Webinar: How Good Is Osteotomy Surgery | Prof Adrian Wilson скачать в хорошем качестве

Webinar: How Good Is Osteotomy Surgery | Prof Adrian Wilson

(0:00) Okay, so I want to talk to you a little bit about osteotomy. And this is something myself and (0:04) Kristian, it's what really brought us together. I was doing live surgery demonstrating on Inside (0:09) ACL. It was the second time it had been seen in Germany in 2010. And it was at Kristian's (0:15) boss's course, Philip Lobenhofer ran a live surgery course. We came together, (0:19) and we've been working in osteotomy, developing things like the care retractor (0:24) and developing techniques together since then. And what osteotomy is all about is preserving the (0:33) knee. And you can see I was in Warsaw actually at a friend's meeting. I saw this guy doing some (0:37) beautiful roller skating. He's not 20 years of age. And people are very active till very late. (0:42) And we can see this spectrum of disease as the knee gets arthritic. And we want to keep people (0:48) in the green. So we want to be doing preservation procedures before we do joint replacements, (0:52) or the salvage stuff. And that's what osteotomy is all about. Now, knee arthritis, the Holy Grail (0:59) was thought to be a total knee replacement. And we believe in these. And we believe in partial (1:04) knees on the inside, on the outside. We get patients sometimes where we do both. But we know (1:10) from national joint statistics for total knee replacement, this was published in 2017, this is (1:15) 65,000 patients with a minimum of 10 years follow up. So they had to have had 10 years before they (1:22) did the scores. And what they found was in the under 55s, 35% fail within seven years. (1:28) Mean time to having to have it redone, four years. It's a disaster. So in certain countries, (1:33) you need two consultants to sign off before we can do a knee replacement in someone of that age, (1:37) because it's just such bad news. Now, we believe in knee replacements. This is Mark. He's a (1:42) physiotherapist. This is his partial knee replacement. And this is him walking on the (1:48) day of surgery. He's done brilliantly. He got back to playing rugby. We believe in it. (1:53) This gentleman here, he's a farmer. He'd actually had osteotomy surgeries, 55. We did both of his (1:58) knees at the same time. This is him a few hours after surgery. And you know, he's moving his knees (2:03) comfortably. He's not in too much pain. He's happy. And he went on to actually shoot this (2:07) lovely testimonial of him driving and being active. This is him. (2:21) So we can get a great result with total knees. This gentleman here, day of partial knee (2:29) replacement. And this gentleman here is absolutely fantastic. He came to us. (2:39) So that's a revision knee replacement two weeks. (2:43) This is easier than the partial knee. (2:49) Do you want me to do an Irish jig? Great guy. (2:55) So what is an osteotomy? And this is quite a nice animation that we can go through, (2:59) which shows a weight bearing line on the inside of the knee, which is most people are various, (3:04) the weight bearings on the inside, as opposed to being not need where the weight bearing would be (3:08) on the outside. There's disease on the inside. And in here, this case here, we can see significant (3:14) arthritic change on both sides. And in grade four, which is makes up 35% of our cases, (3:20) we can perform this operation appropriate patients. And what we're aiming to do is to (3:25) move the weight bearing line from the inside to the middle of the knee. That's what an osteotomy (3:30) is. And it can be done either in the femur or the tibia by either opening a wedge or closing a (3:35) wedge in the tibia or the femur. Everybody has a long leg x-ray calibrated. And then we work out (3:41) whether they're suitable for this surgery by doing virtual surgery before we then go to execute the (3:46) osteotomy. We make through a very small incision now, a minimally invasive approach to cut the (3:52) bone and open. We pack that with borrowed bone and put the plate on and that's an osteotomy. (3:59) Now, we've set up a centre of excellence with Ronald Van Heervaarden, who you see here as part (4:04) of this scientific advisory group. And we've taken Nuclip, which is the leading company now in (4:10) osteotomy surgery, from being not very well known to being number one. And our plate, (4:15) which we helped to design, is the most commonly used plate globally. (4:20) So what about survivorship? This is my series. So I had a large grant, half a million pounds to (4:26) follow patients in Basingstoke. And I made it my, I suppose, my hobby from 2006 and collected (4:34) these patients. And what we found was that at 10 years, 92% are doing well. We won the best (4:43) consensus when we set the consensus document in Europe with Matt Olivier and here Matt Dawson, (4:49) my good friends. And we won the best consensus in Paris for telling surgeons when, where, and what. #osteotomy #kneepain #surgeon #orthopaedics #kneesurgeon #kneetreatment #webinar