November 2019

EHS Ambassador of the Month, Per Kjærsgaard-Andersen

It is a great honour to be the Ambassador for the European Hip Society. Being part of the core within EFORT (European Federation of the National Associations for Orthopaedics and Traumatology) for a decade, and besides being a long-standing member of EHS, it has been a great pleasure to realize the truly deep interest in collaboration between the two organizations, with the overall goal to educate and research within the hip pathology, to improve treatment of coming generation hip patients.

EHS has a significant position, not only within Europe – but worldwide. Also, EHS has a highly recognized group of European leaders within or close related to the Board. This combined with a well-established bi-annual congress and our own scientific journal, makes an important impact on clinical colleagues cross mainly Europe, when they select educational congresses and sessions to join.

For that reason, EHS for sure will withstand strong in all aspects, although complexity in the manufactures compliance rules and new medical device regulation, for now have shown unforeseen impact on both surgeons, patients and also societies.

Being in my “third age”, however – I feel even more prepared to stand-by and assist in fulfilling the aims of both EHS and EFORT.

I did my first total hip replacement back in 1988 – astonishing 31 years ago! What has happened during this period? Well, we still use an acetabular cup and a femoral stem, although within the period several attempts have been done to find “new ways”.

In 1988 the stem was a mono-block component. Modularity was developed to ease reconstruction of the patient’s anatomy and revisions surgery. Consequences: Metal debris and its negative outcome. Neck modularity has been withdrawn from the marked by most companies for that reason. When will head-modularity be withdrawn? We then will be back with mono-block stems.

Osteolysis in the cement-bone interfase was initially considered to be “cement-disease”. Therefore, non-cemented components increased in numbers quickly world-wide. Later, the “cement-disease” was learned to be due wear products from the poly-insert. The quality and sterilization of the poly was significantly improved, and since the latest generation highly crosslinked poly was introduced in 2008, osteolysis is no more an issue. Consequence: We however still use the significantly more expensive non-cemented implants, although registries like the Swedish Hip Arthroplasty Registries have shown comparable results between cemented and non-cemented implants. The true cement-paradox.

And I could list several other examples how we as hip surgeons “forget the past” and do not take that period in good enough consideration in our daily praxis.

However, the most significant change over the 30 years – at least in the Nordic area – has been the dramatic change in the programme for a standard total hip replacement patient. In 1988, a patient was normally hospitalized for 15-20 days, staying in bed for 5-6 days – up to today, where 95% of patients are mobilized fully on the day of surgery, 10-15% discharged on that same day as surgery, and in total 85% discharged within 24 hours after surgery. Consequence: We would think that waiting-list for surgery would have disappeared, but no – we are doing more and more surgeries. Total hip replacement is no longer only for the elderly, retired patients – but also for younger, suffering active patients. Moreover, we have a more active elderly generation – claiming an active “fourth age” of their life.

Therefore, total hip replacement – and especially non-replacement surgeries, will expect to increase in demand for our coming colleagues. So, EHS has a big demand to stand clear in education of coming hip surgeons, to make sure when we need a total hip replacement, we also have been the ones educating them to do the perfect approach.

Finally, a short summary of my career. My first training was under the leadership of Professor Otto Sneppen at Orthopaedic Hospital in Aarhus. Here I also started as senior surgeon at Aarhus University Hospital (AUH) and became an associated professor at AUH. As a young scientist, I in 1995 initiated the Danish Hip Arthroplasty Registry together with senior surgeon Ulf Lucht. In 1999, I moved on to Vejle Hospital as Head of Section for Hip and Knee Replacement – and as Associate professor at South Danish University. From 2008-2010 I served as President in the Danish Orthopaedic Society; was Congress President for the 12th EFORT Congress in Copenhagen in 2011; Secretary General for EFORT from 2012-2016 – and it’s President from 2018-2019.

I am much excited to contribute as an Ambassador for EHS, and look forward to a continuing great collaboration between two of the leading orthopaedic organization in Europe – EHS and EFORT.

Assoc Prof Prof Kjærsgaard-Andersen