Interview - Orthopaedics
Knee surgery for the Arab elite

Middle East Health speaks to Dr Jurgen Toft, one of the world’s foremost knee surgeons and founder of the Alpha Klinik in Munich, Germany.

Dr Jurgen Toft is one of Germany’s pre-eminent knee surgeons and has conducted knee surgery on more than 27,000 patients. He is a pioneer of knee biosurgery where emphasis is placed on the repair of the joint with tissue generated from the patient's own body – joint preserving surgery – rather than using arthroscopy or knee replacement.

Dr Toft is the founder of the Alpha Klinik in Munich, Germany and is a Professor at the University of Milan.

Middle East Health: How many foreign patients do you see at Alpha Klinik and where do they come from?
Dr Jurgen Toft: Currently, about 30% of our patients are foreigners. The largest contingents come from the GCC countries, Russia, and the UK. Overall, our patients come from 70 different countries – from New Zealand to Brazil, from the USA to China.

MEH: Arab patients have a preference for German healthcare. How does Alpha Klinik adapt to this clientele? Which specific services do you offer?
JT: Alpha Klinik has been working with Arab patients for a period of well over 20 years. Initially, the majority came from the United Arab Emirates and Kuwait, but gradually, the number of patients from Saudi Arabia, Bahrain and Qatar increased. We have always had an Arab Patient Service with Arabic speaking staff who help optimise the patient's stay. In our patient accommodation, more than 15 Arabic TV channels are available, as well as Arabic newspapers, magazines and DVDs.

MEH: How do you go about attracting patients from the Arab world? Are there any specific marketing measures?
Alpha Klinik regularly takes part in regional exhibitions in the Middle East. Occasionally, there have been reports about our clinic in Arabic dailies and magazines. But of course, previously treated patients are our most effective publicity. We are also very well known in the health departments of regional embassies.

MEH: Are there any cultural peculiarities a German doctor should be aware of when treating Arab patients?
Over my 20 years' experience with Arab patients, I have time and again noticed that there is no need whatsoever to behave differently with Arab patients. In fact, I particularly enjoy working with Arab patients and find them very grateful.

MEH: What treatment methods does your clinic specialise in?
From the outset in 1984 Alpha Klinik has specialised in minimally invasive joint surgery. This operation technique is much less painful and has elicited a phenomenal response. But also in the realm of endoprothetics – the insertion of artificial joints – Alpha Klinik increasingly relied on minimally invasive surgery.

MEH: Are there any typical disease patterns among Arab patients?
The main problem among Arab patients is athrosis, often aggravated by overweight and badly trained muscles. Among our female Arab patients, knee-cap problems frequently occur. My overall impression is that people from the Arab world are nowadays much more aware of their own health and fitness issues than they were 10 or 15 years ago.

MEH: Most Arabs prefer to travel with their families. How are the dependants of patients attended to in Munich?
The clinic itself can accommodate entire families, but there is the Sheraton Grand Hotel opposite Alpha Klinik where families can find every conceivable comfort. As it is just across the road families can be with the patient at all times. Within the hotel, there is a rehabilitation facility called Fortina Reha, so that families can enjoy the city while their dependants are being treated. This aspect is perceived as particularly convenient.

MEH: In comparison to other clinics, in which price segment would you place Alpha Klinik?
Alpha Klinik provides a very distinguished quality standard, not least due to our high degree of specialisation. But of course, quality and specialisation have a price. At our clinic, patients can be sure they will have an experienced specialist performing the operation. Over the last 20 years, we have not had a single infection case in our clinic. This is a Europe-wide record. You could say that our prices are roughly 20%-30% above those of public hospitals, which is justified given the quality we provide.

- The Alpha Klinik is at the forefront of technology and minimally invasive surgery. Employing the latest, and often revolutionary, surgical techniques, the clinic enjoys a success rate of more than 90%. Patients are accommodated in five-star comfort and the clinic has seen many dignitaries, royalty and top athletes including the likes of Sheikh Ahmad bin Saeed Al Maktoum, Adnan Khashoggi and Her Majesty the Queen of Malaysia.

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Total shoulder replacement provides pain relief

Loss of the cushioning of the shoulder joint cartilage is often a slow and progressive process. Because we don’t walk on our shoulders, we can generally tolerate levels of shoulder osteo and rheumatoid arthritis that might be unbearable in the weight-bearing hip or knee joints. Nevertheless, a time comes when simple tasks are difficult in the face of shoulder joint arthritis. Treatment options should always start with nonsurgical measures. If appropriate, physicians can provide a long-acting corticosteroid injection – an agent which decreases pain by quelling arthritis-associated inflammation.

Dr William Jay Bryan, Orthopaedic Surgeon at the Methodist Hospital, Houston in the United States, has been injecting arthritic knee joints with hyaluronate with great success. Dr Bryan confirmed that his team is participating in a study which will test the effectiveness of OrthoVisc (hyaluronate) injections versus standard corticosteroid injections..

Surgery for shoulder arthritis involves resurfacing the joint with metal and plastic. As cartilage wears away, nerve endings within the bones become exposed. A shoulder replacement decreases pain by eliminating contact between the exposed nerve endings. Simply resurfacing the head of the humerus (the ball part of the joint) can produce acceptable results. Dr Bryan points out that “outcomes are much better when care is taken to provide both a plastic socket (the glenoid component) at the same time of humeral head replacement, rather than just resurfacing. In this fashion, both surfaces are protected”.

Total shoulder replacement surgery takes close to two hours of general anaesthesia and 1-2 nights of hospital stay for pain control, observation, and standard postsurgical antibiotics. A shoulder immobiliser (sling) is provided for pain control and to take the tension off of the surgically reconstructed shoulder soft tissues for the first month. Physical therapy commences two weeks after surgery; it is imperative to follow the appropriate do’s and don’ts.

Universally, patients enjoy pain relief after total shoulder replacement. Basic activities of daily living become easily tolerated. Moderately aggressive activities such as golf, light object lifting, or gardening are often improved. Overhead activity such as tennis or lifting objects above the head is achieved in some but not all patients. Although the final results depend on many factors, outcomes can be directly related to the patient’s effort during the 4-6 months following surgery.

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