Developments in Orthopaedic Surgery this Century
Wednesday 7 February 2018
After more than twenty years as an Orthopaedic Consultant specialising in hip and knee replacement surgery, I am able to reflect upon the changes in practice that have taken place.
In hip replacements there has been a turbulent phase where metal on metal articulations were considered to be the way forward and actively encouraged by a number of implant manufacturers. Unfortunately, and with the benefit of hindsight, I realises that such a change has had a disastrous effect in a significant minority of patients, requiring further and quite complex revision surgery. It has been a salutary lesson to understand that probably the tried and tested implants that have been in use, with a well-established life history if inserted with the appropriate expertise, serve patient’s requirements better than some newly untried articulations. This has been specifically the case with a number of metal on metal hip replacements and hip resurfacings. I still see some patients whose hips I replaced twenty plus years ago functioning perfectly well and I realise that perhaps the results of tried and tested materials are more of a guarantee for success in achieving long term pain relief and mobility than some newer and untested implants. Currently with the “Getting It Right First Time” (GIRFT) initiative proposed by the British Orthopaedic Association there is encouragement (partly finance driven) to revert to old cemented implants.
One of the major progresses in rehabilitation of hip joint replacement has been the enhanced recovery programme whereby the mini incision approach which I use in over 95% of my patients has allowed the faster recovery of patients, reducing their length of stay from 10 - 14 days ten years ago to an average length of stay of 3 days today. This is with the support of dedicated nursing and physiotherapy staff at North Downs Hospital.
With regards to knees, the major progress has been the use of jigs and appropriate apparatus to insert the implants correctly and a better understanding of the biomechanics and soft tissues. As a consequence, the results of knee replacement surgery in appropriately and correctly selected patients have continued to improve year on year. It is evident that patient selection and patient understanding of the procedure is the key to the success. The supporting nursing and physiotherapists at North Downs, both for in-patients and for out-patients rehabilitation, provide specific and tailored care resulting in excellent patient satisfaction and repeated success.
With the benefit of this experience, I continue to provide consultations for patients requiring opinions and surgical treatment for private patients, those who wish to self-fund and for NHS patients through the excellent facilities. Private and self-funding appointments at North Downs Hospital can be made by contacting my personal assistant, Pauline Butcher, on 01293 778927 or firstname.lastname@example.org
Khalid J Drabu, Consultant Orthopaedic Surgeon