Orthopaedics Today Europe Commentary

Within a few weeks, the pandemic due to the novel coronavirus became the largest game changer experienced in modern times. This terrible virus has, until now, killed more than 100,000 people worldwide, behaves unpredictably and brings suffering and fear. Its impact on societies across the world is unbelievable with lost lives, lost jobs, a world economy that is under great pressure and other consequences. It just does not seem right to discuss medical education, congresses and meetings in the shadow of all the aforementioned suffering simply because we must now, despite the ongoing COVID-19 pandemic, start planning a “new time” for meetings and congresses because this virus is expected to stay among us for a longer period of time.

In the past, having patients go home on the same day they underwent total hip replacement was done rarely and only in select cases. As a hip surgeon, I remember these rare cases because the request or demand to go home on the same day that the surgery was performed never came the surgeon. It always came from the patient, who was typically a younger man whose job involved a leadership position and he expected to be “back in business” the next day.

When we, as orthopaedic surgeons, plan a surgical procedure, we certainly demand that safe implants be used. When a patient accepts to undergo surgery performed by us, he or she expects the implants we use are safe. When the manufacturer produces and delivers implants to us to be used in our patients, they take the implants through a meticulous investigation followed by an evaluation of the products by regulators and notified bodies, before the implant is released for free use on the European market by physicians. In this way, all “stakeholders” expect and desire to do their best to bring about safe implants that are used in surgery for patients, which fulfills patients’ expectations of receiving safe treatment.

As someone who has been in orthopaedic surgery for nearly 4 decades, I certainly welcome both evolution and innovation. However, I also prefer stability in my orthopaedic practice and tend to be patient when it comes to new advances in the specialty. As a hip surgeon, I have reflected on the implants, surgical techniques, pain management and rehabilitation programs used and the attitudes of the surgeons and patients in 1982, when I began my practice.

As more patients each year undergo total joint replacement, an increasing number of patients develop periprosthetic fractures, especially femoral and proximal tibial periprosthetic fractures, and are referred to orthopaedic clinics. In the future, the numbers of patients with periprosthetic fractures following TJR procedures is expected to increase even more due to patients’ demands for an active lifestyle after they undergo TJR and due to the ever-larger overall pool of patients with a TJR.

Regularly, I am confronted with a patient who demands a hip replacement when that patient, in my opinion, is not a candidate for surgery based upon the generally accepted recommendations that need to be followed before surgery can be considered. Such a situation usually becomes stressful for both the patient and the surgeon because, if we stay true to our professional, academic-based knowledge, ultimately, the expert the patient has been look forward to meeting will not perform the surgery and the patient cannot undergo the surgery he or she has anticipated.

The European Union Commission has launched a new medical device regulation for devices sold in the European Union that replaces the existing medical device directive. Under the new regulation, devices on the market are classified into one of three levels, with class 3 consisting of high-risk devices that need the strictest regulations.

Another great EFORT Congress just concluded. This one, which was held in Lisbon, was the 20th EFORT Congress. As president of EFORT starting June 2018 and ending immediately after the Congress in Lisbon, it was a special event for me, as might be expected.

The 20th EFORT Congress to be held 5 to 7 June in Lisbon, Portugal is just around the corner. When we started planning the scientific content for the congress some 18 months ago, we decided the main theme should be registries and their impact on our daily practice. At that time, we could not possibly have known that the topic of registries and their outcomes would be focused even more at the time of the congress due to the upcoming new medical device regulation process in Europe, initiated by the European Union Commission.

Mental health is not usually considered to be much of a factor that influences the overall outcome of patients who undergo planned orthopaedic surgical procedures, but studies are now starting to show that a patient’s mental health may be linked to poor outcomes after shoulder surgery, spine surgery and lower limb joint replacement. I am sure we are now just seeing the tip of the iceberg in this area.