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The most common birth defect of the musculoskeletal system is hip dysplasia. Four out of one hundred children born in Poland have her. Krakow orthopedists from the University Children’s Hospital under the direction of Dr. Jarosław Feluś have been carrying out surgeries for two years, thanks to which patients with this defect do not develop degenerations leading to the need to replace the hip joint with an endoprosthesis. A few days ago, they operated on a 17-year-old girl. Krakow is the second, after Otwock, center in Poland that regularly performs such treatments.
- On November 16, 2018, a hip surgery was performed at the University Children’s Hospital in Krakow (pelvic perithelial osteotomy) using the method of prof. Ganz. Although a Swiss orthopedist from Inelspital in Bern – the most famous in Europe and one of the best centers of hip surgery in the world, developed it several years ago, in Poland it has been routinely performed only for several years – in Otwock and Kraków
- Treatment using the method of prof. Ganza is performed with hip dysplasia, i.e. persistent congenital underdevelopment, in order to avoid degenerative changes resulting in the need to replace the hip joint with an endoprosthesis
- – Hip dysplasia, i.e. persistent congenital hypoplasia of the hip joint, is the most common congenital defect of the musculoskeletal system – it affects up to 4 percent of newborn children in Poland – says Dr. Jarosław Feluś – Krakow orthopedist, operating on a teenager, specialist in the field of the hip joint
Despite the extensive diagnostics of infants, it happens that the defect is diagnosed too late for its effective treatment, it is not diagnosed in infancy or, despite the correct diagnosis, it is not possible to cure the sick, underdeveloped joint. Then the hip is subject to much earlier wear, degenerative changes and pain develop, which results in the necessity to replace it with an endoprosthesis.
To avoid this, the hip joint rescue procedure (prolonging its painless functioning) is the so-called Bernese Osteotomy (also known as Ganz’s peripendicular osteotomy). Thanks to the anatomical studies carried out in Bern by the team of Professor Ganz, the vascularization of the proximal part of the femur and the pelvis was discovered in detail. This knowledge made it possible to perform intra-articular hip surgery – previously considered impossible due to the risk of necrosis of the femoral head.
What is Bernese Osteotomy prof. Ganza?
– Osteotomy, the so-called Bernese involves excision of the entire hip joint from the pelvis without damaging its vascularization (it does not undergo necrosis and fuses with the rest of the pelvis after surgery) and does not destabilize the rest of the pelvis (the patient can walk shortly after the procedure). Then the cut fragment is rotated so that the hip is positioned in the correct way (analogous to a healthy hip joint) and is stabilized with screws, attaching it to the rest of the pelvis, with which it fuses within a few weeks – says the operating orthopedist from the University Children’s Hospital – the team leader operating a teenager.
Bernese Osteotomy is considered a very complicated procedure. Suffice it to say that it is performed in a few specialized clinics in Europe and in the world (usually one or several nationwide). So far in Poland, it has been regularly performed only in Otwock by the team of prof. Jarosław Czubak. The Krakow team, under the leadership of Dr. Jarosław Feluś, performed the first such operation in December 2016, and since this year (2018) it has been performed regularly in another orthopedic center in our country, next to Otwock.
According to Dr. Jarosław Feluś, the idea of creating a modern hip-sparing surgery center in Krakow appeared over five years ago, in 2013. – On the one hand, the inspiration was the numerous cases of severe, poorly projected deformities of the hip joint as a consequence of childhood illnesses hips, and occurring in young, active patients, with whom we orthopedists from pediatric orthopedics often meet every day. At that time, we had very limited possibilities to help them effectively. On the other hand, there were more and more publications of very promising treatment results presented at conventions and in magazines by colleagues from leading centers. For this encouragement and motivation from the then head, head of the Department of Orthopedics USD in Krakow, Dr. Tadeusz Lejman, a fantastic specialist and recognized specialist in hip surgery in children – says the orthopedist.
Krakow orthopedists educated in the best centers in the world
In the following years, an intensive training process continued – acquiring knowledge and practical skills in the field of modern surgery and hip arthroscopy, as well as acquiring the necessary experience. – I learned the techniques of pelvic surgery, thanks to the openness of professor Czubak, during many trainings in Otwock, but also in the center of professor Ganz in Bern, or in Barcelona with one of the leading hip surgeons in Europe – Dr. Manuel Ribas. In arthroscopy of the hip joint, we have improved at the best, in York, Berlin, Barcelona and Munich. We also hosted outstanding specialists in Krakow – they helped us operate on our first patients. Thanks to all this, together with Dr. Bartłomiej Kowalczyk, co-organizer and the other parent of the center of natural hip-sparing surgery, we have achieved the level of knowledge and skills that allow us to perform a full range of hip surgeries in the world in young, sports-active patients, allowing them to improve functioning, reducing pain, often returning to sports and delaying the occurrence of degenerative changes in the hip with the need to replace the joint with an endoprosthesis, which in young patients is an acceptable solution, but certainly not optimal – summarizes the orthopedist, Dr. Jarosław Feluś.