Bristol Hip Meeting 2014


November 2014

Our Keynote supporter for the 2014 meeting was Jri Orthopaedics.

Additional supporters were:Spierings Orthopaedics, DePuy Synthes, Corin, B Braun, Stryker, Fannin, Biomet, Wright, Össur, Lima Corporate, CeramTec, Orthodynamics, Medacta, Symbios, Biocomposites.

I would like to express my grateful thanks once again to David Penford and Mark Janes of Clockwork Marketing and Events and Richie and Adam (sound and vision) for another successful meeting.

Course Co-Convenors:

  • Evert Smith
  • Anthony Ward
  • Ashley Blom
  • Richie Gill

During the last eleven years, the Bristol Hip Meeting has become a prominent international orthopaedic meeting, attracting a faculty of highly renowned hip experts from around the world. The course once again succeeded in provoking sturdy debate on the topics discussed and the feedback from attending delegates was excellent.

We were proud to have the President of the English Rugby Football Union, Bob Reeves, as our guest speaker for the course dinner. Bob talked to us on leadership through the lens of sport, enlightening us as to the way his privileged position has enabled him to travel all over the world where he has benefitted from meeting many people. This has permitted him to see the influence of sport and how this empowers people and engenders a common purpose. He envisions rugby as a driving force for self-achievement and therefore aspires to develop the game and make it universally accessible to more people.

The conference was launched with the first session on Joint Infection by a riveting presentation from Peter McLardy-Smith, engaging the audience in an erudite discussion on all aspects of infection. Peter discussed when the DAIR technique (debridement, antibiotic and implant retention) might be employed; stressing that it should not be used as panic surgery.

Cathy Stannard talked brilliantly in the session on Pain, conceptualising the patient with chronic pain and hip problems. Andy Judge presented two deft analyses, one on mortality and the other on obesity in association with hip replacement. He compared mortality amongst patients undergoing metal-on-metal resurfacing and total hip replacement. He advocated the adoption of four simple clinical management strategies to reduce mortality: posterior surgical approach, mechanical and chemical prophylaxis, and spinal anaesthesia. He observed that underweight patients presented a higher than normal mortality risk, but that limiting access to THR on the basis of BMI appeared unfounded as current referral practice effectively controls risk in relation to unfavourable outcomes.

The session on Adaptive Strategies saw some excellent talks, including Rob Nelissen’s discussion on the challenge of supporting innovation while protecting patients, emphasising the need for design improvement but advocating the necessity to tread carefully when fashion trends seem alluring. Other topics included a look at new technology on DVT and the use of pulse technology, as well as exercise therapy from Rob Middleton. Edward Draper, representing our keynote supporter, JRI, gave a UK Implant Manufacturer’s perspective on the future of hip surgery. David Woodnutt discussed the importance of follow-up and Lipalo Mokete gave us a vision of hip surgery in South Africa.

Primary Total Hip Arthroplasty was launched by Jeremy Latham carving a case for dual mobility sockets to reduce risk of dislocation. David Woodnutt gave an inspirational analysis on dislocation, while Matthew Burwall and Rudolf Poolman discussed short stems. Rudolf offered an analysis of conventional stems compared to short stems in permitting better offset reconstruction, but concluding no advantage for short stems. Jim Holland talked warmly of his experience and great results at 15 years with the BHR and he also gave an elucidating talk on the Exeter rim fit cup. Other talks included an excellent dual for supremacy between Matthew Wilson who took on Tim Waters as they discussed the advantages of cementless versus the cemented primary THA. This was followed by Lipalo Mokete who asked if we are prepared for the patient with osteonecrosis of the hip in HIV.

The final session of the first day was moderated by Mehool Acharya and Sanchit Mehendale who presented some excellent radiographs during the highly popular Radiographic Forum.

Day two began with a Technological Update and Richie Gill and Tom Joyce presented to the audience on factors influencing taper strength and corrosion; and taper junction wear and corrosion. Francesca Benazzo gave an outstanding talk on dual conicity stems and enlightened the audience about their design and development. Ian Clarke’s presentation skilfully discussed lessons learned from retrieval analysis and the implications of this for future implant designs.

Again in the session on Revision Hip Surgery Rob Nelissen gave an excellent presentation about the problem of loosening in THA, discussing the case for gene therapy, alongside percutaneous fixation. Andrew Manktalow showed the audience how to manage the awkward acetabulum and Matthew Wilson debated whether impaction grafting is still the best option. Once again, Francesco Benazzo gave a discerning presentation on acetabular reconstruction comparing porous material and cages.

Periprosthetic Fractures was the final session of the conference. Andrew Manktalow discussed fractures of the femur; Mehool Acharya presented on peri-operative fractures of the acetabulum and Rudolf Poolman offered some alternative techniques to retain the implant at revision.

Our aim is to inspire, challenge and exchange knowledge in order to advance outcomes in our specialty and once again the course fulfilled its objective.


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