Last week I was invited to present to a select group of orthopaedic trauma consultants. There was great representation from all the UK major trauma centres. I presented a few our complex cases of the year. It was great environment to learn new techniques and to think about new research trials. I presented a few cases from Kings where we use intra-operative CT scans which is a first for fracture cases in the UK. In addition, we've all signed up to a secure platform to discuss future 'live' cases. This allows us to share uploaded X-rays and CT scans securely so that we can share opinions on the best management plans, instantly accessing combined hundred years of experience from around the country within minutes.
Last month I flew to Malmo, Sweden for the Stryker European Complex Fracture Symposium. This is an annual event where 30 of the top trauma surgeons from around Europe are invited to present their most complex fracture cases from the previous year. The group dynamics and discussions were great and we all learnt from each other by sharing our approach and outcomes from these unique cases. It was also good to hear that my peers in other countries are equally excited about the potential for 3D printing and custom-made plates in trauma orthopaedics and we hope to collaborate on some of the research we are conducting at King’s College Hospital in this space.
It's been a pretty tough week at KTC (Kings Trauma Centre) this week. There were some highs and some lows, however great colleagues and strong team work meant we pulled together during this major incident and made it all bearable. The high was then being invited to meet the Duchess of Cambridge while she was visiting my patients on the ward at Kings.
Robot-assisted surgery training in Basel, Germany
How do orthopaedic surgeons make sure that their technique and positioning of hip and knee replacements is as precise as it can possibly be?
The answer is that increasingly the world's leading orthopaedic surgeons are using robots to assist them with their surgery.
Most people do very well with standard techniques using jig and 'eye' ball instrumentation for hip and knee replacements, but there is a small percentage people who don't have good outcomes with this technique. Often single degrees and millimetres here and there make a big difference in a patient's outcome.
The Stryker MAKO robot is the first mainstream instrument to guide the surgeon's hand to millimetre precision, based on 3D CT scans of the patient which are uploaded to a computer for pre-operative simulation. With over 300 robots in action around the world and over 90,000 successful surgeries performed, the UK is a couple of years behind the US, Italy, Germany and Japan.
I have just come back from a training course in Basel which has taught me to use the MAKO and I am delighted to be one of only a handful of UK surgeons qualified to perform robotic assisted surgery for partial knee replacements, total knee replacements and total hip replacements. I did a lot of robot-assisted surgery during my training at Imperial, so the transition to the MAKO system has been straightforward.
What happens next? Princess Grace Hospital has bought the first MAKO Robot in the UK with great success so I am looking forward to using it there. At Kings College Hospital we are also going to start research into computer-assisted applications related to percutaneous pelvis trauma.
Last week I visited a new cutting edge research centre and manufacturing site for a company who produces 3D printed custom-built hip replacements. In UK orthopaedics it's only just starting to be used in a few tertiary referral centres where hospitals send their complex orthopaedic cases. Why am I excited about it? Well, in the vast majority of cases a standard off-the-shelf hip implant will do perfectly well for someone having a primary or secondary hip replacement. But sometimes, a patient has extreme amount of erosion and bone loss, which means that a standard prosthesis won't sit properly. This means a poor outcome for the patient with potentially multiple revisions operations which add cost and stress to the NHS and the patient. In these cases we send 0.6mm CT scans of the patient's unusual bone structure and the company then designs and prints a fully customised trabecular titanium prosthesis, 3D printed from titanium dust using an electron beam. This implant have much better ergonomics for the patient and is easier to put in for the surgeon. We are just starting to use this innovative technology for exceptional cases at King's Hospital and I'm excited to see where it can go...