BLOG: Experts convene to develop international consensus for hot topics in arthroplasty
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Key takeaways:
- The inaugural World Expert Meeting in Arthroplasty was held in Istanbul in September.
- More than 500 experts in arthroplasty met to create consensus on controversial topics in arthroplasty.
The first World Expert Meeting in Arthroplasty was held in September in Istanbul. We were honored to be faculty and take part in the inaugural event.
The meeting was attended by more than 500 international renowned hip and knee surgeons from 92 countries who were invited to participate based on their expertise. Prior to the meeting, 64 controversial topics were selected from more than 300, and questions were posed. Expert surgeons were categorized into teams along with research liaisons to perform a literature review and develop a recommendation/consensus statement on each topic.
This was presented at the meeting, debated upon and voted by all experts in the room. The final consensus statements and accompanying review papers will be published as a supplement in the Journal of Arthroplasty.
As faculty for this inaugural meeting, we were blown away by the entire experience. To begin with, Istanbul was an amazing city to host a meeting, and the hospitality of the Turkish delegation was overwhelming. We were lucky to have time to explore the city and take in sites, such as the Blue Mosque and the Grand Bazaar. The surgeons were also offered a tour of Acibadem Maslak Hospital to experience the International Joint Center, which offers world-class care.
The “meat” of the meeting was in the topic discussions. To have surgeons from around the globe not only debating but also agreeing on hot topics in hip and knee replacement puts into perspective how tight the arthroplasty community is.
After each topic presentation, there was time for surgeon experts to come to the microphone and offer arguments for or against the consensus statement presented. Each question had lines forming at the microphone where surgeons were ready to work to come to a consensus. Although there was not always immediate agreement on every topic, consensus was reached on all 64 statements, with some statements receiving editing along the way.
Dual mobility in primary THA
One of the hot topics that stood out to us as particularly notable was regarding the use of dual mobility in primary total hip replacements. The question posed was: What are the indications for the use of dual-mobility bearing surface for patients undergoing primary THA?
As this technology is far more popular in some areas of Europe compared with the United States, this topic brought significant debate and highlighted the differences in practice patterns. In addition, the debate helped us to better see what research questions still need to be investigated, such as comparing monobloc to modular dual-mobility components. The final consensus statement emphasized the selective use of dual mobility bearings in patients at high risk for dislocation.
THA vs. hemiarthroplasty for geriatric hip fracture
Another particularly engaging topic was whether there are differences in outcomes between hemiarthroplasty and THA for patients with displaced femoral neck fractures. As arthroplasty surgeons, we lean toward the belief that there is significant benefit to THA compared with hemiarthroplasty for most of our hip fracture patients. But during this meeting, it was presented that the data does not support that conclusion at this time.
The consensus statement emphasized that there appears to be no important difference between hemiarthroplasty and THA up to 5 years after surgery. The interesting segue from this topic is that data do not clearly state after 5-year follow-up whether hemiarthroplasty or THA is performing better and so, this leaves a question of what to do in our patients with hip fractures who are younger and healthier. The possible research questions discovered from these discussions were endless.
Metal hypersensitivity
The final topic that captured our interest was whether metal allergy to knee arthroplasty components exists. After the review of the literature, the answer seems to be that we still do not know. The experts identified that the rate of metal hypersensitivity is higher among patients who underwent total joint arthroplasty, but there are patients who tolerate the metal implants even when the skin test is positive for metal hypersensitivity.
The experts concluded that while it is possible that hypersensitivity-related complications after surgery exist, revision surgery for metal hypersensitivity alone is not recommended. They recommended against routine metal allergy screening and agreed that positive skin testing is not a good surgical indication for revision. Obviously, this question begets many more questions than it answers.
Overall, the inaugural World Expert Meeting in Arthroplasty was an overwhelming success, as it not only allowed important consensuses to be reached among international surgeons, but also established further areas where research should be focused.
The final outcome of the meeting was a great feeling of camaraderie among the international surgeons in attendance. We learned so much just by speaking and listening to those with different perspectives and experiences, and forged connections that will continue to improve patient care across the globe. Thank you to Acibadem Hospital for hosting. It was truly an experience to remember.
Reference:
- International Joint Commission. www.ijc.org. Accessed Sept. 30, 2024.
- World Expert Meeting in Arthroplasty. wem-a.org. Accessed Sept. 30, 2024.
Jenna Bernstein, MD, of Quinnipiac University and Connecticut Orthopaedics, can be reached at jenbernstein27@gmail.com.
Linda I. Suleiman, MD, of Northwestern University Feinberg School of Medicine, can be reached at lsuleima@gmail.com.
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