RSM Orthopaedic Section Podcast RSM Ortho

We discuss revision knee surgery with Mr. Peter James (Nottingham).

Peter James is a consultant surgeon in Nottingham who undertakes a large number of hip and knee replacement operations each year both in the NHS and privately at the Park Hospital and has developed a national and international reputation for revision and complex knee replacement. He has particular expertise and experience in high performance knee replacements for active patients and difficult revision knee surgery. In September 2010 he was recognised by his peers as being amongst the UK’s top knee replacement surgeons in a survey conducted by the Daily Mail.

Questions that we cover include:

1.  Is some pain almost inevitable after TKR and how do you assess the painful TKR?

2.  Should revision TKRs be done at specialist centers and what have we learnt from the NJR?

3.  What are the key surgical steps in revision TKR and is there a role for robotics?

4.  Do you think robotic assisted surgery will reduce revision TKRs?

5.  What advances do you anticipate in the field of revision TKRs?

In this episode we cover knee osteotomy surgery and joint preservation with Mr. Matthew Dawson. 

Matthew Dawson is one of the leading authorities on osteotomy surgery in the UK and he is a founder member of the Osteotomy Expert Group. Mr Dawson is a strong advocate of the principle of joint preservation in order to prolong knee activity and knee function to the highest level. He launched the annual Northern Osteotomy Masterclass. in June 2015 and he is a founder member of UKKOR, the world’s first national osteotomy registry. He is the current chair of ESSKA’s Osteotomy committee.

Questions that we cover include:

1.  Is there an age or functional cut off for knee osteotomy and what pre-operative tests are essential?

2.  Is osteotomy ever a temporary solution?

3.  What are the recent technical advances in osteotomy surgery?

4.  What are the key intraoperative steps?

5.  How do you rehabilitate your patients?

Mr Dinesh Nathwani (Imperial College) discusses robotic technology in total knee replacement. 

Mr Dinesh Nathwani is a consultant orthopaedic surgeon at Imperial Healthcare Trust with extensive experience in computer assisted knee surgery in partial and total knee replacement, using both the NAVIO and the MAKO systems. Dinesh is the president elect of the computer assisted orthopaedic surgery uk society (https://www.caosuk.org) and he is a firm believer in the use of computer assisted navigation to increase the accuracy of bony resection and decreasing the chance of implant malposition, thereby maximising the likelihood of a successful outcome in knee replacement surgery.

Mr. Alex Liddle (Imperial College) discusses how we can improve outcomes in Total Knee Replacement surgery.

Mr Alex Liddle is a Clinical Senior Lecturer in Orthopaedic Surgery at Imperial College whose principal interest is in the improvement of joint replacement surgery through the use of big data and new technologies. He previously undertook a DPhil (PhD) at the Univeristy of Oxford before becoming NIHR Clinical Lecturer at University College London, based at the Institute of Orthopaedics and Musculoskeletal Sciences at the Royal National Orthopaedic Hospital.

Mr. Henry Bourke (Heatherwood and Wexham Park Hospitals) discusses knee ligament injuries including:

Henry Bourke completed fellowships at the North Sydney Orthopaedic and Sports Medicine Centre and The Park Clinic in Melbourne before becoming a dedicated knee consultant at Heatherwood & Wexham Park Hospitals in 2013. Appointed on the retirement of Robin Allum, Henry inherited an established knee ligament practice. He has quickly gained extensive experience in all aspects of ligament repair and reconstruction including a growing series of complex multi-ligament knee injuries. Henry is the Director of the renowned Wexham Park International Cruciate Ligament Meeting.

01:33: How to approach patients with acute ACL tears compared with chronic ACL tears

04:57: Why he selected his preferred technique for ACL reconstruction

07:00: Is success dependent on rehabilitation?

08:24: What are the key features of managing multi-ligament injuries?

11:34: What does the future hold for knee ligament surgery?

In this episode we discuss meniscal and chondral knee injuries with Mr. Tim Spalding. 

Tim Spalding is a renowned Consultant Orthopaedic Surgeon based at the University Hospitals Coventry whose expertise includes autologous chondrocyte transplantation as well as an unrivalled experience in meniscal transplantation. He is also one of the lead developers of the National Ligament Registry.

Questions:

00:46: Introduction

01:24: How do you approach a patient with a meniscal tear? 


03:06: What is the rule of fours?

04:21: What do you tell the athletic patient with a meniscal tear in clinic?

05:31: What are the technical considerations for performing meniscal repair?

07:21: How do you diagnose a meniscal root tear?

09:01: Who are the main beneficiaries and what is the cost effectiveness of meniscal transplantation?

12:51: How would you summarise meniscal surgery?

13:01: Articular cartilage from aetiology to management of injuries

15:21: NICE Guidelines on ACI vs microfracture including the cost effectiveness