Orthopaedics & Trauma

General Info: 

The Orthopaedics and Trauma Department in European Interbalkan Medical Center is open on a 24-hour basis and boasts a highly qualified and experienced staff consisting of Orthopaedic Surgeons that have been trained in the most contemporary medical centers of the World in new techniques and treatment methods. A fully equipped Rehabilitation Center and an ICU are always available to provide further medical services. Modern equipment is used in order to implement the newest surgical methods for orthopaedic lesions and injuries:

  • Osteosynthesis for spine, as well as for upper and lower limbs fractures, with minimally invasive techniques.
  • Treatment of elderly hip fractures with modern techniques, for immediate rehabilitation.
  • Spine surgery: micro-discectomy, spinal fusion, scoliosis, vertebroplasty, kyphoplasty, especially for osteoporotic fractures, and epidural injections with the use of C-ARM.
  • Sports Injuries Surgery: Knee, shoulder, hip, elbow, ankle and wrist arthroscopy, rehabilitation of meniscus, tendon, cruciate ligament, and musculotendinous cuff ruptures, injuries of the synovial cartilage, cartilage transplant, and treatment with autologous factors.
  • Arthroplasty for hip, knee, shoulder, elbow, ankle, finger joints of legs and arms, with latest generation prostheses manufactured in the most renowned foreign labs and minimally invasive operations.
  • Successful replacement of any hip or knee arthroplasty by experienced surgeons.
  • Lower limbs surgery and treatment of hallux valgus, metatarsals injuries, etc.
  • Open and endoscopic carpal tunnel aperture.
  • Upper limbs microsurgery.
  • Needle and guided biopsy, with a CT scanner for bone and joints lesions.
  • Treatment of bone and joints infections with surgery and mild therapy, in cooperation with specialized infectious diseases doctors.
  • Removal of tumors of the musculoskeletal system and replacement with special prostheses.

Total hip replacement with the ASI technique

Our doctors have achieved impressive results in Total Hip Arthroplasty (THA) using an innovative anterior approach technique, ASI (anterior supine intermuscular). By minimising trauma to soft tissues (muscles and tendons), this technique ensures a nearly bloodless surgical field through a small incision. Postoperative pain is mild and is effectively treated with simple analgesics. The risk of dislocation is practically abolished. Patients can begin walking on the very first postoperative day and soon they are able to return to their normal daily routines. Due to immediate mobilisation, there is a significant reduction of the risk of serious complications, such as pulmonary embolism. The advantages of ASI are particularly apparent in overweight patients, for whom it is considered a special indication. 


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Athens Medical Center

Dr. V. Bitounis, M.D. Bristol, Ph.D., FRCS Ed.

  • Senior Lecturer in the University of Bristol
  • Member of the Royal College of Surgeons
  • Visiting Professor of the University of Salonica

Dr. Ioannis Tsarouchas

Director of Orthopaedic Surgery Clinic

  • Member of Hellenic Society for Orthopaedic Surgery
  • Member of Hellenic Society for Bone Metabolism Research

European Interbalkan Medical Center

Apostolou Thomas

Orthopaedic surgeon

  • Lecturer specialised in Spinal surgery, 1st Orthopaedic University Clinic, Aristotle University of Thessaloniki, Greece

Ulf Moebius MD

Shoulder and Knee Orthopaedic Surgeon

Iatriko Psychikou


Christodoulou Nikolaos MD, PhD

Director of Orthopaedic Department

News By Page

Revision of total hip arthroplasty: Now also with the minimally invasive ASI technique

Written by Dr. Ioannis Tsarouchas, MD, PhD,  Orthopaedic Surgeon,  Director of Joint Implant Orthopaedics Department, Athens Medical Center, Athens Medical Group

Total hip arthroplasty is one of the most successful surgical operations in orthopaedics. Nevertheless, a significant number of patients undergoes revision (second surgery/ reoperation/ revision).

Proper material placement during the initial operation, so that the patient surgical outcome to be perfect, requires significant surgical experience. In case of poor prosthesis positioning, mechanical problems arise, which together with the loosening or wear of the prosthesis, microbial infection and fractures around it, are the most common causes of revision. Regular postoperative monitoring is particularly important for the prevention and early treatment of these problems.

The main symptom of patients with problematic total hip arthroplasty is pain in the inguinal region and/ or thigh, so in case something like this is observed, it is necessary to visit the orthopaedic on time. The faster assessment and treatment of problematic arthroplasty is of particular importance, as it usually leads to avoidance of worst bone deterioration around the prosthesis, making its revision (revision) easier.

Total hip arthroplasty revision is a difficult and demanding procedure. Its success requires special knowledge and techniques, as well as great surgical experience, so it is better to be performed by experienced and fully trained surgeons in large centres.

Traditionally, hip revision surgeries require extensive accesses (large incisions, significant soft tissue injuries, great blood loss) accompanied by a higher rate of complications as compared to the first surgery. In cases where only one part of the prosthesis has a problem, individual replacement is preferrable, making the revision less time-consuming, with less need for blood and quicker recovery.

The minimally invasive ASI technique (Anterior Supine Intermuscular), apart from its great success in the initial total hip arthroplasty, is also used with excellent results in cases necessitating revision of the acetabular component, ensuring maximum advantages of old prosthesis’ partial repair. With the ASI method, needs for transfusion are practically minimised, recovery time is dramatically reduced, and complications accompanying the long recovery period following extensive access to the hip are avoided. The advantages of this method are due to minimal injury of soft tissue around the artificial joint (which is already injured by the previous operation) and the surgeon’s good visibility during the operation.

In the Major Joints Clinic of Athens Medical Centre, we have performed a large number of revisions with the ASI method combined, where appropriate, with the reliable acetabuloplasty techniques and the insertion of grafts in bone defects regions (impaction grafting, strut grafts, etc).

Acetabuloplasty, in particular, is a tested method for the management of incomplete acetabulum formation and great bone defects of the pelvic bones.

The selection of patients who may undergo revision surgery with the ASI method is made after a detailed preoperational check, to exclude the case of great damage of the femoral prosthesis. Furthermore, it is also necessary to exclude the case that the bone defects of the acetabulum are that large to require more extensive access.

Through the revision of the problematic total hip arthroplasty, patients ensure the multi-annual smooth functioning of their intention and maintain their quality of life high.

Athens Medical Centre: Total hip arthroplasty revision with a minimally invasive technique

Significant number of successful operations with the ASI technique

The Large Joints of Athens Medical Centre, with Director Mr. Ioannis Tsarouchas has successfully performed a significant number of problematic total hip arthroplasty revisions, through the minimally invasive ASI (Anterior Supine Intermuscular) technique. Patients undergoing this surgery ascertain the multi-annual smooth functioning of their prosthesis and maintain a high quality of life.

Total hip arthroplasty is one of the most successful surgical operations in orthopaedics. However, a significant number of patients undergoing revision (second surgery/ reoperation) because of mechanical problems (loosening or wear of the prosthesis, misplacement), microbial infection or fracture near the prosthesis. In several of these patients, the revision many not lead to the desired results, and thus it will be required to undergo a revision surgery for the second, third, or even fourth time. It should be noted that hip revision surgeries require large incisions, severe injuries of soft tissues and significant blood loss, while they are accompanied by increased rate of complications as compared to the initial operation.

The innovative ASI method is the most modern minimally invasive method, and it is used with great success in cases where the revision of the acetabular component is necessary. Some of the key advantages of the ASI method include minimisation of postoperative dislocations risk, elimination of postoperative leg length discrepancies risk, as well as access to the old prosthesis, and the placement and orientation of the new with greater ease and reliability. At the same time, recovery time is reduced, and complications accompanying the long recovery period following extensive access to the hip are avoided, while no transfusion is required.

“Athens Medical Centre performs with great success the innovative ASI technique also in revision cases, sparing patients from postoperative discomfort. In this context, we have achieved impressive patient recovery, demonstrating in practice the commitment of the Athens Medical Group to constantly stand one step ahead” said Mr. Ioannis Tsarouchas, Director of Large Joints Clinic of Athens Medical Centre.

Total Hip Arthroplasty Revision

Writen by Vasileios Kon. Bitounis, MD Bristol, PhD, FRCS Ed Director Orthopaedic Surgeon at Athens Medical Centre

Total hip arthroplasty, as described and defined by the famous Professor of the University of Bristol, Iain Learmonth, was and is the 20th century’s surgery.

Forty years of research, technology and surgical experience by orthopaedics have made total hip arthroplasty safe, with excellent results and reduced complications. This has led surgeons to use total hip arthroplasty in younger and younger patients, resulting in the need for much longer lasting results for the patient and thus an increase in the number of arthroplasties that progressively fail and require revision.

Figure 1A: Significant bone destruction and dislocation of the LEFT hip (neglected case).
Figure 1B: Repair using the method of impaction grafting use of special cages with excellent repair.

Today, there are many different views on the way hip arthroplasty should be performed, with the interest mainly focused on access. Since all substantial questions have been answered. However, this is not an advancement, but rather it could be a possible cause of premature arthroplasty failure, and patients should be aware of this, as demonstrated by arthroplasty registration centres.

Figure 2A: Managed through the placement of a special femoral stem.
Picture 2B: Anatomic restoration

Hip arthroplasty revision is performed in cases where either arthroplasty shows early complications, such as dislocation and early loosening, or in cases of wear of arthroplasty materials, which in turn damages the underlying bone, and leads to prosthesis failure.

Hip arthroplasty revision may include either full prosthesis replacement or part thereof, while at the same time bone substratum preservation and improvement are attempted.

Therefore, this arthroplasty revision is a much greater surgical operation as compared to the initial arthroplasty. Arthroplasty revision requires great experience and it cannot be performed using the... cookbook method, i.e. “wait and see”.

The main problem in modern arthroplasty is the deterioration of the bone, which grows around the implants. The main priority of arthroplasty revision is to preserve the bone substratum, aiming simultaneously to preserve joint function and to achieve a result that will last for many years.

Figure 3: A case in which impaction grafts were used both in the acetabulum and the femoral, and using a special custom acetabular prosthesis.​

The first factor of arthroplasty’s success is the accurate identification of the problem and the successful planning of the surgical operation.

This detailed preoperative study, often considered an academic exercise, in fact guides proper operation and facilitates the rational design of arthroplasty. Of course, surgeons should remember that hip injuries are always greater than those seen in X-rays.

The choice of the technique and materials to be used for hip arthroplasty should always depend on the patient's age, activity, and of course his expectations. But the decisive factor for successful joint arthroplasty is the underlying bone substratum, and the continuous need to use a bone graft.

This bone substratum strengthening technique was the main project of the signatory and it is called the technique of impaction grafting. The bone substratum strengthening technique was first used in the Netherlands by Bob Slouf, and perfected at the University of Bristol by Professor Ian Learmonth and the signer.

The aim of the method is the creation of bone substratum, which first allows arthroplasty’s revision when other methods have failed, and secondly it creates the conditions for performing further surgical operations, if required. ​

Athens Medical Centre: Model Centre for Greece and Europe in the innovative total hip arthroplasty technique ASI

More than 200 operations with innovative minimally invasive ASI method for Total Hip Arthroplasty, have been performed at Athens Medical Centre by Mr. Ioannis Tsarouchas, Director of Major Joints Clinic and his team, highlighting the clinic as a model centre for Greece and all Europe.

Through the ASI method, impressive patient recovery, immediate mobilisation, and reduction of frequency of complications are achieved. The innovative element of the technique lies in the way the surgeon reaches the joint. In particular, through an anterior intersection with a length of only 6-7 cm, it is ascertained that soft tissues are not injured, while preventing muscle and tendon intersection. It is important to note that the operation lasts approximately 1.5 hours, while postoperative pain is minimal. The duration of hospitalisation is limited to three to four days and very soon the patient is returns to daily activities and normal life.

At the same time, dislocation risk is almost eliminated since no muscles are injured, while rapid mobilisation reduces the risk of complications, such as thrombosis. Of particular interest is the fact that the ASI technique is suitable for overweight patients, who face major problems with all other existing techniques.

The ASI technique is the most recent development in minimally invasive methods, and it offers solutions to problems that occurred with the previous ones.  Thus, for example, it poses no injury risk for the nerves or other joints of the lower limb, while it allows accurate control of limbs balancing.

“With this technique, we consider that a major step forward has been made towards the full relie of the patient from the postoperative discomfort of an operation, which is necessary for good quality of life. This is an innovative method, demonstrating in practice the commitment of Athens Medical Group to constantly stay one step ahead” stated Mr. Ioannis Tsarouchas, Director of Large Joints Clinic of Athens Medical Centre.

ASI TECHNIQUE: The evolution in total hip arthroplasty

Dr. Ioannis Tsarouchas,MD Orthopaedic Surgeon PHD, University of Athens Director Of the Large Joints Clinic Athens Medical Center.

The correct function of the joints, irrespective of age, is essential for most everyday activities and, therefore, for a good quality of life. 

More specifically, the hip joint, connecting the legs to the trunk, is necessary for all body movements. If it is defective, it may cause severe pain and motion hindrance.

Anatomy of the hip joint 

The hip joint is formed by an articulation of two elements:

  • a hemispherical head of the femoral bone and
  • a concave acetabulum of the pelvis.

The rounded head of the femoral bone rotates inside the cup-like surface of the acetabulum.  The contact area is covered by a smooth,  glossy tissue, called articular cartilage, which prevents friction, and by a small quantity of synovial fluid, which acts as lubricant, so that under normal conditions,  the movements of the joint are carried out smoothly, without friction. The joint is stabilised by strong ligaments and its motion is facilitated by strong muscles.

What is osteoarthritis?

Hip osteoarthritis is a chronic, degenerative disease, which causes deterioration of the cartilage and results in joint stiffness and progressively increasing pain in the groin, the anterior surface of the thigh, or sometimes in the knee.

What causes it? How frequent is it?

It may be caused by a variety of factors or conditions:

  • hereditary: congenital dysplasia (malformation), also known as congenital hip dislocation
  • a chronic disease, such as rheumatoid arthritis
  • previous trauma, such as hip fracture, leading to posttraumatic arthritis
  • aseptic necrosis of the femoral head. 

Extended studies show that 10% of the population suffer from osteoarthritis.


Major symptoms are pain and joint dysfunction, that is, stiffness and limping gait, which hinder everyday activities.

What is the treatment?

Depending on the particular characteristics of each patient, the doctor recommends appropriate medications. When, however, a point is reached when drugs no longer offer adequate relief, surgical treatment by total hip arthroplasty is the best solution. This  possibility of replacing the damaged joint by an artificial one, is among the most important achievements of orthopaedics, as it allows the patient to return to a normal way of life.

The main treatment of hip osteoarthritis is total hip arthroplasty. A major advance in recent years is the use of an anterior approach, with spectacular results.   

Techniques of total hip replacement

There are various techniques of performing the operation, which are mainly differentiated by the method of approach, that is the type of incision the surgeon uses to get to the joint. The classical techniques, which use lateral or posterior approach, require long surgical incisions with significant injury to the soft tissues (muscles and tendons). This results in correspondingly large blood loss necessitating transfusion of at least one, but usually two or more units of blood. Postoperatively, the patients may suffer from pain, they have to remain in hospital for several days, but the main problem is, that the trauma to the soft tissues takes about six weeks to heal. During this time the patients have to be very cautious in their movements and to use a walking aid, such as walkers, crutches or canes. These problems also apply to surface arthroplasty, which however, has the advantage of minimal bone loss.

Innovative method: Anterior approach - ASI

The major advantage of ASI (Anterior Supine Intermuscular) is minimal trauma to the soft tissues. The skin incision is anterior, very short, 6 to 7 cm, section of muscles and tendons is avoided and the duration of the operation is approximately one and a half hour. Thus, blood loss is limited and in patients with normal haematocrit, transfusion is practically never needed. Postoperative pain is minimal and the patient can be mobilised immediately. Depending on the patientʼs physical condition, a walking aid may be unnecessary from the very beginning. Hospitalisation is limited to three to four days. A danger of subluxation is practically non-existent, since no muscle is damaged. Rapid mobilisation decreases significantly the danger of serious complications, such as thrombosis and pulmonary embolism. The patient quickly resumes everyday activities and a normal life. Especially important is the fact that ASI is specially indicated in overweight patients, for whom other techniques are associated with significant problems.

In addition to the obvious advantages of the ASI technique as compared to conventional ones, it is also superior to other, older, minimally invasive techniques. These use special mechanisms of traction, which may cause nerve damage, fractures or subluxation of other joints, at the same time impeding intraoperative assessment of limb length. This may result in limb-length discrepancy. The ASI technique leaves the legs free to be moved. The complications of traction are avoided, while in addition, it permits exact intraoperative limb-length equalisation.

In short, total hip arthroplasty with the ASI method gives a rapid, effective, definitive solution to patients with damaged hip joints