An ideal match

Post-operative follow-up care with CoxaTrain

From Bauerfeind Life Magazin

In short After undergoing cartilage cell transplant surgery, tennis player Amelie Intert received the novel CoxaTrain hip brace from her surgeon, Dr. med. Alexander Kurme.

Amelie Intert was number 30 in the German tennis rankings when her impingement syndrome halted her career. It was not until she met a specialist in cartilage cell transplantation in the hip and tried a new type of brace during follow-up treatment that she could finally be pain-free.

What if? Amelie Intert does not dwell on this question for long. “If I hadn’t had hip pain, I would probably still be active as a professional player.” ‘If wishes were horses, beggars would ride’ as they say. Today, the 26-year-old is free from pain, is studying midwifery and is once again enjoying playing in smaller tennis tournaments. Let’s take a look back: a few years ago, she was playing among the cream of the crop. Tennis insiders attested Amelie Intert great talent. She was on her way to the top. In 2016, she started experiencing problems, initially on the outside of her knee. Then, she got osteitis pubis, an inflammation of the pubic symphysis probably triggered by stressed hip adductors due to her mild dysplasia, early participation in competitive sports and the sliding movements typical in tennis. MRI findings eventually revealed a focal cartilage ulcer in the left acetabular cup as well as deformities at the head-neck junction (CAM impingement). Hitting the joint rim during hip flexion resulted in damage to the acetabular labrum, shoving off the acetabular cartilage. Although the cartilage still covers the bone like a carpet, it can no longer withstand biomechanical loads during movement of the hip joint. Doctor visits, osteopathic treatments and surgery on the right hip followed. The complaints, however, continued to increase, especially on the left side.

“The hip is a whole different ball game compared to the knee.”

Dr. med. Alexander Kurme 

“We had to take action. There was a high risk of sustaining more and more cartilage damage.” Dr. med. Alexander Kurme is one of only a few specialists in the Hamburg area who carries out arthroscopic procedures on the hip and the only one who also performs autologous cartilage cell transplants. “In this regard, the hip is a whole different ball game compared to the knee,” the orthopedic surgeon points out. The hip is located in the center of the body, making cell removal and infiltration more complex, and the legs must be supported on an extension table. The critical cartilage repair phase requires 48 hours of bed rest after surgery and reliable partial weight-bearing for the following six weeks. “As a young, active patient, Miss Intert met all the requirements for a transplant,” Dr. Kurme explains. “But athletic patients in particular tend to overestimate themselves and can bear higher levels of pain.” Here, the physician had not been able to find a suitable brace that would prevent the movements that could damage the growing cartilage. “For a long time, I had been looking for an appropriate tool that would maximize the chances of successful cartilage repair.”

CoxaTrain got there just in time

Three days before the scheduled cell transplant in July of 2021, Dr. Kurme received a visit from the Bauerfeind sales representative in his orthopedic practice in Seevetal, carrying the new CoxaTrain in her sample case. A lightweight hip brace designed for active patients with osteoarthritis of the hip, rheumatoid arthritis or impingement syndrome that provides relief while walking and reduces muscular imbalances in the lumbo-pelvic-hip complex. Due to its pain-reducing effect and the positive impact on the gait pattern (see study), CoxaTrain is particularly suitable to support therapeutic exercise. The brace stabilizes the hip joint and allows flexion and extension to be limited, if necessary.

“From the first moment, the CoxaTrain with its pelvic frame made me feel secure,” says Amelie Intert.

A brace that ticked all boxes

“I knew at first glance that this is what I had been looking for,” Dr. Kurme recalls. “I was immediately convinced by the fastening concept of the CoxaTrain on the iliac crest. I already knew that from the SacroLoc back brace.” It also offered protection while allowing controlled load-bearing. “This requirement was fulfilled by the joint splint with the limiting hinge. As a spacer or even stopper that exerts a certain distraction on the joint, the brace came very close to ticking all boxes.” Dr. Kurme requested that Amelie Intert be fitted with the brace right away. Now, nothing stood in the way of surgery, and it went according to plan. The CoxaTrain was applied right after the procedure. However, the brace was able to show off its strengths especially during the subsequent six-week follow-up phase.

In-growth of chondrocytes

“Since Amelie was my first patient to wear the CoxaTrain, I didn’t have any reference values for the follow-up treatment yet,” explains Dr. Kurme. “Under no circumstances should the operated leg be loaded with more than 20 per cent of the patient’s own body weight. It was legitimate to adopt this value from other procedures performed on the knee.” The necessary relief was achieved primarily by using crutches, and additionally with the CoxaTrain. The brace allowed safe movements to ensure the cartilage cells, called chondrocytes, could grow into the surface, combined with moderate joint distraction.
The selected angle setting enabled a maximum of 30 degrees of flexion over the first three weeks of rehab, then 60 degrees over the last three weeks.

CoxaTrain also in non-surgical care

Four months after surgery, Amelie Intert was back on the tennis court. She remains symptom-free to this day. In January 2022, a preponed MRI showed replacement cartilage over the acetabulum. They did it! “From the first moment, the CoxaTrain with its pelvic frame made me feel secure,” she says in retrospect. “It was a great help. I’m thankful for having the extra protection when I needed to be careful.” In the meantime, she has successfully completed the rehab phase. A tennis match is scheduled between the patient and the doctor to mark this milestone. Without CoxaTrain. Dr. Kurme now also uses it in non-surgical therapy – to preserve the joint as long as possible when osteoarthritis of the hip is diagnosed early. As in the case of Amelie Intert. Advantage CoxaTrain.

Images: Stefan Volk

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