Ortho & Physio in Dialogue · Issue 4
“The man seizes his chance; the woman waits for it.”
For decades, Dr Maren Kapella was usually the only female doctor at the operating table. Hand surgery is her favourite; joint replacements are what pay well in hospital. In her Berlin practice, she initially sends almost every patient home without a date for surgery.
A conversation by Jesaja Brinkmann for Somana
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8 min
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September 2026
Dr. Maren Kapella
Specialist in orthopaedics and trauma surgery, Berlin
When the phone rings in the operating theatre, Maren Kapella says something she could not get away with anywhere else in the hospital: “I cannot talk now. I am in surgery.” She has operated on hands, hips and spines for decades, now as a senior physician at Caritas-Klinik Dominikus in Berlin-Reinickendorf, a certified joint replacement centre. Hands are her favourite — precisely the procedures that do not pay off for her hospital. A conversation about when the scalpel helps and who profits from it.
01
A world of its own
Somana
What does operating give you?
Kapella
Orthopaedic surgeons are essentially craftspeople with academic training. You have a task and can solve it immediately. Recently, while I was on duty, there was a young woman who had crashed her motorcycle and broken her wrist. The fracture was surgically realigned; now it is stable.
Somana
And when the door closes?
Kapella
That is the pleasant part. The operating theatre is a world of its own, the heart of a hospital. Nobody can bother me with anything else there.
02
Two consulting rooms
Somana
How many patients from your practice do you operate on?
Kapella
Initially, I send practically every patient away without operating. I always try to save the joint with conservative treatment first — without surgery. Only in a few cases is it immediately clear that surgery is necessary. Everything else can wait. A practice is not an emergency department; patients must not feel rushed into an operation.
Somana
Hospitals are operating more and more often. Why?
Kapella
These hospital consultations are designed to decide whether an operation is necessary. That is the only thing the hospital earns money from. That is simply how it is.
Somana
You are saying that about a system you profit from yourself.
Kapella
I still make sure the decisions are right for the patient. That is the big difference: it depends on how you approach the person.
“Initially, I send practically every patient away without operating.”
03
Before the incision
Somana
How do you recognise a knee that really needs surgery?
Kapella
Pain brings patients to the doctor — that is the subjective criterion. Then there are the objective ones: an extension deficit, meaning the leg can no longer straighten fully, along with ligament instability and possibly a deformity. And the X-ray has to match too. I can have two patients with the same X-ray showing osteoarthritis: one is doing very badly, while the other says osteoarthritis is not something they know.
Somana
The physiotherapist sees the patient months before surgery. What should they have achieved by then?
Kapella
Addressing the extension deficit. We always approach the knee from the front and open the capsule there. An extension deficit can only be corrected mechanically to a limited extent: you wake up from surgery with the same joint mobility you had going in. That is why the joint capsule and ligaments must be stretched and stabilised beforehand, even if surgery follows.
“You wake up from surgery the way you went into it.”
Somana
Imagine you developed knee osteoarthritis yourself tomorrow. What would you do?
Kapella
First, every conservative option. Exercise, more cycling, which is not even my sport. Strength training, footwear, cushioning. Everything to postpone a replacement. If my ligaments became unstable and I had to think about every step, I would want a knee replacement. At that point, it is also the rescue.
04
A bit brutal in the past
Somana
Is there an operation you regularly performed twenty years ago that you now consider wrong?
Kapella
No, not really.
Somana
Not a single one?
Kapella
Spinal operations would come closest. Spinal surgery always comes too late. With osteoarthritis, I replace the destroyed joint, and afterwards the actual arthritic pain is gone. With the spine, I have almost always missed that moment: wear across several levels, where all I can do is fuse it — firmly connect two vertebrae. The biomechanics are completely different and cannot be compared with joint surgery.
Somana
That sounds like a problem with the specialty. What did you personally get wrong?
Kapella
We used to be a bit brutal about that. We would tell even an eighty-year-old: this is collapsing, we will stabilise it, using cement in the porous bone if necessary — which is, however, useful for pain relief after fractures. But it does not help those patients. It is now becoming accepted that spinal fusion should be avoided in the very elderly. And of course people who operate on spines present it to patients a little differently.
“We used to be a bit brutal about that.”
05
What a hand is worth
Somana
Your favourite hand operations are considered loss-making in hospital. An artificial knee brings a high case-based payment; hand surgery takes a similar amount of time and earns a fraction of that. Why?
Kapella
The case-based payment reimburses materials, not time. An artificial joint contains an expensive implant that can be billed for. Carpal tunnel syndrome — a compressed nerve at the wrist — has a 99 per cent success rate in my experience and according to the research, and all I need is a small incision and little time. The same applies to trigger finger and ganglion cysts.
Somana
What does that mean for patients?
Kapella
If I can no longer walk in old age, I at least need my hands. Drinking something on my own, washing myself. That is the bare minimum. But it does not pay, and that is sad, because these procedures help patients a great deal.
“The case-based payment reimburses materials, not time.”
06
What physiotherapy can do
Somana
When a patient returns to you, how can you tell that physiotherapy has been good?
Kapella
By the fact that they are still motivated. I had a ministry official, an unassuming man in a suit. At some point he said: Ms Kapella, I sometimes stand without holding on and keep practising on the S-Bahn now. I probably saved him from several spinal operations. And I send patients back for physiotherapy too: this is not enough yet; it was a good start, do not stop now.
Somana
Where does our profession, physiotherapy, overestimate itself?
Kapella
When colleagues go very deeply into the diagnosis through manual therapy. I am exaggerating now: pelvic torsion, the piriformis, and that alone is supposed to explain it. It is an overall problem, and a single muscle is given too much importance. It is the same with the sacroiliac joint. It is not a proper joint; it is like a crack in a rock. Then the blockage is in the patient’s mind, and I find it very hard to get it out of there.
Somana
What can a good therapist do that you cannot?
Kapella
They keep functional anatomy in view and always have an exercise to go with it. The physiotherapist literally has the patient in their hands. Muscle tension, that persistence: at the muscular level, I am out. I can feel it, but it is not my field.
“At the muscular level, I am out.”
Somana
What do you want from a physiotherapy practice you refer patients to?
Kapella
For the patient to keep going after the last prescription. At first we want to relieve the pain; afterwards they need to move for themselves until they no longer think about the pain at all. It never disappears completely; even well-trained people eventually get back pain. But then they know: I can get this under control again. That is the effect I want for every patient.
07
Good machines
Somana
When you started, how many women stood beside you at the operating table?
Kapella
Usually none, apart from the theatre nurses. That has changed a great deal. But look closely at the roles women fill. The higher levels in the hospital hierarchy — senior physicians and heads of department — can still be counted on two hands.
Somana
What did you have to listen to over all those years?
Kapella
That orthopaedics was too physically demanding for a woman. Too much strength, too much hammer and chisel. Then out comes my favourite line: I have my male assistants. And I have good machines.
Somana
And what do you tell a female junior doctor starting today?
Kapella
To have more confidence in herself. The boss asks who wants to operate; both the man and the woman are beginners. The man says, of course; the woman says: I cannot do that yet. But a specialist is standing beside her; she is not doing it alone. The man seizes his chance; the woman waits for it.
08
Where the money belongs
Somana
Musculoskeletal disorders cost €49.9 billion a year; follow-up care runs through more than a thousand dedicated rehabilitation facilities. You can introduce one reform. Which one?
Kapella
Abolish rehabilitation hospitals. That sounds sarcastic, but we are not healthier because of them. I am not against follow-up treatment; doing without it would be absurd. In the Netherlands, a physiotherapist comes to the patient’s home every day for six weeks, which is cheaper than inpatient rehabilitation. With older patients, I check what aids they need, or I look at the workplace. We need to move away from this expectation of having everything provided for us. The spa towns will survive, by the way: travel there, take your prescription, book yourself in for a week and pay for the physiotherapy yourself or redeem your prescription.
Somana
And where should the money go instead?
Kapella
Into prevention, and that starts in kindergarten. I see so many obese children and teenagers and ask: what is your plan? Nothing comes back. People who grew up with sport adhere to treatment very differently. I tell them to do the exercise five times, and they understand that it will not be right the first time. Everyone calls for prevention; nobody wants to pay for it.
Quick questions
A sentence about orthopaedics you never want to hear again?
The most underrated exercise?
Something physiotherapists do better than orthopaedists?
Your benchmark for a new method?
Whoever helps is almost always right.
The instrument you most enjoy holding?
The scalpel.
Ortho & Physio in Dialogue
About the interviewee
Dr Maren Kapella
Dr Maren Kapella is a specialist in orthopaedics and trauma surgery. Her additional qualifications include specialist orthopaedic surgery, hand surgery, physical therapy, manual medicine and sports medicine. She runs Orthopädie Mitte, a solo practice for privately insured and self-paying patients at Anton-Wilhelm-Amo-Straße 6 in Berlin-Mitte. She also operates as a senior physician in the Department of Orthopaedics and Trauma Surgery at Caritas-Klinik Dominikus in Berlin-Reinickendorf, a certified maximum-care joint replacement centre. Her previous posts include Vivantes Humboldt-Klinikum.
More interviews to come
Ortho & Physio in Dialogue is an interview series by Somana. Doctors and therapists discuss where collaboration breaks down and how patients can receive better care.
