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.

 

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

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. 

 

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.

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.

 

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.

 

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. 

 

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.

 

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.