Heritage meets Innovation
International Hip Symposium, 21-23 January 2009
My presentations:
The Changing Face of European Orthopaedics
The History and Development of the Taperloc Stem
Modes of Failure with THA
Changes in Revision of the Acetabulum
Ceramic on Ceramic
I chaired the meeting in Rome which celebrated 25 years of the cementless Taperloc stem, where the historical influences and impact of recent technological advances in hip surgery were debated.
We were honoured by the presence of Dane Miller – founder of Biomet Inc. and co-designer of the Taperloc stem with Arthur Steffi and then William Kennedy. We were also thrilled to welcome Jeffery McLaughlin from Winsconsin (successor to William Kennedy). Jeffrey presented his published series on this prosthesis with data and studies which originate from the inception of the Taperloc.
Unfortunately the hotel personnel went on strike and there was a hiatus in service. However this did not deter the delegates and faculty; the meeting was not put off its stride and we decamped en masse to another venue for the dinner on the final night of the meeting. The meal was a resounding success. It could not have been staged better!
I opened the meeting with a presentation on The Changing Face of European Orthopaedics - an overview of European hip surgery with collated data from the National Joint Registries, which confirmed that cementless implants are being used with increasing frequency, particularly in the younger patient.
The challenges of training orthopaedic surgeons, control of prosthetic infections, answers to the choice of bearing surfaces and improvement of patient satisfaction were highlighted. It was felt there should be more collaboration between the hip units in Europe during postgraduate training. The data collected by the National Joint Registries provides the world with vital information on survivorship analysis and risk factors. An inter-registry network for collaboration has been set in place; this is the Nordic Arthroplasty Register Association (NARA).
The History and Development of the Taperloc Stem identified the origins and development of the Taperloc stem and Jeff McLaughlin’s clinical experience provided the delegates with the data and outcomes of the prosthesis.
The Modes of Failure with THA and implant selection were debated. Bearing surfaces were felt to be the critical issue. The advantages and disadvantages of cementless and cemented components and bone preserving prostheses were discussed.
There is good evidence to show that accelerated recovery can be achieved by a multidisciplinary approach in specialist hip units. Anterolateral, posterior and ASI approaches were compared and Eric de Witte and I demonstrated a video of one of his operations.
The Exceed ABT system was presented by Tony Ward as a broad multi-bearing system for acetabular fixation. Porous metals have altered revision practice and this material is now being used for acetabular bone defects, particularly when there is extensive bone loss. The techniques of dealing with severe bone loss were annotated in detail. It was pointed out that some bone defects can be treated by impaction grafting and cementation, but this is a highly technique dependent method. These points were reflected in my presentation Changes in Revision of the Acetabulum.
A presentation from the Nuffield Orthopaedic Centre, Oxford on a series of pseudo-tumours in Resurfacing Hip Replacement revealed a high incidence of probable Type 4 hypersensitivity in these cases. Why is this not being replicated in other centres and what is the overall incidence of this problem?
A workshop using artificial saw-bones ended the second day.
William Harris from Harvard, Massachusetts stated that "Fixation is not the problem, osteolysis is". This quote underlines the important issue that standard polyethylene is the Achilles heel of the long term outcome with all prostheses.
Big head technology and alternative bearing surfaces were debated. Osteolysis can be significantly reduced with alternative bearing surfaces such as ceramic on ceramic or the latest hard on hard bearing surface, ceramic on metal. Which will be shown to be the best? Hydroxyapatite, RGD peptide surface coating and antibiotic coatings were discussed but Vitamin E infused E-Poly is the bearing surface most likely to have a massive impact in total hip replacement.
I left Rome exhausted but exhilarated by a superb meeting!