Our service includes:
  Fracture care
  Joint preserving surgical care of hip disorders
      Open revision of the hip joint
          with surgical dislocation of the joint
              cheilectomy of the femoral head
              re-shaping of the acetabular cup
      Osteotomies of the pelvic bone
      Osteotomies of the femur
  Joint replacement of the hip
  Revisions of total hip replacements

  Teaching means

  Fractures of bones about the hip and pelvis
  • Fractures which do not involve the hip joint
    The pelvis is the biggest bone within the human body. In fact, it is formed from two symmetrical bones which are linked by a cartilage, the symphysis pubis. Each one of these "hemi-pelvises" is built up of three bones which consolidate at the age of 12 - 14 years: the ilium, the ischium and the pubis. The pelvis is the mechanical link between the spinal column and the lower limbs. The articulation to the spine is called the sacro-iliac joint and the articulation to the thigh is called the hip joint. Although fractures in this region are exceptional in children, they are common fractures in the elderly, mainly due to osteoporosis. The severity of these fractures goes together with displacement of the fragments which causes harm to the soft tissues, blood vessels, nerves etc. Complex pelvic fractures are life-threatening conditions which need immediate surgical care.

     
     
     

      • Hip fractures
        These fractures do not involve the joint surface, or cartilage, of the hip joint. Hip fractures are very frequent and represent an important socio-economic factor in view of our ever-increasing elderly population. Depending on the localization of the fracture, the hip joint is either replaced by prosthetic implants or the fracture is fixed and splinted by an osteosynthetic device. The ever present aim in fracture care remains fast recovery of the ability of the injured to walk.

          Fracture
        		Osteosynthesis
         
        		 
         
        		 
         

         

            Intact
         
        		 
         


        Fracture
        		Prosthesis
         
        		 
         


  • Fractures which involve the joints
    If a fracture involves a joint, the joint surface and its cartilage layer may be displaced, producing a step. If this is the case, the joint will not work properly anymore (even after the fracture has healed!) and it is quite likely that the joint will degenerate prematurely, becoming painful and impairing function. In the pelvis, fractures which involve the hip joint are called acetabular fractures. The acetabulum is the "cup" which accomodates the upper extremity of the bone of the thigh: the femur. As acetabular fractures per se do not require immediate surgical care, they are best repositioned anatomically and fixed operatively to allow early mobilization of the joint and walking. In the femur, fractures which involve the hip joint surface (femoral head fractures) are rare. These fractures are difficult to treat and sometimes have a poor prognosis due to the disturbed blood supply of the femoral head.

     
     



      Joint preserving surgical care of hip disorders
    The hip joint has amongst other things a two-fold function: The joint must transmit a significant load from the body to the lower limbs and allow significant mobility within the three planes of space. Optimal load transmission and stability occurs through maximal coverage of the head of the femur by the acetabular cup. Optimal mobility of the joint occurs through a minimum of constraints or minimal coverage of the head of the femur. We believe that a majority of articular dysfunction and pain about the hip joint results from a dysbalance or mismatch between morphological inheritance and function. There are some surgical means which may safely correct such unfavorable conditions. These belong in the realm of so-called joint preserving surgery of the hip joint.

     

      •   Open revision of the hip joint
        There might be cases which demonstrate a morphological discrepancy or mismatch between the cup of the acetabulum, the head and the neck of the femur. This mismatch might be congential (inherent) or acquired. The discrepancies may lead to early degeneration and pain. By means of an open surgical approach to the hip joint (  surgical dislocation of the joint), the joint surfaces can be seen, and possible coxo-femoral impingement (mismatch between the joint surfaces within normal range of movement) can be evalutated. Bony and soft tissue impingement are dealt with and adaptations made to optimize hip joint function (  cheilectomy of the femoral head,   re-shaping of the acetabular cup). This operation can be done without harming the soft tissues or jeopardizing the femur. It is much less invasive than, for example, joint replacement of the hip and may avoid or at least significantly delay the need for more invasive surgical means.

         

         Before surgery
         

         Before surgery MRI
         

         After surgery
         

      •   Osteotomies of the pelvic bone
        The hip joint may undergo abnormal growth before and after birth. Its development is terminated between age 12 and 14. Abnormalities in development of the joint (“hip dysplasia”) are checked systematically after birth and treated by orthopaedic or surgical means. The most important problem which might occur during this development is the loss of stability of the joint or impingement which is due to an abnormal "cup" or acetabulum. The natural progress or spontaneous development of such a joint is that it is likely to degenerate prematurely, becoming painful and impairing function. To save the joint, avoid or at least postpone the need for artificial joint replacement, surgical techniques by means of bone cuts around the joint have been developed. The orientation of the cup can thus be modified by cutting it out of the pelvic bone and rotating and displacing it for better stability and congruency of the joint. Prerequisites for optimal results are detailed pre-operative 3-D imaging and image simulation of the re-orientation of the joint.


         

         

        One thus can define more precisely abduction/adduction dysplasia and its correction (R1), Extension/flexion dysplasia and its correction (R2) and anteversion/retroversion dysplasia and its correction (R3).

         

        Before

        		 After
         
         
         
         

         
        Tridimensional dysplasia of the left hip After re-orientation of the acetabulum
        in adduction-flexion-anteversion
         
         

         
        Retroversion dysplasia After re-orientation of the acetabulum
        in anteversion
         
         

      •   Osteotomies of the femur
        Following trauma, maldevelopment or other diseases, function of the hip joint may be impaired and becoming painful. After meticulous assessment of the problem by radiographs and other imaging means, the orientation of the upper end of the femur can be modified by cutting the bone for rotation and displacement. The joint may thus be loaded on a healthy part of the joint surface or in a mechanically optimal orientation and thus avoid painful function and degeneration.
        Before
        Malunion of the femur
         
         
        After
        Osteotomy of the femur and reorientation
         
         


      Joint replacement of the hip

    In the case of dysfunction of the hip joint following trauma, unfavorable morphology, overload or diseases, the articular layer of the joint may undergo progressive destruction. In the course of the 20th century, and especially since about 1960, articular implants have been developed to simulate hip joint function. Although they generally produce excellent functional results after the surgical procedure, hip joint replacement has been known to undergo aseptic loosening and failure in the long-term.

    Arthrosis
    		After : joint prosthesis
     
    		 
     

     


      Revisions of total hip replacements
    In cases of aseptic loosening or other failures of total hip replacement, function is impaired and painful. Revision surgery implements removal of the implants and replacement with a new prosthesis. This exchange is more invasive than at the first operation. The risk of infection and the probability of a lack of bone stock for stable fixation is increased.

      Teaching means

    Courses (Organisation / Course Co-Chairman):

    K.Klaue (Org.)
    La Chirurgia conservativa dell'anca, attuali opzioni chirurgiche "biologiche" nell'artrosi dell'anca (symposium), Lugano, 17.02.2005

    K.Klaue (Org.)
    La Chirurgia conservativa dell'anca, Symposium ortopedico della clinica Luganese, San Carlo, Lugano, 15.05.2003

    K.Klaue (Org.)
    Giornata di Chirurgia Ortopedica
    Presentazione del reparto di ortopedia dell'Ospedale San Giovanni.
    Castel Grande di Bellinzona. Tema: Chirurgia ricostruttiva funzionale dell'anca, della mano e del piede, 12 relazioni, 9 relatori, Bellinzona, 17.06.1998

    K.Klaue (Chair)
    prosector, The ilio-inguinal approach for periacetabular osteotomy, 6th oct.
    Surgery of the pelvis and acetabulum. Cadaver dissection workshop. The 3rd. international consensus,
    Pittsburgh, oct. 5-11, 1996

    K.Klaue (Chair)
    section: Periacetabular osteotomy, 10th oct. 09:15-11:50
    Surgery of the pelvis and acetabulum. The 3rd. international consensus,
    Pittsburgh, oct. 5-11, 1996

    K.Klaue (Chair)
    section: Biomechanics, 9th oct. 08:00-09:40
    Surgery of the pelvis and acetabulum. The 3rd. international consensus,
    Pittsburgh, oct. 5-11, 1996

    K. Klaue, J. M. Meyer (Chair)
    Sections ”Freie Mitteilungen”: Spine and ”Varia”
    56. annual congress of the Swiss Society of Orthopaedic Surgery (SGO), Bern, 13.06.96

    K. Klaue, A. Dimeglio (Chair)
    Section "Application Imagerie 3D en Orthopédie et Traumatologie" and "Communications libres"
    Imagerie 3D en Orthopédie-Traumatologie. Applications pratiques et Recherches. Symposium international (Prof. Railhac, Université Paul Sabatier, Toulouse III), 11.5 - 12.5 1995

    K. Klaue, R. Trousdale, Akio Inoue (Chair)
    Surgery of the Pelvis and Acetabulum. The second international consensus. Case presentations: pelvic osteotomy, Pittsburgh 27.10.94

    K. Klaue (Chair)
    The anterior approach for the Periacetabular Osteotomy.
    Surgical Anatomy of the pelvis and acetabulum. Cadaveric dissection Workshop (Dir. Dana C. Mears) Surgery of the Pelvis and Acetabulum. The second international consensus, Pittsburgh 22.10.1994

    Demonstrations:

    K.Klaue: Clinical demonstration operation of one case of periacetabular osteotomy (PAO) ) with preoperative planning using the ilio-inguinal approach.
    Centre Hospitalier Regional Universitaire de Lille, Clinique d’Orthopédie et de Traumatologie (Prof. H.Migaud) 18.11.1999

    K.Klaue: L'esame ortopedico di base - Giornata di aggiornamento per medici generici del Canton Ticino e Grigioni italiano, ORBV sede Bellinzona, 5 relatori,
    Bellinzona 21+28.09.2000

    K.Klaue: Clinical demonstration operation of two cases of periacetabular osteotomy (PAO) with preoperative planning using the ilio-inguinal approach.
    Klinik und Poliklinik für Unfallchirurgie und Rekonstruktive Chirurgie, TU Dresden (Prof. H.Zwipp) 5.11. and 27.11.1997

    K.Klaue: Clinical demonstration operation of one case of periacetabular osteotomy (PAO) ) with preoperative planning using the ilio-inguinal approach.
    Centre Hospitalier Regional Universitaire de Lille, Clinique d’Orthopédie et de Traumatologie (Prof. A.Duquennoy) 3.11.1997

    K.Klaue: Clinical demonstration operation of one case of periacetabular osteotomy (PAO) and intertochanteric osteotomy (IO) with preoperative planning using the ilio-inguinal approach.
    St Göran’s sjukhuset, Stockholm (Dr. A.Ekelund) 18.4.1997

    K.Klaue: Clinical demonstration operation of one case of periacetabular osteotomy (PAO) ) with preoperative planning using the ilio-inguinal approach.
    Centre Hospitalier de Luxembourg (Dr. L.Schuman) 25.11.1996

    K. Klaue: Clinical operative demonstration of one case of periacetabular osteotomy (PAO) with preoperative planning using the ilio-inguinal approach.
    Bon Secours Hospital ( Dr. J. J. Byrne), Glasnevin, Dublin, Ireland, 3.11.95

    K. Klaue: Clinical operative demonstration of two cases of periacetabular osteotomy (PAO) with preoperative planning using the ilio-inguinal approach
    Department of Orthopaedic Surgery, St. Thomas' Hospital (Dr. D. Reynolds), London, 15.3.1993

    K. Klaue: Clinical operative demonstration of two cases of periacetabular osteotomy (PAO) with preoperative planning
    Department of Orthopaedic Surgery, St. Thomas' Hospital (Dr. D. Reynolds), London, 7.3.1990

    K. Klaue: Clinical operative demonstration of one case of periacetabular osteotomy (PAO) with perioperative planning
    Clinique Sainte Marguerite, Auxerre (Dr. Hulin) 15.09.1989

    Video, Software and Computer demonstrations:

    K. Klaue, A. Dimeglio
    Section "Application Imagerie 3D en Orthopédie et Traumatologie" and "Communications libres"
    Imagerie 3D en Orthopédie-Traumatologie. Applications pratiques et Recherches. Symposium international (Prof. Railhac, Université Paul Sabatier, Toulouse III), 11.5 - 12.5 1995

    K. Klaue, S. Bresina, S. M. Perren, R. Ganz, P. Guélat
    3D Simulation in Planning of Peri-coxal Osteotomies
    AO-ASIF Scientific Exhibit
    SICOT 19th World Congress Aug. 28 - Sept. 3, 1993 Seoul, Korea

    K.Klaue, S.Bresina
    CT/MR - method of catching data of surfaces e.g. subchondral bone for pre-operative simulation of correcting osteotomies.
    diskette available on request, (Bresina/Klaue)
    Instruction manual "ORTHOSIM" 1991

    K.Klaue: Conférence-atelier (workshop): Planification assistée par ordinateurs dans les ostéotomies de hanche (org. par Dr. D. Dagrenat et J. C. Dosch)
    CTO Université Louis Pasteur, Faculté de Médecine, Strasbourg, sept. 1990

    K. Klaue, A. Wallin: Die Überdachung des Hüftkopfes
    10 Min. PAL-SECAM Juni 1987
    Stiftung M. E. Müller, AV-Technik, Bern
    ::: previous page ::: ::: Home Page ::: ::: contact me :::
    I climb on a man s back and force him to carry me; nevertheless, I try to convince him and his entourage that I will do all I can to relieve his fatigue and pain, except get off his back. (Lev Tolstoļ)