Hip replacement surgery

Complex Hip Replacement in Charité: Clinical Case

Diagnosis

Right-side primary coxarthrosis Grade 3. Condition after osteosynthesis of the right acetabulum using fixing plates with screws. Shortening of the right lower limb. Narrowing of the joint space of the right hip joint. Leftward curvature of the lumbar spine axis. Femoroacetabular impingement (FAI) of the hip joint. Antiphospholipid syndrome, deep vein thrombosis of the right lower extremities.

Patient's Complaints

"A year ago, I was in a car accident and suffered a comminuted fracture of the acetabulum, as well as foot drop on my right leg. Two metal plates were installed. To this day, I walk with crutches. When putting weight on my leg, I feel pain in the hip joint area, radiating along the groin crease. I take painkillers. A tendency to blood clots was identified. Total hip replacement of the right hip joint was recommended."

Patient's Preferences & Expectations

• Surgical approach: The surgery should be performed using a lateral or anterior approach. The posterior approach is excluded, as the nerve could be damaged again, resulting in foot drop.
• Implant brand: The prosthesis should preferably be from Zimmer.
• Surgeon's qualification: I would like the surgery to be performed by an experienced surgeon, a professor.
• Clinic specialization: The clinic and doctor must specialize in hip replacement so that this operation is performed routinely.

Orthopedic Surgeon's Response (Professor Carsten Perka)

We are ready to perform the treatment, including hip replacement using a Zimmer Biomet prosthesis.

To reconstruct the destroyed acetabulum, we would prefer the TMT or Allofit socket system by Zimmer Biomet, and for the stem (shaft), the Avenir Complete system (Zimmer). We remove existing metal plates only in cases of absolute necessity. If they do not interfere with the implantation of the hip joint, we would leave them in place.

Regarding the antiphospholipid syndrome, we recommend a preliminary examination and consultation on blood clotting control. After that, a decision on preoperative procedures will be made. This examination can also be carried out at Charité Clinic.

Diagnosis: Severe post-traumatic coxarthrosis on the right.

Treatment: Right total hip arthroplasty (hip replacement).

Duration of inpatient treatment: Approximately 5–7 days. Intensive care unit (ICU) stay is not required.

Additional costs: Only for laboratory tests, X-rays, anesthesia, and outpatient coagulation consultation.

Patient's Questions

• What surgical approach will be used in this case?
• If a lateral or anterior approach is used, how can the plates located posteriorly be removed if necessary?

Surgeon's Answer

• This is a valid question. We would use an anterolateral approach. The anterior approach requires dislocating the femur from the soft tissues, which is often difficult in post-traumatic situations. Therefore, the anterolateral approach is preferred—between the gluteus medius muscle and the tensor fasciae latae. This approach is gentler and does not require the division and transection of large thigh muscles.
• It is true that with this approach we will not be able to completely remove the existing plates. Therefore, if the screws interfere, they can be removed using a high-speed burr. The plates themselves will remain.

Preliminary Cost of Treatment: €27,400

Performed Treatment

Minimally invasive implantation of a cementless total right hip prosthesis was successfully performed. The hip replacement surgery was carried out using an anterolateral approach.

To prepare for the surgery, digital preoperative 3D computer planning was conducted, building a three-dimensional model of the hip joint bones.

Due to the suspected antiphospholipid syndrome, an examination was performed at the Department of Hemostaseology at Charité Clinic. Diagnostics revealed no signs of antiphospholipid syndrome; therefore, for thrombosis prophylaxis, the administration of heparin was recommended, to be continued for 10 days...

Patient's Review

I would like to thank Konstantin, representing GHP Pulse, a company that assists in finding doctors for surgeries in Germany. On July 14, 2025, I reached out to Konstantin with a request to find the best orthopedic professor for a total hip replacement. On the very same day, I sent him my X-rays, orthopedic reports, and my preferences regarding the clinic, doctor, and implant.

On July 15, Konstantin requested an additional medical summary from the hospital in Russia. I sent it to him, and on that same day, he provided a response from Charité Clinic from Professor Perka. The professor confirmed that he could perform this surgery and install implants manufactured by the American company Zimmer. I checked how long the doctor has been working at Charité — it turned out to be about 30 years, and he currently heads the Orthopedics Department there. This was also very valuable information for me.

On July 15, I asked a few more clarifying questions to the professor regarding which approach he would use (posterior or anterior) during the surgery and how to handle the metal plates that were already in place.

On July 16, I received the surgeon's response from Konstantin in Russian, which fully satisfied me. Thus, just two days after contacting Konstantin, I received comprehensive answers to all my inquiries: with Konstantin's help, I chose one of the best clinics in Europe and a professor who ranks among the TOP 10 orthopedic surgeons in Germany! A few days later, Konstantin also sent me an offer from another professor at a different clinic.

On August 20, I received my visa, and we asked the professor about possible surgery dates. He replied promptly — August 22 or August 27. I am writing this letter on August 28.

Yesterday, the professor successfully performed the operation, and today I have already walked 1 km — albeit on crutches, and I will have to walk on crutches for another 6 weeks. The joint pain is completely gone. I can lie in bed with my leg fully extended, which was previously impossible. My legs are now equal in length. Furthermore, I have walked duck-footed (like Charlie Chaplin) since childhood, and I asked the doctor to preserve this foot rotation, which he did.

On September 1, I am being discharged and moving to another clinic for rehabilitation. An extremely complex task was successfully accomplished by Konstantin in just 2 days!

Initially, I contacted 12 German companies specializing in medical tourism and finding doctors and clinics for surgeries. Three companies dropped out immediately — they asked for an advance payment for their services before even delivering them. Others dropped out for various reasons: either the doctors wrote complete nonsense (for example, that two surgical teams would be needed — one to remove the plates and another to place the implant, whereas it was actually preferable not to remove the plates at all to avoid damaging the nerve again, which Professor Perka successfully managed to avoid), or the clinics were questionable, or they simply delayed their responses.

My summary is as follows: be sure to use GHP Pulse and Konstantin in this company when searching for a doctor in Germany. This is top-tier organization and client support in Germany. Speed and professionalism — that is the briefest characterization of their work.

I will undoubtedly recommend him to my acquaintances.

In addition, Kostya provided me with detailed instructions on what documents needed to be prepared for border control to avoid any disruptions at the border, and he also acted promptly when searching for a rehabilitation center in Germany.

And a few words about the surgery in Germany: Everything is at the highest level. Hospitalization takes place the day before surgery, followed by one hour in the preoperative room right before surgery, a one-hour operation, one hour of post-operative observation, and another 6 days in the clinic under supervision. Three orthopedic surgeons, three assistants, and an anesthesiologist were present during the surgery. Everything was smooth and well-coordinated, in true German style.

I am extremely pleased with the work performed by all of us, and Konstantin undoubtedly set the right direction for this process. Kostya, taking this opportunity, I express my gratitude for your approach to work, and at the same time, I admire your drive and professionalism.

— Oleg