It was the 10th annual Masterclass and the best one we have done to date. I am very proud of the course and the fact that over the last decade we have educated more than 750 surgeons from the UK and more recently further afield. This year we had eight surgeons attend from Poland, as well as delegates from Belgium, Brussels, India, France and elsewhere. As always we had a fantastic national and international faculty - they are all currently globally leading osteotomy surgeons.
I really tried to break the two days into a basic high tibial osteotomy on day one and a more complex day on day two with live distal femoral osteotomy surgery and new topics covering new alternative treatments for arthritis.
We kicked off day one with the biomechanics and had two superb lectures from professor Andrew Amis and Dr Bob Teitge who gave us a great start and set the scene for the course. Ronald van Heerwaarden did his usual brilliant job of taking the delegates though the importance of accurate planning and how to physically plan an osteotomy. David Howard then gave a run through on how to use pre-op planning tools digitally to plan an osteotomy and did some example cases. Steven Claes presented on how accurate we currently are with osteotomy surgery and gave us a review of his own meta-analysis that he published last year with his group from Herentals. Chris Wilson told us about the standard indications and the more extended indications for osteotomy surgery.
Then for the first time I had the idea of combining a lecture , videos with the use of a live cadaveric demonstration to take the delegates through a step by step guide on how to do a high tibial osteotomy surgically. I used my video which we put on YouTube several years ago (which has had thousands of views) on how to do an HTO, and combined this with some new material. This year rather than just show the video and take the delegates through the different aspects of surgical technique for HTO, I broke it down into the use of my video and a link with the Arthrex mobile cadaveric lab which we had on site. We had Bhushan Sabnis (my good friend and the leading osteotomy expert in India currently) and Konrad Slynarski (another leader in the osteotomy world who has been on faculty since the start) and together they showed the delegates the different steps with an intro and video explanation from me. This worked really well.
We broke it down into:
After each individual step delegates had chance to ask the faculty how and why? This was particularly well received and was a great new addition to the course.
We then split the delegates into two groups. They alternated between a great demo of how do to an ACL reconstruction combined with a high tibial osteotomy from the mobile lab. Bhushan and Konrad were back for another session together and did a lovely demonstration. The other half of the delegates did a hands-on workshop using Sawbones and carried out high tibial osteotomy surgery under the direction of Ronald Van Heerwaarden and the rest of the faculty.
In the afternoon we carried on with the results of osteotomy, and Raghbir Khakha (my previous fellow who is now a consultant at Guys and St Thomas's hospital) presented our combined results from Basingstoke, Carlisle and Cardiff. We now have over 1000 osteotomies that we have carried out and this is the largest followed series currently in the world. We presented that we had a less than 5% complication rate with 87% good or excellent. Mr Khakha also presented our biomechanical and clinical results of using a bone wedge which is something we have innovated and pioneered in Basingstoke (an idea I introduced two and a half years ago). We showed significantly less pain, less swelling and earlier healing with the bone wedge and a statistically significant improvement in strength using a bone wedge when we examined its effects in the lab.
Will Jackson from Oxford presented the indications for an osteotomy in terms of the Oxford groups philosophy and the indications for partial knee replacement. He talked about this important group of patients who fall into a "treatment gap" which is typically someone 40-55 with partial thickness wear and tear arthritis who is not yet bone-on-bone and therefore not a good candidate for partial knee replacement surgery. He felt that without the osteotomy option they would be told there was nothing that could be done despite incapacitating pain, but this group do very well with osteotomy surgery.
David Elson one of my other previous fellows got us up to speed on UKKOR - the UK knee osteotomy registry which we set up together 3 years ago. This has now had great uptake around the country and is being used regularly by more than 70 surgeons. David has done really well with this project and we are really proud of what we have all achieved in setting up this national database for ostoteomy surgical outcome. We are the envy of the rest of the world and it has spurned the Germans and my good friend Steffen Schroetter to set up the German equivalent which will be launched later this year in 2018.
Matt Dawson (who is a founding member of our team) gave two great lectures on how to be more precise using the Nuvasive nailing system as a new way of doing osteotomy surgery and showed some really excellent results.
We had a great overview from Dietrich Pape on where we are with the new plating systems. He is another great friend and leader in the world of osteotomy surgery and the "go-to guy" for assessing the biomechanics of plates and how well they perform in the lab. His work has really helped to guide surgeons on which plating system to use based on basic science. He also oversaw a great project with my PhD student James Belsey on the use of bone wedges in osteotomy surgery and their behaviour in the lab, and I'm delighted to say that the results show a real benefit in using a bone wedge in terms of providing biomechanics support. Day 1 was a great success.
Day 2 was more focused on femoral osteotomy surgery and newer interventions.
We started the day with the experience of the use of a bone wedge in osteotomy surgery from Steven Claes and his group in Herentals. They are performing 150 osteotomy surgeries a year and have gone from treating it with very strict indications to using it more and more in bone arthritis patients. The ratio in the unit (which is considered one of the leading centres in Europe) has gone from from 3 total knee replacements to 1 high tibial osteotomy three years ago to doing 1:1 in terms of TKR to HTO!
They showed, like us, much more rapid rehabilitation with the use of a bone wedge - far less pain and also showed patients getting back to work, sport and activities of daily living much more rapidly than when they hadn't used a wedge but had followed the more traditional approach.
Mike Risebury (my good friend and colleague in Basingstoke) then did a masterful demonstration of a distal femoral osteotomy live from the operating theatres. This was the first live demo of a DFO ever performed in the UK and was very well received by the delegates. This was a very good new contribution to the course.
I then did a step-by-step demonstration of each stage of the DFO procedure and linked once more with our mobile cadaveric facility which was parked outside, and had Kristian Kley and Ronald van Heerwaarden doing the cadaveric demo of each step as we went. As always I personally learnt some new information which I have since introduced into my practice. They are two of the leading lights in osteotomy surgery globally. Ronald personally does over 300 cases a year and is exclusively doing osteotomy surgery and Kristian has a very similar practice.
We then went to the workshop and showed the delegates how to do a distal femoral osteotomy using Sawbones. These workshops always get the best feedback from the delegates and this year was no exception. Seb Paratte from Marseille did a superb job of getting us up to speed on patient specific instrumentation (PSI) and HTO surgery . He has been a pioneer in this field for a decade and with Newclip has a truly brilliant solution for PSI and osteotomy surgery. He has a much more accurate result and doesn't even use intra-operative X-ray now as he is so confident in the technology. This I'm sure is going to play a much bigger part in osteotomy surgery in the future. I have had some experience with this technology but Newclip really seem to have an excellent solution.
Bogdan Ambrozic from Slovenia has a lot of experience too in PSI and showed its use in DFO surgery and more complex procedures. He, like Seb, produced some very interesting results and again showed how we can be more accurate if we use the PSI guides.
Konrad Slynarski gave a great lecture on the use of orthobiologics and in particular the use of fat-derived stem cells . Konrad was the first surgeon globally to use fat for the treatment of arthritis and now has results which have shown 80% success rates maintained out to three years. It was Konrad and his pioneering work in stem cells derived from fat that got me interested in this topic and we have now got a similar early experience with our patients who have come through our own Regenerative Clinic. This technique is going to play a very important part in the management of arthritis and musculoskeletal injury in general as we move forward.
Konrad has also adopted the principle of distraction therapy to treat grade IV arthritis. In this technique a simple external fixator is applied in theatre and then distracted 5mm over a 6-week period with 1mm distraction being introduced each week. Konrad first came up with this idea and has 3-year results to show well that this works. I'm sure a combination of fat derived stem cells and distraction for end-stage arthritis of the knee is going to be a good way to manage bad arthritis and we are now looking at introducing this combined treatment through our regenerative clinic.
Konrad then summed up and gave the final word on what was a great second-day overview of osteotomy surgery.
I am very proud of what Neil Thomas and myself set up 10 years ago in Basingstoke. We have put osteotomy on the map in the UK and together with my group have really helped to shape eduction in Europe for the use of osteotomy surgery in the knee. I'm now looking forward to Spring 2018 when we have the first London course.