Hip replacement surgery

Diagnosis

Right-sided hip osteoarthritis, grade 3. Condition after metal osteosynthesis of the right acetabulum with fixation plates and screws. Shortening of the right lower limb. Narrowing of the joint space of the right hip joint. Leftward curvature of the lumbar spine. Femoroacetabular impingement syndrome (FAIS) of the hip joint. Antiphospholipid syndrome, deep vein thrombosis of the right lower extremities. 

Patient Complaints

One year ago, I was involved in a car accident and sustained a comminuted fracture of the acetabulum as well as paresis of the right foot. Two fixation plates were implanted. I still walk with crutches. When bearing weight on the leg, I experience pain in the hip joint radiating to the groin area. I take pain medication. A tendency toward thrombosis has been detected.
Total hip replacement of the right hip joint has been recommended.

Patient’s Wishes Regarding the Surgery

• The operation should be performed using a lateral or anterior approach. The posterior approach is excluded, as it could again damage the nerve, which previously led to paresis.
• The preferred prosthesis is from the company Zimmer.
• I would like the operation to be performed by an experienced surgeon, a professor.
• The clinic and surgeon should specialize in hip replacement surgeries and perform them on a regular basis.

Response from Professor Carsten Perka

We could provide the treatment. We can offer total hip arthroplasty using an implant manufactured by Zimmer Biomet. For reconstruction of the damaged acetabulum, we would prefer the TMT or Allofit cup system (Zimmer Biomet). For the femoral stem, we would choose the Avenir Complete system (Zimmer). The existing fixation plates would only be removed if absolutely necessary. If they do not interfere with hip implantation, we would leave them in place.

Regarding the antiphospholipid syndrome, we recommend preoperative testing and consultation on coagulation management. Based on the results, we will decide on the necessary preoperative measures. This examination can also be performed at Charité.

Diagnosis: Severe post-traumatic right-sided coxarthrosis.

Treatment: Right total hip arthroplasty with implantation of a total endoprosthesis.

Expected hospital stay: approximately 5-7 days. Intensive care unit admission is not required. Additional costs include laboratory tests, X-rays, anesthesia, and outpatient coagulation consultation.

Patient Questions

• Which surgical approach will be used in this case?
• If a lateral or anterior approach is applied, how will it be possible to remove the plates located posteriorly if necessary?

Response from the Physician

• That is a valid question. We would use an anterolateral approach. The direct anterior approach requires mobilizing the femur from surrounding soft tissues, which is often difficult in post-traumatic cases. Therefore, the anterolateral approach — between the gluteus medius and the tensor fasciae latae — is preferred. This approach is less invasive and does not require splitting or detaching major muscles of the thigh.
• It is true that with this approach, we cannot completely remove the existing plates. However, if the screws interfere, they can be removed using a high-speed burr, while the plates themselves remain in place.

Estimated treatment cost: €27.400

Performed Treatment

Minimally invasive cementless total hip replacement of the right hip joint was performed using the anterolateral approach. Preoperative planning was conducted digitally in 3D mode, including construction of a three-dimensional model of the hip bones. Due to suspected antiphospholipid syndrome, an examination was carried out at the Department of Hemostaseology, Charité. No signs of antiphospholipid syndrome were detected; therefore, heparin prophylaxis was recommended for 10 weeks postoperatively to prevent thrombosis.

Hip Prosthesis Components:

• Stem: Avenir Complete with hydroxyapatite coating, size 7.5 (Zimmer)
• Head: M ceramic, 36 mm
• Cup: TMT, size 54 (Zimmer)
• Fixation: two 30-mm screws
• Liner: Longevity polyethylene for 36-mm head

Intraoperative Procedures:

• Total synovectomy
• Removal of anterior, caudal, and posterior osteophytes
• Reaming of the acetabular floor due to severe sclerosis
• Autogenous bone grafting of the acetabulum
• Soft tissue balancing and muscle release of the hip joint
• Removal of the synovial bursa
• Intraoperative visualization and monitoring system used
• Tissue samples sent for histological analysis

Postoperatively, analgesic therapy was administered. Rehabilitation began on the first postoperative day under the supervision of a physiotherapist. The patient successfully practiced stair climbing. The surgical wound remained dry and free of inflammation. Peripheral circulation, motor function, and sensitivity were preserved. The patient was discharged from the clinic in good condition on the 6th postoperative day.

Patient Review

I would like to thank Konstantin, representing the company GHP Pulse, for organizing my surgery in Germany. On July 14, 2025, I contacted Konstantin with a request to find the best orthopedic professor for hip replacement surgery. On the same day, I sent him my X-rays, orthopedic reports, and my preferences regarding the clinic, surgeon, and implant.

On July 15, Konstantin requested an additional hospital discharge summary from Russia, which I sent the same day. That evening, I received a response from Professor Carsten Perka of Charité, who confirmed that he could perform the surgery and use implants from Zimmer. I checked the doctor’s background and found that he has been working at Charité for about 30 years and now heads the orthopedics department — which was very reassuring.

The next day, I asked additional questions about the surgical approach and the existing fixation plates. On July 16, I received a full response in Russian from Professor Perka, which completely satisfied me. Thus, within two days after contacting Konstantin, I received detailed answers, selected one of the best clinics in Europe, and a professor ranked among the top 10 orthopedic surgeons in Germany! A few days later, Konstantin also sent me an alternative proposal from another professor.

I obtained my visa on August 20, and the professor offered surgery dates on August 22 or 27. I am writing this letter on August 28.
Yesterday, the professor successfully performed the surgery. Today, I have already walked one kilometer with crutches (which I will need to use for another six weeks). The hip pain is gone, and I can now lie flat with my leg extended — something that was previously impossible. My legs are of equal length. I even asked the doctor to preserve my slight “Charlie Chaplin” gait, which he kindly did. I will be discharged on September 1 and transferred to a rehabilitation clinic.

The entire process — from initial request to successful surgery — took only two days, thanks to Konstantin’s exceptional work. Initially, I contacted 12 German companies that specialize in arranging medical treatment. Three were immediately ruled out because they demanded prepayment before providing any service. Others failed for various reasons — slow responses, questionable clinics, or unconvincing offers.

My conclusion is clear: always use GHP Pulse and Konstantin to find a doctor in Germany. Their speed and professionalism are unmatched.
I will definitely recommend them to my friends. Konstantin also provided detailed instructions on the documents required for border control and quickly found a rehabilitation center for me in Germany.

As for the surgery itself — everything was top-level: hospitalization one day before surgery, one hour of preoperative preparation, one-hour operation, one hour of postoperative monitoring, and then six days of inpatient care. The team included three orthopedic surgeons, three assistants, and an anesthesiologist — everything worked precisely and efficiently, in true German fashion.

I am very satisfied with the work done by everyone involved.
Special thanks to Konstantin for his energy, professionalism, and commitment.

Oleg Agapov

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