Orthopaedics Today Europe Commentary

The American Academy of Orthopaedic Surgeons Annual Meeting will get underway on March 12. My first AAOS Annual Meeting was in 1988 in Atlanta. Since then, I have only missed one AAOS Annual Meeting. I am probably among the most consistent attendees at that meeting as this is my 30th time to participate in the meeting.

Following the November 2018 “storm” that occurred before and immediately after several journalists released The Implant Files Investigation, which contained data they collected about problems with orthopaedic implants, various reactions to this information were published. Among them was a statement from the EFORT leadership. Certainly, orthopaedic surgeons care that the best and safest implants are used in patients. No patient should ever question that. However, we, as surgeons, also must ensure we do some self-examination whenever we begin to use a new product or when the outcome of an implanted product does not meet our expectations.

In addition to ensuring our patients get the best, safest and most evidence-based treatment, senior orthopaedic surgeons have the duty to make sure the next generation of orthopaedic surgeons are sufficiently trained in surgery to take over when “we have left the podium and pass on the relay for them.” This transition must be focused on in all areas of an orthopaedic department. Basically, it comes down to a simple statement: Every time a trainee and a senior surgeon are together around a patient – in surgery or not – there is a great opportunity to train and educate the trainee to improve her or his skills and knowledge for the benefit of patients in the future.

In the 1980s when I started training in orthopaedic surgery, heterotopic bone formation in the soft tissue around a newly implanted total hip replacement was a common event and an occurrence that was regularly observed on radiographs taken as soon as 3 to 6 months after surgery. In fact, at that time, severe bridging Brooker grade IV ossifications were frequently observed in as many as 5% to 10% of cases, which left patients who underwent THR with a permanently significantly reduced hip range of motion. In some cases, patients even had a stiff hip in a flexion contracture, as well as pain during the first 6 to 12 months after the index surgery.

In a few days the 19th EFORT Congress will take place in Barcelona. The scientific and educational program has been finalized for several months and another exciting meeting awaits us.

Young patients are seen almost daily in our emergency units after they have a head injury and exhibit symptoms that indicate they have some degree of concussion. Most of these patients are observed shortly in the emergency unit and, if they show no further symptoms, are discharged with information about the circumstances in which they should return to the hospital immediately. Few of these patients show up again, but what happens to the rest of those patients? Do we really know how they perform in the longer term?

The hip-spine syndrome has been recognized for several years, but recently, more aspects of the condition have been appreciated. Particularly, as orthopaedic surgeons perform more total hip replacement or spine surgeries on an increasing number of patients, and there is an increasing demand for return to function in active, elderly cases, we regularly face troublesome cases that affect the hip and spine. For example, we may encounter cases where spine surgery for lower lumbar degenerative disease or THR either did not relieve any of a patient’s pain in the hip region, as expected, or it did not sufficiently relieve all the patient’s pain.

During the last decade, a huge development in early mobilization and early discharge has taken place in fast-track total hip and knee replacement, enabling most patients undergoing total joint replacement to be mobilized a few hours after surgery with most patients discharged no later than 24 hours after surgery. Among the most important keys to that development is the dramatic change in pain treatment programs.

A few short years ago, most orthopaedic surgeons would not think that in as early as 2017 the industry would develop a technique whereby virtual reality tools are used to train orthopaedic surgeons. However, this year at the EFORT Annual Congress in Vienna, this technology was presented by more companies than in the past, which makes one wonder how virtual reality training tools will influence how orthopaedic surgeons are trained in the future. Is this technology only applicable for the young, upcoming surgeons or may more experienced surgeons also benefit? How will hospital leadership and owners view this new option? These are some relevant questions to address in the future.

In the last 2 decades, an ongoing worldwide discussion of work-hour restrictions has had unintended consequences for residents, surgical education and training. Over time, medical staff also has been impacted by national decisions on maximum working hours per week, in average, for some period. I belong to the older generation of surgeons who were educated in the late 1980s and early 1990s, when we had limitations for maximum working hours, but not to the extent seen in some places in Europe now.