David Woodnutt
Sancta Maria Hospital, UKPresentation Title:
The Performance of a Short Stem Total Hip Arthroplasty as an Alternative to Resurfacing Arthroplasty in Young and Active Patients; a 10 Year Review
Abstract
Resurfacing Hip Replacements gained extraordinary popularity in the early part of this millennium and generally provided a good alternative to traditional previously available metal-on-plastic hip replacements in a young and active group of patients. However, with the advent of high failure rates with some metal-on-metal implants and the need for ongoing post-operative monitoring, an alternative product was needed. The short stem arthroplasty shared some advantages of the resurfacing arthroplasty in being bone preserving and physiologically loading and was adopted as an alternative in our unit. This study retrospectively compares the sequential series of resurfacing and calcar bearing short stem arthroplasties in almost 2,000 similar patients over a period of 15 years (maximum 23 and 15 years respectively). A prospectively collected database of the 1,092 Birmingham Hip Resurfacing (MMT, UK; Smith & Nephew, Warsaw, USA) and 899 MiniHip / Trinity couple (Corin, Cirencester, UK) performed in our unit was retrospectively compared. Patient demographics were compared using a two tailed t-test for parametric data and chi-squared tests for non-parametric data to test if the population to be examined were similar. Parameters compared for similarity between the two groups were, pre- and post-operative HHS and OHS, age at surgery, ASA, Satisfaction VAS, BMI, smoking at time of surgery. Dislocation, Infection Rates, wear, and periprosthetic fracture rate was recorded. The outcome using Cumulative KM survival curves was analysed using a Log-Rank Test. The Included patients were compared in a KM cumulative Survival Curve with 95% Cis. A significant increase in Hazard Ratio (1.52, 1.01 to 2.56, 95% Cis) and Log-Rank Test was found with the MiniHip having greater survival to stem failure (97.2% vs 96.0% at 10 years, 97.2% vs 94.4% at 14 years). This study suggests that the short stem is a viable alternative to resurfacing arthroplasty in young active patients.
Biography
Mr Woodnutt started his career as a Synthetic Organic Chemist working for the Open University. Subsequently, he completed his training as an Orthopaedic surgeon in South Wales. After starting a substantive Consultant post in Swansea in 2001, he specialised in Arthroplasty of the lower limb, especially in younger persons. He introduced the first Surgical Assistant and Pre-Assessment in Wales shortly after starting and set up the first ring-fenced ward for arthroplasty. This lowered the average length of stay from 14 days to (eventually) less than 3 days. It also reduced infection rates and improved through-put for which he won an award from the Welsh Assembly in 2005. In setting up a prospective database, research and follow-up data was collected on arthroplasty patients 10 years before the commencement of the National Joint Registry for which he later worked as a Regional Clinical Coordinator for 12 years. He later pioneered the introduction of the Dynamic Pelvic Motion analysis for acetabular cup positioning in conjunction with Corin (UK) Ltd. He has travelled extensively providing Orthopaedic care in Bangladesh and South Africa and was the first Orthopaedic Surgeon to visit the Islands of St Helena and Tristan da Cunha in the South Atlantic; and he currently visits The Falkland Islands periodically to provide Orthopaedic care. To date, he has completed nearly 9,500 joint replacements (including more than 1,000 revisions). He has published and presented a large number of papers both for educational courses and International conferences and is currently a reviewer for Hip International, Bone and Joint Journal and the European Journal of Orthopaedic Surgery. His current research projects include the Mathematics of Follow-up, the outcome of Implants and wear related analysis of hips in the longer term as well as maintaining an interest in teaching junior Surgeons helped by his role as a qualified Flying Instructor and Examiner for the Civil Aviation Authority.
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