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

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