The impact of recent advances in orthopaedic surgery on patients' outcomes

There have been numerous advances in orthopaedic surgery in the last few decades and many of them have brought about significant improvements in patients' outcomes. Orthopaedic procedures are now less invasive and they are associated with less disability and shorter recovery periods, allowing patients to be more functional sooner.

Specific advancements in such a diverse specialty as orthopaedics are too numerous to mention, but some of them have had notable impacts on patients' outcomes in recent years.

Total hip replacement is a common method of treating arthritis in elderly patients. The use of femoral (long bone of the thigh) prosthesis made out of metal components and plastic socket for the round head of the long bone predispose the joint to loosening of the components in the long term, resulting in much pain and bone loss. For this reason, total hip replacement is not recommended for younger patients who would normally use of their replaced hips for much longer periods than the elderly patients.

The introduction of a new generation of metal on metal prosthesis is a significant advancement in hip replacement surgery aimed at resolving this problem. In a review conducted by Sieber HP et al (1999), volumetric wear of metal-on-metal prosthesis joint surfaces was about 60 times less than their metal-on-polyethylene counterparts.

The metal debris produced is much smaller, the cellular reactions activated are much less and there is some degree of self-polishing of the metal surfaces. These factors confer long term stability on the metal-on-metal hip prosthetic system with no requirement for complex revision surgery in later years.

Some centres have introduced the use of autologous chondrocyte implantation into the management of damaged, articular cartilage in young patients. Damaged articular cartilage has a poor repair potential, so injury tends to result in arthritis after some years. While elderly patients may benefit from total replacement surgery, younger patients must be offered an alternative treatment modality as previously explained.

Hyaline cartilage transplant may be used to replace the damaged articular cartilage and restore joint function but there are only very few sites where donor articular cartilage can be obtained without damaging the joint. New techniques have recently been developed to culture small amounts of the donor cartilage and increase the cell population within a short period. This is a significant advancement in the repair of damaged articular cartilage resulting in better quality of life and prevention of arthritis in younger patients.

Another significant advancement in orthopaedic surgery positively impacting on patients' outcomes is the use of flexible metal alloy nails for the treatment of long bone fractures in children. These fractures have traditionally been treated with traction, leading to long hospitalisation and possible discharge in plaster casts which are uncomfortable and difficult to manage.

The introduction of flexible metal alloy nails, small enough to fit into the marrow of the long bone, via a small incision on the skin provides stable fixation while maintaining the shape of the bone. The nails can easily be removed after the union of the fracture. For femoral fractures, the children can return to school after a very short stay in hospital and weight bearing can resume after a much shorter period.