© Freepik
In surgery, joint replacement has long been routine.
January 1, 2023
Robert Emich
This is hip: Latest research provides orthopedics with alternative treatment methods
The numbers are impressive: Almost 230,000 people receive an artificial hip joint. 170,000 patients receive knee endoprostheses and about 60,000 shoulder joints. For the individual affected, the procedure usually means a massive turning point in life – away from years of chronic pain and limited mobility towards a new, carefree mobility.
In surgery, joint replacement has long been routine. Just over 70 years ago, the British orthopedic surgeon George Kenneth McKee implanted the first truly usable and durable artificial hip prosthesis – back then still made of stainless steel. Today, parts with components made of polyethylene, ceramic, and titanium are predominantly used.
Developments in this field have been so far perfected over the past years that no further major revolutions are expected in the near future, says Prof. Dr. Andreas Imhoff, who led the department and polyclinic for sports orthopedics at the University Hospital on the right side of the Isar in Munich for over 25 years.
“We have a success rate of 95 percent for hip joints. That is really quite good. Of course, we want to get even better, but we will never reach 100 percent, because the patient himself, especially his psyche, naturally also plays a significant role. Ultimately, the body has to relearn how to properly handle the joint. In this process, physiotherapy also plays a very important role," said the internationally renowned expert, whose successfully treated patients include such prominent names as the Kings of Malaysia and Saudi Arabia and top athletes like Bastian Schweinsteiger.
Find a DoctorSearch the network for suitable specialists and contact them directly
Professor Dr. Andreas B. Imhoff is considered one of the world's most renowned experts in the field of orthopedics.
A lot of research is being done towards individual prostheses that are tailored to the patient, but these can only be used in special cases because they are not affordable by the healthcare system in large numbers. In general, the trend, according to Prof. Dr. Imhoff, is much more towards ensuring that the replacement of a joint should be the last resort. Minimally invasive procedures that repair what can still be repaired are his current focus. And this for several reasons.
Although endoprostheses today have a lifespan of up to 20 years, at the same time the average life expectancy of people has increased. Maintaining the natural joint as long as possible, to avoid having to replace an artificial one twice, is therefore the top priority. This is especially important because a re-implantation alone, due to the patient's higher age and longer operation time, brings more risks of complications. On the other hand, there are promising approaches in the fields of autologous blood therapy, the cultivation of artificial tissue and cartilage transplantation. Especially the latter topic holds great potential.
"We have worked very intensively on this over the past 20 years," says Prof. Dr. Imhof. "Today we can cultivate cartilage in the lab from harvested cells and then transplant it arthroscopically, meaning minimally invasively, into the joint. This way, cartilage damage that would have previously led to a joint replacement can be treated successfully." With the help of growth factors obtained from blood, it is also possible to generate tissue in the lab, so that, for example, a tendon heals better on the bone.
When it comes to early-stage osteoarthritis, therapy with autologous blood, perhaps in combination with hyaluronic acid, is a good option to "slow down degeneration," according to Prof. Dr. Imhoff. "It does not result in a cure, but if we can slow the inflammatory component, the wear process does not progress as it did before – you gain time."
