50 years of hip replacement surgery in the Czech Republic ****************************************************************************************** * 50 years of hip replacement surgery in the Czech Republic ****************************************************************************************** Charles University Professor Martin Krbec heads the Orthopaedics and Traumatology Clinic a Vinohrady University Hospital. He told me more about the anniversary in a field where the itself is expected to last some 25 years. “The beginning of modern endoprosthetics of the hip joint is dated to early 1960s and is c John Charnley in England. He was the first to develop a successful so-called total endopro hip joint, meaning the replacement of both components of the joint – the head of the femur acetabulum. “The sliding surfaces used in this joint were a combination of metal and polyethylene prov friction, what enabled good long-term function. In late Sixties the method was broadened i and further development continued namely in Switzerland. The original Swiss endoprosthesis professor Maurice Muller, the so called “banana” stem and polyethylene socket. “The Iron Curtain in this period limited accessibility to top technologies in the Eastern Sixties, before the Soviet-led invasion of Czechoslovakia in 1968, the political situation enabled the development of better relations and expert collaboration in numerous areas, in of medicine.” What was Professor Oldřich Čech’s contribution? “Professor Čech used the opportunity to be at the right place at the right time. In the ye he was employed at Orthopedic Clinic in St. Gallen, under the leadership of Professor Maur was another great contributor to this technology. “After his return to Prague, he performed the first THA surgery at the First Orthopedic Cl on 19 Feb 1969 using an original Swiss endoprosthesis which at that time was imported in l only. It was the very first implantation of such device within the entire Eastern Bloc. La Čech played an even more important role, taking centre stage in the development of the ori endoprosthesis. Production started in 1972 at the Poldi Kladno iron and steel works outsid Is it fair to say that the design of this articulate hip joint hasn't changed that much ov the material has? “Concerning the design of the prosthesis the main principle – the ball-shaped joint - rema The design of the stem has changed several times during history in order to achieve better the bone cavity and surface of the implant. The surface of the implant that time was relat prosthesis was fixed to the bone by use of bone cement (polyacrylate). “And the structure of the surface changed radically later on when so-called non-cemented i use. The first endoprostheses were made from stainless steel (no longer used), later cobal were used and also titanium alloys in non-cemented types.” “Poldi was one of the first companies in the world producing stainless steel. By impulse a with Professor Oldřich Čech, they started to produce not only endoprostheses but also surg osteosynthesis. The type of endoprosthesis they made got the nickname Poldi-Čech.” I have heard that specialists in this field such as yourself don't count time in years but “Exactly. The requirement on the function of artificial joints is extremely high. You have it is a mechanical device working in an aggressive environment of body fluid achieving mil (steps) during years and years of use. The lifespan of the implanted joint should, under n last more than 25 years.” How many cases of hip replacement surgery are there in the Czech Republic annually? “There were 16,000 cases the last year, similar to the total number of knee replacements.” As far as operations go, have there been big changes or improvements in the procedure over As far as surgery is concerned, techniques of course also developing over the years – ther in the direction of “physiological surgery” which is less invasive with less blood loss, w saving techniques, super-aseptic conditions and so on.” How difficult is it for the patient in terms of healing and full recovery? “After surgery, the patient is free of previous serious constant nagging pain. Of course, there is some postoperative pain, but that can effectively be reduced. Rehabilitation help range of motion of the joint. And this is the aim. Patients are usually very motivated to life soon. “Sometimes you get a young patient, about 20, who needs hip replacement - usually as a con developmental hip dysplasia. The symptoms are a minimal range of movement in the joints, a ambulatory, but not too much pain. The decision to operate or not in this age and under th the patient on one side and the potential risks and limited survival of the prosthesis on not simple. “All the greater is the feeling of pleasure when you meet the person after years walking w together with his or her family.”