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 ........new 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