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Tradition of excellence continues at the Royal National Orthopaedic Hospital
New work includes the creation of an intraosseous transcutaneous amputation prosthesis.
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Heralded as a jewel in the National Health Service crown by the British government, the current clinical work, training program and research at the Royal National Orthopaedic Hospital builds upon more than 100 years of orthopaedic excellence.
“The mission is to place the RNOH on the highest possible level for the management of and research into all conditions of trauma, orthopaedics and diseases of the musculoskeletal system,” Orthopaedics Today Europe Editorial Board member George Bentley, ChM, FRCS, said. “Our ultimate mission is to be No. 1 in the world.”
Scoliosis management
Founded in 1905, the RNOH was formed from three specialist orthopaedic hospitals: the Royal, the National and the City. A “town branch” of the RNOH was established in central London in 1909 and a “country branch” was founded in Stanmore, England, in 1922.
Soon after its foundation, the hospital became known for its work in the area of poliomyelitis.
“In the world of pediatrics, it was historically a center for the management of poliomyelitis and cerebral palsy,” Steven Cannon, MA, McH(Orth), FRCS, told Orthopaedics Today Europe. “It still does a lot on cerebral palsy, leg lengthening and Perthes disease, for which it has a very famous history.”
After World War II, the hospital gained recognition in treating scoliosis and peripheral nerve injuries. The hospital’s reputation for scoliosis treatment was advanced through the pioneering work of Charles Manning, FRCS, and others, and now handles about 550 scoliosis cases per year.
“Scoliosis management has certainly been revolutionized at the RNOH,” said Cannon, who is the immediate past president of the British Orthopaedic Association and surgeon at the hospital’s London branch. “It is the largest institute in the management of scoliosis in Europe in terms of sheer volume.”
The hospital opened a spinal injuries unit in 1984, which was the first of its kind in the United Kingdom. Today, the unit is one of six in the United Kingdom and has a staff of 10 surgeons.
“After the war, the management of peripheral nerve injuries by Sir Herbert Seddon, FRCS, FACS, was one of its forays, and that has continued to be developed into a very active peripheral nerve injury unit as well,” Cannon said.
Investigators at the hospital are now focusing on better treatments for brachial plexus injuries.
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Image: Royal National Orthopaedic Hospital |
“One of our surgeons is doing a lot of pioneer work in implanting the cords of the brachial plexus, which have been torn at the spinal cord, back into the spinal cord,” said Bentley, who is a surgeon at the Stanmore branch and a former president of the European Federation of National Associations of Orthopaedics and Traumatology. “That is very new [and] it appears to work to a limited extent.”
Biomechanical engineering
The hospital also played a key role in the early development of total knee and hip prostheses. Bentley said John Scales, FRCS, was a driver of this movement at the RNOH. His influence can be seen in Cannon's work and ongoing research in the biomechanical engineering unit headed by Gordon Blunn, PhD.
“[The unit] developed this prosthesis which can be stimulated externally by radiofrequency to grow to increasing length,” Bentley said. “It is not absolutely novel, but I think that we are the pioneers in that.”
Cannon also pointed to the hospital’s recent creation of an intraosseous transcutaneous amputation prosthesis (ITAP).
“The ITAP is a development of that work, whereby we can get metal coated with hydroxyapatite to actually bond not only with the bone, but also with the muscle and the skin so that it can be fused and separated from the external atmosphere,” he said. “You get a protruding piece of metal coming out of your limb, which normally will be a source of infection, but because you bind it to the prosthesis and the natural tissues, it is protected and infection does not occur.”
Education
Bentley noted that the RNOH was the first orthopaedic hospital in the United Kingdom with a combined clinical and academic base. The Institute for Orthopaedics was founded in 1945 and is now a part of the University College London.
The RNOH continues to play a vital role in the education of orthopaedic surgeons, he said.
“It is the chief educational program for training orthopaedic surgeons in the U.K.,” said Bentley, who was a director for the institute and head of the academic department for 20 years. “It is not only the largest, but it has actually been voted the best.”
Nearly 20% of orthopaedic surgeons in the United Kingdom will gain some of their training at the hospital, according to Bentley.
“We are recruiting certainly the brightest graduates from the universities in the country to orthopaedic surgery, which means that we have tremendous potential for the future,” he said.
Today, the RNOH is the largest orthopaedic hospital in the United Kingdom. Nearly 6,000 outpatients are seen per year at the London and Stanmore branches and about 11,000 procedures are performed at the Stanmore site, Bentley said.
In addition, the hospital is home to the largest cartilage transplantation and sarcoma units in the United Kingdom.
“I think that it will continue to be the major British orthopaedic center both from the clinical and research point of views until the foreseeable future, and we will develop new concepts in the areas of implants, the management of tumors, cell engineering fields and the management of children,” Bentley said.
For more information:Reference:
- George Bentley, ChM, FRCS, can be reached at Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom; +44-208-909-5532; e-mail: profgbentley@talktalk.net.
- Steven Cannon, MA, MCh(Orth), FRCS, can be reached at Royal National Orthopaedic Hospital, Middlesex Hospital, 45-51 Bolsover St., London W1 5AQ, United Kingdom; +44-208-909-5619; e-mail: sue.cannon@tesco.net.