Mr Dirk van Bavel's Blog

This research paper between Dr Keat Ooi and myself will be presented as Poster at the Combined meeting of The AOA and NZOA this month in Rotarua NZ. It has previously been presented at the Annual Scientific meeting of the Victorian Branch of the AOA.

The use of Large volumes of local anaesthetic infiltrated into the tissues at the time of a joint replacement can give significant pain relief and reduce the need for narcotic analgesics. With this it is hoped that patients can rehabilitate without pain and nausea, and improve the post operative recovery.

Media attention has also focused on the promotion of the Anterior approach to the hip and its portrayed benefits.

The Australian Arthroplasty Society released a statement on 18/7/11 , which includes the comments that  “There is no scientific evidence that endorses one surgical approach over the other”  and “Surgical approach has little influence on results”

Further to this I am concerned that in an effort to use the anterior approach there is the potential compromise of the surgeons choice of prosthesis.

For hip replacement I use a posterior approach. This approach is safe, allows excellent visualization and allows the use of the prosthesis which I believe will give the best results long term.

In recent years the use of the LARS ligament has received widespread media attention and has become popular with some surgeons.

In March 2011 The Australian Knee Society released a position statement on this saying  “The Australian Knee Society (AKS) is concerned about the increasing use of the LARS device for anterior cruciate ligament reconstruction in the absence of sufficient evidence to support its widespread use.

In a 2011 survey of members of the AKS the majority considered that this device does not heal to bone, may cause articular surface damage (with possible premature arthritis), and will fail as have other synthetic ligaments.”

This is a vindication of the stance that I and many other surgeons have taken. The use of autograft tissue (in my practice mostly hamstrings tendon) is recognized to give reliable and long lasting results in ACL reconstruction.

The British regulator, the Medicines and Healthcare Products Regulatory Agency (MHRA ) has issued a warning on the use of MoM prostheses and the British Orthopaedic Association(BOA) has circulated a statement reflecting press interest and the need for longer term follow-up of these implants. This is an interesting development and one we need to keep an eye on.

There is concern within the Orthopaedic community both in Australia and overseas regarding potential problems with MoM hip replacements. I do not use MoM articulations but am happy to discuss the options available to patients when they are considering having a hip replacement.