From May 13th to 17th, Prof. Pfeil, joint surgery expert, and the former Medical Director of St. Josefs-Hospital Wiesbaden, Germany arrived in Guangdong Clifford Hospital as an international visiting professor. He conducted a series of academic exchanges in the hospital, including outpatient consultations, ward round, surgical guidance, internal training in the department, discussion of department management, discussion of key difficult cases, and master open class.

From May 13th to 17th, the international joint surgery master Prof. Pfeil wrote a perfect ending for his five-day visiting professorship at the Guangdong Clifford Hospital. Deputy President GONG Caixia of the hospital, Director ZHAO Hongpu of the Orthopedics Department, and directors and young talents from other departments all presented at the welcoming ceremony for Prof. Pfeil, the former Medical Director of St. Josefs-Hospital Wiesbaden, Germany. Deputy President GONG also indicated that the master’s visiting professorship in China which promotes Sino-German exchange in Orthopedics would be a perfect opportunity for Guangdong Clifford Hospital to improve its diagnosis and treatment level. Prof. Pfeil performed surgery for the Minister of the Federal Ministry of Defense of Germany. The short stem he invented has been a hot sell across the world. Years ago he had a live-stream while performing surgery in the biggest hospital in Moscow, and hundreds of joint specialists were on the spot to learn. He is also the founding member of the French-German Orthopaedic Association. Guangdong Clifford Hospital is the ceiling of China’s private hospitals. It is also the grand vision of life for China’s medical system of the patriotic entrepreneur Mr. PENG Linji. Prof. Pfeil had a fulfilling five-day work schedule with Director ZHAO Hongpu of the Orthopedics Department: outpatient clinics, ward rounds, case discussion, surgical guidance, discussion on department management, open master lectures, etc. Prof. Pfeil spoke highly of Director ZHAO’s work. He also gave many valuable suggestions to the Orthopedics Department in terms of subdivision and reconstruction of specialties as well as the management and promotion of the department in the future. Late in the afternoon on Friday, Prof. Pfeil visited Gloryren’s office in Guangzhou. He had a discussion with our colleagues from the International Public Relations Department (IPR) on the future planning and development of Guangdong Clifford Hospital. He also highly appraised the work performance of the IPR. Our team of IPR started their learning with anatomy at the very early stage of work, possessing a huge load of bilingual medical vocabulary. That's the reason why they can perform fluent interpretation for every project. The same day at dusk, Prof. Pfeil also had a taste of freshly made coffee, fresh peaches, and various Cantonese Desserts in our office’s tea room.

Welcoming Ceremony

In the morning of May 13^th, Deputy President GONG Caixia of the hospital, Director ZHAO Hongpu of the Orthopedics Department, Director LIU Huiliang, Director LI Yannan, Head Nurse ZHANG Xinggui and directors and young talents from other departments all presented at the welcoming ceremony for joint surgery expert. In the welcoming Ceremony both side introduced their hospital for better communication.

Director ZHAO Hongpu of Orthopedics Department presided over the welcoming ceremony.

In her speech, Vice President GONG Caixia warmly welcomed ProF. Pfeil and introduced the hospital's profile. She said that she was honoured to invite Prof. Pfeil to visit the hospital for academic exchanges. She expressed her hope that this visit would turned out to be a fruitful and beneficial interactions between the two sides, and to improve the development of orthopedic department of the hospital.

Vice-President GONG Caixia presented Prof. Pfeil with the appointment letter of "Visiting Professor".

After the ceremony, with the company of Director ZHAO Hongpu, Head Nurse ZHANG Xinggui, and the talents of his team, Prof. Pfeil was shown around the outpatient clinic, the Surgery Building, and the Internal Medicine Building. Prof. Pfeil pointed out that the ward distribution design of Guangdong Clifford Hospital is proper and reasonable, and the spacious structure and enjoyable surroundings show its ability to provide a quality hospital environment for patients. Director ZHAO also showed Prof. Pfeil around the Clifford National TCM Center, introducing under the active promotion of Guangdong Clifford Hospital, how the time-honored TCM treatment blends with the Western medical treatment system and adopts a holistic treatment notion including both symptoms and root causes to improve and solve all kinds of disorders.

Lecture and difficult case discussion

After the short tour of the hospital, Prof. Pfeil and the team of Director ZHAO returned to the department. Prof. Pfeil gave a lecture on the topic of Hip-joint Reconstruction in Children and Adolescents (caused by dysplasia, joint infection, etc.), systematically introducing in detail various osteotomy techniques for children and adolescents with hip joint conditions. After the lecture, Director ZHAO and his team raised questions related to the topic, and Prof. Pfeil offered answers one by one.

In the afternoon, the Orthopedics Department prepared 7 difficult cases related to hip and knee joints and discussed with Prof. Pfeil diagnosis and treatment concepts, including options of hip-preserving treatment or arthroplasty treatment for patients at the ages of 40 to 50 with local osteonecrosis of the hip joint, comparison of the pros and cons of HTO and UKA, and Prof. Pfeil’s related treatment experience. The academic exchanges conducted through the welcome ceremony, the master’s lectures, and the discussion on difficult cases are not only the prove of the friendly exchanges between China’s hospitals and Germany’s but also proof of Guangdong Clifford Hospital’s resolve to be in line with the international treatment standard and to develop a first-class Orthopedics Department.

Ward round and lectures

On the morning of May 14^th, 2024, the international joint master Prof. Pfeil headed to the Orthopedics Department of Guangdong Clifford Hospital. Together with Director ZHAO and his team, Prof. Pfeil conducted a ward round. They first checked on the recovery conditions of a patient who was on his fifth day after the hip replacement surgery, and Prof. Pfeil gave some suggestions concerning the exercise and activity for rehabilitation based on the patient’s condition.

Then they learned some information about a patient who was admitted to the hospital after receiving conservative treatment for five months for his tibial plateau fracture. After that, they went to the ward to have a physical examination of the patient and have a discussion on the possible treatment based on the patient’s condition. Later on, it comes to the lecture section. Prof. Pfeil delivered a speech on the topic of Knee-preservation Surgery: UKA and HTO, systematically concluding the indications and contraindications of UKA and HTO. Prof. Pfeil also shared some practical cases and discussed them with Director ZHAO’s team.

Perioperative management guidelines for THA and TKA

For the academic discussion in the afternoon, Prof. Pfeil also shared perioperative period guide surrounding the hip and knee replacement, including pre-operative preparation, premedication, tips for post-surgery getting-out-of-bed activity, instructions for rehabilitation and physiotherapy, notes for prosthesis, and management and control for post-surgery pain and swelling. This guideline perfectly meets the needs of patients. Distributing it to patients at the outpatient stage can greatly help them understand how to self-manage during the perioperative period of joint replacement surgery and follow doctors’ instructions in diagnosis, treatment, and rehabilitation. Promoting such guidance for patients during the perioperative period at the Guangdong Clifford Hospital can be of great help.

In the discussion of difficult cases, Director ZHAO shared two cases of complex hip replacement revision with Prof. Pfeil, and had discussions on the diagnosis and treatment flows and the options of revision prosthesis, aiming to improve Guangdong Clifford Hospital’s techniques in difficult hip revision surgery through exchanges.

New ideas in THA

On the morning of May 15^th, 2024, Prof. Pfeil delivered a lecture on the topic of Approaches for Hip Replacement and shared with the team of Director ZHAO the usual approaches for hip replacement in Europe (namely the posterior, posterior lateral, anterior, pertrochanteric, lateral, anterior lateral, groin, double incisions and other improved approaches) and their respective key anatomical structure. The emphasis was placed on the introduction of the Wiesbaden Approach (anterior approach) which is mainly adopted by St. Josefs-Hospital Wiesbaden, including its operating procedure, the patient’s position and placement during the surgery, etc.

Furthermore, Prof. Pfeil noted how to deal with the hip joint capsule and the exposure femur for the anterior lateral approach and showed the surgery essentials of such an approach for hip replacement by video. In the following discussion, they talked about whether it is needed to remove the joint capsule, whether to keep the drainage tube and the indwelling needle, how to improve post-surgery pain management, when to get out of bed, and how to plan the weight-bearing stage. All these discussions have offered precise and meticulous reference through the sharing of Prof. Pfeil’s practical experience with the Orthopedics Department for diagnosing and treating patients who need joint replacement. Director ZHAO also shared his experience in adopting DAA and its complications and discussed with Prof. Pfeil its pros and cons.

In the afternoon, their discussion was surrounding the details of various acetabular cups and the compression, as well as the important role of pre-operative preparation in the selection of prosthesis, the amount of osteotomy, restoring the natural offset, and other important factors during the surgery. Based on his rich experience in clinical diagnosis and treatment, Prof. Pfeil especially indicated that for patients whose main complaint is knee pain, examining their hip functions and observing their gait patterns are requisite during the physical examination. That’s because many patients with knee pain complaints actually have the root cause of degenerative changes or dysplasia in the hip joint, which means that they need a hip replacement instead to improve their knee pain and deformity.

Sino-German master open class

May 16^th, 2024 came as the fourth day of Prof. Pfeil’s visit as a visiting professor at the Orthopedics Department of Guangdong Clifford Hospital. In the morning, Prof. Pfeil engaged in the morning shift session, learning the basic information of how the department functions and makes shifts and bringing out relative suggestions. Later on, Prof. Pfeil together with the department conducted specialist consultations on the key elder patient who had a femoral neck fracture. They had detailed discussions on the timing for surgery after fracture, and whether to choose the cementless or the cemented prosthesis for joint replacement in femoral neck fracture.

In the afternoon, the Sino-German Master Open Lecture and the activities of the Joint Surgery Branch of the Guangzhou Medical Association were held as scheduled at Guangdong Clifford Hospital. The meeting president Director ZHAO, the former Medical Director of St. Josefs-Hospital Wiesbaden, Germany and senior joint expert Prof. Pfeil, and other directors of joint departments from the First Affiliated Hospital of Guangzhou Medical University, Guangzhou First People’s Hospital, and other hospitals in Guangzhou all presented in the meeting. Firstly, Prof. Pfeil delivered lectures on the topics of Bone Defect Management in the Revision of Hip Prosthesis and Comparison of Cemented and Cementless Hip Prosthesis and had discussions with participating experts on the topics. Later on, Prof. Pfeil engaged in the case discussion of revision surgery for knee replacement for hyperextension, pain, and unequal leg length after hip replacement, pain after hip replacement for dysplasia, etc. The Master Open Lecture serves as a precious opportunity for Sino-German academic exchanges in Joint Surgery and is also a prove of Guangzhou Medical Association’s intention to constantly introduce internationally renowned experts for mutual learning.

Lecture on Knee Prosthesis Selection and Hip Replacement Topic

On the morning of May 17^th, 2024, after arriving at the department, Prof. Pfeil delivered a lecture on the topic Selection of Knee Prosthesis first and then the History of the Development of Hip Replacement in Germany. Prof. Pfeil had a very systematic arrangement for his lectures on Joint Surgery, and his presentations on the pros and cons and indications of various prostheses for hip and knee provided quality instructions for understanding joint replacement for young doctors.

After the lectures, the department brought up several difficult cases for discussion with Prof. Pfeil, including osteotomy for treating fracture below the tibial plateau with osteomyelitis, and knee replacement for degenerative knee joint after internal fixation for distal femur fracture, etc. When discussing lower extremity osteotomy for deformity correction, Prof. Pfeil demonstrated in detail how to apply Prof. Paley’s principle of lower extremity deformity correction to realize precise osteotomy by calculating the angle between the joint line and mechanical axis.

Later on, Prof. Pfeil and Director ZHAO had an in-depth discussion on how to construct a joint replacement center at the Guangdong Clifford Hospital, how to build a systematic, precise, and meticulous perioperative management system for hip and knee replacement (which requires the participation of both doctors and patients), and how to achieve quick recovery after replacement surgery. Under the leadership of Prof. Pfeil, St. Josefs-Hospital Wiesbaden, Germany has developed into a top ten joint surgery center in Germany, with annual surgery of 2,000 in 2024. Therefore, with rich clinical experience in hip and knee joint surgery, from case discussion, topic lectures, specialist consultation, advice for department management and specialty construction, Prof. Pfeil’s one-week visit at the Guangdong Clifford Hospital and his exchanges with Director ZHAO Hongpu’s Orthopedics Department offers not only systematic and comprehensive guidance for joint surgery diagnosis and treatment but also constructive suggestions for the overall development of the department. Prof. Pfeil has written a perfect ending for his visiting professorship at the Guangdong Clifford Hospital, and the hospital is welcoming a promising future for internalization and precision-oriented development.