As of: March 15, 2024, 5:00 p.m
By: Andreas Beez
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Professor Rüdiger von Eisenhart-Rothe does not share Federal Health Minister Professor Karl Lauterbach's criticism of too many hip and knee joint operations.
© TUM
Anyone who needs a new knee, hip or shoulder should take a close look at the doctor and clinic.
The best tips about the operation.
How long can you live with osteoarthritis?
When does the pain become too severe and the loss of quality of life too great?
Ultimately, everyone affected has to decide for themselves when the time is right for an artificial joint.
Here, a top specialist explains what patients should pay attention to before and after the procedure.
Osteoarthritis treatment: High satisfaction ratings after joint replacement operations
Joint replacements are booming in Germany - and these operations are not always without alternative or even useful, according to Federal Health Minister Professor Karl Lauterbach.
“The flood of hip and knee joint operations must come to an end,” he criticized several times.
However, this requirement has also contributed to the uncertainty of many patients.
Because those who suffer from osteoarthritis in an advanced stage often have a high level of suffering: constant pain, even at night in bed, and ever greater restrictions on movement.
“In most cases, we can give these people a lot of quality of life back with an artificial joint,” says Professor Rüdiger von Eisenhart-Rothe, director of the endoprosthesis center at the University Hospital Rechts der Isar.
The fact is: “So many artificial hips, knees and shoulders are used because we have one of the best health systems for caring for sick people.” In addition, joint replacement procedures are among the most successful in modern medicine.
Around 80 to 90 percent of patients are very satisfied with the result of their operation;
When it comes to artificial hip joints, this rate rises to well beyond 90 percent.
An artificial hip joint can bring back a lot of quality of life for osteoarthritis patients.
© Science Photo Library / Sebastia
Nevertheless, it is a major operation.
How can osteoarthritis patients be sure that all treatment options have been exhausted and that they are in good hands with their surgeon?
Unfortunately, these questions cannot be answered in general terms, but there are clues and decision criteria:
Over 1250 endoprostheses per year
House of cutting-edge research: The world's largest study on the use of cannabis as a medication begins this year at the Rechts der Isar University Hospital and other German university hospitals.
© Matthias Balk
Professor Rüdiger von Eisenhart-Rothe, a father of two, has headed the Clinic for Orthopedics and Sports Orthopedics as well as the Maximum Care Endoprosthetics Center at the Rechts der Isar University Hospital since 2012.
The 52-year-old also specializes in cancer operations and the treatment of prosthetic infections.
His team of doctors inserts more than 1,250 artificial knees, hips, shoulders and elbows every year.
They also have special know-how in the field of robotics.
Von Eisenhart-Rothe and his colleagues have already implanted 850 artificial knee and hip joints using the Mako robot.
The right time for surgery – when conservative therapies fail
“Joint replacement surgery is rarely an emergency, so you should not be pressured into a specific appointment.
You alone decide when you want to have the operation,” advises von Eisenhart-Rothe.
Ultimately, it is important to consider soberly: Are you still getting along well in everyday life?
Or is the pain and movement restrictions already so severe that the desire for a better quality of life is greater than the fear of the operation?
One criterion can also be how many painkillers you need.
Anyone who swallows several Voltaren or Ibuprofen tablets every day risks, among other things, cardiovascular and gastrointestinal diseases.
You should also keep in mind that the muscles around the joint deteriorate due to protective postures, thereby worsening the conditions for rapid rehab after the procedure.
On the other hand, the following also applies: An X-ray or an MRI scan alone is not a reason to have surgery quickly.
There are patients who, despite severe cartilage damage, can manage their pain and even do sports - often with the help of conservative therapies.
This includes physiotherapy and special training, injections with hyaluronic acid or autologous blood treatments.
“But you shouldn’t fool yourself,” says von Eisenhart-Rothe.
“These treatments cannot cure osteoarthritis, nor can they usually stop it, but rather slow down its progression.
If osteoarthritis is severe and the level of suffering is high, conservative therapies are no longer useful.”
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Experience counts: Why you should meet your surgeon before surgery
Experience and routine are crucial.
“On the one hand, the surgeon should have done the operation many times and, on the other hand, should still carry it out often.
Practice makes perfect,” explains von Eisenhart-Rothe.
The background: Studies show that the complication rate decreases when both the surgeon and the clinic carry out more than 50 joint replacement operations over several years.
A record of over 100 such interventions would be better.
In specialized houses this number is achieved very easily.
It is also important that the chemistry between doctor and patient is right.
Insist that you have seen your surgeon before your procedure - unfortunately this is not always the case.
And dare to ask questions: How often have you had the procedure, how long have you been using artificial joints?
“It’s also okay if you see two or three specialists.
A confident doctor will have no problem with this,” says von Eisenhart-Rothe.
The clinic: Osteoarthritis patients benefit from maximum care
Many osteoarthritis patients suffer from other illnesses.
People with diabetes or heart problems in particular are well advised to go under the knife in a so-called maximum care clinic.
If necessary, experts from all specialist departments are quickly available and work hand in hand, such as cardiologists or kidney specialists.
In an emergency, the patient does not have to be transferred to another hospital.
Joint replacement specialists: quality assurance through certification
In order to guarantee patients high quality, joint replacement specialists are certified.
Among other things, independent auditors regularly check whether the surgeon and his clinic meet the most important success and safety factors.
Further information is available on the Internet at www.endocert.de.
Safety during joint replacement operations: Avoid prosthesis infections
Nowadays, even very old and sick patients can undergo safe surgery; the general surgical risks are low.
The most feared complication in joint replacement procedures is a prosthesis infection.
Bacteria settle on the artificial joints - sometimes even years after the operation.
Although this danger is very rare, the risk varies between one and 2.5 percent when artificial joints are inserted for the first time, depending on the clinic.
However, if this joint replacement disaster occurs, complex therapy with several further operations is required.
That's why good hospitals try to avoid prosthetic infections during surgery preparation.
One means is so-called preoperative decolonization.
“The patient is given a special washcloth the day before the operation.
With this he has to clean himself from head to toe.
This is intended to prevent germs from later getting from the skin into the surgical wound,” explains von Eisenhart-Rothe.
The hospital stay: How long should it last?
There are two tips: Firstly, you should not go to the clinic too early and secondly, you should not stay too long - always provided that you recover as planned.
The risk of infection doubles within a week.
“On the other hand, you shouldn’t be overly afraid of infections, because certified clinics pay strict attention to hygiene,” says von Eisenhart-Rothe.
As a rule, patients stay in the hospital for four to seven days after joint replacement surgery before beginning their rehabilitation.
It can be done on an inpatient or outpatient basis.
Preparation for the operation: building muscle, losing weight and quitting smoking
Use the time before the operation to specifically train your muscles.
A good level of fitness will help you get back on your feet more quickly after the procedure.
Losing weight is also worth it if you have a few extra kilos on your ribs.
Even with a body mass index of 27 to 31, the risk of wound infection during surgery is fourfold increased, and with a BMI of 31 or more, it is even eightfold increased.
“Even if you lose five kilos, you have a proven advantage,” reports von Eisenhart-Rothe.
You should also stop smoking at least four weeks before the procedure.
Mention allergies in the pre-op consultation.
“Patients with a nickel allergy may be able to use a special allergy prosthesis.”
This article only contains general information on the respective health topic and is therefore not intended for self-diagnosis, treatment or medication. It in no way replaces a visit to the doctor. Our editorial team is not allowed to answer individual questions about medical conditions.