Last week, I organised the first London pelvis trauma course to give registrars and surgical fellows an introduction to pelvis surgery and encourage them to join the specialty.
Over 30 delegates attended from all over the UK at the London Transport museum depot which was one of the few places big enough for the huge Stryker teaching lab on the bag of a lorry.
We had 12 faculty members including the legendary Martin Bircher, Pete Bates, Paul Culpan and John Dwyer (President of AO UK, www.aouk.org) who all gave up their valuable time to teach. Orthopaedic Research UK (www.oruk.org), Stryker (gold sponsor, www.stryker.com), LEDA Orthopaedics (www.ledaortho.com) and Siemens all kindly donated to this educational event so that we could keep the costs down for delegates.
The registrars learnt the fundamentals of pelvis and acetabular trauma cases and tips and tricks to surgical approaches. We debunked to the teaching lab where 8 dry-bone stations allowed the students to practice fixing posterior wall fractures and open book pelvis fractures.
My personal favourite was getting the delegates to play with the the image intensifier C-arm where they could practise their wire and screw orientation using a Starr frame. This video which brings what we were practicing to life (www.youtube.com/watch?v=HXzsZr_mtA8).
There was great feedback and so the plan is to run the course every year.
A few weeks ago, I ran the London Marathon for the sixth time. Unfortunately for my pride, it was another failed attempt to break 3hrs after 6 months of training (should have tried to train up my sweat glands!) but one silver lining was successfully avoiding a tendinopathy.
In previous years, I’ve pushed my training too hard and too fast and ended up with a range of different tendinopathies including proximal hamstring injuries, piriformis hip tendonitis, achilles tendonitis and perineal braves (foot) tendinopathies. Each of these took over 4 weeks of virtually zero load training to settle down and ultimately affected my performance.
I see many patients with similar issues so I thought I would share a few thoughts on how to avoid and treat tendinopathies.
As a reminder, a tendon attaches a muscle to a bone and a tendinopathy occurs when the load being applied to the tendon is too great for the tendon to withstand. This means the tendon begins to become stressed and then inflamed. This can happen for a number of reasons - bad shoes, bad technique, running too fast, running too far - however the main cause is not factoring in a gradual build up in your training. I worked a lot this year on strengthening by hip abductors, my core muscles, good dynamic stretching, meticulous warm up and warm down. I also focused on adopting a more symmetrical running technique after a great running gait analysis at www.onebodyclinic.co.uk in Notting Hill by physiotherapist Sarah Morton.
All of these marginal gains meant that I avoided injury for the first time but for those who do have tendinopathies which don't get better through rest, the first thing to do is to get the right diagnosis by seeing a specialist. Once you have this, there are a variety of interventions which start with targeted physiotherapy programmes, shock wave therapy, ultrasound-guided injections. Only as a last resort (and only in some circumstances) is surgery advised.
For me, my next stop are the World Half Ironman Championships in Fynn (Denmark) in July 2018, fingers crossed I stay injury-free until then.
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...