14 November 2014
Successful first AO Recon symposium in Middle East
This first AO Recon educational activity to take place in the Middle East, in Dubai, UAE, on October 15, 2014, addressed the basic principles and complications of adult hip and knee arthroplasty.
Of the 90 participants, 75 completed the feedback questionnaire providing insight into the demographics of the audience: Most of the participants (69%) were residents or independent surgeons with less than three years' experience. The majority of respondents (58%) indicated that their current practice is orthopedic trauma, followed by 39% in general orthopedics (reconstruction surgery). Of these respondents 73% assist in one to five joint replacements a week, while 38% indicated that they perform joint replacements as their primary surgeon.
The post-event survey revealed that 92% of the participants would recommend this event to their colleagues while 94% stated that the content of the symposium was very useful for their daily practice while 78% stated that the international and regional faculty were very effective in the role they played.
Before Jean-Noël Argenson began the first part of the program, which focused on the knee, AO President Suthorn Bavonratanavech gave a short presentation, welcoming the participants and giving an update on the AO Recon initiative. He explained the rationale for the AO to choose this direction: rising case numbers of joint replacements due to trauma and degenerative diseases and a high need for joint preservation and replacement education (according to the AO Education Institute) while at the same time there being no global network of surgeons in the field. Finally, he asked the participants to provide feedback, as it is crucial for the AO to respond to their needs.
Part 1: Principles in adult knee arthroplasty
After Suthorn Bavonratanavech's presentation, Jean-Noël Argenson introduced the first session on knee replacement. Christopher Dodd presented indications for and principles of Uunicompartmental Knee Arthroplasty. He mentioned antero-medial osteoarthritis (90%) as the main indication, and pointed out the higher revision rate as the significant disadvantage. Ashok Rajgopal then discussed indications for Total Knee Arthroplasty (TKA). He explained the basic principles and the challenges of TKA, eg, demographic changes and instability as reason for failure. After this, Matthew Abdel debated about avoiding complications in TKA and stressed pre-operative planning including physical exams and a thorough check of the patient's history and social perspective as the most important step. Samih Tarabichi presented the variety of patient expectations and outcomes after TKA. He stated that patients' expectations have risen, as they want the knee to feel "normal". As satisfaction is biased by every patient's expectations, he mentioned a new (American) knee society score as an objective means to measure outcomes.
The topic moving toward the actual procedure, Francesco Benazzo demonstrated incisions and approaches in TKA, followed by Imran Ilyas who explained the proper making of required bone cuts in this surgical procedure. As the soft tissue has to be taken into account, Samih Tarabichi followed up on Imran Ilyas' talk with the topic. He suggested involving plastic surgeons when in doubt in the management of the soft tissue and stressed the importance of deep tissue adhesion relative to the ability to bend the knee. Getting into more complex cases, Ashok Rajgopal explained the treatment algorithm for the correction of deformities. He stressed that it is key to understand the structures that need to be released/resected, the available options include using the gap balancing option or the measured resection technique.
In the subsequent round table discussion, all faculty agreed that patient expectations management is crucial in the process. While some of the symposium participants reported that the majority of their patients only present when in severe pain and only expect to be able to get back to praying, it was agreed in the plenary that there is a clear trend for the patient population to expect that they can return to the same active lifestyle postoperatively as they had before.
Part 2: Principles in adult hip arthroplasty
After lunch, Carsten Perka introduced the afternoon session, which was focused on the hip. George Macheras gave the first presentation, with an overview on the indications for Total Hip Arthroplasty, and stressing that this is the most successful operating technique in the history of medicine. He pointed out that despite a variety of indications each case is different. Jean-Noël Argenson continued with a comprehensive overview on anatomical considerations in this area. He stressed the importance of 3D analysis to study anatomical modification and highlighted the large individual variability. Imran Ilyas then talked about component selection in THA. He stressed that understanding the philosophy, design principles and historical evolution of the various systems available is important in selecting the implant. Thereafter, Matthew Abdel gave a talk on proximal femoral fractures and the advantages and disadvantages of hemi- or total joint replacement as treatment options.
The late afternoon session was focused on complications of adult hip arthroplasty. George Macheras talked about the issues with infection and reported findings on defining PJI from the consensus meeting in 2013. Regarding instability and recurrent dislocation, Carsten Perka pointed out that stability is substantially dependent on acetabular component orientation with the highest effect seen at 45° inclination. In an overview about periprosthetic fractures, Tilman Pfitzner showed the options of osteosynthesis and THA revision procedures. Francesco Benazzo then presented about the painful hip after THA. He stated that the pain can be related or unrelated to the implant, while intrinsic and extrinsic causes must be considered.
Another roundtable discussion was held at the end of the hip presentation, where the audience participated very actively, even if it was at the end of the day. Carsten Perka moderated the session and discussed questions from the audience with his peers.
In their closing remarks, co-chairs Perka and Argenson highlighted the outstanding interest and level of participation in the discussions and thanked all the involved faculty and participants for this unique event. As the survey outcomes described at the beginning of this article indicate, the participants share the opinion of the faculty that it was a highly successful event. All parties are looking forward to more activities of AO Recon in this field.
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