Transcript Recent Advances in Lower Limb Reconstructive

John Hodgkinson
Consultant Orthopaedic Surgeon
Wrightington Hospital
October 2010
Orthopaedic Surgery
Aims of Joint Replacement = relief of
pain and restoration of function
Development
1850s
 1867
 1895
 1900
 1940s
 1960s
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1970s
1990s
Primitive Anaesthetics
Carbolic acid – asepsis
X- rays
Trauma and Orthopaedics
IM Nail ( Kuntscher ) WW2
AO ( Internal fixation) of fractures
Hip Replacement
Knee Replacement
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
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“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
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Thank you