EPISODE ONE｜The World’s Great Doctors - Prof. Heiko Graichen

Q1: When did you decide you wanted a career in medicine?

A1: That starts quite early. When I was 14 or 15, I decided that this can be a very interesting field. The reason is that when I was young, I did a lot of sports, so I was very active at gymnastics. Then I visited a lot of the hospitals because of the injuries. And as part of the team, I had regular examinations from the team doctors, which I thought it was a very interesting field.

Q2: Why did you decide to specialize in orthopaedics, and why the joint surgery?

A2: My specialization in orthopaedics was very early. As I said, my first contact in medicine was orthopaedics. During my medicine studying, I thought orthopaedics was the most fascinating field, which firmed my decision on orthopaedics surgery. And during your education as a resident , you see all different fields of orthopaedics surgery, for example, spine surgery, I worked there for a while. I also did arthroscopy and foot surgery, but the most fascinating part for me always was arthroplasty, especially the kneel arthroplasty.

Q3: Who were the people who inspired you in your career, and what advice of theirs do you remember today?

A3: There are a lot of people on the long journey. First of all, I want to mention is my parents, because they encouraged me to study medicine and supported me all over the long time. And in the field of medicine, I think two teachers that guided me, there was one clinician, the head of the orthopaedics hospital, where I did my first two years education. He guided me a lot, and he was also a guy who was very enthusiastic about the treatments. So I tried to copy him a bit. Then later on, I went for my PHD essay thesis to Munich into a big anatomical centre, the head of the department, he was a very great researcher and he gave me a lot of insights to do researches. So I think he also was a very important person in my career, not only looking at the clinical specialization, but also look at researches and publications, and all that which I think is very important to become a good doctor.

Q4: What do you hope to achieve as the Medical Director of Asklepios Orthopedic Clinic Lindenlohe in the next few years?

A4: That’s a very difficult question. You know as a medical director, you have to look at different aspects of the hospital, so it’s not all about your speciality as an arthroplasty surgeon and that field that I also have to take care of the entire hospital. And the colleagues of mine have a good basis to work on. So what we do is that we want to develop the spine department by integration of some neurosurgeons, so this field also become broader. As I said, we integrated the hand and plastic surgery two years back, so that field is under my focus for the next three to five years. So we will increase that team and do more surgery in that field. And as a medical director, I also have to look at some very basic things, like how does the rooms for patients look like, do we need to spend money for innovation, so we have a plan for that, also investments on new medical device, like MRI and all that. And for the arthroplasy area, in one or two years, we will have a big investment of new robot coming into the operating room, so that’s also something I am looking forward.

Q5: As a specialist in joint surgery, what are the biggest challenges facing the field right now, and what kinds of changes have brought to your career?

A5: I don’t know in China, but in Germany the number of patients is constantly increasing, but the problem is the budgets are going down and down, so that’s quite difficult to manage. On one hand you should treat more and more patients, on the other hands the payment for the patients is coming down, so that’s a big challenge. So we work very hard on efficiency. In the past days, we did around 3 arthroplasty surgeries a day, now we do 5 to 6, and I think there will be a lot of digital technologies that will support us over next years to increase that numbers to 7 or 8. So that’s one of the challenges that we have to do more and more surgeries still maintaining the quality. Of course you can be faster and faster, but then you lose the quality, and this is something we can not afford. So quality is Number 1 and time is Number 2. So over the last years, I think that’s the main challenge I have seen.

Changes over the time, as I said digital technology was introduced ten years back when we started in navigation, so now all the arthroplasty surgeries were done with navigation. But there are also some digital programs that have us standardize the surgeries, so by that the process is very streamlined, very much focus to the point. So there is a minimum of instruments on the table for the nurses. So the interaction is very focus, so that mean’s the lengths of surgery come down from around one hour ten to now fifteen minutes. So I think that is one real big change. Then outside the operation room, there is a lot higher turnaround. So that’s definately somethings that change daily workflow in the hospital in the last years.

Q6: Could you describe some memorable cases you have treated, and the outcomes?

A6: That’s a very interesting question. So meanwhile, I think I have done more than 10 000 arthroplasty, but of course, there are some memorable cases. So, for example, if you treat someone from your family or if you treat some of your friends. Once I did the surgery on the mother of our former CEO from Asklepios. So those are cases you keep in mind. But I think the most important thing is that you treat every case as a very difficult case. So the next case should be again the case where you focus on, try to deliver the best result you can. And that’s the main challenge in arthroplasty surgery. Every patient that is coming into your hospital, he wants to leave the hospital with minimum pain, with well functioning joints and restore to almost normal. And to deliver that in nearly 100% of the cases, that’s really a challenge. That means you have to standardize your analysis, you have to make a good pre-op planning and then you have to do a very precise executional of your plan, and also the post protocol needs to be as good as possible, and as individually as possible. So I think that’s the great challenge we have and so for me personally I can not remember every case, but for me every case is as important as the most important one. Your know so that is my challenge to deliver quality always in every patient.

Q7: Could you identify some exciting developments in treating the joint surgery today?

A7: Yes, I think if you look at the total knees, I think that’s the more exciting part than the total hip. So the total hip more or less, at the moment we believe everything is solved, so I think we have good approaches, we have very good implants, we have excellent results. So I think in hip arthroplasty there is not a lot of new things on the horizon, but if you look at the total knees over the last years, they started a lot of discussions on individual total knee arthroplasty. What does that mean? So it does mean that we don’t want to do the surgery in every patient the same way. The new treatment plan is to analyse the knee, so not every knee is the same. And then based on different parameters, maybe your alignment philosophy is a bit different than the standard one, maybe also your releasing technique is a bit different, maybe implant positioning is more individual, so there are a lot if things changing at the moment, and of course also the technology on that side. It’s giving us new options, so we use the navigation system now for more than ten years, but I think the robot that has entered the market over the last 2 or 3 years from different companies, would also change the precision of the surgery again. So this is something we also work hard on to get the robot in our theater, because I believe that the quality will again increase.

Q8: What recommendations would you offer to Chinese joint surgeons on their medical career?

I think you have to be passionate about it. So you really have to spend your energy into understanding the basic principles and understanding what other problems, try to solve the problems. And it is a constant learning, you know it is not, I spend one or two years and everything is done. It’s constant learning over the time. Even if I am in my fifties, I am still learning, I still go to a lot of conferences, I still write a lot of papers. So I really try to get better and better day by day. I think that is something you can tell the young surgeons. And I have a lot of residents in my hospital, I always tell them, you have to get better and better day by day, what is your strength and what is your weakness, you have to analyse that and then work hard on it. And back to the question we have before, the one thing is of course, you are a doctor, you have to be as good as possible, but the other thing is you have to be respectful also to the other team members, so that is very important, and also to the patients that are around you.

Prof. Dr. med. Heiko Graichen

Medical Director of the Asklepios Orthopedic Clinic Lindenlohe

Specialized in:

• Unicompartmental knee arthroplasty

• Total knee arthroplasty

• Revision

• Cartilage and arthrosis research (DFG grants)

• 3D joint kinematics (numerous DFG grants)

Career highlights:

• since 2011: Medical Director of the Asklepios Orthopedic Clinic Lindenlohe

• since 2005: APL professor at the Orthopedic University Clinic Friedrichsheim

• 2002-2004: Senior Consultant at the Orthopedic University Clinic Friedrichsheim

• 2001-2002: Senior Physician at the Orthopedic University Clinic Friedrichsheim

Awards and prizes:

• Top Doctors for Knee Arthroplasty and Knee Surgery in FOCUS Gesundheit.

• 2003 - 2004: Poster Price DGOOC

• 2003: Perthes Price DVSE

• 1999: Poster Price EORS

• 2000, 2002, 2003: Poster Price GOTS

Memberships in medical associations:

• 1998-2011: AGA

• since 1999: DVSE

• since 1997: DGOOC

Journals and publications:

• member of the editorial board of Clinical Biomechanics

• approx. 350 publications, abstracts in congress volumes

The introduction of Asklepios Kliniken and Asklepios Klinik Orthopedic Lindenlohe

The hospital group, founded in 1985, has 7 hospitals in the United States and 160 hospitals in Germany. In total, it has 27,000 beds and 75,000 employees that offer medical service to 2 million patients per year. In 2011, the hospital group has finished its acquisition of Mediclin AG, which is also a hospital group that has 34 hospitals and nursing homes that are equipped with 9,000 employees and 8,000 beds. In 2020, it finalized its acquisition of Rhon Kliniken, which also has 5 max hospitals and 1 university with 17,000 employees in there. Besides, the hospital group also sets up a hospital laboratory, called Medilys, to collect and analyse medical data from its hospitals. It could do more than 10 million analyses every year.

The Asklepios Klinik Orthopedic Lindenlohe, equipped with 120 beds, has received more than 10,000 outpatients and has done more than 4,000 surgeries annually.

Arthroplasty Centre: 1500 joints

Spine Centre: 500 fusions

Sports Med Centre: 1200 Arthroscopies

Foot and Ankle Centre: 300 procedures

Hand and Plastic Surgery Centre: 500 procedures