RECENT ADVANCES IN LOWER LIMB
RECONSTRUCTIVE ORTHOPAEDIC SURGERY
John Hodgkinson
Consultant Orthopaedic Surgeon
Wrightington Hospital
October 2010
Orthopaedic Surgery
Aims of Joint Replacement = relief of pain and restoration of function
Development 1850s Primitive Anaesthetics 1867 Carbolic acid – asepsis 1895 X- rays 1900 Trauma and Orthopaedics 1940s IM Nail ( Kuntscher ) WW2 1960s AO ( Internal fixation) of fractures
Hip Replacement 1970s Knee Replacement 1990s Other Joints
Life Expectancy Hip and knee surgery – improves quality of
life
Mortality – risk with any operation.......
Major surgery : mortality risk 0.2%
Main causes are CVA accidents / pulmonary emboli / arrhythmia / myocardial infraction / renal failure / multi system failure
Long term results of Charnley THR
90% survival at 10 years 80% survival at 20 years
Functional Expectations of THR & TKR
Normal activities Driving Walking > 5 miles Stairs Non Contact sport Full time employment
Recent Developments in Hip Surgery Resurfacing Hip Cementless fixation Metal on metal Ceramic on ceramic Hip arthroscopy
Recent Developments in Knee Surgery Arthroscopy
Meniscal repair
Ligament reconstruction
Joint Replacement
Patello femoral replacement
Unicompartmental replacement
Is failure to RTW a failure of surgery ?? Many factors : motivation /poor job
satisfaction / claim culture ??
Sometimes - of course if there is a complication
After joint replacement 5% of patients suffer a complication of some sort
Complications that will affect morbidity Infection - 0.8% DVT and PE - 2% Dislocation - 2% Leg lengthening discrepancy Muscle weakness Neuro vascular injury Long term failure
Recent advances and how complications are dealt with
Evidence presented through History & Clinical Examination X rays MRI scans CT scans Ultra sound scans Isotopic bone scans
Patello femoral arthritis
Patello femoral replacement
Medial compartment arthritis
Total knee replacement
Knee revision with extensive bone loss
Hip arthritis with hip replacement
Loose and dislocated hip with revision and bone grafting
MRI Scan
CT Scan & Bone Scan
Word of caution ........new is not always best
Registries
“Clear trend towards the use of uncemented fixation – with an increase from 2.6% to 12% between 2001 and 2007”
“The use of uncemented prostheses has produced an increased risk of revision”.
“There is no trend towards improvement in the cohort undergoing surgery during the most recent ten years”.
“Uncemented fixation also increases the risk of serious problems during the first two years, predominantly loosening and fracture”.
“The uncemented cup has a significantly increased
risk of being revised”
The future Education & increase in number of specialist
centres
Computer aided surgery
Stem cell therapy
Thank you