Bristol Hip Arthroplasty Course - 14 to 15 November 2019 The Zenith and Watershed in the Treatment of the Hip Keynote Sponsor: Stryker Additional Sponsors: Adler Ortho, Biocomposites, CeramTec, Corin, DePuy Synthes, Game GR Ready, JRI Orthopaedics, Materialise, NHS Blood and Transplant, Physiolab, Signature Orthopaedics, Symbios Course Convenors: • Evert Smith • Anthony Ward • Richie Gill • Richard Baker • Mehool Acharya • Michael Whitehouse
Once again, the international Bristol Hip Arthroplasty Course was a terrific event, with a record number of delegates in attendance. Following last year’s successful conference ‘live feed’, we were once again thrilled to have the participation of orthopaedic surgeons in India thanks to Dr Ashok Shyam and his team, as well as Dr Srikanth, one of my former Fellows in Bristol.
We went into bat with the first session dedicated to pelvic and femoral fractures, with surgical approaches in the management of femoral head fractures. An interesting, alternative approach was discussed for treatment of acetabular fractures in the elderly and those at high risk, or with increased comorbidities. In session two, Derek Bennett talked us through simple strategies to improve the skill set of the postgraduate orthopaedic trainee.
In the period 1993 to 2016 the average body mass index amongst the UK population has significantly increased, making obesity a hot topic amongst the medical fraternity and a regular feature in UK multimedia. Alun John noted that increased body weight not only causes osteoarthritis, but also affects the treatment and rehabilitation of patients following surgery. Alun also eloquently presented on the optimisation of pre-operative haemoglobin as a significant factor in achieving satisfactory results in elective hip arthroplasty.
The conference was treated to a wonderful presentation by Akintunde George, offering an overview on sickle-cell disease. He identified the demographics and pathophysiology of sickling, as well as giving insight into problems relating to total hip replacement in an extremely young cohort population.
Another fascinating, alternative procedure for periprosthetic fractures was delivered by James Berstock and Harvey Sandu and this strategy sparked intense debate. We are very happy that James Berstock has accepted our invitation to join the course coordination team.
Richie Gill of The University of Bath provided insight into AI machine learning, in a unique prospective research project where a neural network was successfully learned, permitting identification of femoral neck fractures more accurately than analysis by consultant radiologists. This research is being funded by my charity, Arthroplasty for Arthritis.
A watershed moment in hip orthopaedics was discussed by Matthew Wilson. He identified precision implant positioning and alignment with robotics, referring to the impact this will have on the development and experience of surgical trainees who, over time, must assume a three-dimensional skill set to be successful in arthroplasty surgery. Alister Hart supported this trend in technology, providing a stimulating 3D assessment following patient specific instrumentation and guidance in femoral stem positioning in the primary total hip replacement. Alister also gave a lecture on reconstruction of acetabular defects utilising 3D in the form of EOS technology to provide leg length restoration in a cohort of revision hip patients.
An update on Orthopaedic Data Evaluation Panel work and management of the dysplastic hip and the younger patient was offered by Ed Yates and Callum McBryde.
Great enthusiasm was again shown by our delegates during the radiographic forum at the finale of day one. This session gives delegates an opportunity to analyse and discuss treatment of individual cases.
Following our course dinner, the conference entered day two of discussion and debate with renewed vigour, kicking off with revision hip surgery. This is a most important topic on the joint replacement agenda as people now live longer, more active lives than ever before. Primary hip replacement can occur at a younger age and as a result, we are seeing a growing trend in revision hip replacement.
Daniel Kendoff, our esteemed guest from Berlin, shared a wealth of revision experience, displaying his use of custom-built acetabular components for patients with significant bone stock loss. His work has only been exhibited in some highly regarded specialist centres of the world. Derek Bennett gave some valuable, technical, revision hip tips and tricks; while Simon West and Tim Waters developed the theme of surgical treatment of patients with a varying range of bone stock loss in the femur.
Infection was the penultimate session of the course and Daniel Kendoff gave insight into his research using gel coupled with antibiotics in the treatment of single stage surgery for prosthetic joint infection. Michael Whitehouse presented the latest National Joint Registry data on the risk factors that impact surgical outcomes for septic hip replacement.
The final session of the day showed us that we have indeed reached the zenith in many areas of hip replacement surgery, demonstrating yet another watershed in orthopaedic hip surgery. Recent publications clearly establish the necessity to update NICE guidelines with regard to fracture neck of femur. The treatment of femoral neck fractures and the value of a total hip replacement, as compared to surgical treatment with a hemiarthroplasty, is a subject of much controversy.
Tim Waters meticulously guided conference through the worldwide shift in surgeon choice of articular bearing surface. Cross-linked polyethylene coupled with either a ceramic head or a ceramtised metal head has now taken the place of ceramic on ceramic bearings as the favoured option.
A note of appreciation for the excellent work of Clockwork Medical who have worked with us for many years in coordinating the course.
The delegate feedback will give course coordinators further zeal to adjust and improve the Bristol Hip Arthroplasty Course in preparation for the 2020 meeting. The vibrant, interactive style, which the BHAC is renowned for, was as strong as ever. Our thanks to all those involved in delivering another superb conference. Thank you.