Orthopaedic Department / Top clinic in Germany, Friedrichshafen

Orthopaedic Department

The department of trauma medicine, orthopaedics and endoprosthetics under the guidance of orthopaedic surgeon Prof. E. Winter, is responsible for the treatment of orthopaedic disorders and accidents. Our Center for joint replacement is a leading German orthopedic institution which performs the minimally invasive joint surgeries with computer navigation. Endoprothesis replacement at the Friedrichshafen Clinic is performed at the highest technological level of modern orthopedic medicine.

We are certified by the German Association for Trauma Medicine as a specialist clinic of the "Lake Constance-Upper Swabia Trauma Network". Annually, over 20,000 out-patients and over 3,000 in-patients are treated in the orthopaedic unit of our clinic in Friedrichshafen, Germany. We perform over 3,000 joint replacements annually, including knee-, hip-, and shoulder replacement.

Besides the treatment of injuries and all types of orthopaedic disorders, our orthopaedic unit is particularly focused on endoprosthetic hip and knee replacement surgery. We carry out over 700 orthopaedic hip and knee replacements and revision surgery procedures annually.

Sport orthopaedics and foot surgery are also specialist areas of our orthopaedic department in Friedrichshafen, Germany and include arthroscopic surgery of the shoulder, elbow, hips, ankles and feet. In the orthopaedic unit, we also treat acute spinal injuries and vertebral body fractures resulting from osteoporosis and a range of other orthopaedic disorders.

Besides primary operations performed in the orthopaedic unit, we also perform around 70 revision procedures annually, mostly on orthopaedic patients referred from elsewhere. Thanks to the trust of our patients and the referring physicians, the annual number of orthopaedic operations performed at our clinic in Germany has risen from 1,500 (2003) to over 3,200 in 2012.

Together with the orthopaedic clinics in Tübingen and Stuttgart, our head physician, orthopaedic surgeon, Prof. Winter, is authorised to train surgeons in the areas of basic surgery, conservative joint therapy, orthopaedics, trauma medicine and specialist trauma medicine".

Our clinic in Germany is the academic training hospital of the Tübingen University and the Surgical Clinic II is involved in the academic and practical training of medical students.

Spectrum of services

Trauma medicine of the musculoskeletal system: Surgical and conservative therapy of orthopaedic disorders (bone fractures, joint and muscle injuries). Our clinic is always ready to deal with accidents and orthopaedic emergencies.

  • Special trauma medicine:
    • Care of seriously injured patients
    • Spinal injuries
    • Pelvic injuries
    • Brain injuries
    • Paediatric traumatology
  • Areas of specialisation:
    • Orthopaedics: Primary endoprosthetics (joint replacements) – hip, knee, shoulder and elbow
  • Arthroscopic procedures ("keyhole surgery") due to injury or chronic orthopaedic disorders:
    • Knee (torn ligaments/meniscus injuries)
    • Shoulder dislocation/rotator cuff disorders)
    • Hip (impingement/early arthritis)
    • Ankle and elbow (cartilage damage/instability)
  • Diagnostics and therapy in sport orthopaedics and sport trauma medicine
  • Cartilage repair – knee/ankle/hip (cartilage transplant)
  • Hand surgery (broken bones/tendon injuries/ganglia)
  • Diagnostics and therapy of chronic spinal disorders (conservative and surgical)
    • Minimally invasive and open spine stabilisation in vertebral body fractures
    • Balloon kyphoplasty in vertebral body fractures due to osteoporosis
    • Stabilisation of vertebral body metastases
  • Nerve congestion surgery – elbow/hand/ankle
  • Bone/soft tissue tumour surgery
  • Orthopaedic foot/ankle surgery
    • (Orthopaedic forefoot corrections, e.g. "Hallux valgus", malalignment after injury/ligament reconstruction)
  • Chirotherapy, manual therapy, acupuncture
  • Extracorporeal shockwave therapy for orthopaedic disorders
  • Musculoskeletal pain therapy, e.g. infiltration, sometimes monitored by X-ray

Joint therapy

Orthopaedic Department

Joint diseases are divided into inflammatory and degenerative. The development of degenerative diseases is caused by the destruction or aging of articular cartilage. The joint simply cannot handle common loads and work as a shock-absorber. Inflammatory diseases are divided into chronic and acute. Depending on the age a preventive therapy is performed in Germany.

Drug therapy is aimed at relieving the pain syndrome and reducing inflammation. But it is not capable to fight the reasons of such diseases. Blockade therapy method implies injecting anesthetics directly into the joint.

Physical joint therapy in our clinic includes micro massage, electrotherapy, diathermy and other methods that reduce pains and inflammatory reactions.

Lately joint therapy methods such as manual therapy, chirotherapy or acupuncture have become popular in Germany. These traditional therapy methods are also available in our clinic.

Surgical joint therapy is performed only in cases of severe damages. Our doctors have rich experience in performing arthroscopy and joint prosthetic repair. The newest medical equipment, modern technologies and high quality standards give us ability to gain excellent results in joint surgical therapy.

Joint therapy with the use of keyhole surgery implies minimally invasive methods. Friedrichshafen Clinic performs numerous keyhole surgeries for complications after traumas and chronic orthopedic diseases. We offer the arthroscopy of:

  • knee joint (in case of cruciate ligament rupture or crescentic cartilage damage);
  • shoulder joint (in shoulder slip or rotator cuff diseases);
  • hip joint (in impingement syndrome or early stages of coxarthrosis);
  • ankle or elbow joint (in cartilage destruction or joint instability).

The arthroscopic therapy doesn't require complete joint opening, as traditional surgical methods require. This allows reducing the post-surgical recovery therapy and increasing chances for success, as the most of connective tissue stays undamaged.

Endoprosthesis replacement is indicated for the cases of damaged or aged joint, when arthroscopic therapy cannot give required results.

Our clinic offers endoprosthesis replacement for knee, shoulder, elbow and hip joint (hip resurfacing and total hip replacement, with a short shank, as well as using McMinn method).

Joint replacement

Joints are moving junctions between bones. All joints in a body are experiencing severe stress during the human life, leading to their gradual deterioration. Joint damage causes different problems, from mild complaints when walking up to acute pains even at rest. Artificial hip replacement surgery or knee replacement surgery implant can help to eliminate pain and restore freedom of movement when conservative treatments are no longer effective. The joint replacement cost is not low in Germany, but not as high as in Switzerland or Austria.

Joint replacement is one of the most successful types of surgery. Our doctors have more than 40 years of experience in the installation of prostheses. Surgeons in Germany perform more than 170 000 joint replacement operations annually. The specialists try to keep the natural joint as long as possible. Arthroscopy is a type of surgery that allows to keep the patient's own joint.

The decision to install prosthesis is accepted only in case of a significant joint destruction, causing severe pain to the patient. The joint replacement procedure is usually performed by experienced surgeons with the help of modern medical equipment. The quality of implants also plays an important role. Constant research is held in medical institutions in Germany in order to develop effective operative methods and new types of prostheses.

The joint replacement is carried out with the help of computer navigation and minimally invasive surgery. These methods allow to better protect the tissue during the replacement, to reduce the risk of complications and the patient's recovery time.

Today any kind of joint can be replaced in our department: there're prostheses for hip, knee, shoulder, elbow, ankle, finger and toe joints. All the damaged parts are removed during the operation and replaced by a set of plastic, metal or other materials. Complete (total) or partial hip replacement (for example, surface arthroplasty) can be performed depending on the state and degree of bone destruction.

Fixing the artificial part is done either by bone cement or using cementless fixation with bone ingrowth into the endoprosthesis. Hip replacement with a cementless fixation is primarily used if the bone is not badly damaged, which is often the case with younger patients. A combined method of fixation might also be used.

Individual selection of the optimum treatment and the type of prosthesis depends primarily on the condition of the particular patient. Accurate diagnosis including x-rays and MRI is carried out by our experts a few weeks before the operation. VISIONAIRE technology selection of individual endoprosthesis is often used. It guarantees comfort and maximum durability of the artificial joint.

We use only the proven prostheses of high quality, which are usually manufactured in Germany, Switzerland or America. High-quality implants account for biocompatibility, durability, longevity, good biomechanics and the use of durable materials resistant to friction. Prostheses are usually made up of two different materials. They can combine steel, cobalt-chromium alloys, titanium alloys, plastics and ceramics. New advanced materials, such as high quality polyethylene are constantly developed and applied in Germany to reduce friction between the moving parts of the prosthesis.

Various modern coatings are used to optimize the ingrowth of the prosthesis, e.g. hydroxyapatite, plasma spraying, bone morphogenetic protein or silicified silane coating. In Germany anti-infective coatings such as silver or copper, having antimicrobial activity and low toxicity are used in patients with high risk of infection. Continuous improvement of materials allows extending the life of prostheses, which ranges from 15 to 25 years.

After the joint replacement surgery, we usually recommend our patients to undergo a course of rehabilitation, which lasts 2 to 3 weeks. Hip or knee replacement recovery is crucially important for further mobility. It is an important part of joint replacement treatment in Germany. Modern technology considerably reduces the duration of recovery after the replacement procedure, so that patients can very soon return to their normal life and even do sports. Moderate sport loads help to accelerate natural bone restoration and strengthen the muscles supporting the joint.

Modern joint replacement provides patients with an opportunity to completely get rid of pain and return to an active life. Durability and reliability of prostheses allow to maintain the freedom of movement and to preserve the mobility for a long time.

The department of traumatology, orthopedics and prosthetics at the Friedrichshafen clinic performs all types of artificial joint replacement, e.g. primary hip replacement (total prosthesis, complete replacement, short-stem prosthesis cap prosthesis, and minimally invasive prosthetics), knee, shoulder and elbow replacement, hip replacement, using BHR (Birmingham hip resurfacing) method etc.

Orthopedic surgeons, working under the leadership of Prof. Dr. Eugen Winter, are acknowledged experts in the treatment of diseases of the musculoskeletal system. They have gained enormous clinical experience in performing such surgery both for young patients and for older age groups. Using high-quality materials, minimally invasive surgical techniques and different ways of fixing the components of the (endo)prosthesis belong to the special range of services at the Friedrichshafen clinic.

The joint injections

The joint injections of hormones (corticosteroids)

Corticosteroid hormones (corticosteroids) are drugs, common property of which is a marked anti-inflammatory effect. The best known drugs of this group are kenalog and diprospan. The injection of corticosteroids into the joint leads to a rapid remission even of a severe inflammation. This, in its turn, results in weakening of such main symptom as osteoarthritis – the joint pains.

In terms of its anti-inflammatory effect corticosteroids have no parallel. But, unfortunately, these drugs have many serious side effects. Therefore, today, the joint injections of corticosteroids are used rarely.

The joint injections allow:

  • to avoid further joint destruction
  • to relieve or eliminate pain
  • to improve the mobility
  • to withdraw the swelling
  • to improve their quality of life

However, you shouldn’t be in horror of hormones, because even today there are situations when the single joint injection of them for the patients with osteoarthritis may be justified.

The joint injections of hyaluronic acid

This is one of the most effective and promising methods of joint osteoarthritis treatment. Since 2003, this method is included into the list of measures recommended by the World Health Organization for the patients with trivial and moderately expressed symptoms of osteoarthritis (2 and 3 Kellgren stages).

In most cases, treatment by the joint injections of hyaluronic acid is used when such conservative methods as pills, ointments, conventional injections and the like are inefficient. It significantly reduces dependence on analgesics and anti-inflammatory drugs, has a long-lasting therapeutic effect, slows down the progression of osteoarthritis and allows delaying the joint replacement operation.

Hyaluronic acid is a constituent of synovial fluid of a healthy joint and is a natural structural component of an articular cartilage. In the event of osteoarthritis, there is the decrease of the concentration of hyaluronic acid in synovial fluid of the joint that increases the friction in the joint and degenerative changes in the cartilage. The joint injections of hyaluronic acid have a positive effect on the metabolic processes in the tissues of the joint and cartilage: sodium hyaluronate forms a protective layer over the damaged cartilage, which prevents it from further destruction and makes sliding of adjoining cartilage surfaces better. Moreover, the injections of hyaluronic acid penetrate deep into the cartilage, improving its elasticity and flexibility. Thanks to hyaluronic acid the "dried up" and thinned, because of osteoarthritis, cartilage restores its shock-absorbing properties. As a result, pains and stiffness in the joint reduce, its functions and range of motions recover.

The joint injections of plasma (PRP-therapy)

Plazmolifting is joint therapy based on the joint injection of autologous plasma of the patient’s own blood. It’s a gentle and effective therapy used for treatment of polyarthritis, muscles and tendons injuries. These injections replace more complex operations, as a result of which the patients stay in hospitals longer, need long-term rehabilitation and prevention of complications.

The injection of specially treated patient's own blood into the joint cavity allows treating various types of arthritis, muscles and ligaments damages carefully and efficiently. This technique may be an alternative to complex and expensive operations. This reduces not only the time of staying in hospital, but also a rehabilitation period, as well as the probability of complications.

To perform PRP-therapy the patient's own blood is centrifuged in a special mode. During this procedure the fraction with a high concentration of platelets, containing a large number of tissue growth factors, releases. The accurate adherence to the mode of centrifugation and sterility is very important.

The careful selection of the reagents and sterility, as an important component of this method of treatment, have the highest priority in our clinic in Germany.

Endoprosthetics

Hip

Orthopaedics in Germany

Besides treating injuries and orthopaedic disorders of all kinds, our orthopaedic department also specialises in the insertion of hip, knee and shoulder endoprosthetics – approx. 700 orthopaedic procedures of this nature are performed at our clinic in Germany every year.

In a total hip replacement, the femoral head and neck are removed and a shaft is attached to the femur, a durable method that is used in about 85% of patient in orthopaedic procedures. In the case of cap prosthetics, the femoral head and neck remain intact, thereby also retaining the normal biomechanics of the hip. This has great advantages from an orthopaedic point of view: retention of bone, normal load-bearing of the hip. Good bone quality is a prerequisite. It is used in about 15% of orthopaedic patients with arthritic hips. The long-term results of the BHR original McMinn prosthetics used in our orthopaedic unit are excellent – and this has also been scientifically verified.

Knee

Knee replacement surgery is performed when orthopaedic patients suffer from constant, unbearable pain. In 90% of cases in our orthopaedic unit in Germany, surface prosthetics are preferred. The damaged surfaces are removed and “crowned” with a new surface. In less than 10% of cases, sliding prosthetics or hinge prosthetics are used. Our orthopaedic unit has years of experience with all types of prosthetics with excellent, long-term scientifically verified results.

Shoulder

In our orthopaedic unit, shoulder prosthetics are used for:

  • Communited humeral head fractures
  • Stage 4 arthritis

Our orthopaedic unit has had excellent scientifically verified results with shoulder replacement surgery in the last 10 years.

Endoprosthesis replacement

Endoprosthesis replacement is used in our clinic as a surgical treatment of damaged or worn joint that implies replacing it with an artificial one.

It is worth mentioning that endoprosthesis replacement is only indicated for the cases when drug therapy of joint arthrosis is ineffective, and the quality of patient's life is constantly worsening due to unbearable pains. Endoprosthesis replacement is used to restore the life quality of such patients.

There can be different reasons of arthrosis development, like inborn defects, traumas, extensive loads when training. Often arthrosis appears as a result of rheumatoid disease. However it is not always possible to detect a specific reason.

There a few methods of endoprosthesis replacement in our clinic. The most popular surgeries for joint replacement are hip replacement surgery and knee joint endoprosthesis replacement. The doctors of Friedrichshafen Clinic in Germany also perform endoprosthesis replacement of shoulder, elbow, ankle joints, small joints of feet and fingers.

To replace the pathologic joint prosthetic implants are used. They are made of ceramics, metal and extra strong polyethylene. Over the last years the development of endoprosthesis technology in Germany allowed restoring the functioning of damaged joints and returning patients to their active lifestyle. Endoprosthesis fixation is performed by a newly built-up bone tissue that easily covers the implant. As the bone tissue growth takes a lot of time, the doctors often use bone cement to strengthen the endoprosthesis. With the help of bone cement endoprosthesis can be precisely fixated in correct position that guarantees the optimal joint functioning. Today the endoprosthesis replacement is performed by three implant fixation methods: cement, cementless and combined.

Depending on the used kind of implant endoprosthesis replacement is also divided into resurfacing, partial and total. Joint resurfacing and partial endoprosthesis replacement is indicated in young patients with a good quality of bone tissue. An orthopedic surgeon takes into account that in future such patients may require revision endoprosthesis replacement, and saving big amount of bone tissue is very important.

One of the most famous methods of hip joint replacement is hip resurfacing by McMinn's method that is also called "Birmingham Hip Resurfacing". This kind of surgeries is successfully performed by our orthopedic surgeons.

If hip resurfacing surgery is impossible, we offer McMinn's Birmingham. This is a partial endoprosthesis replacement that implies removing only a part of femoral head, saving the most of the bone. The cost of this endoprosthesis replacement surgery in standard package is €15,000.

Both resurfacing and partial endoprosthesis replacement can be performed by minimally invasive surgical methods. Such approach allows minimizing the risk of post-surgical complications and decrease the time of rehabilitation.

Total endoprosthesis replacement is indicated mostly in elderly patients or in cases when joint resurfacing or partial replacement is impossible. Although this method implies removing the most of the bone, total endoprosthesis replacement allows precise joint replacement even in case of high-scale damages.

Knee joint endoprosthesis replacement is mostly performed with the aim of a sliding or total endoprosthesis. The sliding prosthesis is used in partial replacement.

The process of rehabilitation is highly important for successful knee or hip endoprosthesis replacement. It is performed by experienced orthopedists and physiatrists of our clinic. Total endoprosthesis replacement of knee or hip joint requires 1-2 weeks for rehabilitation. A standard rehab course in our clinic, including regular consultations and X-ray control is €4,000 - €5,000.

Endoprosthesis replacement in Friedrichshafen Center in Germany is performed at the highest level of quality standards, using the newest equipment and reliable, long-term prosthesis. Our orthopedic surgeons possess rich experience and will help to return to the normal mobility within a short time.

Materials and procedures used in our orthopaedic unit

The classical surgical procedures performed in the orthopaedic unit of our clinic are supported by the latest orthopaedic materials, some of which stem from burn medicine.

In the case of permanent implants in orthopaedics and other areas of medicine (breasts, wrinkles, joints) we only work with accredited suppliers.

In our orthopaedic department, we prefer minimally invasive techniques – key-hole surgery. In orthopaedics, arthroscopy is used to examine the joints.

Joint arthrodesis

Joint arthrodesis is a surgery which helps to restore previous support ability of the joint by fixing it in stationary position. In case of joint arthrodesis cartilage surfaces are removed, while joint surfaces are fixed in the most appropriate position in the terms of functionality and tight contact. In some cases, if joint surfaces are under pressure, compression joint arthrodesis may be required.

In our clinic the joint therapy is conducted under general or spinal anesthesia. As for the latter, patient stays conscious during joint arthrodesis surgery, but lower part of their body is numbed. The surgery takes about 2-5 hours. Tourniquet bandaging is an option if it is necessary to prevent bleeding.

Types of joint arthrodesis

There are three types of arthrodesis:

  1. Intraarticular. The difference is that articular, not epiphyseal cartilage, is removed.
  2. Extraarticular. Cartilage is not removed; bones are fixed by bone graft.
  3. Mixed. Cartilage is removed; bones are fixed by bone graft and metallic fixators.

After joint arthrodesis it may be necessary to wear plaster bandage up to one year.

Joint arthrodesis techniques

Donor material derived from another body is used as an implant. It Is provided by a special laboratory which deals with bone grafts, their procurement and conservation. Material is placed between the bones to accelerate the process of knitting.

Another technique of joint arthrodesis is implanting base metals: the joint is closed, and bones are fixed in the area of knitting. However, it is impossible to do without bone implant: it is of great importance for bone knitting.

Indications and contraindications to joint arthrodesis surgery

Indications:

  • Joint malunion
  • Tuberculosis of bone
  • Chronic inflammation in the joint
  • Hanging joints
  • Contractures
  • Deforming arthrosis
  • Aftereffects of poliomyelitis, etc.

Contraindications:

  • Children under 10-12
  • Elderly people of 60 and older
  • Nontuberculous fistulas
  • Local lesion, if there is festering tendency
  • Grave condition of patient

Possible complications:

Rare, but still possible, are the following complications after joint arthrodesis:

  • Bleeding
  • Change in gait
  • Bone osteomyelitis (if infection was brought during the surgery)
  • Damaged nerves
  • Venous thrombosis in lower limbs
  • Need for repeated operation.

If you noticed or sensed the following indispositions, it is important to inform you doctor about them:

  • High temperature and fever
  • Plaster bandage turned red (possible bleeding)
  • Severe pain even after taking pain relievers
  • Numbness, pricking in legs
  • Limbs turning grey
  • Short breath, nausea and vomiting.

The joint replacement costs vary, according to the individual indications, joint type and state of the joint damage. The average price (including 1 week of rehabilitation) makes up about €8,000 - €12,000.

Rehabilitation

Rehabilitation period after joint arthrodesis may take up to 4-8 months. It is prohibited to take a bath or wet the operated area without doctor’s permission. When plaster is taken off, it is important to do an X-ray.

During two months after surgery patients get about only on crutches. After three months it is allowed to lean on operated leg. It is likely that doctor prescribes additional physical therapy (ultrahigh frequency treatment, electrophoresis, etc.), curative gymnastics, such as exercises for healthy joints, muscle stretching and breathing exercises.

Complete rehabilitation after joint arthrodesis usually takes about 8 months (sometimes a year). After that regular doctor’s control of limbs is required.

Despite joint arthrodesis being a complex surgery, you don’t have to be afraid of complications if you visit Friedrichshafen clinic. If you are interested in this kind of knee surgery, you can contact us in any suitable way. Our doctors' professional competence will help to restore your usual mobility.

Cost factors

The joint replacement cost depends on many factors and is calculated individually. The price of hip replacement in Germany already comprises the cost of modern, high-quality prosthesis materials. The hip joint implants perfectly replicate the features of natural human joints. As a result the implants are not rejected by the body and provide good joint mobility.

Where is the procedure cheaper?

The price of joint replacement surgery in Germany is usually much more attractive than in Great Britain or in the USA; at the same time German clinics offer the same or even the better quality.

The cost for endoprosthesis replacement varies in different German regions. It depends on specific patient's health condition as well as on complexity of the surgical intervention.

The approximate cost of knee and hip joint replacement in Germany, Great Britain and the USA is:

Treatment in Germany: The range of medical services The Friedrichshafen Clinic Munich Clinics Great Britain USA
Hip joint replacement from €17.400 / $19.500 from €25.100 / $28.130 from £14.000 / $18.600 $50,000 - $100,000
Knee joint replacement from €16.700 / $18.700 from €26.500 / $29.700 from £11.700 / $15.600 $40,000 - $80,000
Orthopaedic Department

4.8/5 (1740 votes)

Comments and questions

Henry Teye Kwablah Mon, 21 Мая 08:19

I had a damage ankle and want to find out how much it will cost me to fix it thanks.

Ali ahmad Sat, 31 Mar 13:15

Hi.greeting I am ali Ahmad from Pakistan I wants treatment of my disability im your country so plz higher me and make me able to walk my own foot. I have no future in Pakistan so that's why I am requesting u hope so u must concentrate my humble request I am waiting for your response. Thank u so much

Noha Sat, 17 Mar 19:23

I would like to ask about Cinderella feet surgery if available in your clinic what’s the cost and recovery time
Thank you

Kabir Shittu Wed, 14 Feb 18:28

Greetings,
I ran into this Web page, but am not sure if this is a good platform to discuss private topics. I do have an ankle injury with a metal replacement in one of missing bones(metatarsal) just where I have the flight/jump bone. Please I need to know if I can get access to the best specialist to discuss my current situation such as the availability to a surgery, so I can replace the metal replacement with the best available replacement such as BONE REPLACEMENT. Kindly advice me on any latest technology used. Thanks.
Warm regards,
Kabir

Gasan Klimov Mon, 22 Jan 12:42

Good day!
My son is 1 year old. He has a condition called hemihyperplasia. The left side of his body is bigger than the left and so his left leg is about 2 centimeters longer. Does your clinic do leg lengthening or shortening procedures?

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Medical Staff

Prof MD Eugene Winter

Prof MD Eugene Winter
Head of the Orthopedic Department of Clinical center of Friedrichshafen

MD Norbert Heuer

MD Norbert Heuer
Head physician assistant

MD Christoph Kaiser

MD Christoph Kaiser
Senior physician

MD Rainer Schnell

MD Rainer Schnell
Senior physician

Ingrid Glauss

Ingrid Glauss
Medical secretary

Services

Knee

Hip

Shoulder

Spinal column

Elbow

Foot

Info

Facts and Figures

  • 12000 outpatient
  • 2523 inpatients
  • 2500 surgeries
  • 735 arthroplasty of the joints of the hip, knee and shoulder
  • 1500 hand surgeries

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