Dr Christian Fulghum
Specific field: Orthopaedics/trauma surgery
Chief Physician at the endogap Joint Replacement Institute, Garmisch- Partenkirchen Hospital
Expert medical care at hospitals and rehabilitation clinics
endogap Joint Replacement Institute – the acclaimed specialist endoprosthetics clinic at Garmisch-Partenkirchen Hospital – implants more than 2,300 artificial hip and knee joints each year. The institute is one of the top five endoprosthetics clinics in Germany and the leader in this field in Bavaria.
In addition to this, there is the excellent national and international reputation enjoyed by the institute’s chief physician, Dr Christian Fulghum, and his senior consultants Drs Florian Wolpert, Rolf Schipp and Wolfgang Reng. The use of the term ‘Garmisch School’ by experts in the field is recognition of the major role that they have played for decades in the development of new implants and less aggressive surgery techniques.
Dr Fulghum, last year in Germany nearly 200,000 people were fitted with a hip prosthesis and 150,000 people received knee replacements – a huge increase in comparison with previous years. Why do you think that is?
Dr Fulghum: Patients with hip or knee problems today opt for a joint replacement (endoprosthesis) significantly earlier than they would have done a few years ago. This is partially due to the fact that the prosthetics and the surgical techniques involved have improved considerably, while surgeons, physiotherapists and prosthetics manufacturers now have far more specialist experience. And nowadays, for example, modern implants remain perfectly functional for a great number of years. This means that even those patients at the younger end of the scale can receive an artificial knee or hip joint if the symptoms and, in particular, the level of pain suggest that surgery is the best option. Reduced surgical risks through techniques ensuring minimal damage to the surrounding tissue (e.g. minimally invasive methods), shorter stays in hospital and in rehabilitation centres, quicker recoveries and swifter physical resilience – all this accounts for the fact that surgical joint replacements are often the best solution both for younger and older patients who want to be able to live a symptom-free i.e. pain-free life once more.
At what point should an operation be carried out?
Dr Fulghum: That has to be decided on a case-by-case basis. The old motto ‘the later the better’ is only really true now in exceptional cases. One way of putting it would be as follows: if your quality of life is decreasing and your degree of suffering is increasing because exertion and movement pains are becoming less and less manageable using non-operative techniques, then you shouldnʼt delay the decision for surgery much longer. This holds all the more true if there is a risk of complications. Limping, for example, can be accompanied by inappropriate weight bearing, which can then permanently affect the entire locomotor system – particularly the spinal column.
The time it takes to surgically implant an artificial hip joint usually takes one to one-and-a-half hours, but it takes all of 45 minutes at the endogap Institute. Is this also simply a matter of routine?
Dr Fulghum: Absolutely. We are a highly specialised clinic and carry out about 50 operations of this type every week. The technical know-how, our extensive experience, the fact that our team has been working well together for many years – these are all prerequisites for making a success of this work. But we are totally committed to our patients; it is they who are the focus of all of our endeavours. At the endogap Institute, each patient receives medical care that is customised to his or her individual needs. Our goal isnʼt simply to implant a hip or a knee joint to the best of our ability. That goes without saying. But what is crucial for us, is that patients feel that they are in the best possible hands, for that is the only way that they will be able to work with us after the operation to literally get back on their feet as quickly as possible.
“Life is movement, but only pain-free movement means quality of life.” (Dr Holm Schlemmer, Chief Physician at endogap from 1991 to 2010) Dr Christian Fulghum, Chief Physician at the endogap Joint Replacement Institute, Garmisch- Partenkirchen Hospital