Scientific Program

Day 1 :

Keynote Forum

Luca Lucente

Nuova Itor Clinic Rome, Italy

Keynote: The New Surgical Technique to the Positioning of Hip Prosthetic Implants: The Medial-Inguinal Approach

Time : 10:00 AM to 10:40 AM

Biography:

My name is Luca Lucente and I am an Italian 56 year old orthopedic surgeon. I am an expert in prosthetic surgery, especially of the hip, and I have devised a new surgical approach to implant the hip prosthesis: it is the inguino-medial approach. I participate constantly in national and international conferences and I have published scientific papers in national and international journals. He is currently a Medical Director at the Orthopedic Department of the Nuova Itor Nursing Home and he is a freelancer at the Quisisana Nursing Home and the Villa Salaria Nursing Home in Rome. Author and / or co-author of national and international scientific publications and member of numerous scientific societies, he participates constantly in scientific congresses and courses of superspecialization in Italy and abroad and has collaborated with the Verduci Publishing House as a translator of scientific texts International.

 

Abstract:

Introduction: True to the concept of Tissue Sparing Surgery, we invented this new surgical technique to reach the coxo-femoral joint by starting at the inguinal-medial region.

Methods: We performed total hip arthroplasty on 100 patients suffering from hip arthritis.

Results: In our case study, operation time and blood loss were lower, there were no complications, and recovery time was incredibly fast.

Discussion: We have invented a surgical process that allows for a safe, easy and fast replacement of the hip, and that spares the hip stabilizer muscles completely. Throughout the operation, the surgeon can view the acetabulum from the front, a view that is preferable to the one available with known techniques. There is no need for special equipment or special operating tables, and surgeons don’t face a steep learning curve when first introduced to the procedure. Since risks of dislocation are non-existent, the patient is allowed to lie in bed in any position. The procedure is preferable aesthetically, since any scarring is hidden from view in the inguinal folds of skin. Patients can resume walking immediately, using 2 Canadian crutches only for a few days.

Conclusion: The authors think that, thanks to its low costs and ease of performance and replication, this technique offers nothing but advantages for the patient. Easier rehabilitation is another positive aspect. The procedure can be considered a valid alternative to other common surgical approaches.

 

Keynote Forum

Hosam E Matar

Wrightington Hospital, UK

Keynote: Cruciate-retaining Total Knee Replacements for Valgus Deformity Secondary to Osteoarthritis: 5.5 years Follow-up Survival Study

Time : 10:40 AM to 11:20 AM

Biography:

Mr. Raut has been working as a Consultant Orthopaedic Surgeon at Wrightington Hospital since 1996.  He did his basic Orthopaedic Training in Bombay, India at the King Edward Memorial Hospital (University of Bombay) and was a Lecturer in Orthopaedic Surgery at the University Hospital before coming to the U.K.  He trained in U.K. as a Registrar in Orthopaedics at Oswestry on a 3-year rotation.  His Senior Registrar Rotation was at Birmingham working at the Royal Orthopaedic Hospital in Birmingham and the Coventry District General Hospital.
During his training period he acquired a master’s Degree in Orthopaedic Surgery (M.Ch.Orth.) from the University of Liverpool and from the University of Bombay (M.S.Orth.).  He secured the Speciality Fellowship in Orthopaedics (F.R.C.S.Ed. Orth.) from the Royal College of Surgeons of Edinburgh.

Abstract:

Background: Clinical survival studies for cruciate-retaining TKR for valgus knees are very limited in literature. We present our series of valgus knees secondary to osteoarthritis treated with lateral soft tissue releases and CR-TKR.

Methods: A survival study of CR- TKR in knee OA with valgus deformity with functional MCL, has been performed by retrospective analysis of hospital data. Revision for any cause is considered the end point. 108 TKR in 102 patients with a minimum follow up of 1 year, who had a CR-TKR for knee arthritis with valgus deformity between December 2001 and November 2012 are included in the study.

Results: Mean follow up is 5.5 years (median 5 years, range 1 -14 years). Mean improvement in the valgus angle is 14.28 degrees +/- 2 degrees at 95% CI (Median 14, SD 9 degrees). Mean flexion is 105 degrees (Median 100, range 80-150).  10 patients have died due to non-orthopaedic causes. One patient has non-progressive lucency around the components and has not required revision. None of the tibio- femoral components have been revised so far. One patient had a fall and dislodged the Patellar Button which had to be removed.  No instability has been noted in any of the patients during follow up. Two patients have persistent pain, but investigation has not shown any cause.

Conclusions: CR components for TKR for knee OA with valgus deformity has shown satisfactory survival at 5 years with low revision rate when adequate soft tissue balance is achieved at the time of implantation.

Implications: CR-TKR, which helps preserve femoral bone stock, can be successfully implanted in a valgus knees, as shown in our series, with 100% survival at an average of 5.5 years when the soft tissues are balanced at time of implantation.  However, long term follow-up is required to ensure there are no late failures.

 

  • Arthroplasty | Radial Head Arthroplasty | Hip Arthroplasty |
Location: Renaissance London Heathrow Hotel Bath Road, Hounslow TW6 2AQ, United Kingdom

Session Introduction

Andrew Clarke

Plymouth Hospitals NHS Trust, UK

Title: Tranexamic acid use in Lower Limb Arthroplasty - The Derriford Experience
Speaker
Biography:

Andrew Clarke is working at Institution of Plymouth Hospitals NHS Trust at UK.

 

Abstract:

Patients undergoing lower limb arthroplasty have increased risk of perioperative bleeding.  Prevention of bleeding with an anti-fibrinolytic may be preferable to blood transfusion.  Tranexamic acid (TXA) inhibits fibrinolysis by competitively blocking plasminogen binding sites.  We retrospectively sampled all patients who underwent primary total knee replacement (TKR) and total hip replacement (THR) for one month.  We assessed whether patients were given TXA, amount of blood loss, rates of transfusion and length of stay.  Departmental policy was implemented advising use of TXA for lower limb arthroplasty unless hypersensitive.  Repeat retrospective sampling and analysis was performed.  The initial study of 33 TKR and 17 THR showed mean patient age of 66 years with 60% female.  Two THR patients received TXA, compared to 17 TKR patients.  Change in haemoglobin levels pre to post-operatively were 3.06g/L for the non-TXA group versus 2.29g/L for the TXA group.  Independent ‘t’ test was statistically significant, p=0.003.  Two patients received blood transfusion; both did not receive TXA with blood loss over 3g/L.  Mean length of stay for the non-TXA group was 5.06 days compared to 3.74 days for the TXA group.  Repeat analysis after policy implementation gave a study-set of 49.  Mean patient age was 67 years with almost 60% males.  Similar proportions of TKR and THR were noted to the initial study with 32 TKR and 17 THR.  We saw dramatic improvement in use of TXA; 30 TKR and 13 THR patients in-total.  By extrapolating the improved use of TXA, this represents a total of 33.11g/L blood loss saved cumulatively across the 43 patients who received TXA.  The cumulative outcome of the 43 patients who received TXA had a shorter hospital stay by 56.76 days.  This represents a benefit to patients and the hospital with decreased rates of blood loss, shorter length of stay with significant cost saving. 

 

Anish Agarwalla

Safdarjung Hospital and VMM College, India

Title: Short Term Results of Replacement Arthroplasty in Irreperable Mason Type III Radial Head Fractures
Speaker
Biography:

Anish Agarwalla did his post-graduation from Central Institute of Orthopedics, Safdarjung Hospital, New Delhi and is currently serving as senior resident at the same place. He is highly interested is academics and research related works. He is the co-author of two books and is looking forward for more books in near future. The author is highly interested in joint disorders and wants to pursue his career in arthroplasty.  His clinical practice is based on very sound principles and he is a person with firm dedication towards his patients and has friendly relations to his students.

 

Abstract:

Background: The radial head is considered as the main stabilizer of the elbow especially when the medial and lateral ulnar collateral ligaments have been damaged. Radial head arthroplasty (RHA) is indicated for patients with unreconstructible radial head fractures. The present study was carried out to analyse the early clinical results after treatment of irreparable radial head fractures with radial head replacement.

Methods: 32 patients with Mason’s type III radial head fractures were treated with cemented Monoblock stainless steel radial head replacement during 2014-2016. The patients were followed up for a period ranging from minimum of 12 months to a maximum of 23 months, with average being 16 months. During each visit their functional outcome with any associated complications were noted and were graded with Mayo’s elbow performance score (MEPS).

Results: At the final follow up, 24 patients (75%) had excellent results, 6 (18.75%) good and two (6.25%) had fair results. 6 patients were associated with complications like pain, stiffness and valgus elbow instability. Variables like MEPS, pain and stiffness were found to have significant association with time interval between injury and surgery, with cases being operated earlier showing better results. Significant association was also seen between associated elbow injury and elbow instability. No case of radio capitellar overstuffing was seen. However, one case was associated with lateral epicondylitis which is a relatively rare non-documented complication.

Conclusion: We conclude that radial head arthroplasty is a good treatment option for irreparable type III radial head fractures, with cases operated earlier showing better results. It restores elbow kinematics and stability with good functional outcome, provided care has been taken to avoid overstuffing of the joint. Early mobilisation of elbow is important to restore elbow motion and function.

 

Avais Raja

TRIA Research Institute, USA

Title: Normative Data of the Hip Disability and Osteoarthritis Outcome Score (HOOS), JR in a Healthy United States Population
Speaker
Biography:

Avais Raja is a post-doctoral research fellow currently working at TRIA Research Institute. TRIA focuses on improving healthcare in outpatient ambulatory orthopaedic surgery. The patient reported outcomes program at TRIA focuses on collecting patient reported outcomes from all orthopaedic surgical cases to follow patients function and quality of life post-operatively. Avais is currently in transition to orthopaedic surgery residency and has shown promise in orthopaedic surgery research.

 

Abstract:

Background: Patient reported outcome measures (PROMs) play a vital role in the care we provide our patients. To help understand the application of PROM in arthroplasty, normative and benchmark data to serve as a comparison to patients pre- and post-surgery would be extremely valuable. We collected normative data of the Hip Disability and Osteoarthritis Outcome Score (HOOS), JR on a healthy population, greater than 17 years of age, in the United States devoid of hip injury and/or surgery.

Methods: This was a cross-sectional study, where hard copy surveys were administered to 1140 patients, being seen for an orthopaedic issue unrelated to their hip, and non-patient visitors in July 2018 at an outpatient orthopaedic clinic in a suburban metropolitan city. Participants were eligible if they self-reported a medical history negative for hip replacement, current hip pain/disability, or hip procedure (surgery or injection) within the past year. Mean, standard deviation, median and interquartile ranges on the HOOS, JR interval scores were calculated by sex, age decade, BMI, reason for visit, history of orthopaedic procedure and past medical history.

Results: Four hundred twenty-five men and 575 women were included in the final study cohort. Women aged between 70 to 79 years reported the lowest mean interval score (mean = 88.8). Overall women scored lower as well (93.3 vs 95.7, p = 0.001). There was not a statistical difference between the interval scores by tobacco consumption (93.5 vs 94.4, p = 0.49) and between patient’s vs non-patient visitors (94.2 vs 94.5, p = 0.672). Lower scores were observed in participants with a past non-hip orthopaedic procedure (92.6 vs 94.9, p = 0.016), past medical history of a chronic illness (92.5 vs 95.9, p = <0.001), and participants classified as obese (BMI >30) (91.7 vs 95.2, p< 0.001). On regression analysis, there was a decrease of 0.3 and 0.1 in the interval score for each unit of BMI and age by year, respectively (p<0.001).

Conclusion: This study provides normative reference values for the HOOS, JR in a United States population from a suburban metropolitan city greater than 17 years of age. These scores can facilitate physician-patient shared decision making to help patients understand expectations post-hip arthroplasty in respect to PROM.

 

Juned Salam Ansari

Harrogate district hospital, UK

Title: Uncemented Hips -- current status
Speaker
Biography:

Dr Juned S Ansari graduated from MAMC, New Delhi and completed FRCS (Ortho & Trauma), London in 2014 while working in Singapore. He did his Fellowship in Hip & Knee Arthroplasty from Chapel Allerton Hospital, Leeds, UK. He did a literature search on Uncemented hips under Prof Hemant Pandit and managed to publish the paper on Uncemented hips – current status in Feb 2018.

 

Abstract:

Background and purpose: Total hip replacement (THR) has been an established procedure for symptomatic end stage arthritis of hip to improve function and alleviate pain thereby improving the quality of life of millions of patients. Of the range of possible joint replacements, it is suggested that THR is a landmark surgery. Its success in the short-term as well as in the long-term has led to THR being performed in younger and more active patients. Survival of THR in the young and active patients was suboptimal for many years and management of this group continues to be a challenge.

Methods: This paper provides an up to date review of relevant history of Uncemented hips, key design features, mechanisms of fixation, current status, guidance to use and long-term results of Uncemented hips.

Results: THRs have long-term survival rates of more than 90% for uncemented as well as cemented stems. Despite encouraging long-term fixation of the metallic shell, long-term survival of uncemented cups is frequently compromised by excessive liner wear and peri-acetabular osteolysis particularly in the young and active patients. Kearns et al looked at the survival of femoral and acetabular components and noted that femoral stem survival was 99.3% (range, 98.4–100%), 98.9% (range, 97.7–100%), and 96.8% (92.5–100%) at 5, 10, and 15 years, respectively. Including all component designs acetabular survival was 98.7% (range, 97.4–100%), 84.6% (78.8–90.4%), and 52.5% (40.7–64.3%) at 5, 10, and 15 years, respectively. Overall survival was 46.8% (33.5–58.1%) at 15 years.

Conclusion: Uncemented THR is increasing globally as a good option for young and active patients needing hip replacement. It provides long lasting good to excellent results provided the indications are met.

 

  • Fracture and its Classifications | knee Arthroplasty | Biomaterials in Arthroplasty |
Location: Renaissance London Heathrow Hotel Bath Road, Hounslow TW6 2AQ, United Kingdom

Session Introduction

Jonathan Boyd

American Association of Tissue Banks, USA

Title: Clinical Application: The Changing Landscape in Allografts
Speaker
Biography:

Jonathan Boyd has worked in multiple roles within the tissue banking industry for nearly 10 years including surgical tissue procurement, in leadership roles and eligibility evaluation. Jonathan is now the Director of Certification & Online Learning at the American Association of Tissue Banks.  Jonathan is a Certified Tissue Banking Specialist and is the AATB Liaison to the Education Committee, American Board of Tissue Banks and Recovery & Donor Suitability Council. 
 
Jonathan is an active member of the International Association of Coroners & Medical Examiners, an Affiliate Member of the National Association of Medical Examiners, a member of the American Society of Association Executives and is an active committee member with both IACME & NAME.
 

Abstract:

Processing and classification of most human cell and cellular based tissue products has remained the same for decades. The basic homologous function of transplanted osteocondrial allografts and total joint replacements utilizing allografts has fundamentally followed suite. However, guidance from the United States Food and Drug Administration may shift some of these approaches and the grafts which are available for implantation or transplantation. The purpose of this presentation is to review and evaluate changes in processing, distribution, classifications and possible shift in the United States tissue banking community to medical devices and biologics as a result of this guidance providing and developing different options in arthroplasty.

 

Mostafa A. Elnemr

Global Care Hospital Cairo, Egypt

Title: Patient specific template shortens operative time in TKA
Speaker
Biography:

Mostafa Elnemr was born on 23rd of December at cairo, Egypt.He is an orthopedic Surgeon at Global Care Hospital, Orthopedic Surgeon at October 6 University (Faculty of Medicine) and Specialist in orthopedic surgery at Alzaitoun Specialized Hospital.

Abstract:

Background: Since the introduction of computer-assisted total knee arthroplasty (TKA), the literature has been focusing on comparing the efficacy of this technique to the conventional technique of TKA in terms of success rate, postoperative outcome, and rehabilitation. This paper aimed to compare computer-assisted TKA using patient-specific template (PST) to conventional TKA in terms of operative time.

Methods: Thirty patients with different degrees of knee osteoarthritis and variable types of deformities were enrolled in this study. They underwent TKA surgery and were divided into two groups: group 1 included 15 patients who underwent TKA using PST technique; group 2 included 15 patients who underwent TKA using conventional technique. Mean operative time for each group was documented.

Results: Mean operative time for PST and conventional groups was 113min and 137min, respectively; that is, PST was shorter by 24min, which was statistically significant (P<0.001).

Conclusions: PST had an advantage over conventional instrumentation as it significantly reduced operative time.

Mahmoud Hafez

October 6 University, Cairo Egypt

Title: Survivor-ship Analysis of Arthroplasty Procedures
Speaker
Biography:

Professor of Orthopaedics and Head of the Orthopaedic. Department, October 6 University, Egypt. Locum Consultant Orthopaedic Surgeon (part time), NHS hospitals, UK. Examiner, SICOT Diploma, World Orthopaedic Organization, Belgium. Representative of Egypt in International Society of Arthroplasty Registries, Sweden. Executive Committee Member in International Federation of Inventors Associations, Switzerland. Executive Committee Member in CAOS-International Society, Bern, Switzerland. Editor & reviewer to few orthopaedic, medical & scientific journals & institutes. Board Member and Ex Vice President of the American Fracture Association, IL, USA. Founder of the Egyptian Musculoskeletal Research Association, Egypt. Chairman of the International Arthroplasty Conference, B Surgical Skills and the Orthopaedic Review Courses, ATLS Instructor, Egypt. Founder and Ex CEO of Al Mohsen Medical charity, Cairo, Egypt.

Abstract:

Objective: To evaluate the 10-year outcome of this register in view of revision rate and complications.  

Materials and methods: In this analysis, we included THA and TKA cases since 2007. We identified cases with primary index was recorded in this register whether the revision was recorded in the register or was done in other hospitals which are not included in this registry. TKA and THA with a ratio: 1.39 to 1.0. Implants used were from J & J, Zimmer, Stryker, Biomet, Link, Corrin, Samoa, Implant Cast, Implant International, Surgical and Hippocrates. Kaplan Myers test was used for survivorship analysis.

Results: For THA: Mean age was 51 years (19-86), Female to male ratio was 1.15:1. Indications were paeds hip diseases, failed ORIF of # NoF, AVN, posttraumatic and OA. Uncemented THA was 85%, Cemented 10% and hybrid 5%. Primary THA was 49%, complex primary 30%, while revision 21%.

For TKA: A female to male ratio was 3.14:1. The Indication was OA in 73%. 47% had severe varus and 15 17% had significant bone defect. Both THA and TKA had a revision rate of 2% and their implants were made by 8 companies. The incidence of infection was 2 % in the absence of laminar flow, space gown and pulse lavage. Hip and knee instrumentation systems are not stocked in hospitals and they are used as loan on a case per case basis.  Unexpected results are unnecessarily to be surgeon-dependent but could be also due to young age and indications for THA other than OA, the high % of complex THA & TKA due to late presentations and complex pathology.

 

Day 2 :

Keynote Forum

Rajesh Kushwaha

Shree Vishudanand Hospital, India

Keynote: A Rare Case report: Fracture Neck of Femur and Acetabulum with Free Floating Femoral Head in True Pelvis

Time : 10:00 AM to 10:40 AM

Biography:

Rajesh Kushwaha is a Consultant orthopaedic surgeon and Head of trauma unit at Shree Vishudanand hospital and research institute (Kolkata). He is also the Head of cerebral palsy unit at Mahavir Seva Sadan. Freelancing Consultant orthopaedic surgeon at Bellevue clinic, Medicare nursing home and Marwari relief society hospital.

 

Abstract:

60-year male patient presented with fracture neck femur right side with acetabular floor fracture.  Femoral head migrated through the acetabular floor defect into the pelvis and lying free floating in the pelvic cavity. Patient was operated once at periphery with exposure of hip by posterior approach and failure to retrieve head of femur from the pelvic cavity. CT scan and3D reconstruction images of hip showed acetabular floor defect and fracture of acetabulum anterior column and wall with head of femur lying inside the true pelvis near superior pubic rami brim. Single stage surgery was planned. Head of femur was extracted from true pelvis by right anterior illioinguinal approach. Acetabular floor and wall reconstruction done with recon plate fixation.

Cemented THR done in lateral decubitus position through old posterior approach. Mesh wire net was used in floor of reconstructed acetabulum to prevent cement leak into pelvic cavity. Gentle range of movement’s hip joint started from the next post-operative day and was mobilised with walker. Full weight bearing mobilisation started after suture removal.

Conclusion: acetabular fractures are complex fractures and difficult to treat due to its complex anatomy and proximity to vital structures. Fracture of acetabulum associated with dislocation of hip, protrusio, central dislocation has been reported in literature. However acetabular fracture with neck femur fracture and migration of free floating femoral head into the true pelvis is very rare and not reported. Single stage fracture fixation and Total hip replacement is good option for pain free early mobilisation. However, one should be familiar with different approaches to remove the femoral head from the pelvic cavity.

 

  • Total Shoulder Arthroplasty | Injury to Joints | Paediatric Orthopedics
Location: Renaissance London Heathrow Hotel Bath Road, Hounslow TW6 2AQ, United Kingdom

Session Introduction

Amjad N Bhatti

Betsi Cadwaladr University Health Board (Glan Clwyd Hospital), UK

Title: Potential role of Patient Reported Outcome Measures (PROMs) combined with Radiological Imaging in follow-up after elective Joint Replacement Surgery
Speaker
Biography:

Amjad Bhatti is a Consultant Orthopaedic Surgeons provide a wide range of emergency and elective treatment to patients throughout North Wales. He is currently in the Department of Orthopaedics working at Betsi Cadwaladr University Health Board (Glan Clwyd Hospital).

Abstract:

Patient reported outcome measures (PROMs) were introduced in orthopaedic practice in UK, since 2009, the National Joint Registry emphasized its use by NHS trusts in order to improve quality of care, in this study we looked into the potential role of PROMs combined with radiological imaging in follow up after elective joint replacement surgery.

50 patients who underwent primary elective joint replacement surgery from Jan 2013 till Jun 2013 under care of senior author, were randomly identified, pen and paper Oxford hip and knee score questionnaires, with radiological imaging request forms were sent by post, a covering letter explaining the rationale of study to patients in simple language was added, for the radiology request form patients were advised to go to their nearest hospital at their convenience, a business reply pre paid envelope was included with the letter for returning the Oxford scoring questionnaires.

38 out of 50 patients responded to the postal request, giving a response rate of 76 %, an overall improvement of 12 % from the agreed standards for postal surveys with pre-paid envelopes. The X-rays were reviewed by the radiologist and senior author for any radiological evidence of aseptic loosening, none out of 38 X-rays which were reviewed, showed any evidence of aseptic loosening. Oxford hip or knee score for each individual patient was calculated using a 0-48 method.

Response rate of 76 % indicates that PROMs though not validated for follow-up, may have a potential role if combined with appropriate use of Radiological imaging in medium to long term follow-up after elective joint replacement surgery, which might prove beneficial in reducing work load on routine Arthroplasty follow-up clinics.

Sourish Bhattacharya

CSIR-Central Salt and Marine Chemicals Research Institute, India

Title: Bioprospecting of marine resources for biopolymer production
Speaker
Biography:

Sourish Bhattacharya is a Junior Scientist at Process Design and Engineering Cell Discipline in CSIR-Central Salt and Marine Chemicals Research Institute, India.

 

Abstract:

West coast of India can be considered as important area for collecting diverse marine microorganisms with biopolymer producing capacity. In this attempt, 200 marine isolates from west coast of India was obtained, out of which one strain CSMCRI’s Bacillus licheniformis PL26 was found to be potential for producing ε-polylysine and polyhydroxyalkanoate simultaneously in same fermentation medium. The PHA produced by Bacillus licheniformis was found to be poly-3-hydroxybutyrate (P3HB). Further, in order to improve the ε-polylysine production, the carbon source was replaced with glucose which yielded 1.2 g L-1 ε-polylysine as oxygen transfer rate is very low in the medium containing crude glycerol. Further, an advanced modelling and optimization technique was applied to optimize medium parameters for enhanced ε-polylysine production by marine bacterium Bacillus licheniformis. The critical nutrients including glucose, yeast extract, magnesium sulphate and ferrous sulphate were incorporated in artificial neural networks (ANN) as input variables and ε-polylysine as the output variable. The ANN topology of 4-10-1 was found to be optimum upon training the model with feed-forward back propagation algorithm and on application of the developed model to particle swarm optimization resulted in 3.56 ± 0.16 g L-1 of ε-polylysine under the following optimal conditions: glucose, 34 g L-1; yeast extract, 2.3 g L-1; magnesium sulphate, 0.44 g L-1 and ferrous sulphate, 0.08 g L-1. Thus, this optimization technique could significantly improve ε-polylysine by 196.7 %, as compared to un-optimized medium.   

 

Andrew Clarke

Plymouth Hospitals NHS Trust, UK

Title: Outcome of Triathlon Total Knee Replacement - minimum six-year follow-up
Speaker
Biography:

Andrew Clarke is working at institution of Plymouth Hospitals NHS Trust at UK.

Abstract:

The Triathlon total knee replacement (TKR) was designed with a single flexion-extension axis (FEA) to maintain ligament tension throughout range of motion, reduce mid-flexion instability, and reduce contact stresses and sub-laminal wear.  Our study assessed mid-term survivorship of the Triathlon TKR.  Secondary outcomes of radiological loosening and clinical Oxford knee scores were assessed. We retrospectively analysed 394 patients who received Triathlon TKR from January 2009 to October 2011.  Mean patient age was 68 years.  Indication for operation was predominantly osteoarthritis and mean follow-up was over seven years.  Almost 95% of operations used articular surface mounted navigation for distal femoral and proximal tibial cuts.  Implant survivorship was assessed via all cause revision rate and revision for aseptic loosening.  Follow-up radiographs were assessed using ‘The Knee Society Roentgenographic Evaluation System’.  Oxford knee scores were obtained using virtual arthroplasty databases and telephone questionnaires.  Results showed that 359 TKRs were cruciate retaining; the remaining 35 were posterior stabilised.  Patella resurfacing occurred in 363 knees.  All cause revision rate was 3.04% (12/394) with aseptic loosening in 0.76% (3/394).  Radiological assessment showed that of the 382 non-revised TKR, 348 had no evidence of radiolucent lines.  Of the 34 TKR with radiolucent lines, five showed radiolucency to all tibial component zones.    Oxford knee scores showed an improvement in clinical outcome for patients post-operatively. In conclusion, to our knowledge this is the largest study with mid-term follow-up reporting on navigated Triathlon TKR and our results are comparable to other knee replacement designs in orthopaedic literature. 

 

Saleh Alsaifi

Pediatric Orthopedic Consultant, Alrazi Hospital- Kuwait

Title: Guided Growth in Blount’s Disease
Speaker
Biography:

Saleh Alsaifi is a Pediatric Orthopedic Consultant with more experinced in pediatric care and health currently working in Alrazi Hospital at Kuwait.

Abstract:

In 1966, Walter P. Blount describes osteochondrosis deformans tibiae, an epiphyseal and metaphyseal lesion of the proximal tibia. Blount’s disease is commonly attributed to an intrinsic, idiopathic defect in the posteromedial proximal tibial physis resulting in progressive bowing of the leg, Intoeing, and lateral knee thrust. Not easy to manage and follow.  Traditionally treatment depends on patient’s age and surgeons preference. Permanent joint damage and deformity can be sustained if left untreated. Early on the disease (< 4 years), bracing has been utilized, yet the effectiveness is controversial Majority of cases require surgical intervention in a form of proximal tibial osteotomy, which is technically challenging with higher potential complications (NV injury, compartment syndrome, infections). Hemiepiphysiodesis has the advantage of being less invasive procedure with fewer major complications.

 

Lateral tibial hemiepiphysiodesis in Blount disease was previously described in a 1992 in case series. The literature was quite generous discussing this topic since but it still insufficient in some aspects. Minimal invasive procedure, Coast effective, Pain management, No post-op immobilization, early weight bearing, Limited complications.

 

Hemiepiphysiodesis, Safe and effective first line of treatment for skeletally immature patients. Surgical decision-making must weigh the safety and simplicity of this procedure against the much more extensive but much more predicable realignment obtained with osteotomy procedures.

Technical issues

  • Avoid mechanical failure by using Solid stainless
  • Screw.Pre-driling the cortex and avoid wide divergence
  • Initially Plate coaptation to the bone (2 plates, 4 holes plate)
  • If varus recurs, re-do the procedure. Follow patients till skeletal maturity

Literature lacks

  • Prober description of surgical placement and location of TBP
  • All modalities of treatment talks about offloading the physis, were non-describes dealing with the pathology itself

 

  • Total Elbow Arthroplasty | Spine Arthroplasty | Ankle Arthroplasty
Location: Renaissance London Heathrow Hotel Bath Road, Hounslow TW6 2AQ, United Kingdom

Session Introduction

Guglielmo Macali

Orthopedic surgeon, Icot Latina, Italy

Title: Hip Replacement Differences Between Three Main Access Surgery Way Functional Study
Speaker
Biography:

Guglielmo Macali is an Orthopedic surgeon with more interest on research works in filed of Orthopedics currently working in Icot Latina at Italy.

 

Abstract:

The aim of this study is analysing clinical and functional preliminary results of patients underwent total hip replacement through thee different access way. The innovation of this study is to show the difference in the functional recovery between three main access surgery way. A cohort of 75 patients (36 woman and 39 man) was analysed. The Patients, after surgery replacement of hip were analysed through biomechanics and electromyographic study. Clinical results showed that Hueter (anterior access) offers a kinematic activity in the post-operative recovery, in the short and average term (6 weeks-2 years) overall slightly higher than the lateral postero and definitely superior to the direct lateral approach.

 

Shariff Bishai

Henry Ford Macomb Hospital, USA

Title: The Affect of Humeral Inclination on Post-Operative Range of Motion Following Reverse Shoulder Arthroplasty
Speaker
Biography:

Dr. Bishai specializes in arthroscopic surgery of the shoulder, knee and hip as well as shoulder and knee replacements and reconstructions. Dr. Bishai received both Bachelor's and Master's degrees in science at Michigan State University. He received his Doctor of Osteopathy from Michigan State University College of Osteopathic Medicine in 2001, Orthopaedic Surgery residency at Henry Ford Macomb Hospital, followed by an Orthopaedic Sports Medicine Fellowship at Plancher Orthopaedics and Sports Medicine in New York, NY. Dr. Bishai has published numerous papers in the orthopaedic literature and has spoken at multiple national and international orthopaedic meetings. He also serves as an Associate Master Instructor for the Arthroscopy Association of North America (AANA) teaching other orthopaedic surgeons arthroscopic skills. Dr. Bishai is a Fellow of the American Osteopathic Academy of Orthopedics (FAOAO). He is an Assistant Professor for the Michigan State University College of Osteopathic Medicine as well as Oakland University William Beaumont Hospital School of Medicine. He is also a Professor for the Detroit Medical Center Sports Medicine Fellowship. He is the Past-President for the American Osteopathic Academy of Orthopedics Sports Section and the Past-President of the Detroit Academy of Orthopaedic Surgery, both 2-year terms.

Abstract:

Reverse total shoulder arthroplasty has gained increasing popularity over the past several years. It has become a reliable surgery for patients with significant glenohumeral arthritis without a rotator cuff, and an intact deltoid. Expected outcomes from a reverse total shoulder arthroplasty are decreased pain, but post-operative range of motion is unpredictable. Based off outcomes in our practice, we hypothesized that humeral inclination in various implants, including a 155 degree and 147-degree neck shaft angle, would affect post-operative range of motion. We retrospectively reviewed 27 patients, 15 patients with a155 stem and 12 patients with a 147 stem. There was no difference in patient age at time of surgery or type of medical comorbidities. We chose to focus on forward flexion range of motion. We found that patients with the 155-stem had a on average a 53-degree improvement in forward flexion compared to their preoperative range of motion. The patients with the 147-stem had 40-degree improvement in range of motion. In summary, patients with the 155 implants had better post-operative forward flexion when compared to the 145 stems.

 

Abdulwanis.S.Mohammed

Benghazi University JALA Trauma Hospital, Libya.

Title: Open fracture, evaluation and management Prospective and retrospective for 500 hundred case of gunshot and explosive injuries in Libyan civilian war from 2011 - 2018
Speaker
Biography:

Dr. Abdulwanis is a consultant of Orthopedic and Trauma, Department of Orthopedic, Benghazi University, JALA Trauma Hospital Benghazi, Libya.

 

Abstract:

OPEN fractures are complex injury that involve both, the bone and surrounding tissues. Management goals are prevention of infection, union of fracture, and restoration of function. Achievement of these goals requires a careful approach based on detailed assessment of the patient and injury. The classification of open fracture is based on type of fracture, associated soft tissue injury, and bacterial contamination present, Tetanus prophylaxis and intravenous antibiotics administration is a useful adjunct the open fracture wound should be thoroughly irrigated and debrided, although the optimal method of irrigation remains uncertain. controversy also exists regarding the optimal timing and technique of wound closure. Extensive soft-tissue damage may necessitate the use of local or free muscle flap techniques of fracture stabilization depend on the anatomic location of the fracture and characteristics of injury.