Berlin/Sommerfeld, Germany, 1-2 April 2011
“Problem case in hip surgery”
Not too long ago, endoprosthetic replacement of the hip joint was an intervention that promised pain relief primarily for the elderly. Today, total hip replacement is producing excellent functional results, and is thus becoming an option for an increasing number of younger patients as well. PD Dr. Andreas Halder, head of the EFORT Instructional Course “Hip Replacement in the Young Patient”, which will take place in Berlin/Sommerfeld this April, outlines some methods and indications. Dr. Halder is chief physician in the endoprosthetic clinic of the SANA Kliniken Sommerfeld.
Dr. Halder, why are more and more younger patients undergoing hip replacement surgery today?
The demand for mobility and freedom from pain is on the increase. On the one hand, this is partly due to increased demands at work. On the other hand, people are making increased demands upon themselves – such as in sports. These factors lead to an increasing number of hip replacements in young patients. Excellent long-term results play an important role in the decision process because patients can now rely on their artificial hip replacement to function well for a long time. Therefore, the decision for a hip prosthesis is now made more quickly, whereas patients previously agonised over such a decision a lot longer.
What are the indications for hip replacement in younger people?
Hip dysplasia, for one, is still significant, though the number of cases is decreasing due to successful preventive measures. At least as consistent, if not slightly on the increase, is the incidence of femoral head necrosis. This can be idiopathic, but it can also be brought about through drug-induced damage to the femoral head or by chronic alcohol abuse. And then, of course, there is post-traumatic osteoarthritis stemming from traffic and sports accidents. Finally, femoro-acetabular impingement was recently pinpointed as a frequent cause of hip arthritis in the young patient.
You mentioned dysplasia. What therapeutic possibilities does one have in this case?
It depends on the stage and the degree of dysplasia. Depending on the condition of the cartilage, we can preserve the joint of the femur or acetabulum by means of osteotomy in certain cases. If the joint is completely worn, demanding hip replacement solutions are indicated. During our workshops, we will discuss the broad range of options to develop a therapeutic algorithm for interventions.
What is there to say about femoro-acetabular impingement and its treatment?
Again, once hip arthritis is present, only a prosthesis helps. In the early phase, femoro-acetabular impingement syndrome can be very well treated by arthroscopy, however. In our course, we want to carefully differentiate how we adress indications for an arthoscopic approach versus open surgery.
What messages can course participants take home with them, what techniques will they learn?
The course is divided into two parts. The first part deals with the presentation of the clinical pattern with appropriate diagnosis as well as joint-preserving therapy, such as osteotomy and arthroscopy. In the second part, the subject of joint replacement is on the programme. Possibilities as well as advantages and disadvantages of the minimally invasive approach will be covered there and demonstrated through live surgery. Moreover, the new short shaft systems will be introduced – usually, by the designing surgeons themselves.
Orthopaedic surgeons today usually have a very busy schedule and lots of training opportunities. Why should someone register for this course in particular?
Because we will focus on the burning issue of “hip replacement in young patients” – which is a real challenge in hip prosthesis! We cover the most important medical conditions in this domain and have very competent instructors, a “who’s who” of hip experts, so to speak.
