complaints and ensures that operations can often be avoided. If surgery is nevertheless necessary, for example in the case of serious cartilage damage or complex ligament reconstruction, he uses minimally invasive and state-of-the-art procedures to minimize the burden on patients.
The editorial team of the Leading Medicine Guide spoke with Prof. Dr. Schräder and learned more about “Robotics in endoprosthetics”.
In endoprosthetics, i.e. the replacement of joints with artificial implants, robot-assisted procedures are becoming increasingly important. These systems enable unprecedented precision in the planning and execution of operations, which significantly improves the positioning of prostheses as well as post-operative functionality and longevity. At the same time, they open up new possibilities for taking individual anatomical conditions into account and further developing minimally invasive procedures.
“We have been working with the Cori robot from Smith + Nephew, a so-called hand-held robot, for over two years and have opted for this model because it offers a good combination of surgeon experience and the maximum benefit of robotics. Ultimately, the robots are always linked to the respective endoprosthetics company. So you can't use a robot from company A with a prosthesis from company B. And we had the navigation aid from this company for over 20 years, and the robotics is the supplement to this. As we are extremely familiar with navigation, the learning curve for robotics was very short because the software and the necessary planning were already very familiar. Only fine-tuning and changes to the hardware were then necessary, which took place on a sterile-wrapped iPad on the operating table. The handling of the robot, which is a milling machine, must of course be practiced, for which you need about 20-50 operations to be completely proficient. You can't make any big mistakes here, and at the beginning there are also two experienced surgeons at the table who are also highly experienced in handling the navigation. This means that everything can be done well, quickly and safely. At the beginning, the operation takes about 10-15 minutes longer than usual, but we were able to implement everything very quickly, so that the operation time with and without robotics is now identical,” says Prof. Dr. Schräder on the introduction of robotics in Jugenheim.
A major advantage of robot-assisted systems is the reduction of intraoperative tissue trauma. Robotic assistance allows for smaller, more precise incisions, which puts less stress on the surrounding tissue and muscles. As a result, healing is promoted, post-operative pain is reduced and patients can return to their rehabilitation more quickly. Robotic systems also offer the ability to make intraoperative adjustments in real time during the procedure, reducing the need for repeated corrections or adjustments that may be required with traditional techniques. Prof. Dr. Schräder explains: “With robotics, you combine the precision of axis alignment, which is crucial for the function and longevity that navigation enables, with the exact incision and precise implementation of preoperative planning. And this preoperative planning is the biggest advantage of robotics, as you can run through the entire operation beforehand, whether that means the size or position of the implants, the thickness, etc., and can run through the various options on the sterile I-pad, compare them with each other and decide on the best option”.
Robot-assisted procedures in endoprosthetics offer significant advantages when it comes to increasing the longevity and functionality of endoprostheses. These technological advances enable more precise implantation and optimized fitting of prostheses, which improves both the immediate functionality and long-term durability of the implants. “We can already see the first signs of the effects of robotics on function and better mobilization due to less pain. It is not yet possible to measure longevity, as you have to look at 10-20 years, which is simply not yet feasible given the current situation. The hard facts are simply not yet available. We can only say that the precise implantation of the prosthesis has a decisive effect on longevity, and this is the case with robotics. This means that the hypothesis is plausible, but it has not yet been proven,” says Prof. Dr. Schräder.
Preoperative planning plays a decisive role in endoprosthetics, as it forms the basis for the entire surgical procedure and ensures that the implantation of the prosthesis is optimally adapted to the patient's individual anatomical conditions.
“In principle, there are custom-made prostheses. We do not do this, and it is the case that very few clinics with very good results and high case numbers do this. This option exists, and it also seems plausible - but this procedure has not caught on. Because in the end, customization is not that relevant. A prosthesis does not have to be 100% accurate to a tenth of a millimeter. Positioning is important! Because this defines the axis and stability. And this is exactly what robotics and navigation do,” explains Prof. Dr. Schräder, explaining what is done with the patient before the operation once the decision to use a prosthesis has been made:
“First of all, a whole-leg x-ray is taken, digitized and provided with reference spheres. The entire leg axis from the hip joint to the ankle joint is measured using X-rays. I can use this X-ray to simulate and plan the operation in advance. I can try out different positions with different implant sizes until I have the optimum position for the best result. In the operating theatre, locators are attached to the upper and lower leg of the opened knee so that the computer can see exactly what position the leg is in - whether it is bent or extended, whether it is bow-legged or knock-kneed, etc. This representation is dynamic so that I can see how the leg changes under different forces. Using a special palpation device, I can scan the shape of the knee joint, which produces an image. The computer then calculates a suggestion as to how the implant can be inserted and I compare this with my planning in order to intervene and make a decision based on my experience. This shows the great advantage of robotics: the computer analyzes the decision and predicts its positive or negative consequences. This results in a very good decision-making process. The prosthesis is then implanted and the wound is closed. We follow the fast-track concept, i.e. the patient becomes mobile again very quickly. The patient is allowed to eat and drink again in the recovery room and is already fitted with a mobility splint. The patient can put full weight on their leg on the day of the operation. However, it is also the case that the patient remains hospitalized for as long as they need. Our aim is to help patients become independent as quickly as possible!”.
The use of robotics in endoprosthetics is expected to undergo even more far-reaching development in the coming years.
“The use of artificial intelligence and more intensive robotics will certainly increase in the next stage of development, especially with regard to the digitalization of internal networking, including preoperative planning and intraoperative implementation. Quality assurance will also be partly organized by AI, as the implementation of the desired quality can be well documented. We are certainly still at the beginning here, but it is important for us to play an active role in shaping the entire process. The enthusiasm for the latest technical developments is understandable, but we have to make sure that we can also intervene here. Networking will certainly continue to advance. Patients are also becoming increasingly digital: they are given smartwatches and tasks to prepare for surgery. We are now also carrying out digital gait analyses to check axial relationships and movement sequences. In the future, there will certainly be cooperation with manufacturers of robotics, navigation systems and endoprostheses - as well as with insurance companies and cost bearers,” explains Prof. Dr. Schräder.
Certification as a maximum care endoprosthetics center makes a significant contribution to improving patient care and optimizing surgical results by ensuring the highest quality standards and specialized expertise. Clinics that receive this certification must prove that they have extensive experience and expertise in performing complex endoprosthetics operations.
“Certification is carried out by a company commissioned by the specialist association for orthopedics and trauma surgery, which is specifically responsible for endoprosthetics, and includes an extensive list of criteria. This includes the number of doctors employed at the center with their respective qualifications, and a minimum number of endoprostheses per year must also be performed. Process quality is also taken into account - how patients are admitted and how they are x-rayed, for example, how anesthesia is carried out, etc. Finally, a qualitative check is carried out, which is crucial for assessing the quality of results. This involves looking closely at the percentage of complications and the percentage of prostheses that are implanted correctly. These audits are carried out annually and include follow-up checks, referrer, patient and satisfaction surveys - all in all an extensive catalog of requirements that must be met. Preparation for this process takes about a year. Many documents have to be submitted, and a team of auditors made up of experts from the field of endoprosthetics and from the quality assurance department comes to the site for the audit. Certification as a maximum care endoprosthetics center is the highest level of care we have received. Only a few clinics have this certification: seven in Hesse and around 150 throughout Germany. In view of the approximately 2000 clinics in Germany, of which around 1000 offer endoprostheses, 500 of which are certified and only 150 are considered maximum care endoprosthetics centers, the exclusivity of this certification becomes clear,” explains Prof. Dr. Schräder.
“We have been performing endoprosthetics in Jugenheim for 30 years and recently celebrated our anniversary. During the preparations for this anniversary, we came up with the idea of aiming for certification. It was clear to us from the outset that we would meet all the requirements. However, it is a completely different challenge to make all processes ready for certification. After all, all processes have to be reviewed again and the entire team has to be motivated. My deputy and I were the driving force behind this. We spoke to our senior physicians and finally assigned the respective competencies. This was followed by numerous joint meetings and close teamwork. We reflected together on whether our approach was sensible and effective. Suddenly, ideas emerged from a wide range of disciplines to optimize and adapt processes. Ultimately, the patient is very likely to receive the best possible treatment outcome in a maximum care center. This is due to the close interdisciplinary cooperation and the high level of expertise of the designated main and senior surgeons, who ensure maximum safety and a minimum complication rate. For many patients, this means accepting a longer journey in case of doubt in order to receive the best possible treatment option. A key health policy objective is for maximum care centers to cooperate closely with other endoprosthetics centers and general practitioners and form a network,” says Prof. Dr. Schräder at the end of our discussion.
Thank you very much, Professor Dr. Schräder, for this informative insight!
