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Hip Replacement Surgery

Digitally controlled interventions, minimally invasive operating methods and a consistently implemented treatment regimen: cutting-edge methods have made hip replacement operations both safer and more efficient. Adrian Tschannen is one of many who have experienced this type of surgery.

lim and athletic, Adrian Tschannen was in his mid-50s when – all of a sudden – he felt a pain in his right hip. A stabbing sensation that was quite overpowering. "At first, I thought I'd pulled a muscle," Adrian Tschannen recalls. He isn't someone who pays heed to every little ache and twinge, so he ignored the pain. He also brushed aside his constant need to take several steps before he became able to carry on more or less normally. But then he reached the point where he couldn't manage any longer. A visit to the orthopedist shed light on the problem: the X-ray image clearly showed that he was suffering from arthritis of the hip. 

This came as something of a shock to Adrian, who is a business IT specialist. Most patients with this condition are not expecting such a diagnosis, even though about half of all people in Switzerland aged above 60 suffer from degenerative hip and knee disease. And it also raises a question: what should I do now? This is usually the starting point for a journey into unknown territory, because it is no longer possible to reverse arthritis caused by progressive breakdown of the joint cartilage. "We start out by trying to help the patient with conventional treatment," says Daniel de Menezes, a senior physician and consultant in orthopedic surgery and traumatology of the musculoskeletal system who specializes in knee and hip surgery. Conservative treatment methods include the administration of painkillers with anti-inflammatory properties, cortisone preparations and hyaluronic acid as well as physiotherapy. 


This meant that Adrian Tschannen was able to keep his hip pain in check for a while with the help of medication. "I'm an avid outdoor sports enthusiast," he explains, pointing to the rope and crampons hanging on the wall. Alpine mountain tours, deep-snow skiing and even skydiving and cycling: Tschannen is a man of action who engages in an almost endless list of sports. He took strong painkillers to fight the increasing agony caused by his hip, while continuing to take part in challenging winter ski tours. Until the day when he came to a realization: "I was suffering so much that I was no longer able to enjoy these expeditions." What had happened? The painkillers, which also have fever-reducing properties, brought his body temperature down so far that he was getting extremely cold in the freezing temperatures high up in the mountains. That day, he knew that he couldn't go on like this any longer. And when his pharmacist then suggested that he would actually be better off having the hip repaired, he reached the point where he had to admit to himself: he needed a new hip. 

"It's entirely up to the patient to decide the appropriate time for a hip replacement", Daniel de Menezes notes. Nowadays, this hip surgery is a routine operation for this experienced orthopedist – thanks to improved materials, state-of-the-art minimally invasive operating techniques, and increased safety during the surgery with digital support from a modern navigation system. All these factors have helped to raise the safety of these interventions to an exceptionally high level in recent years. And by no means least, the materials used today are superior to their predecessors, as de Menezes explains: "The main factor that leads to good results is highly crosslinked polyethylene with minimal wear and tear, which we now use as standard in conjunction with a shaft prosthesis."

The Hip Joint: the Hinge in Our Pelvis 
The Hip Joint: the Hinge in Our Pelvis 
The hip joints are crucial for biomechanical alignment in the statics of the skeleton. They ensure that the pelvis is kept horizontal and the spinal column is positioned at right angles above the pelvis. This allows the body's weight to be supported optimally on the legs.

The femur and hip bones in the human skeleton are connected by a ball-and-socket joint. This consists of the femoral head, located at the end of the femur, and the acetabulum, a hemispherical depression in the pelvic bone. The hinge between the leg and the pelvic bone allows the thigh to move very freely.

To ensure that this works smoothly, the acetabulum and the femoral head are covered with a sliding layer of cartilage that cushions every movement – acting as a "shock absorber". Synovial fluid inside the joint also supplies the cartilage with the necessary nutrients and provides additional "lubrication" for the joint. 

uring the operation itself, the surgeon relies not only on his team's abilities and his own medical skills, but also on support from a digital navigation system: the "Surgical Procedure Manager" (SPM). This audiovisual system uses sound and on-screen images to provide guidance throughout every step of the operation. Each member of the medical team knows what they have to do, when, and where. Moreover, every step is monitored and the operation can only be continued when each process has been completed correctly. "This system increases safety during an operation," de Menezes points out. "Everyone in the team takes the right step, at the right time and in the right place." No action is forgotten. What's more: valuable data is collected for analysis at a later stage. Using digital technology to ensure the safety of processes involved in performing operations is important, the specialist notes, because it means that human error can be almost entirely eliminated. "This has long been a mandatory requirement in other areas such as air traffic control," he adds. 


The Biel Hospital Center generally follows a standardized procedure throughout the process – known as the clinical pathway (CPW). This means that the procedures carried out by a team of medical specialists are always identical. So that patients are as fit as possible for the operation and to ensure the fastest possible recovery afterwards, they benefit from a customized information and exercise program before and after surgery. This provides a sense of security. "Right from the outset, I felt that I was in good hands," Adrian Tschannen recalls. As the first step, he was invited to an informed consent discussion with other patients and family members; then he was assigned his own caregiver – so from the very beginning, he knew what he and his family could expect. "You have a lot of questions at first. But when Karin was assigned to me, I had the support of someone that I could contact at any time – she was with me throughout the process." Experiences gained with patients are collected digitally and analyzed so that errors can be eliminated with greater consistency. The costs are another positive point: it has been possible to reduce them thanks to the standardized procedure used at Biel Hospital Center. All things considered, this is a comfortable situation for the patients. 

A huge surprise was in store for Adrian Tschannen immediately after the operation: "On the very first day, I was allowed to stand on the leg – and even walk!" But this comes as no surprise to Daniel de Menezes: "Minimally invasive operating techniques reduce post-operative pain, so the recovery process is ultimately shorter." This was also true in Adrian Tschannen's case: he was back home within a couple of days. Of course, he still needed several months to build up his strength and mobility with the help of physiotherapy. But his progress was constantly "onward and upward" – quite literally! After a little over five months, this keen amateur athlete was back amid his beloved mountains, balancing his way over the high ridges. One and a half years after the operation, he feels just as safe and free as he used to: "Most of the time, I forget that I ever had problems with my hip."

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