The Royal Society of Medicine's Orthopaedic Section Podcast

Professor Kevin Shea is an orthopaedic surgeon and academic at Stanford University Medical Center (California, USA) and the Lucile Packard Children's Hospital. He is well known as a founding member of PRiSM, ROCK and SCORE. He is in the presidential line at POSNA.

In this engaging episode, Prof Shea and I cover a lot of ground including:

Prof Shea's orthopaedic journey and life lessons: 01:20

• Work ethic and the value of hard consistent work
• Coaching and Mentoring
• Medical school (UCLA and time in the Soviet Union)
• Fellowships including Rady Children's Hospital (San Diego, USA), Bern (Switzerland) with Dr Ganz (Switzerland), Dr Fernandez (Trauma) and Dr Staubli (Sports), Lecco (Italy) for Ilizarov training, South America for the AOSSM Traveling Sports Medicine Fellowship
• Private Practice in Boise and being invited to become Professor of Orthopaedics at Stanford University
• The concept of "Deep Work"
• Planning early / mid / late career
• Value = Quality / Cost, what is the role of orthopaedic surgeons in this equation?
• The need to balance work and personal life

Paediatric Sports Injuries (42.00)

• How as the world of paediatric sports injuries changed during his career?
• Is there an increasing incidence and have the nature of the injuries changed?
• Have our interventions evolved?
• What is the role of injury prevision programs?
• What is the next big advance in the field?

Paediatric Knees (53:00)

• How did he go about setting up a cadaveric lab?
• Did he find anything surprising in the dissections?
• How has his deep understanding of anatomy influenced his clinical and operative techniques?

Research groups - PRiSM, ROCK and SCORE (64:15)

• Why establish these groups? What is the importance of an interdisciplinary approach to advancing research?
• What impact have these groups had so far?

Orthopaedic Education - What are his top tips for medical students, residents and newly qualified surgeons? (69.30)

• The importance of good cultures and teams

Final thoughts and advice (72.00)

Dr Evelyn Kuong is an Associate Professor at the Li Ka Shing Faculty of Medicine (University of Hong Kong) and an Orthopaedic Consultant at the Duchess of Kent Children's Hospital.

This episode covers skeletal dysplasias and is of particular interest for those approaching postgraduate examinations and the general orthopaedist who may encounter the occasional patient with a rare condition. We discuss a system of decision making, the role of the MDT and how to approach rare dysplasias. We delve into achondroplasia, pseudoachondroplasia, MED and SED. We then discuss the treatment of short stature in general terms.

We finish by discussing Dr Kuong's orthopaedic journey and her perspective on diversity in orthopaedics.

We speak with Dr Marí Thiart who is an orthopaedic surgeon in Tygerberg, Cape Town, South Africa. She is also the president of the International Orthopaedic Diversity Alliance. In this episode we discuss the set up of South African paediatric orthopaedic services, trauma, infection and training.

01:08: Set-up of Paeds Ortho Services in South Africa

04:40: Set-up of South African Trauma Services

06:30: Blunt vs Penetrating Trauma

10:50: Common Trauma in Cape Town and Top Tips

16:00: How to manage gunshot injuries in children

18:15: Musculoskeletal Infection in Children including acute haematogenous osteomyelitis (PhD subject of Dr Thiart)

21:50: Offending organisms

23:40: Surgical management of osteomyelitis is rare right? - "100% of kids need surgery"

28:00: Critical bone defects in infection

33:00: Quick Fire Round - High yield orthopaedic topics for the FRCS / Postgraduate exams

43:40: IODA and how to get involved

We speak with Mr Emeka Oragui (Chelsea & Westminster Hospital, London) about femoral acetabular impingement, sportsman hernia and treating young patients with hip replacement surgery through an anterior approach.

In this episode we cover:

01:40: What is femoral acetabular impingement (FAI)?

06:00: Is hip arthroscopy witchcraft? 

08:20: Is subtle hip dysplasia under diagnosed? How does this link to FAI? 

10:27: Pearls of wisdom – How do you approach a young person with vague pain in the hip with an MRI scan showing a labral tear? 

20:10: Sportsman Hernia – an interface area. The anatomy and what is the genesis? What is the Doha agreement?

27:00: Should orthopods stray north of the inguinal ligament?

34:25: What can an orthopaedic surgeon do to treat sportsman hernias?

42:50: Anterior approach hip replacement

Mr Andy Williams (Fortius, London, UK) spends an hour speaking with us about his life lessons, philosophy on knee surgery and how to optimise your performance. This is an episode not to be missed!

Timestamps:

01:40: From humble beginnings and overcoming imposter syndrome

04:29: Should orthopods be builders? How do we become more precise?

06:38: How did your fellowship and having experience abroad influence your practice? Should trainees aim for some time away and why?

11:18: How has your philosophy on knee surgery changed over time? How does treating elite athletes influence your management of non-athletes?

15:38: Are athletes anatomy different? Can you extrapolate your research and results in athletes to non-athletes?

18:06: Is ACL surgery easy? What are the 7 steps to the perfect ACL Reconstruction? What ACL Graft options do you consider and when?

24:14: How much data do you need to change your practice?

28:35: MCL injuries... should be be treating them surgically?

32:40: What is your non-operative MCL Rehab protocol and why?

35.20: What are the lessons that you've learned from professional sports?

40:46: The importance of having the right team, how to set-up a team and how do you choose your colleagues? How do you choose your physios?

46:45: The importance of being a perfectionist

47:50: Rehab prescriptions and what do muscles do? The importance of doing the basics really well.

50:30: The importance of psychology in sports

52:00: Any advice for trainees for how to optimise our training, adopt a winning mentality and become top surgeons?

Mr Nev Davies (Reading, UK) is a consultant knee surgeon who has championed injury prevention through SKIPP Charity's Power Up To Play national campaign. In this episode we discuss the role of injury prevention and what we can do to reduce the incidence of young adult knee injuries.

Link to the charity here: https://poweruptoplay.org

We feature Professor Sandeep Patwardhan (Sancheti Hospital, Pune, India) who is the Vice-President of the Paediatric Orthopaedic Society of India. He has a wealth of experience in managing children with trauma and orthopaedic conditions. In this episode we cover:

Public vs Private Healthcare in India: 01:06

MSK Infections in Children: 07:30

DDH: 18:35

SCFE: 20:35

Perthes: 30:55

Clubfoot: 35:55

Tumours: 41:25

Training the next generation: 42:55

Professor Heather Vallier (Case Western Reserve University, Cleveland, Ohio) is the 36th President of the Orthopaedic Trauma Association (OTA) and the first ever female President. She is well known in the world of orthopaedic trauma and has been instrumental in several leading publications within this field. In this podcast we discuss the importance of recognising psychological trauma and how this is both cost effective and improves patient outcomes. We discuss the evolution of trauma care including early appropriate care, predictive modelling and clinical grading systems. We also discuss several METRC studies which have shaped trauma practice in recent years. 

Professor McNally (Oxford, UK) has been an influential force in the world of fracture related infections. This episode highlights some of the key points we should all be aware of when managing orthopaedic patients with bone infection. 

Ms Deepa Bose (Birmingham, UK) discusses the indications for using tibial nails and circular frames. We also discuss the management of infected tibial nails. 

Mr Mike Walton (Wrightington, UK) is an experienced shoulder surgeon with a vast experience in treating high performance athletes. We speak through his mantra for managing patients with injuries to the shoulder girdle. 

We speak with Mr Quick (Peripheral Nerve Injury Unit, Stanmore) about the management of peripheral nerve injuries. 

Professor Gwilym (Oxford, UK) discusses the optimal management of humeral shaft and proximal humeral fractures. We also discuss the HUSH and FISH trials. 

We sat down with Professor Lyndon Mason (Liverpool) to discuss the optimal management of calcaneal fractures and ankle fractures. Prof Mason dispels commonly held myths in this high yield episode. 

We invite Professor Cobb back to discuss the latest in surgical education with particular focus on arthroplasty surgery. Questions include:

- How has hip arthroplasty practice changed globally in the last 20 years?

- How this compares to UK practice and explanations behind the difference?

- Which practice is more effective and which is more cost-effective?

- Is there a large learning curve to direct anterior approach and if so how can it be mitigated?

- How does cognitive task analysis, virtual reality and team simulation address this?

Professor Justin Cobb (Imperial College London) speaks with us about approaches to the hip joint, patient reported outcome measures and the outcome of arthroplasty surgery. Specific points we cover are:

- When trying to determine the outcome is between different hip approaches, can we rely on patient reported outcome measures? 

- What is the ceiling affect of patient reported outcome measures?

- Are walking speed and gate potentially outcome measures?

- Does the approach to the hip matter? 

- Does implant choice matter and why?

- Who stands to potentially benefit the most from the direct anterior approach?

We speak with Professor Sébastien Lustig (Lyon, France) about the latest evidence surrounding dual mobility hip replacements. This high yield 20 minute episode covers a range of questions including:

How do dual mobility hips differ from convention?

Are there still concerns about loosening with dual mobility because of forces at bone-implant interface?

What was the evolution of implant design in dual mobility hip replacements and what was the rationale for changes?

Is the clinical range of movement less?

What are your indications for use in a primary THA?

Do dual mobility implants help in the revision setting?

Is the placement of the cup less critical in dual mobility THAs?

There has been an evolution in design over the years, what is next for dual mobility?

Mr Aresh Hashemi-Nejad (Royal National Orthopaedic Hospital) joins us to discuss the common pathologies affecting the young adult hip. We cover:

- What are the sites of hip pain in the adolescent hip & do they differ from adult arthritis?
- What clinical features are indicative of underlying hip deformity?
- What makes a good X-Ray of the Hip?
- What are your tips for a good arthrogram?
- What are the different surgical options for achieving hip congruency?
- What are the long-term outcomes of Adolescent hip reconstruction?
- Should one be mindful of the future need for a THR?
- What is the role of non-arthroplasty intervention in the young adult hip?

Mr. Matthew Wilson (Exeter Hip Unit) speaks with us about the important relationship between the spine and the pelvis when performing total hip arthroplasty. In this engaging talk he breaks down the complexities of this subject into very easy to digest core knowledge which we hope will be beneficials for all of our listeners. This is a great episode and we're really excited to bring it to you. 

Dr Louis Koizia (Imperial College London) is a consultant physician and geriatrician with a specialist interest in the medical management of older surgical patients. In this episode he discusses the pre, peri and post operative care for these patients - and what evidence supports these strategies. 

We speak with RSM Orthopaedic Section President Mr Michael Pearse (Imperial College London) about the management of fractured neck of femur patients. We cover the evidence and best practice guidelines. 

Professor Cecilia Rogmark (Lund University, Sweden) is featured on the podcast. She has an extensive experience in managing patients with hip fractures and has published widely in the field. In this episode we discuss hip fractures in younger patients and the HFU-60 trial. 

Mr. Khaled Sarraf (Imperial College London and The Cromwell Hospital) speaks with us about how we can differentiate between infection or inflammation in the paediatric hip. 

Professor Deborah Eastwood (Great Ormand Street Hospital and Royal National Orthopaedic Hospital) speaks with us about late developmental dysplasia of the hip. 

Mr Greg Firth (Royal London Hospital) speaks with us about Perthes and the Neurological Hip. A great episode that covers these important concepts. 

Professor Dan Perry (NIHR Research Professor) speaks with us about developmental dysplasia of the hip, slipped capital femoral epiphysis and paediatric trauma trials. In this engaging and high-yield episode, he describes all the important factors we should be aware of in these common paediatric orthopaedic conditions. 

We speak with Professor Matt Costa (Oxford, UK) about the importance of research in orthopaedics. Is it still important for trainees? How can you get involved? What are the tips and tricks? This lively discussion also covers his own path into pursuing an academic orthopaedic career. A great episode that helps demystify the world of academic orthopaedics. 

We speak with Professor Bert Perey (Vancouver, Canada) about the WRIST trial. We discuss the implications of it's findings and the follow-up studies that may also change practice in the management of distal radius fractures. This lively discussion covers the latest evidence and how to apply it to the patients being treated. 

Mr. Lee Van Rensburg (Cambridge, UK) takes us through elbow trauma including how to keep the elbow stable, tips and tricks for managing the unstable elbow, when to fix or replace a radial head fracture and how to avoid stiffness after elbow trauma. This in-depth discussion covers the evidence and rationale behind different treatment strategies to improve patient outcomes following elbow trauma. 

Mr. Jamie Nicholson (Edinburgh, UK) provides us with the latest evidence in the management of clavicle fractures. This is a very detailed discussion that covers all of the key papers and decision making algorithms employed in their unit.  

Mr. Michael Pearse (Imperial College, London & President-Elect of the RSM Orthopaedic Section) is no stranger to managing patients with significant bone loss and open fractures. He established one of the first orthoplastic centres in the 1990s and has a breadth of experience in improving patient outcomes. This podcast episode will given the listener a detailed insight into how to approach these injuries.

Professor Robert O'Toole from the SHOCK trauma centre in Baltimore joins us to discuss the results of the FIXIT Study. This was a Prospective Randomized Trial to Assess Fixation Strategies for Severe Open Tibia Fractures: Modern Ring External Fixators Versus Internal Fixation. We also discuss his experience in managing open fractures in the tibia. 

Mr. Fergal Monsell (Bristol, UK) takes us through how to manage open fractures in kids. He also discusses the paediatric trauma network and what he thinks will be the next big thing to improve outcomes for patients. 

Fergal Monsell has been a Consultant Paediatric Orthopaedic surgeon at the Royal Hospital for Children Bristol since 2005.

He has a broad-based practice with a special interest in the management of patients with congenital limb abnormally and deformity following trauma and septicaemia. He is active in all aspects of paediatric trauma.

He is involved in education at all levels, is Visiting Professor at Cardiff University, Director of the Avon Centre for Musculoskeletal Education and Projector at the Grand Academy. He has an active clinical and basic science research portfolio and is widely published.

Mr. James Hunter (Nottingham, UK) discusses the FORCE, CRAFFT and SCIENCE studies. What are these trials? What should we know about them? And should these change our practice? We also discuss his role as the GIRFT (Get-It-Right-First-Time) paediatric orthopaedic lead for England. 

We speak with Ms Anna Clarke and Mr. Martin Gargan (Bristol, UK) who highlight several important tips, tricks and traps in managing paediatric patients with upper limb and lower limb injuries. This high yield episode is a must listen for any orthopaedic surgeon involved in treating children. 

In episode 12, we speak with Mr. Abtin Alvand (Oxford) who is an expert in treating patients with prosthetic joint infections (PJI). He delivers a powerful and comprehensive review of everything from identifying PJI to the management options. He also speaks about what the future holds in what some consider to be the 'next frontier' in arthroplasty surgery. 

We cover the following questions:

1.  What are the main methods for prevention of peri-prosthetic joint infections?

2.  Have we solved the problem of diagnosing infection?

3.  Should revision arthroplasty be a one or two stage procedure?

4.  What is the role of plastic surgery in revision knee arthroplasty?

5.  What advances do you see in the field of prosthetic joint infections?

Mr Abtin Alvand is a Consultant Orthopaedic Knee Surgeon in Oxford who undertook specialist clinical fellowships in complex hip and knee surgery in Oxford and Stanmore before completing a Fellowship focusing on peri-prosthetic joint infection at the Rothman Institute (Philadelphia, USA) with Professor J Parvizi. Abtin has an unrivalled experience in the management of peri-prosthtic joint and he is a member of the International Consensus Group for the management of peri-prosthetic joint infection and he also sits on the UK Revision Knee Surgery and Peri-prosthetic Joint Infection Working Groups. Abtin also has an interest in simulation-based training methods for teaching and assessing surgical skills.

We discuss revision knee surgery with Mr. Peter James (Nottingham).

Peter James is a consultant surgeon in Nottingham who undertakes a large number of hip and knee replacement operations each year both in the NHS and privately at the Park Hospital and has developed a national and international reputation for revision and complex knee replacement. He has particular expertise and experience in high performance knee replacements for active patients and difficult revision knee surgery. In September 2010 he was recognised by his peers as being amongst the UK’s top knee replacement surgeons in a survey conducted by the Daily Mail.

Questions that we cover include:

1.  Is some pain almost inevitable after TKR and how do you assess the painful TKR?

2.  Should revision TKRs be done at specialist centers and what have we learnt from the NJR?

3.  What are the key surgical steps in revision TKR and is there a role for robotics?

4.  Do you think robotic assisted surgery will reduce revision TKRs?

5.  What advances do you anticipate in the field of revision TKRs?

In this episode we cover knee osteotomy surgery and joint preservation with Mr. Matthew Dawson. 

Matthew Dawson is one of the leading authorities on osteotomy surgery in the UK and he is a founder member of the Osteotomy Expert Group. Mr Dawson is a strong advocate of the principle of joint preservation in order to prolong knee activity and knee function to the highest level. He launched the annual Northern Osteotomy Masterclass. in June 2015 and he is a founder member of UKKOR, the world’s first national osteotomy registry. He is the current chair of ESSKA’s Osteotomy committee.

Questions that we cover include:

1.  Is there an age or functional cut off for knee osteotomy and what pre-operative tests are essential?

2.  Is osteotomy ever a temporary solution?

3.  What are the recent technical advances in osteotomy surgery?

4.  What are the key intraoperative steps?

5.  How do you rehabilitate your patients?

Mr. Alex Liddle (Imperial College) discusses how we can improve outcomes in Total Knee Replacement surgery.

Mr Alex Liddle is a Clinical Senior Lecturer in Orthopaedic Surgery at Imperial College whose principal interest is in the improvement of joint replacement surgery through the use of big data and new technologies. He previously undertook a DPhil (PhD) at the Univeristy of Oxford before becoming NIHR Clinical Lecturer at University College London, based at the Institute of Orthopaedics and Musculoskeletal Sciences at the Royal National Orthopaedic Hospital.

Mr. Henry Bourke (Heatherwood and Wexham Park Hospitals) discusses knee ligament injuries including:

Henry Bourke completed fellowships at the North Sydney Orthopaedic and Sports Medicine Centre and The Park Clinic in Melbourne before becoming a dedicated knee consultant at Heatherwood & Wexham Park Hospitals in 2013. Appointed on the retirement of Robin Allum, Henry inherited an established knee ligament practice. He has quickly gained extensive experience in all aspects of ligament repair and reconstruction including a growing series of complex multi-ligament knee injuries. Henry is the Director of the renowned Wexham Park International Cruciate Ligament Meeting.

01:33: How to approach patients with acute ACL tears compared with chronic ACL tears

04:57: Why he selected his preferred technique for ACL reconstruction

07:00: Is success dependent on rehabilitation?

08:24: What are the key features of managing multi-ligament injuries?

11:34: What does the future hold for knee ligament surgery?

In this episode we discuss meniscal and chondral knee injuries with Mr. Tim Spalding. 

Tim Spalding is a renowned Consultant Orthopaedic Surgeon based at the University Hospitals Coventry whose expertise includes autologous chondrocyte transplantation as well as an unrivalled experience in meniscal transplantation. He is also one of the lead developers of the National Ligament Registry.

Questions:

00:46: Introduction

01:24: How do you approach a patient with a meniscal tear? 

03:06: What is the rule of fours?

04:21: What do you tell the athletic patient with a meniscal tear in clinic?

05:31: What are the technical considerations for performing meniscal repair?

07:21: How do you diagnose a meniscal root tear?

09:01: Who are the main beneficiaries and what is the cost effectiveness of meniscal transplantation?

12:51: How would you summarise meniscal surgery?

13:01: Articular cartilage from aetiology to management of injuries

15:21: NICE Guidelines on ACI vs microfracture including the cost effectiveness

Mr. Raj Bhattacharya (Imperial College Healthcare NHS Trust, London, UK) discusses the Royal Society of Medicine Trauma Symposium and his vision during his tenure as president of the Trauma and Orthopaedics section of the society. 

All views expressed in this podcast are of the speakers themselves and not of the RSM. Produced by the Orthopaedics Section Council at the RSM. Join in the conversation #RSMOrtho

Mr Bob Handley (Oxford University, UK) discusses Getting It Right First Time (GIRFT) and its importance in Trauma and Orthopaedics.

All views expressed in this podcast are of the speakers themselves and not of the RSM. Produced by the Orthopaedics Section Council at the RSM. Join in the conversation #RSMOrtho

We discuss the latest VTE Guidelines, resuscitation in trauma and optimal hip fracture care with Professor Xavier Griffin (University of Oxford, UK)

All views expressed in this podcast are of the speakers themselves and not of the RSM. Produced by the Orthopaedics Section Council at the RSM. Join in the conversation #RSMOrtho

We discuss the topics of elbow instability and elbow replacement surgery in trauma with Professor Dr. Roger van Reit (AZ Monica, Belgium) 

All views expressed in this podcast are of the speakers themselves and not of the RSM. Produced by the Orthopaedics Section Council at the RSM. Join in the conversation #RSMOrtho

Discussions with Dr. Bill Ricci (Hospital for Special Surgery, USA) regarding peri-prosthetic femoral fractures. 

All views expressed in this podcast are of the speakers themselves and not of the RSM. Produced by the Orthopaedics Section Council at the RSM. Join in the conversation #RSMOrtho