“Quality of life is always key”

Conservative hip treatment using the CoxaTrain

From Bauerfeind Life Magazin on 03.07.2024

In short PD Dr. med. habil. Lars Homagk, Adjunct Professor and Specialist in Surgery, Trauma Surgery and Orthopedics with practices in Naumburg and Weißenfels, always relies on conservative methods first when treating patients suffering from osteoarthritis of the hip. Activating his patients is key for him. In order to alleviate pain and support movement, he prescribes the CoxaTrain hip brace, for example. The results were so convincing that he now also uses the brace for other indications related to the hip – for his patient Michaela Elsner, for example, who suffered from complications after a femoral neck fracture with her mobility and ability to work being severely restricted.

As soon as hip pain starts, patients gradually reduce their active participation in life. This is often caused by osteoarthritis and does not exclusively affect those over the age of 70 but also younger patients who work and want to keep working for a long time. Dr. med. habil. Lars Homagk, Associate Professor and Specialist in Surgery, Trauma Surgery and Orthopedics with his practices in Naumburg and Weißenfels, Germany, explains how the CoxaTrain brace can be used to alleviate pain and aid mobilization.

“Conservative treatment always comes first,” says Dr. Lars Homagk, stating his motto for treating patients who suffer from osteoarthritis of the hip in order to preserve the hip joint for as long as possible. “We will recommend joint replacement only when patients suffer from permanent limitations and even have problems getting into a car or on a bike or can no longer engage in their beloved gardening activities. Quality of life is always key,” highlights the physician, who we visited at his practice in Weißenfels.

Multi-modal, personalized treatment

“We provide comprehensive consultations, we check what suits patients best and what they’re open to,” says Dr. Lars Homagk, describing his approach, “and we will treat conservatively for as long as it makes sense.” For pain reduction, he offers, for example, infiltration therapy with hyaluronic acid or the patient’s own conditioned blood plasma as an individual out-of-pocket service, in addition to oral medication. In about 80 per cent of his patients, however, more exercise would have the greatest effect because they are not active enough or, in the worst-case scenario, are no longer active at all. Be it mobilization with a physical therapist or rehabilitation exercises at the gym – there are plenty of options these days. He often performs shock wave therapy as an accompanying measure. Particularly in cases of osteoarthritis in joints with a lot of muscles, such as the hip or shoulder, he has had good results. This is because the degenerated muscles around the joint affected by osteoarthritic degeneration respond very well to this approach. Tried-and-tested components include foot orthoses and braces to relieve affected joints and to support kinesiotherapy.

“The pain remains even when they have a new joint, making patients unhappy.
We have to prevent this with conservative treatment.”

Associate Professor Dr. med. habil. Lars Homagk

Counteracting the chronification of pain

“Lightweight and flexible braces like the CoxaTrain are designed to reduce pain and activate the muscles. They offer guidance during movement rather than immobilizing the joint,” Dr. Lars Homagk explains. Pain caused by osteoarthritis of the hip results in a reduced range of motion. Patients will develop harmful postures to help relieve the pain and most will only attempt to walk short distances. With a brace providing the hip with targeted relief, “many patients report that they can walk better and complete longer distances. They then often decide to postpone having surgery. In combination with other components of conservative treatment, this can be an excellent solution for many years,” explains Dr. Lars Homagk. The experienced physician believes that it is important to prevent pain becoming chronic before surgery is performed. “In these cases, the pain remains even when they have a new joint, making patients unhappy. We have to prevent this with non-surgical treatment measures and make sure patients keep their muscles as strong as they can be. This is one of the deciding factors for successful surgery and rehabilitation measures later on.”

Exercise is crucial before and after surgery

If quality of life becomes too restricted because of pain and increasing immobility, Dr. Lars Homagk believes it is not a question of age to decide about the timing of surgery. “It’s no longer true that a prosthetic implant will last for an average of 15 years. Plus, you mustn’t underestimate the muscular problems that will intensify without surgery in cases of osteoarthritis.” He will therefore do everything possible to perfectly prepare his patients for the moment of the surgery, and he points out to them that range of motion must still be worked on afterwards. “We don’t carry out hip replacements ourselves. We refer our patients to specialists. If patients come to us using crutches six weeks after their surgery, I know that their muscles have not yet developed sufficiently. Today’s hip arthroplasty regimen shouldn’t really require crutches after the subsequent rehabilitation measures. Patients should be able to do everything like before.” The physician will then assess the individual’s situation to determine the CoxaTrain can provide support in the post-operative phase “During the initial stage, it can promote confidence to exercise more if there are concerns about subjecting the hip to strain.”

“Products like the CoxaTrain definitely have a place in our active treatment approach.”

Associate Professor Dr. med. habil. Lars Homagk

An active approach to osteoarthritis of the hip

Dr. Lars Homagk has been prescribing the innovative hip brace for about 2 years. Thanks to massage effects exerted during walking, it provides relief to those muscles that carry out movements. “We’re always checking how we can provide our patients with even better help, we’re always up-to-date. And when I’m convinced by something, I will use it. Products like the CoxaTrain definitely have a place in our active treatment approach.” This strategy is confirmed by his patients’ behavior. The brace is typically well-accepted by patients. It supports them in activities of everyday life, at work and during leisure time. “The decisive factor is that patients are happy to use it if they feel it helps,” Dr. Lars Homagk reports. If, during regular check-ups, he hears that this is not the case, it often turns out that patients had difficulty when they donned the product independently for the first time. “In my experience, this is not necessarily down to the product. You’ve got pain, receive all this information and add everyday problems – all this can affect how details are remembered, potentially impacting patients’ understanding of how something can be beneficial. We’ll then send the patients to the medical supply retailer to have the fit checked and donning of the product shown to them again. That’s usually quite simple.”
Patient education has a high priority for Dr. Lars Homagk. He believes that it is important for his patients to understand their condition as well as their treatment plan and to familiarize themselves with the prescribed medical aid during an appointment. That is why he shows the products to his patients, explains how they work and prescribes them by name. “We are familiar with the medical aid directory, we know the different products, and we will select a specific solution for individual problems. We have a high level of trust in the medical supply retailers we rely on to provide products for our patients with osteoarthritis of the hip.”

CoxaTrain not just in cases of osteoarthritis of the hip

Thanks to his extensive practical experience, Dr. Lars Homagk knows the effects of the brace on the lumbo-pelvic-hip region, and he does not just use it for the conservative treatment of patients suffering from osteoarthritis of the hip. Just like the SacroLoc, the CoxaTrain stabilizes the pelvis and relieves the sacroiliac joints. As opposed to the pelvic brace, the CoxaTrain features several friction pads that exert a massage effect during movement. This helps compensate for imbalances in the hip and gluteal muscles, which may also be a cause of lumbosacral pain:
“The CoxaTrain can be a suitable solution if a patient suffers from back pain that radiates severely into one of the legs. The hip, or the hip muscles, must be the trigger, otherwise targeting this area will not be effective.”

Mobilization following femoral neck fracture

The orthopedist sees further potential in the use of this brace in post-operative follow-up care of femoral neck fractures. Using an anatomical model of the pelvis, he points to the greater trochanter on the femoral head, where the gluteal muscles attach. “We recently had a young patient who didn’t want to solely rely on the three screws in her bone. The CoxaTrain provided her with the confidence to get back to the necessary activity level. And there are other cases, too,” reports Dr. Lars Homagk and takes us – in agreement with the patient – into the treatment room where Michaela Elsner has come to see him for her follow-up appointment.

After complications resulting from a femoral neck fracture, Michaela Elsner wore the CoxaTrain for five months until her hip replacement surgery. The pre-operative stabilization helped her remain active and able to work.

The patient in her mid 50s fractured her femoral neck during a fall and underwent surgery. The problem was that the bones were severely compressed, leading to a shortening of the femoral neck and impairing the natural union of the bones. As a consequence, material had to be removed. This resulted in serious hip pain during movement, then also during standing or sitting, which radiated into the back and groin. Michaela Elsner was not able to continue her work as a cleaner in a gym and rehabilitation studio without experiencing problems. Dr. Lars Homagk explains: “As a result, she developed femoral head necrosis, making a joint replacement unavoidable. We then had to maintain her mobility as much as possible while waiting for her surgery. That’s why we prescribed the CoxaTrain for stabilization.”

“I can now do everything again and I’m back to working full-time.” Michaela Elsner now no longer needs a brace and does rehabilitation exercises twice a week.

Able to work using a brace

Michaela Elsner reports: “The technician from the medical supply retail store came to my house, took my measurements and fitted the brace right there. Of course, I had to get used to it first. But I noticed quickly that my pain was subsiding so I was able to go to work, even though it was reduced hours, but that was important to me.” She was not able to perform all activities then, but she kept active which benefited her after surgery during rehabilitation. She now does rehabilitation exercises twice a week, goes to physiotherapy once a week and works out using equipment once a week. In total, Michaela Elsner wore the CoxaTrain for five months until her joint replacement surgery. She thought the brace was nice and lightweight, donning of the product was quick, and she always wore it under her coat during work as well as under wide trousers outside work. With a beaming smile, she adds: “All that really helped me. And with my new hip, I can do everything again, and I’m back to working full-time.”

Treatment in Burgenlandkreis

After ten years in hospitals in Leipzig, Halle and Weißenfels, Associate Professor Dr. med. habil. Lars Homagk started his own practice in Naumburg in 2015. In 2018, he took the opportunity to buy a listed building from the 1920s about 15 kilometers away in Weißenfels to set up a state-of-the-art medical treatment center. In addition to his practice for orthopedics and surgery, the building accommodates his wife’s practice for gynecology as well as a dermatologist, family physician and psychological physical therapist. A care service, a pharmacy and a medical supply retailer are also located there. In 2023, Dr. Lars Homagk and his team of 21 staff member in both locations, including two employed physicians, treated 3,000 patients, providing different surgical, orthopedic and chirotherapeutic services.

Gluteal pad (top left) and trochanter pad of the CoxaTrain hip brace massage during walking and help relax the muscles that carry out movements.

Less hip pain during movement

The CoxaTrain hip brace provides relief during walking and significantly reduces pain. This effect may help to enhance mobility and support kinesiotherapy in cases of osteoarthritis of the hip, rheumatoid arthritis, hip impingement syndrome and other indications. The lightweight brace surrounds the pelvic girdle with circular compression, stabilizes the hip as well as lower back and helps relieve the sacroiliac joints (SI joints). Two dorsal SI joint friction pads, the Gluteal Pad above the posterior part of the gluteus medius muscle and the mobile Trochanter Pad above the greater trochanter offer a massage effect during walking and help compensate for muscular imbalances in the lumbo-pelvic-hip region that affect function.

Images: Bauerfeind, Andreas Wetzel

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