The Great Debate 2016
At the great debate 2016, in the Royal College of Surgeons, we spent a couple of June days debating the big issues in hip and knee replacement with help from around the world.
Total knee design remains the single most ‘valuable’ topic in arthroplasty – if the cost of the devices and the size of the market are taken into consideration.. The thorny old PS/CR debate has been rewritten, with the medially conforming devices now established in clinical use, and an ACl/PCL preserving device is also now in clinical use. So it was fascinating to see how 4 highly respected surgeons were each going to promote an entirely different sort of knee replacement. From the audience’s perpective, the medial pivot designs were the most popular, which isn’t reflected in current implant usage, but may predict a trend. Interestingly each speaker prefaced his remarks in the debate by admitting that he used a uni knee whenever possible – a sentiment that is also not reflected in implant usage in the NJR anyway.
On the hip front, Ronan Treacey made a compelling case for the continued use of resurfacing - a safer cheaper alternative for men anyway. Ceramic bearings were well received in general, and shorter femoral stems were promoted enthusiastically, with no one in the room demanding a return to the old longer stem days. Approaches to the hip and the advantages of minimally invasive surgery were explored thoroughly. The direct anterior approach was vastly more popular with the audience than its place on the registry would suggest.
The role of robots, navigation and PSI in arthroplasty was described and debated. The audience seemed to prefer the expert surgeon using his hard fought skills. Both Bill Walter and Johan Witt were more persuasive this year than any navigators, roboteers or PSI users. Knee alignment was discussed in a debate led by three French surgeons - Jean-Noel Argenson, Michel Bonnin and Charles Riviere. Delegates were enthusiastic about kinematic alignment, once again showing that those attending the Great Debate are well ahead of the curve. There would have been no appetite for anything other than mechanical alignment a couple of years ago. Similarly the topics acetabular orientation and intra-operative assistance were hotly discussed and related back the individual devices and their particular sensitivities to malpositioning. Robert Barrack was persuasive that a digital xray on the table to check positioning was the cost effective and indeed moral option.
Perhaps the most heat was generated in the politics session, where Ronan Treacey locked horns with Henrich Malchau over registries, and the extent to which they were a progressive force. Henrik’s description of the nested trials within a registry environment was novel and encouraging. Richard Field, Emmanual Thienpont and Tim Briggs all contributed to the debate over productivity in the joint replacement environment, thrashing out the problem of increasing output while keeping costs down. The Delegates also made their feelings known: the large majority felt that the GIRFT process had not helped their working life, despite delivering the savings that Tim was demanding.
Our world continues to be both rewarding and demanding in equal measure: we are all looking for the safest way to help out patients. Debate seems a good way to ensure that as a profession we are going in the right direction.
12 CPD Points were awarded
New in 2016: The Great Debate was held at The Royal College of Surgeons, England
2016 Programme
Friday: Knees
0730 | REGISTRATION / COFFEE | |
0800 | TKR design | |
PS TKR is the standard of care | Prof Jean-Noel Argenson | |
Nature gave you a PCL why throw it away? | Mr Dinesh Nathwani | |
Medially stabilised TKR for functional stability | Prof Fares Haddad | |
Bicruciate retaining TKA - second time around | Dr Adolph Lombardi | |
Challenger | Dr Seth Greenwald | |
Chairman | Prof Justin Cobb | |
0830 | Debate - How important is the design of a knee replacement? | |
0855 | Assistive Technologies: how can we deliver the consistency our patients expect? | |
Modern instruments work well | Prof Bill Walter | |
Navigated knees are the gold standard | Mr Dinesh Nathwani | |
PSI is cheap and quick and effective | Dr Adolph Lombardi | |
Robotics: is there a business case? | Prof Fares Haddad | |
Challenger | Dr Robert Barrack | |
Chairman | A/Prof Andrew Shimmin | |
0925 | Debate - Does the knee surgeon today need any assistance? | |
0945 | COFFEE | |
1015 | Limb alignment and joint line obliquity: is a straight leg with a horizontal joint line the right aim? | |
Keep it straight - we know that works | Prof Bill Walter | |
Kinematic alignment is an alternative target | Dr Charles Riviere | |
Physiological alignment - restore what nature delivered | Prof Jean-Noel Argenson | |
Lateral joint line pain after TKA - what are the causes | Dr Michel Bonnin | |
Challenger | Prof Gareth Scott | |
Chairman | Prof Justin Cobb | |
1045 | Debate - Is there one correct alignment for all patients? | |
1105 | MatOrtho Executive Talk: SAIPH® Route to Market | Dr Laura Richards |
1110 | Fixation of implants and bearings: what is state of the art? | |
Cement-less knees are the way forward | Dr Robert Barrack | |
Cemented knees are safer and better | Prof Emmanuel Thienpont | |
Fixed vs mobile, what does the data show? | Prof Henrik Malchau | |
Is there a place for an all poly tibial component? | Prof Gareth Scott | |
Challenger | Dr Adolph Lombardi | |
Chairman | A/Prof Andrew Shimmin | |
1140 | Debate - Cementless fixation works in hips, but knees? | |
1200 | LUNCH |
Company Sponsored Lunchtime Breakout Session: |
Zimmer: Oxford Microplasty Workshop | Council Room |
1300 | Politics and arthroplasty | |
Registry data helps arthroplasty surgeons and patients | Prof Henrik Malchau | |
Registries prevent progress for patients and surgeons alike | Mr Ronan Treacey | |
Treatment centres let surgeons work harder | Prof Richard Field | |
How to motivate arthroplasty surgeons | Prof Emmanuel Thienpont | |
How to get it Right first time for the NHS | Prof Tim Briggs | |
Challenger | A/Prof Andrew Shimmin | |
Chairman | Prof Justin Cobb | |
1330 | Debate - The role of non NHS arthroplasty centres? | |
1355 | The Diversity of the Medial ball-and-socket Knee Principle | |
Introduction | Prof Bill Walter | |
A Medial Subvastus Approach | Dr Geert Veeckman | |
New Technology with the MRK™ | Dr Frank Peters | |
Revision Surgery with a Primary TKR | Mr Chris Evans | |
Discussion | Prof Bill Walter | |
1445 | Compartmental Knees | |
Medial UKA: safer and better than TKA | Prof Peter Aldinger | |
Lateral UKA: better than medial UKA | Prof Emmanuel Thienpont | |
Bi UNI - the answer for the 'gap' patient | Dr Charles Riviere | |
Don’t forget me - osteotomy for the high demand patient | Dr Ronald Van Heerwaarden | |
Challenger | Prof Gareth Scott | |
Chairman | Prof Justin Cobb | |
1515 | Debate - What are the indications for TKA today? | |
1535 | TEA | |
1605 | Case based debate panel | |
Prof Jean-Noel Argenson | ||
Propf Gareth Scott | ||
Dr Adolph Lombardi | ||
Dr Robert Barrack | ||
Prof Peter Aldinger | ||
1655 | Controversies in TKR | |
Tourniquets: a safe component of a rapid recovery programme | Dr Adolph Lombardi | |
No tourniquet rapid recovery knee surgery | Dr Michel Bonnin | |
TKR and deformity, intra or extra articular correction | Dr Ronald Van Heerwaarden | |
Patella resurfacing: an evidence based approach | Mr Robert Barrack | |
Challenger | Mr Dinesh Nathwani | |
Chairman | A/Prof Andrew Shimmin | |
1725 | Debate - How do we ensure safe surgery and rapid recovery every time? | |
1800 | Drinks reception - The Hunterian Museum at the Royal College of Surgeons |
Saturday: Hips
0730 | REGISTRATION / COFFEE | |
0800 | Implant orientation what are we aiming at? | |
Biomechanics of offset in hip arthroplasty | Dr Jonathon Jeffers | |
Cup orientation and stem version - what is ideal? | Mr Ronan Treacey | |
X-ray based planning works well for most cases | Miss Sarah Muirhead-Allwood | |
Functional imaging delivers state of the art orientation | Prof Andrew Manktelow | |
Challenger | Prof Richard Field | |
Chairman | A/Prof Andrew Shimmin | |
0830 | Debate - What is best practice for hip planning today? | |
0855 | Designs are changing for the better | |
Cement-less stem length: is the evolution over? | Mr Johan Witt | |
Lipped liners, do we need them routinely | Dr Seth Greenwald | |
Dual mobility articulations: what do they offer? | Dr Robert Barrack | |
Groin pain after hip replacement | Prof Orhun Muratoglu | |
Challenger | Dr Catherine Van Der Straeten | |
Chairman | A/Prof Andrew Shimmin | |
0925 | Debate - Are short stems the new standard? | |
0945 | JRI Executive Talk: How will Britain afford to continue as the world’s orthopaedics thought leader? | Mr Keith Jackson |
0950 | COFFEE | |
1020 | Achieving the plan | |
Good training and a sharp eye | Mr Johan Witt | |
Intra operative imaging is the best strategy | Dr Robert Barrack | |
Patient specific instruments in hip surgery | Prof Andrew Manktelow | |
Robotics offer the promise of consistency | Prof Fares Haddad | |
Challenger | Mr Ronan Treacey | |
Chairman | Prof Justin Cobb | |
1050 | Debate - Does technology have any role in hip arthroplasty? | |
1115 | New hip implant designs and new treatment pathways still make sense in “Post GIRFT UK” | |
How to evolve successful implants | Prof Justin Cobb | |
Introducing a new implant in my practice | Mr Matthew Burwell | |
Refining proven technology - how hard can it be? | Mr Mez Acharya | |
Day Case - Turning a concept into a reality | Mr Raghu Raman | |
1205 | Bearing choices - cost vs value | |
Ceramic on new poly is the bearing of choice | Dr Adolph Lombardi | |
Ceramic on Ceramic: how big can we go? | Mr Johan Witt | |
Are all new polys the same? | Prof Orhun Muratoglu | |
Why choice is helpful in bearing couples | Miss Sarah Muirhead-Allwood | |
Challenger | Dr Seth Greenwald | |
Chairman | Prof Justin Cobb | |
1235 | Debate - Who should choose the bearing couple: surgeon, patient or payer? | |
1255 | LUNCH |
Company Sponsored Lunchtime Breakout Session: |
Corin: How reliable is a static assessment of a dynamic joint? | Committee Room 3 |
- Seemingly well orientated hip replacements can still fail | Dr David Simpson |
- Optimising your offering | Mr Giles Stafford |
- Case discussions |
1355 | Controversy in THR | |
What is "routine" DVT prophylaxis? | Dr Robert Barrack | |
Hip resurfacing, what is its role in 2016 | Mr Ronan Treacey | |
How to manage the damaged trunion | Prof Andrew Manktelow | |
How often should we review THR patients | Prof Alister Hart | |
Challenger | Mr Johan Witt | |
Chairman | A/Prof Andrew Shimmin | |
1425 | Debate - What is current best practice in THR | |
1445 | Case based debate panel | |
Mr Ronan Treacey | ||
Prof Andrew Manktelow | ||
Prof Fares Haddad | ||
Dr Robert Barrack | ||
Dr Adolph Lombardi | ||
1530 | TEA | |
1600 | Surgical approaches and periprosthetic fractures | |
Direct anterior is fast and safe and cosmetic | Prof Richard Field | |
Posterior is faster and safer | Prof Andrew Manktelow | |
Learning curves and new techniques - what is best practice | Prof Alister Hart | |
Approaches and periprosthetic fractures | Miss Sarah Muirhead Alwood | |
Challenger | Dr Robert Barrack | |
Chairman | Prof Justin Cobb | |
1630 | Debate - Are there real differences or is this just tribal? |