Department of Orthopedics and Sport Medicine at the Clinical Center of Friedrichshafen was established several decades ago and is currently one of the most reputable orthopedic centers in the South Germany. The Department has in its structure two interregional endoprosthetic centres for maximum care (in Weingarten and Friedrichshafen). Both of them were certified (in 2014 and 2015) as centers with maximal medical care.
The team of the department consists of orthopedic specialists, surgeons, physiotherapists, orthopaedic technicians and nursing staff, working closely together to ensure that each knee or hip surgery is a success. Head of the orthopedic department is Prof. MD E. Winter, whose main focus of activity are hip and knee resurfacing (partial replacement of knee joint).
About 2000 knee surgeries (among them around 200 knee osteotomy surgeries, 600 arthroscopic interventions and 700 knee joint replacements) are performed annually at the Clinic of Friedrichshafen. About 4 133 patients are treated on an outpatient basis at the Department of Orthopedic and Sport Medicine in Friedrichshafen.
Our doctors perform all kinds of knee surgeries, called to relieve pain and to restore the functionality. We treat especially often the following conditions:
We use minimally invasive surgical techniques wherever possible combined with the latest implants available for procedures such as knee (replacement) surgery. The special field of specialization is arthroscopic knee surgery and knee replacement surgery.
We are dedicated to using joint-sparing techniques wherever possible in knee surgery, therefore trying to preserve the natural joint for as long as possible by using such techniques as abrasion arthroplasty. However, if the joint is badly damaged and conservative joint therapy (anti-inflammation treatment or injection of steroids/hyaluron) doesn't help, a total or partial knee replacement might be required. Our surgeons, physicians, therapists and nursing staff in Friedrichshafen will help you before and after your knee surgery so that you can return to your normal life as soon as possible.
Pre-operative radiography (CT, MRI) and diagnostic knee arthroscopy allow to make a precise diagnosis and to minimize risks. In case of arthroscopic procedure the orthopedic surgeons can in some cases treat the pathology in a minimally invasive way and thus avoid the knee surgery.
Many aspects may provoke damage of joints and bones. Besides, functionality disorders in knee joints may be inborn. How to identify problems with knee joints? You may experience dumb or acute pain in knees when walking or running. It may also appear when you jump or make quick motions. Pain often occurs during knee-bend and lasts for several minutes or more. It may also be accompanied by crunching and clicking. Some people complain about unpleasant sensations during sports activities (jogging, swimming, cycling, etc.).
Pain may be colicky or constant – no matter what it is, if it persists for a long time, joints may be damaged. Problems may be caused by different aspects:
Besides, wearing of joints may also be caused by excessive physical load. This medical condition is typical of runners and weight-lifters. If you have pain in knees after exercises, it is better to cease training for some time and consult a doctor.
If knee damage is serious and conditioned by pathologies, operation is inevitable. As a rule, surgery is prescribed in serious cases including:
Surgery is also necessary after severe injuries – it allows restoring normal functioning of joints and muscles (implants are also used). Modern operations require minimal invasion, they are safe in almost any age, and require short recovery time.
A method of repairing damage to this very important joint, without having to cut it open, was always the goal of orthopaedic surgeons, but this wish was only fully realised in the nineties. Today, modern orthopaedic medicine cannot do without arthroscopic knee surgery, which involves more than just looking at the joint – in arthroscopic surgery the surgeon can examine the joint and repair any damage at the same time in a minimally invasive procedure. At our clinic in Germany, we have the latest equipment and use the latest techniques. The arthroscopic surgery can in many cases avoid or postpone the knee replacement surgery.
This method involves both the endoscopic examination and surgery. In the case of arthroscopic knee surgery, an arthroscope is inserted through a small incision (approx. 8mm) and the inside of the joint is displayed on a monitor. The joint is filled with a special fluid, in order to better transmit the images. Via a second incision of the same size, surgical micro-instruments are inserted and used to correct or reduce the problem. We specialise in this type of surgery at the Friedrichshafen Clinic in Germany.
Prerequisites for successful arthroscopic knee surgery are a thorough diagnosis and clear indications. Therefore, careful clinical examination and medical imaging (X-ray, MRI) are required. The diagnosis is largely based on the medical history of the patient and the clinical examination of the affected joint. This type of operation is performed thousands of times annually in Germany.
Arthroscopic knee surgery is performed under general or epidural anaesthesia. The blood supply to the leg in question is interrupted so that the surgeon can see better during the procedure. The arthroscope is inserted via a small incision on the front of the joint and the surgical micro-instruments are inserted through another incision. In rare cases, additional incisions are required. The orthopaedic surgeons at our clinic in Germany are highly skilled in this procedure.
The advantage of arthroscopic knee surgery is that the incisions are very small, thereby sparing the articular capsule and the surrounding soft tissue. Compared with the alternative method of arthrotomy, which involves opening the joint completely, the infection risk and the likelihood of vascular and nerve damage are low. Arthroscopic knee surgery heals faster, making rehabilitation easier and produces less scarring.
Arthroscopy allows an experienced surgeon to see and assess any damage to the joint and to apply the optimal treatment with a high degree of precision, thanks to the magnifying properties of the arthroscope. Our orthopaedic surgeons at the Friedrichshafen Clinic in Germany specialise in this method.
The advantage of arthroscopy as opposed to operations that require large incisions is that no healthy structures are damaged in order to get to the area that requires arthroscopic knee surgery. This means less pain for the patient and the joint recovers faster and can bear weight much sooner after the operation. Minor procedures such as meniscus operations can sometimes be performed on an out-patient basis at the Friedrichshafen Clinic in Germany. Larger procedures such as ligament operations require only a short stay of 2 to 3 days in the clinic.
Generally, the usual surgical risks such as infection, bleeding, nerve damage, stiffening of joints, thrombosis, etc. are much lower with arthroscopic knee surgery than with open procedures. Such a procedure as arthroscopic knee surgery costs about €6.000 - €8.000 and allows in many cases avoiding or postponing knee replacement and other severe surgeries.
One common use of arthroscopy is in the treatment of lateral or medial meniscus tears. In the normal case the meniscus provides stability to the meniscus. Some injuries may result in meniscus tear, which causes swelling and severe pain in the knee. Knee arthroscopy is often performed to remove the damaged portions of the meniscus. When you arrive at the hospital for meniscus arthroscopy you may be given some sedative medicaments to get you relaxed and to reveal pain. The procedure is performed under spinal or local anesthesia. An arthroscopic knee surgery usually lasts between 45 and 55 minutes. Your surgeon will get access to your knee joint by using special instruments called trocars. There are usually made 2 or 3 small openings. A special solution is injected into the joint to keep the surfaces apart and to provide better visualization. Next, your surgeon will insert the microscope and other instruments through the various ports. The knee structures are magnified and projected onto the video monitor. Your surgeon will carefully examine the inner part of your knee joint, locate the damage, remove any loose or severy injured parts and use a shaving instrument to smooth any shabby edges during the arthroscopic knee injuries.
In most cases it is possible to repair the meniscus with small stitches and to remove the damaged portion within the same procedure of arthroscopic knee surgery. After the arthroscopic knee surgery you will be taken to the recovery area and be given pain medication as needed. Some patients can leave the surgery unit already within the few hours.
Minimally invasive procedures such as arthroscopic knee surgery are also dependent on adequate post-operative treatment for a successful long-term outcome. This is decided in advance, in a discussion between the physician and the patient.
In most cases, the knee is examined one day after arthroscopic knee surgery and again a week later.
It might be necessary for the patient to use crutches for a while in order not to put any weight on the joint. The need and duration of this measure depend on the exact nature of the procedure. The patient will therefore receive instructions from the treating physician at the Friedrichshafen Clinic in Germany with regard to this matter.
Our clinic for trauma medicine and arthroscopic surgery at the Friedrichshafen Clinic in Germany offers the full range of minimally invasive techniques. We strive to help patients as quickly as possible, using the latest methods available, so that they can regain their mobility. Thanks to innovative, new surgical methods, optimal treatment and faster rehabilitation is available, even in the case of complex joint injuries.
The degree of stability of the affected joint is an important criterion in the choice of the most suitable form of therapy. Annually the specialists at the Clinic of Friedrichshafen perform at least 300 arthroscopic surgeries on cruciate ligament.
Computer-navigated surgery can help the surgeon align the patient's bone and implants with a very high degree of accuracy. Knee navigation surgery
Computer modeling prior to the surgery of knee replacement allows to plan the surgical process in finest detail and to increase the accuracy of knee replacement. Before knee replacement surgery at Friedrichshafen Clinic in Germany, the surgeon plans the procedure based on the diagnosis and the X-rays and selects the model, the implant size and the fixation method according to your individual case.
These new techniques (interasurgical navigation and planning software) are incorporated into the surgical environment of the Clinic of Friedrichshafen and help to achieve higher success rates.
The general indication for knee replacement surgery is osteoarthritis at its advanced stages. As a result of this disease knee cartilage gets extremely thin and in some places gets completely worn out. The joint surface can be deformed with bony growths, which results in pain, swelling and limited mobility in the affected knee.
The other indications for knee replacement are:
Modern orthopedics offers a number of techniques to do the knee replacement. The new biological materials and patient matched instrumentation allow the surgeons in 99,9% to eliminate the problem in such a way that a patient forgets about the troubling symptoms.
In severe cases of knee joint degeneration only the implantation of an "artificial knee joint" can help the patient to restore the knee functionality. The destroyed joint surfaces are removed and a metal component with polyethylene surface is introduced. Important is to mimic the biomechanics of natural joints as closely as possible.
The age, gender, bone quality, weight and regular activities of the patient all play a role in the implant choice. If the natural mechanical axis of the leg is restored after knee replacement surgery, patient can walk normally again and has no pain any more. There are about 180 different designs of knee implants. The most commonly used models are:
The metal components of the implant are produced of titanium or cobalt-chromium based alloys. The plastic parts are manifactured of ultra high molecular weight polyethylene. For younger patients we implement special implants made of ceramics or ceramic/metal mixtures.
The materials used for these synthetic joints are especially produced for medical purposes and are characterised by the highest degree of tolerance by human tissue. They also enable permanent, pain-free functioning of the joint after the procedure.
A total knee arthroplasty is the replacement of the entire affected joint by a synthetic implant. During the implantation of a synthetic joint, the worn cartilage of the femoral condyle and the tibial plateau is removed and replaced by femoral and tibial components.
In knee replacement surgery, a polyethylene surface is used as the friction surface between the femur and the tibia. Pre-existing loss of bone can be corrected in knee replacement surgery by making use of polyethylene components of different thicknesses, thereby compensating for the differences.
The last years have again witnessed breakthroughs in unicompartmental arthroplasty. The introduction of the minimally invasive parapatellar technique helped to achieve better therapeutic results (better motion and gait) and cut risks. Knee replacement surgery by means of a unicondylar endoprosthetics are used for patients when only half the joint (either inner or outer) is affected, provided that the capsule ligament apparatus and healthy cruciate and collateral ligaments are intact. Bicondylar knee resurfacing helps to reshape and repair those damaged surfaces. The major benefit of this surgery is that it helps to retain healthy cartilage, ligament and bone in your knee.
Partial knee replacement implants are much smaller than total knee implants and can be introduced into the body through minimally small incisions (3-4 cm). What is more the cost of the unicompartmental knee surgery is only half of the total knee replacement.
A so-called unicondylar prosthesis primarily supplies a moderate degree of lateral or medial gonarthrosis. The partial denture replaces only the articular surface. The joint continues to be guided through the capsule-band apparatus. Such a partial denture is also referred to as a sled prosthesis.
Patients with a partial denture often assess the functionality of joint replacement better than people with a total endoprosthesis. Besides, they are usually happier with the result of the operation. However, a sled prosthesis is not an option for every patient. If one of the following points applies, the person concerned is more likely to come to a total endoprosthesis:
There are several forms of total endoprosthesis that can be used in gonarthrosis. Among other things, they differ in terms of material, structure and anchorage.
Younger patients are more likely to receive cementless prostheses. These can only be fixed in a stable bone. If necessary, they can be exchanged relatively easily.
In older patients, prostheses tend to be cemented. The reason: The bone structure is often loosened in them, and a different anchoring would be less stable.
In the case of gonarthrosis, two groups of total endoprostheses are distinguished:
In uncoupled surface replacement, only the articular surfaces are restored prosthetically. There is no firm connection between the prosthetic parts on the thigh and the tibia. In some cases, a so-called inlay is placed between these two parts of the prosthesis. As a result, the knee joint remains easily movable.
The prerequisite for this form of total endoprosthesis is that the natural capsule-ligament apparatus is sufficiently stable. Otherwise, an axis-guided prosthesis should be used.
In severe gonarthrosis with defective ligamentous apparatus, guided total endoprostheses are used. They have a firm connection between the two parts of the prosthesis on the femur and tibia. As a result, the force no longer needs to be held by the capsule or straps on the knee. However, the prosthesis is more heavily loaded and can relax more easily.
Gonarthrosis prosthesis: complications
Knee joint replacement with knee replacement, like all surgeries, involves general risks. These include, for example, bleeding or infection.
In addition, the prosthesis used can relax over time. Then usually has to be operated again. Sometimes the prosthesis has to be replaced as well.
Another danger after prosthesis insertion in gonarthrosis concerns the kneecap: it may loosen, break or cause pain. In addition, the bony structures may break around the prosthesis. Doctors call this a periprosthetic fracture. Gonarthrosis patients must undergo surgery again.
|Hospital stay||Average Cost (* rehabilitation cost not included)|
|Arthroscopic management of meniscus tear/knee cartilage repair cruciate ligament repair etc.||1-2 days||€ 6000 – € 8000*|
|Knee osteotomy (Realignment of damaged knee components)||3-4 days||€ 10000*|
|Partial knee replacement||4 days||€ 12000*|
|Total Knee replacement||7 days||€ 18800 – € 20000*|
|Rehabilitation after knee replacement||7-14 days||€ 2200 – € 4400|
We are especially dedicated to quality management and precision during the knee surgery. Our patients we offer
Patients who are considering knee surgery are encouraged to try the most modern techniques of conservative treatment first. Knee replacement is indicated only when other methods proved to be inefficient.
We aim to ensure pain-free movement through individual, patient-oriented care and gentle surgery methods. Our top priority – the patient and his satisfaction with his new knee prosthesis. For questions and appointments, please contact the international office of the Friedrichshafen Clinic in Germany.
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