1 / 26

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

nanda
Download Presentation

Recent Advances in Lower Limb Reconstructive Orthopaedic Surgery

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

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

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

  3. Development • 1850s Primitive Anaesthetics • 1867 Carbolic acid – asepsis • 1895 X- rays • 1900Trauma 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 - 0.8% • 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

  21. Word of caution ........new is not always best

  22. 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 seriousproblems during the first two years, predominantly loosening and fracture”. • “The uncemented cup has a significantly increased risk of being revised”

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

More Related