University Hospital Charité among largest musculoskeletal centers in Germany

The University marks its 300th anniversary in 2010, but it took until 1890 to establish the widely respected orthopaedic surgery and traumatology department.

During its 120-year history the orthopaedic surgery and traumatology department at University Hospital Charité in Berlin greatly increased its musculoskeletal-related clinical, research and educational accomplishments and withstood the many changes that typically accompany vast growth and a greatly expanded mission. This process has resulted is an experienced, well-educated staff and state-of-the-art facilities forming possibly the largest orthopaedic department in Germany and one of Europe’s largest, as well.

The diverse organization, led by chairperson Norbert P. Haas, MD, operates on two of the university’s four campuses.

Among the recognizable orthopaedic pioneers affiliated with the university or the orthopaedic surgery department since its inception in 1890 are Julius Wolff and Friederich Trendelenburg. With their innovative contributions, both men helped make Charité — and Berlin — known worldwide for excellence in musculoskeletal care.

New center follows merger

Formerly, the orthopaedic surgery department at University Hospital Charité consisted of two specialties as was common nearly everywhere: orthopaedic and traumatology surgery. Consolidation of those areas at University Hospital Charité occurred in 2003.

The Charité Hospital, on the Campus Charité Mitte in Berlin, was completed in 1917. Julius Wolff, known for Wolff’s law, was the department’s first chairman, 1890 to 1892. Image: Charité-Universitätsmedizin Berlin

“The German Medical Association made a decision there will be one specialty again. In the past it was two different specialties,” Haas told Orthopaedics Today Europe. When the national change occurred, however, the university was already headed toward merging the two overlapping musculoskeletal groups, he said.

At Charité this change corresponded with formation of the Center for Musculoskeletal Surgery, which started that same year.

“We were the first in Germany to establish a center for musculoskeletal surgery, but there are many other like it now at universities around the country,” said Haas, who came to Charité Hospital in 1992 from Hannover, Germany, taking over leadership of the department in 2003 after his predecessor, Hartmut Zippel, MD, retired.

The Center for Musculoskeletal Surgery has provided a way for the department to better concentrate resources for orthopaedic teaching and research, Haas said. “It has helped us be more effective.”

Currently Klaus D. Schaser, MD, and Carsten Perka, MD, head the trauma and the orthopaedic surgery areas of the center, respectively.

Lars Lidgren, MD, PhD, head of the Department of Orthopaedics, University Hospital, in Lund, Sweden, told Orthopaedics Today Europe, “Prof. Norbert Haas, head of the Department in Charité, and chair of the AO Foundation in Switzerland, has been in the forefront in Germany of creating a modern center for musculoskeletal disease both in the clinical field and research.”

Wolff’s work

Musculoskeletal research still figures prominently in the department’s accomplishments.

The Julius Wolff Institute at Charité, headed by George N. Duda, PhD, was established in 2008 when the orthopaedic and trauma research labs were combined. The institute stands in the tradition of Wolff’s work by focusing on the link between mechanics and biology in trauma and orthopaedics. It currently employs approximately 90 researchers, including engineers, biologists, biochemists and other specialists.

Julius Wolff Institute researchers and others in Amsterdam and Delft, the Netherlands, collaborated on a project to improve the musculoskeletal models that the Dutch groups use to predict internal forces via computer modeling. Individuals in the foreground measure shoulder joint forces in the patient while those at desks behind the patient simultaneously monitor other movements and signals. Image: Julius Wolff Institute

“We started in 1993 with one or two people in the area of musculoskeletal research. There was practically no research being done in the field,” Haas noted.

“As one can imagine, we cover the whole field from measuring in vivo loading to cellular adaptation and stem cell research ... We have been successful in translating research ideas into products that you can now find in surgical theaters around the globe,” Duda said, noting that interdisciplinary research has been the key to success.

Georg Bergmann, PhD, who specializes in studying instrumented implants, is deputy-director of the institute. His public database, www.OrthoLoad.com, provides information regarding the loads acting on hip, knee, shoulder and spine implants along with videos of patient activities.

“At the Institute, we have a big group working on simulation of loads in the human body using computer models of the musculoskeletal system and how that affects joint replacement, loading of fractures and other situations,” Bergmann said. “A large group working on gait analysis tries to predict which gait disturbances result from certain muscle deficits.”

The institute is named for perhaps the most famous member to date of the Charité orthopaedic surgery department, anatomist Wolff, who was the first head of the orthopaedic department, 1890 to 1892.

In conjunction with the university’s 300th anniversary, the institute reprinted Wolff’s 120-year old book, which contains his original law on how bone naturally develops a structure that is able to resist the forces acting on it, and other writings. According to information at the Charité website, the concept of Wolff’s “law” was influenced by Virchow.

Another of Wolff’s contributions was that before he died in 1902 he helped established the original German orthopaedic society, Bergmann said.

Orthopaedic leadership

Wolff’s successor and the department’s second head, Albert Hoffa, was chairperson from 1892 to 1907, according to Haas. “He is known today for (identifying) a fat body in the knee joint called the Hoffa body.”

Hoffa, considered the leading German orthopaedic surgeon in his day, developed a hip contracture brace. Haas credited him with devising more general orthopaedic practices, as well. In addition, Hoffa performed open reductions of congenital hip dislocations and was among the first to emphasize performing them when children are quite young, according to Peltier’s book, Orthopedics: A History and Iconography.

Trendelenburg, a leading general surgeon who worked at the university, identified the characteristic gait of patients with a congenital hip dislocation and what is now called Trendelenburg’s sign.

“Following Joseph Lister, he introduced principles of antisepsis in the clinic,” Haas said of Trendelenburg’s efforts.

More recently, the department has furthered nearly all its endeavors by collaborating with Standford University, Georgia Tech, Oxford University, the AO Research Institute, the National University of Singapore, the University of Queensland, and others groups worldwide. – by Susan M. Rapp

Reference:

• Peltier LF. Orthopedics: A History and Iconography. San Francisco, CA: Norman Publishing; 1993.

• Georg Bergmann, PhD, can be reached at CVK, Forum 4, PSF 24, Augustenburger Platz 1 D-13353 Berlin, Germany; +49-30-450-659-081; e-mail: Georg.Bergmann@charite.de.
• George N. Duda, PhD, is Director of the Julius Wolff Institute and the Berlin-Brandenburg Center for Regenerative Therapies. He can be reached at Augustenburger Platz 1, D-13353 Berlin, Germany; +49-30-450-559079; e-mail: georg.duda@charite.de.
• Norbert P. Haas, MD, is Director of the Center for Musculoskeletal Surgery, Department of Trauma and Reconstructive Surgery, Clinic for Orthopaedics, University Hospital Charité (CVK, CCM). He can be reached at Augustenburger Platz 1, D-13353 Berlin, Germany; +49-30-450-552012; e-mail: norbert.haas@charite.de.
• Lars Lidgren, MD, PhD, can be reached at University Hospital, S-221 85 Lund, Sweden; +46-4617-1500; e-mail: lars.lidgren@ort.lu.se.