The most important factor is the right therapy at the right point in time. Surgery is advisable if other conservative measures have not produced desirable results.
At OrthoPraxis we provide personalised and detailed advice. We discuss the pros and cons of surgical therapy with you. Years of experience make us the perfect point of contact for all your musculoskeletal issues.
Our doctors are specially trained in all areas of orthopaedic and accident surgery. Ongoing training ensures that our medical knowledge is always up to date. With us, you are in the best hands.
Procedures are carried out on an outpatient basis where possible and practical. Where necessary, patients are admitted to the Wolfart Clinic. We place great emphasis on ensuring that you receive optimum care not only during surgery, but that all preoperative and postoperative care is also optimally tailored to your needs (e.g. physiotherapy, follow-up treatment).
Our experienced doctors are happy to assist you at any time.
Whether an injury, wear and tear or a congenital condition – patients with hip problems today have a wide range of treatment options available to them.
Hip replacement surgery / artificial hip joint
You can find information on hip replacement surgery here .
In the case of misalignment or malfunction of a joint, which may lead to the onset or progression of osteoarthritis, joint-preserving revision surgery must be discussed at an early stage, especially with younger patients.
In this way the development of osteoarthritis, as is common with hip dysplasia, Perthes disease or slipped upper femoral epiphysis can be significantly delayed or even effectively avoided.
Depending on the location of the misalignment (pelvis or femur), the hip socket is manipulated back into the anatomically correct position or the femoral neck angle is changed or stabilised using an angle plate. In both instances the aim is to achieve ideal pressure distribution in the hip joint.
X-ray taken after revision surgery to increase anteversion
X-ray taken after triple pelvic osteotomy according to Tönnis/Kalchschmid
Femoral acetabular impingement
Femoral acetabular impingement inevitably leads to damage of the labrum and then to osteoarthritis, due to certain configuration of the acetabulum and/or femoral neck region. This impingement can be treated by addressing the labrum and minimising further damage by means of arthroplasty.
The knee is one of the most complicated joints in the human body, and is subjected to enormous loads during everyday life: Irrespective of whether we are standing, walking, sitting or crouching, let alone jumping – everything places strain on the knees. It is no surprise, therefore, that knee pain is extremely common and can impact severely on quality of life.
The causes of knee pain are many and varied, ranging from slight overuse to progressive wear and tear (arthritis) of the knee joint. The joint cartilage as well as the surrounding structures such as ligaments and muscles can be affected.
Be it a sports injury or wear and tear – a wide range of treatment options is available for healing the joint and restoring pain-free function.
Knee replacement surgery / artificial knee joint
You can find information on artificial knee joints here .
Sports and ligament injuries / arthroscopy
Sports knee injuries can affect the meniscus, the joint cartilage or ligaments, or a combination of all three.
Many of these injuries can be treated conservatively, i.e. using specially adapted bandages or splints (so-called orthoses) and physiotherapy where necessary.
If the cartilage surface is damaged, it can be resurfaced arthroscopically. Localised defects can also be treated by taking a bone and cartilage plug from a joint area with lower physical load. This cylinder-shaped bone plug is then immediately transplanted into the problem area. In the case of more severe cartilage damage, several of these plugs can be inserted into the knee joint. The implanted bone and cartilage pieces bond with the surrounding cartilage substance within a few weeks.
In exceptional cases cartilage cells can also be cultivated (with subsequent transplantation). For this so-called autologous chondrocyte transplantation (ACT) we remove a small amount of cartilage tissue from a healthy, non-load-bearing area of the knee joint. The harvested cartilage cells are then cultivated in a laboratory over a period of 4 to 6 weeks. The cells are kept on a three-dimensional carrier fleece and can thus be cut exactly to the shape required. The carrier substance is placed into the damaged area in a second procedure and is reabsorbed by the body within a few weeks. The transplanted cells form a new cartilage layer.
Hospitalisation is generally 3 to 5 days, and rehabilitation takes up to three months depending on the procedure used.
Meniscus injuries and tears require refixation or removal of the damaged parts. Suture techniques or so-called meniscus anchors can be used for refixation. If refixation is not possible, special instruments are used to sparingly resect the damaged sections of the meniscus. These procedures are performed with an arthroscope and, as a rule, on an outpatient basis. In certain cases short-term hospitalisation may be necessary.
Extensive cartilage damage (examining hook also shown)
Repaired meniscus tear
Medial collaterate ligament injuries, cruciate ligament ruptures
While medial collaterate ligament injuries can often be treated conservatively, cruciate ligament ruptures frequently require surgical procedures using autografts. The procedure involves substituting the missing posterior cruciate ligament with strong replacement tissue. Tendon autografts are usually used for this. A section of the patella tendon (the tendon between the kneecap and the shin) and the semitendinosus tendon (one of the hamstring muscles) are particularly suitable as replacement tissue.
These procedures generally require short hospitalisation. Rehabilitation typically takes approx. 6 weeks. Intensive sport is however not recommended for three to six months, depending on the type of sport. As this is a decision that must be taken on an individual basis, we will gladly advise you in more detail if required.
Wear and tear (arthritis)
Arthritis of the knee develops as the protective cartilage becomes progressively thinner. The bones rub directly against each other. The patient experiences pain and restriction of movement.
Wear and tear of the joint is treated based on the stage of deterioration and the level of intensity. Therapy also depends on the age of the patient. In the early stages, physical and drug therapy are first considered, such as anti-inflammatory medication or joint infiltrations with so-called joint regeneration compounds (e.g. hyaluronic acid). Special insoles are also an option.
In advanced stages, arthroscopic and/or axis correction surgery are recommended. In arthroscopic procedures we implement a minimally invasive technique to resurface the cartilage and meniscus structures, using the camera as our eyes. Any inflammatory cells originating from the synovial membrane are also removed (synovectomy). In the case of leg axis deformities, which frequently lead to early arthritis, revision surgery is performed (see below).
Where wear and tear in young people has occurred as a result of angular malignment (knock knees, bandy legs), angle correction revision surgery can be performed. Typically, corrections are made at the position of malignment, i.e. either in the thigh or lower leg.
For example, by correcting the angle in the case of bandy legs it is possible to shift the load from the worn inside of the knee joint to the outside which is still intact. This is an excellent way of staving off knee joint replacement (knee joint prosthesis) especially in patients with early-stage or moderately severe arthritis of the knee joint.
Hospitalisation for revision surgery of the knee is approx. 5 to 10 days. This is followed by outpatient physiotherapy. The load is gradually increased under guidance. The metal implant is removed again approx. 12 months after surgery. This is generally also possible as an outpatient procedure.
At a later stage, joint replacement surgery (implant) will be necessary, which then either involves a partial or full replacement, depending on the location and degree of deterioration (see Arthroplasty).
X-ray of a knee joint with wear and tear on the inside
X-ray of a knee joint with angular correction
Postoperative correction of the leg axis with decreased load on the medial joint can be clearly seen here.
The shoulder joint is extremely sensitive, unstable and vulnerable to injury. The reason: The socket is significantly smaller than the ball (1:4). As a result, the ball can slip out of the socket at lot easier than is the case with other joints. The anatomy of the shoulder however also has advantages. It enables rotational movement of almost 360 degrees. No other joint allows for this high range of motion. The shoulder joint is surrounded by the so-called rotator cuff. This is a group of four muscles that stabilises and moves the shoulder.
Injuries to the shoulder can affect the tendons, ligaments and cartilages or the bony structure. They include AC joint separation, fractures, dislocations (luxation) or a combination of injuries.
Congenital and wear-related disorders also often cause intense discomfort, and necessitate a visit to an orthopaedic surgeon.
Shoulder replacement surgery / artificial shoulder joint
You can find information on artificial shoulder joints here .
Rotator cuff and impingement syndrome
“Impinge” means “to be forced upon or against something”. The space between the humeral head and the roof of the shoulder is inherently quite narrow. Excessive strain on the shoulder can lead to a thickening of the supraspinatus tendon of the rotator cuff. The tendon is progressively constricted, which results in impingement syndrome. This leads to inflammation and pain. Since the supraspinatus muscle is responsible for abduction, flexion and external rotation of the upper arm, every arm movement results in pain.
In less severe cases, injections and physiotherapy for a period of 4 to 8 weeks can help. This treatment is performed on an outpatient basis.
In severe cases, surgery is frequently recommended. This procedure can in most cases be performed by means of arthroscopy. We gently and carefully expand the restricted area so that the muscles, tendons and bursa have enough space again. Any calcium deposits are also removed. We also remove any damaged cartilage.
On the X-ray, the calcium deposit can be seen to the left of the humeral head.
The image shows a shoulder joint with suture repair of the rotator cuff using bone anchors, which provide stable fixation. These anchors are made from titanium and do not need to be removed again.
Rotator cuff tear
The older we get, the higher the risk of one or multiple rotator cuff tears. Where tendons are already damaged, it often only takes slight overloading for the rotator cuff to tear. But a tear can also occur as a result of an accident, for example when colliding with an opponent in sport or falling from a bike.
A rotator cuff tear generally requires surgery, as a torn tendon does not heal on its own. Sophisticated shoulder surgery enables us to repair most torn tendons by means of arthroscopy, in conjunction with a “mini-open” technique where necessary. Reconstruction of the tendon involves re-attaching the ends of the tendon to the bone using tiny implants (suture anchors).
In general, hospitalisation of 3 to 5 days for surgery is followed by physiotherapy over a period of 6 weeks. After 3 to 6 months it is possible to fully return to sports.
If the rotator cuff is stretched to the extent that it can no longer be reconstructed, this is referred to as cuff tear arthropathy. In most cases, marked shoulder joint dysfunction is evident. It is not possible to lift the arm any longer and every movement results in intense pain. The humeral head moves upwards and under the roof of the shoulder, thereby preventing normal function.
In this case it is possible to restore the function of the shoulder and considerably ease the symptoms by means of reverse shoulder replacement or Delta shoulder prosthesis (see Arthroplasty).
A fracture of the collarbone is one of the most common fractures in the human body. All age groups are affected.
The collarbone (clavicle) connects the shoulder girdle to the trunk. It is a single bony structure between the arm and the trunk.
Treatment depends on the type of fracture. Medical professionals distinguish between so-called displaced and non-displaced fractures: if the bone ends are close together it is not necessary to operate. Immobilising the shoulder is sufficient. Within 3 to 4 weeks new tissue is formed and the bone ends grow together again.
If there is no more contact between the bone ends surgery must be performed. Surgical intervention involves moving the bones into the correct position. A plate or rush pin is used to fix the fracture.
In the event of surgery, only a few days of hospitalisation are required. Physiotherapy for a period of around 4 to 6 weeks is always necessary until the bone is healed. Once the bone has healed strengthening can begin. After 6 to 12 months the implants (fixing plates, rush pins or screws) are removed.
Plate treatment after collarbone fracture
Shoulder joint injury
The shoulder joint is located on the “corner” or outer part of the shoulder. The medical term is acromioclavicular joint (or AC joint), as the shoulder joint connects the outer end of the collarbone (= clavicle) with the part of the scapula that forms the highest point of the shoulder (= acromion). The extremely tight AC joint is surrounded by a strong joint capsule. It is also stabilised by ligaments.
Shoulder joint injuries (piano key phenomenon/Tossy injury) largely result when one or multiple of these ligaments are damaged. In less severe cases, these injuries can be treated conservatively, namely by stabilising them with strapping or a splint.
Injuries affecting multiple ligaments require surgery to repair the joint or, in case of old injuries, re-attachment of the ligaments or grafts using the patient’s own bone material. Hospitalisation of 3 to 5 days is followed by physiotherapy for a period of 6 weeks. After 3 to 6 months it is possible to fully return to sports.
X-ray showing AC joint separation
X-ray taken after AC joint separation stabilisation (Tossy III) using a Balser plate
Since the shoulder socket is significantly smaller than the ball, it is easier for the ball to slip out of the socket than is the case with other joints. This is known as dislocation of the shoulder (luxation). A fall is the most frequent cause of luxation of the shoulder, which is extremely painful as the shoulder joint is surrounded by a dense network of nerves. It is almost instantly impossible to use the affected arm.
First-time dislocations due to an accident are generally reduced (repositioned) at the location of the accident. If no major concomitant injuries are present, further treatment involving initial immobilisation followed by physiotherapy usually suffices.
In complicated cases and especially if muscles are torn or the bone is splintered, surgery is necessary. Patients suffering from recurring dislocations after a fall must also undergo surgery to stabilise the joint. In arthroscopic or open surgery the capsule and ligaments are tightened. Titanium bone anchors are often used to fix detached capsular ligaments. To improve the fit of the joint it may in some cases be useful to transplant the patient’s own bone material. Typically, we take this from the iliac crest.
Depending on the scope of intervention required, hospitalisation of 3 to 7 days can be expected. Generally 6 weeks of rest in conjunction with physiotherapy are required after this type of surgery. Sporting activities that place strain on the shoulder can usually only be commenced again after 6 months.
Humeral head fractures
Humeral head fractures are normally stabilised by means of a cast. This treatment generally suffices. The bones grow together again correctly. After 4 to 6 weeks of physiotherapy the healing process is usually complete in this case.
In more serious cases with severe deformity (so-called displaced fractures) or with multiple fragments we perform reconstructive surgery. Hospitalisation in case of surgery is approximately one week, followed by early functional movement exercises. Thereafter, patients can progress to full loading.
Irreparable multiple fragment fractures may require an artificial shoulder joint in order to gain full pain-free movement again (see Arthroplasty).
Wear and tear (arthritis)
In milder cases of arthritis of the shoulder and shoulder joint, relief can be provided with injections into the joint over a period of 4 to 8 weeks. Depending on the type and severity of arthritis, anti-inflammatory medication or joint infiltrations with so-called joint regeneration compounds (e.g. hyaluronic acid) may be an option. In more advanced stages surgical resurfacing is performed using a minimally invasive (arthroscopic) procedure. Normal loading of the shoulder is generally achieved again after 2 to 3-day hospitalisation and 2 to 3-week physiotherapy.
Advanced stages of arthritis (cartilage wear) can be treated by implanting an artificial shoulder joint (Arthroplasty). This type of arthritis often occurs once complicated fractures have healed.
The ankle joint connects the bones in the lower leg with the foot bones. It is made up of two sections: the upper and lower ankle joint. The upper ankle joint allows the foot to move up and down and also a little to the side. The lower ankle joint is less mobile than the upper ankle joint. It enables the foot to tilt to the side. The ankle joint ligaments connect the bones tightly with one another. They are robust and elastic at the same time as they must support both the stability and mobility of the joint. There are three lateral collateral ligaments on the outside of the ankle and the medial collateral ligament on the inside.
Injuries of the upper ankle joint
The most common injuries of the upper ankle joint are ligament related, which, with a few exceptions, can successfully be treated conservatively with appropriate ankle braces. Injury to the bone we generally treat surgically. We use screws and/or plates in this surgical procedure to attach the torn-off bone or cartilage pieces. Torn ligaments are sutured and in case of severe damage replaced by tendon autografts.
In any event, it is extremely important to have the injury examined and analysed by a specialist in our practice. X-rays are also required, in conjunction with specific MRI examinations where necessary, to identify possible ligament injuries.
Wear and tear (arthritis) of the upper ankle joint
Severe damage to the upper ankle joint may require major surgical intervention, such as joint replacement. This affects patients with advanced joint deterioration (arthritis) or rheumatic joint destruction. Besides implantation of an artificial ankle joint, fusion (arthrodesis) of the upper ankle joint is still a valuable treatment technique. Contrary to common belief, this approach leads to a stable, pain-free and steady gait without obvious gait abnormalities in the long term as well. Hospitalisation for this procedure is generally 7 days. Once the bone has healed after approximately 8 to 10 weeks, a plastic cast or surgical shoe must continue to be worn. Thereafter, patients can walk free from pain in standard shoes (with a midfoot wedge to assist rolling of the foot, where necessary).
Foot injuries and complaints are widespread among the population and are a frequent reason for visiting our orthopaedic practice.
The human foot has an extremely complex structure as it must carry the entire body weight and enable us to walk upright. The foot comprises 26 different bones. All 26 bones are flexibly linked to the relevant neighbouring bone by joints. Every foot takes 15,000 steps on average per day.
In view of the extremely complex structure of the feet and the high load they are subjected to, it is not surprising that most people experience problems with their feet at some point in their lives.
Conservative treatment using splints or orthotics is often sufficient. In many cases, infiltrations into the painful joints can successfully alleviate pain.
If these conservative approaches do not help manage the pain, surgery is frequently the only rational route. Different surgical techniques are available for the various complaints associated with feet.
The goal of any treatment is to restore the normal anatomy of the foot and to prevent the development of wear-related joint stiffening (arthritis of the big toe joint (metatarsophalangeal joint)). Where this is no longer possible, fusion operations are also sometimes used.
We also treat orthopaedic conditions in children. Treatment of problems in infants’ feet must often be started soon after birth. You can find further information about this topic in the menu option Paediatric orthopaedics.
Numerous static deformations of the forefoot can occur during the course of life, but also as a result of genetics in younger people, which can then lead to malpositioning of the bones and which should be treated.
Foot pressure measurement is a key element in diagnosis as information about abnormal pressure distribution patterns can be derived (see Fig.). We can perform foot pressure measurements at OrthoPraxis.
Example of a foot pressure measurement: The colour pattern clearly shows the abnormal pressure peak on the right-hand side of the metatarsus region with a fallen transverse arch.
The bunion (hallux valgus) is one of the most frequent foot deformations. Hallux valgus is the outward deviation of the big toe and a visible outgrowth of bone on the side of the foot. In extreme cases, the big toe can almost lie across all the other toes. Hallux valgus is often associated with a flat or splay foot, with occasional formation of a malposition of the 2nd toe (hammer toe), and more seldom the 3rd to 5th toe.
How does hallux valgus occur?
Women are particularly affected, as they often wear high heels and pointed shoes. Women also have weaker connective tissue than men, which becomes even softer through hormonal changes (pregnancy for example). But predisposition also plays a big role.
In general, the deformity must be corrected by means of surgery. The surgical procedure used depends on the location and extent of the deformity. In many cases, the deformity can be treated with SCARF osteotomy, which guarantees safe and permanent correction of the deformity while taking into account the concomitant problem of splayfoot, thanks to its three-dimensional philosophy.
Foot prior to the Scarf procedure: The oblique position of the big toe is apparent (hallux valgus)
Condition after surgical correction. The big toe is straight again.
Schema of the Scarf procedure showing a side view, Part 1
Schema of the Scarf procedure showing a side view, Part 2
Depending on the deformity, the surgical procedure can be performed in conjunction with AKIN surgery.
The procedure involves a short stay in hospital, and in individual cases can be carried out on an outpatient basis. Modern local pain relief measures (foot block anaesthesia) can be used in addition to anaesthesia to ensure a pain-free or at least pain-reduced postoperative phase.
The doctor will prescribe a postoperative surgical shoe, which the patient should wear at all times. After approx. 4 weeks the patient can move to normal yet comfortable and wide shoes. The foot can now take full weightbearing. Patients can however expect to have a swollen foot for several weeks until the healing process is complete. This can be treated with further physiotherapy and lymph drainage.
X-ray taken before severe hallux valgus surgery (Scarf osteotomy)
X-ray taken after severe hallux valgus surgery (Scarf osteotomy)
Hammer toe / claw toes
With hammer toe, one or several small toes can be severely curled. The middle joint points upward. A corn can form if the shoe rubs against the joint. The end joint points down sharply and digs into the sole. Calluses and pressure points develop.
In many cases, WEIL surgery lends itself to correcting toes 2 to 5 (2nd toe to little toe). This procedure involves repositioning the metatarsal head without resection or destruction of the joint surface (similar to Scarf osteotomy). Specially developed twist-off titanium screws are used for fixation, ensuring safe and quick healing. It is not necessary to remove these screws.
With hallux rigidus, the big toe has lost its mobility due to increased degeneration (arthritis). The toe has become rigid. Joint rigidity of this nature can only be treated surgically with resection of the joint or fusion. Implantation of an artificial joint in the area of the base joint of the big toe (metatarsophalangeal joint region) has so far not been reliable enough.
Pain and dysfunction of the hand can impact considerably on the quality of life. It is therefore particularly important to provide treatment as soon as possible.
The causes are numerous, and are often due to overuse, degeneration associated with ageing, or acute injury. Predisposition also plays a role. Benign growths in the palm of the hand (Dupuytren’s disease) may also be a cause for increased functional impairment of the hand and fingers. Finally, carpal tunnel syndrome (CTS) and trigger finger syndrome are common ailments that required those affected to seek an appointment with an orthopaedic surgeon.
From the notorious skier’s thumb to sprains to fractures, hand injuries are often due to sports injuries. Besides bone injuries, which can be treated with appropriate implants (mini-screws, mini-plates), ligament injuries (e.g. skier’s thumb) occur often.
In mild cases, the injury can be treated with a finger/thumb splint or plaster cast. Verified joint instability generally requires ligament suturing. Tendon injuries are treated with sutures or plastic reconstruction.
Dangerous scaphoid injuries must, almost without exception, be treated surgically (Herbert screw).
Wear and tear (arthritis)
Wear and tear can occur either on the joints or tendons of the hand. Wear and tear of the joints leads to arthritis in late-stage cases. Tendon ailments often result in tendonitis.
In many cases, arthritis of the hand affects the heavily used thumb joint and the crucial thumb saddle joint (rhizarthritis). The thumb saddle joint connects the thumb to the carpal bones. Typical symptoms of rhizarthritis are pain when grasping something. The first step is always to try and achieve an improvement with conservative measures. These include anti-inflammatory medication and ergotherapy. If these measures do not help, surgery should be considered. This involves removing a small bone from a row of carpal bones. A tendon from the patient’s body is inserted as a replacement. The tendinous strip is usually obtained from the wrist area. This tendon replacement is known as the Epping resection-suspension arthroplasty procedure.
In severe cases, pain relief can be achieved through surgical fusion (arthodesis), without significantly restricting the functionality of the hand. In exceptional cases, total joint replacement may be recommended.
If conservative therapy does not lead to the desired result in the case of tendonitis, surgery is also indicated here. This involves expanding the overly tight tendon sheath by splitting it and removing the inflamed tissue.
Dupuytren’s contracture is a disease of the tendons in the hand. Shortening of the tendons in the palm of the hand and calluses in the hand cause increasing retraction of the affected fingers. As a result, the fingers can no longer be (completely) straightened. In this case, the thickened connective tissue is surgically removed (on an outpatient or inpatient basis) and the palm of the hand reconstructed.
Carpal tunnel syndrome (CTS)
The carpal tunnel is on the inside of the wrist. An important nerve, the median nerve (nervus medianus) runs through this tunnel. It innervates the thumb, index finger and middle finger. Extreme strain on the nerve can lead to tendonitis. The inflamed tendons compress the median nerve. Neural stimuli are no longer conducted as efficiently or not at all. This results in so-called carpal tunnel syndrome.
As part of the diagnosis, abnormal nerve conduction velocity of the median nerve is measured. The decision whether or not to operate is based on the result and, more importantly, on the intensity of the patient’s suffering. The aim of the surgical procedure is to expand the tunnel, thereby reducing the pressure on the nervous tissue. Follow-up treatment involves wearing a removable wrist splint until the wrist has healed (approx. 12 days after surgery). Physiotherapy is carried out simultaneously.
Trigger finger syndrome
The “trigger finger”, frequently the trigger thumb, is difficult to straighten and suddenly snaps into the extended position. It is also often called a “snapping finger”.
Trigger finger is a disease where the flexor tendon of the involved finger thickens and nodules form at the base joint. As a result, the tendon can no longer glide freely through the tight annular ligament and the affected finger can then only be bent and straightened in a sudden motion.
If conservative therapies are not successful, surgery is possible. Surgical therapy is very simple and involves splitting the overly tight annular ligament. The procedure can be performed on an outpatient basis under local anaesthetic.
We also provide emergency care at OrthoPraxis. Our ultramodern practice is fully accessible and is equipped with a lift, allowing the safe transportation of stretcher-bound patients.
Both doctors are specialists in orthopaedic and accident surgery.
Thanks to the modern diagnostic equipment at OrthoPraxis we are able to perform all examinations right away. Less severe injuries are treated immediately at the practice with bandages, splints or plaster casts. The same applies to minor procedures, which are also immediately performed in the operating room of our practice. We perform all major surgery at the Wolfart Clinic Gräfelfing using the latest procedures and techniques.