Life without limping

The majority of the population is susceptible to an insidious disease… hip joint arthrosis results when this disease develops because of mere trifles. Just a small congenital asymmetry of the pelvic bone or a slight excess of exercise can ultimately lead to immobilization if one does not pay due attention to early symptoms. Markus C. Michel, Doctor of Medicine, co-founder of the Alphaclinic (Zurich) orthopedic clinic, and a specialist in orthopedic surgery and traumatology, speaks to us about the newest methods of treating arthrosis.

– Dr. Michel, why are so many people susceptible to hip joint arthrosis?

– When one is walking, this joint carries the main load, so any decline of its cartilaginous tissue – arthrosis – is very painful. As a rule, arthrosis develops with age, but it’s also diagnosed in young patients who suffer from a so–called dysplasia, which means a wrongly shaped hip joint. This leads to an uneven distribution of weight while walking: some  areas bear more of a load than others, and thus arthrosis develops. Even professional athletes may suffer from arthrosis: for example, if the hip joint has to bear an unnaturally high load while doing strenuous exercises. Often just a small accident which causes minor damage to the joint can start the process which might lead to arthritis over the years.

Arthrosis can be successfully treated; the main thing is to detect the problem in time. If you miss the signs, the degeneration, the cartilaginous tissue’s destruction, will begin, and might end with a complete loss of the shape of the head of the hip joint. Unfortunately, in this case, only joint prosthesis can
be recommended.

– Well, if the joint can still be saved, what treatment methods are the most common?

– There are different methods: hip arthroscopy (point invasive joint surgery), endoprosthetics (bone grafts with artificial parts) and osteotomy (joint position correction). In our center we began started doing hip joint arthroscopy already 20 years ago. At that time it was considered as a rather exotic method of treatment but has been established as the world standard in the meantime.

Arthroscopy is the successful procedure for minor hip joint  damage, impingement, or a labrum tear. But if the patient suffers from a severe damage of the cartilage, then only the prosthetic option remains.

Many years ago, we established that artificial hip joints generally function well, but problems arise because of the tissues that put the joint into motion: ligaments, muscles, etc. Using the traditional procedure for implanting a prosthesis leads to a destruction of many tissues – ligaments, muscles and even nerves have to been separated, which will harm the motor functions.

Therefore, from the very beginning, we were looking for ways to perform less invasive surgery. In 2004, we launched a new technique for the direct access to the hip joint – MicroHip.

MicroHip is a direct anterior approach, intramuscular and intravascular, which bypasses the two nerve regions and directly approaches the joint, so the nerve phases are not affected and neither muscles nor tendons are cut. This means there is no side tissue destruction at all. This minimal invasive technique for joint replacement took us about 10 years to develop and master.

– What are the advantages of this method?

– The artificial hip joint was invented more than 50 years ago, mostly to stop pain, which is an awful effect of arthritis. Yes, while the pain disappeared, mobility got very limited – if, after surgery, the patient could simply walk at a leisurely pace, this was a success. Today people are much more active and much more demanding – if they need a hip joint replacement, they want to return to full activity in a relatively short period of time. This is the big advantage of this MicroHip. It was designed to regain unrestricted activity shortly after joint replacement.

During MicroHip surgery all the soft tissues are handled with the utmost care in order to minimize damage. No muscle, no tendon nor any nerve is cut or separated; the musculature is just pushed to the side during the operation and stays completely untouched. All that needs to be done is a split of the joint capsule in order to get to the damaged joint. Once the joint is replaced, the joint capsule is sutured again so it can fulfill its purpose after healing. In most standard techniques the joint capsule is completely removed, which is one reason why the joint loses stability and quite often gets dislocated. With the MicroHip technique, the joint capsule, as well as all other soft tissue (muscle and tendons), stay in place and don’t lose stability. That’s why it rarely comes to a dislocation after a MicroHip surgery. A great advantage of this hip joint prosthesis method is that it allows for the complete restoration of motor functions, given time. But the most important thing is not only that rehabilitation is much faster and the patient can go back to the previous level of activity, but also that the long term  results are better. The patient will not only feel these benefits during the first two months after surgery, but also throughout the rest of his life.

Although there are many very high quality prosthetic hip joints on the market, still, the important fact is not only which kind of prosthesis is implanted but also how the surgery itself is performed and how much musculature/soft tissue is preserved.

– Has your technique become popular among the specialists in your field?

– Since I developed MicroHip in the early 2000s, many specialists have tried to perform the technique, but then realized that it is necessary to master certain techniques in order to master it – only a highly specialized surgeon with enough experience can perform this procedure. Since about 2010, I have been travelling the world, teaching my method to my colleagues. Today it is a common technique in Europe; in some places about a third of hip joint prostheses are implanted using the MicroHip technique. But even though this method is now known and established globally, there are still countries in which the technique is used less often.

– Do you continue to train specialists in other countries?

– Of course. Strictly speaking, teaching has become my main job. Over the last two or three years, the technique has, in particular, spread across Asia. The MicroHip procedure is actively performed in highly specialized centers.

– You opened the Swiss Sport Clinic in Bern in 2011. Why was it necessary to create a special institution for the treatment of sports injuries?

– Many athletes are diagnosed with hip joint injuries already at a young age. Competition has ratcheted up in professional sports, more daring records are being set, and this means that the loads on the bodies are increasing which generally leads to more injuries. In this cases, we gather specialists in this and other related fields in one place in order to develop and apply new methods to help the patients quickly and efficiently.

Most of these problems can be solved with surgical intervention, mostly with arthroscopy during which minor ossification is removed or a torn bony labrum (meniscus of the hip) is sewn up. Great attention is then also paid to rehabilitation – sports physiotherapists help athletes to recuperate.

– When you talk about young athletes, what age do you mean? 10–15 years of age?

– Sometimes even younger. The youngest patient in recent memory was 6 years old.

– What kind of sport did he do?

– Hockey. I will repeat myself: at first, a wrongly distributed load on the joint causes only minor pain, but after a couple of years it can develop into a serious
disease. The microtrauma, treated incorrectly, can be a real problem for the patient years later.

– I’m sure that professional athletes come to you in the advanced stages of osteoarthritis. How effectively can you help them?

– We come across a variety of cases. For example, there was a professional athlete, about 26–27 years old, in the middle of his career, but he already had significant problems with his hip joint. Our task was to save his career. We had to do everything possible for him to be able to exercise at full exertion for the next
5 to 10 years. Another case is a professional athlete who plays for his national team. His joints are weak, so he is at potential risk.

We can return him to active professional duties in a relatively short time, but then also need to make sure that this information remains confidential so as not to harm his sports career.

– Is it necessary to come to Switzerland for your professional opinion or is it possible to have a long-distance consultation?

– We can diagnose and recommend treatment at a distance if we have high–quality materials: images and MRI.

– How long does the patient need to spend in the clinic?

– If the issue is arthroscopy, then he needs to stay for 2 days. For joint replacement surgery, the patient usually spends 4 days in the clinic. However, if after this time he is still in pain, the patient can stay for another couple of days. After discharge, I recommend using a cane for 2–3 weeks when walking, and after that the person can return to a normal lifestyle.

– What clinic would you recommend for orthopedic rehabilitation?

– There are many good rehabilitation centers available. Care must be taken to choose the one which fits best with the patient’s needs.

– There are groups of patients – for example, women – who, in addition to joint diseases, run an increased risk of bone fractures. What is the reason for this? 

– The most frequent fracture in women is a femoral neck fracture. This is a vast topic, related to osteoporosis, in which there is bone tissue deterioration. Of course, this might be a normal bone fracture, but in most cases femoral neck fractures occur because of osteoporosis. Women face this problem after menopause. It happens because of a low level of hormones or because of premature menopause. In such cases, it is necessary to adjust the endocrine profile.

– Are elderly women with a femoral neck fracture doomed to immobility? Is this the verdict?

– The problem is that older people are not delivered to the hospital in time. They sit at home and contact local clinics. In other countries, particularly in Russia, I have had to operate upon people with femoral neck fractures who had been in bed for six or seven months before surgery. This increases the risks enormously. Serious consequences such as pneumonia etc can occur. It is very important to seek help and begin treatment in a timely manner.

– What tests do you do during the examination?

– If the patient undergoes an extensive examination for osteoporosis, a blood test is mandatory. It is also necessary to measure bone density. A team of highly qualified professionals who can conduct almost any type of examination has been gathered together in our clinic. We will find a specialist for any problem.

– And what about men? Which diseases and bone injuries are the most common?

– Men, as well as women, often suffer from osteoporosis. This is due to the fact that people, especially in northern countries, do not get enough sun to produce vitamin D3, which helps to absorb calcium.

– It turns out that this vitamin should be taken as a supplement?

– Yes, and from a very early age, even from birth. Bone tissue formation is possible only if the body receives a sufficient amount of vitamin D3. You can take as much calcium as you want, but it will not reach your bones without vitamin D3.

– What else can be done to avoid problems with bones and joints?

– It all depends on the cause of the problem. On the one hand, problems might arise due to hormone disruption; on the other hand, it may be a lack of calcium in the body.

Another necessary factor is motion and activity, which help to maintain bone tissue density. Regular physical activity and maintenance of correct weight, with a body mass index of no more than 25, are the main requisites for good health as well as longevity of the joints and the entire musculoskeletal system.

Markus C. Michel

Doctor of Medicine, specialist in orthopedic surgery and traumatology. He graduated from the University of Bern in 1985 and did his post-doctoral research studies at Harvard Medical School and MIT in Boston. He has worked in leading medical institutions in Switzerland as well as in various countries around the world. He is the founder of the Swiss Sport Clinic in Bern as well as the co-founder of the Alphaclinic in Zurich. Currently he works mainly in Zurich and is an International Consultant for minimal invasive hip surgery. He is the creator of the MicroHip hip joint replacement surgery technique.