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Recent Advances in Lower Limb Reconstructive Orthopaedic Surgery

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1 Recent Advances in Lower Limb Reconstructive Orthopaedic Surgery
John Hodgkinson Consultant Orthopaedic Surgeon Wrightington Hospital October 2010 Recent Advances in Lower Limb Reconstructive Orthopaedic Surgery

2 Orthopaedic Surgery Aims of Joint Replacement = relief of pain and restoration of function

3 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

4 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

5 Long term results of Charnley THR
90% survival at 10 years 80% survival at 20 years

6 Functional Expectations of THR & TKR
Normal activities Driving Walking > 5 miles Stairs Non Contact sport Full time employment

7 Recent Developments in Hip Surgery
Resurfacing Hip Cementless fixation Metal on metal Ceramic on ceramic Hip arthroscopy

8 Recent Developments in Knee Surgery
Arthroscopy Meniscal repair Ligament reconstruction Joint Replacement Patello femoral replacement Unicompartmental replacement

9 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

10 Complications that will affect morbidity
Infection % DVT and PE - 2% Dislocation - 2% Leg lengthening discrepancy Muscle weakness Neuro vascular injury Long term failure

11 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

12 Patello femoral arthritis

13 Patello femoral replacement

14 Medial compartment arthritis

15 Total knee replacement

16 Knee revision with extensive bone loss

17 Hip arthritis with hip replacement

18 Loose and dislocated hip with revision and bone grafting

19 MRI Scan

20 CT Scan & Bone Scan



23 Word of caution is not always best


25 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”

26 The future Education & increase in number of specialist centres
Computer aided surgery Stem cell therapy Thank you

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