28/09/2024
FROM JAVAD PARVIZI MD: Last week the inaugural meeting of World Experts in Arthroplasty concluded in Istanbul. Thanks to the Executive and Organizing Committee the meeting was a resounding success. More than 500 experts travelled from 92 countries to debate 64 controversial topics in arthroplasty. There was an immense energy throughout the two days and we all learnt from each other. Thanks to Acibadem Health Group for providing the generous support for the meeting.
There were my takeaways:
1) The patients and surgeons around the globe face the same issue. The solution will not come from one institution or one country but from the cumulative wisdom and energy of every dedicated scholar from around the globe
2) We have evidence for many of these controversial issues and we should put those to rest. Examples:
o There is no need to use surgical drain after routine primary arthroplasty (85% agreement)
o Tranexamic acid should be administered to ALL patients (except those with allergy to the drug) undergoing TJA (97% agreement)
o Aspirin is an effective agent against VTE after TJA (85% agreement)
o Patients should be weight bearing when obtaining preoperative radiographs (90% agreement)
o Intravenous steroids (dexamethasone) should be administered to all patients undergoing TJA (90% agreement)
o Intravenous heparin should NOT be administered to patients undergoing TJA (94% agreement)
o Urinary catheter should not be routinely used for patients undergoing TJA, even in patients receiving regional anesthesia (85% agreement)
o Patellar resurfacing (vs not resurfacing) does not affect the outcome of primary TKA (83% agreement)
o The use of ceramic femoral head reduces the incidence of ALTR in primary THA (90% agreement)
o The use of robotics does NOT improve the outcome of primary THA (91% agreement)
and many others.
3) We must stop practicing eminence based medicine. We are in desperate need of evidence for some controversial topics.
o Do robotics increase the risk of complications during TJA
o Does outpatient TJA improve outcome for patients
o Should hardware be removed concurrently or staged for patients undergoing conversion TJA
o Should patient activity be restricted after routine primary TJA
o Is there a difference in outcome of UKA when mobile versus fixed bearing is used
o What factors determine the use of tibial stem during primary TKA
o Does evidence support the use of all polyethylene tibial component during primary TKA
o Is there a difference in the outcome of primary TKA when mechanical versus kinematic alignment is used
o What non-arthroplasty options are available for patients with early stage osteonecrosis of femoral head
o What are the indications (and outcome) for modern hinged prosthesis in patients undergoing TKA
Mohit Bhandari with his inspirational speech energized us all to get to work. Under his erudite leadership a global research workforce will be assembled to generate the needed (and unbiased) evidence. LET'S GO
