OA Surgery - Explained by Mr John Hardy a UK Arthritis Consultant

www.JohnHardy.co.uk

		Literature Want to know more about a particular problem or solution to that problem? Please navigate the pages below to learn more..... Joints Joint Pain Keyhole Surgical Techniques Cartilage Repair - Mosaicplasty Cartilage Repair - ACI/MACI Arthritis Finger Joint Replacement Gout Prevention of Arthritis Mini-incision surgery for Knee Replacement Prevention of Infection Knee Ligament Reconstruction Minimally Invasive Surgery Extra-corporeal Shockwave Lthotripsy for Calcific Tendonitis (Mr Hardy does not recommend this as there is little evidence for its efficacy over conservative or surgical methods of treatment). Guidance on selection of hip prosthesis Metal on Metal hip replacement Hand Injury Carpal Tunnel Syndrome Cubital Tunnel Syndrome Dupuytrens Disease Dupuytrrens Disease - Needle fasciotomy (Mr Hardy says that this is a good stopgap for those patients who present late with inoperabable contractures to prepare the hand for formal excision of the Dupuytrens fascia at a later date). Trigger Thumb Trigger Finger Joint replacement for CMCJ Thumb - NICE guidelines Sports Injuries Quadriceps Tendon Rupture This is a new radiological sign to prevent Quadripceps Tendon Rupture being missed by inexperienced A&E officers. Patella Dislocation in Athletes 5% of all patella dislocation are associated with an osteochondral fracture that is easy to miss on x-ray to the detriment of the athlete as early repair has a good prognosis and late recognition a bad one. Extracorporeal Shockwave Therapy for Tendonopathy such as Achilles Tendonitis (NICE has decided that there are still uncertainties about whether the procedure works). The Footballers Fracture A demographic study of the largest series of fractures in footballers managed by Mr Hardy ever published with a commentary by Steve Bollen editor of the British Journal of Sports Medicine. Trauma Dynamisation of Tibial Fractures When a patient needs to be treated with an External Fixator dynamisation results in beneficial changes in both cyclic movement progressive closure. Fracture Stiffness This is one of the only two objective measures of fracture healing that Orthopaedic and Trauma surgeons have to assess when a patient has healed and is match fit. Callus Index and NSAIDS A small prospective randomised study that suggests but does not prove that NSAIDS have a beneficial effect on intramembranous fracture healing. Fracture Stiffness Measurement Quantitative measurement of fracture healing is more accurate than qualitative measurement as long as the technique is performed properly. Salvaging Stripped Drive Connections This is a technique to get an Orthopaedic and Trauma Surgeon out of trouble when removing metal ware. Tibial Fracture Stability This research looks at the influence of fixator type on the amount of micromovement at the fracture site. Tibial Fracture Movement During Normal Activity This research looked at the micromovement that was taking place at the fracture site with normal patient activity. Why does your surgeon loosen your fixator after 6 weeks? You have broken you shin in a football match and the surgeon has recommended one of the new lightweight disposable fixators. At about 6 weeks the surgeon will loosen part of the fixator to speed up healing. Here is the science behind why. Bone Grafting Your surgeon has recommended you have a bone graft procedure. This may be part of a bigger operation. It may also be one of a number of types of bone graft: 1.Autograft: This means the bone that comes from another part of yourself and be used on you to strengthen your own bone. 2.Allograft: This means that the bone will come from another patient to be used to strengthen your own bone. 3.Xenograft: This is graft from another species that is used to strengthen your own bone. Management Anaesthesia Many operations are usually carried out under general anaesthesia as a day-case procedure. As a team Dr Coates, Consultant Anaesthetist and Mr Hardy, Consultant Orthopaedic and Trauma Surgeon offer an appropriate anaesthetic and good pain relief. Smoking Patients who smoke do not just risk lung diseases. There is plenty of evidence that smoking delays fracture healing following scaphoid fracture, open tibial fracture, compound fractures, osteotomy of the forearm and shin bone fractures. Happily, if you stop smoking then fracture healing is improved according to a Finnish study. So if you are a smoker and are about to undergo Orthopaedic or Trauma Surgery then stop and use the excuse to give up or accept the increase risk of complications. NHS Waiting Lists Given the finite resources in the NHS 83% of patients would prefer to see a Consultant and go on a waiting list than wait to see a Consultant but have the opportunity to be operated on rapidly. Copying Letters to Patients Mr Hardy subscribes to these good Practice Guidelines. A copy of every letter he sends to a General Practitioner is also sent to the patient following consultation. As a result of this policy Mr Hardy believes he and his patients are rewarded with improved consultations, better understanding of treatment options and the chance to correct genuine mistakes in health records. Accuracy of Digital Image Analysis Digital image analysis of radiographs is 20 time more accurate than the human eye. Shaving with Static Electricity Mr Hardy has used this is a simple technique for reducing the risk of postoperative wound infection in the operating theatres for years. Osteoporosis Fracture Reduction - Technical Tips Mr Hardy says that this is the technique he teaches on the Basic Surgical Skills courses he runs in Bristol and London for surgical trainees in Foundation years 1-2. Private Medical Insurance Inflation on corporate health plan costs rose on average 5% in 2007 compared to an average of 3% in 2006 - the lowest it has been for more than two decades - according to analysis by Mercer Human Resource Consulting, the UK’s largest pay and benefit consultancy and services provider. Despite this drop, many insurers are still applying inflation rates of as much as 10% to the calculation of companies’ annual healthcare premiums. Surgical & Anaesthetic Fees Mr Hardy follows best practice in that his contract of duty of care and fees are with his patients (and not with any third party insurer). Click on the link above for his fair and reasonable fees for 2009. The table is based on the OPCS-4.5 classification which is mandated for implementation on 1 April 2009 by the NHS and system suppliers. These fees have increased in line with the same inflationary pressures that have guided the subscriptions for PMI noted above. Having discussed treatment options with Mr Hardy please telephone for a date for surgery and a letter confirming the fees.His secretary will send you a Surgical Fees Letter. Please check whether there is a difference between the amount you will receive from your insurer according to the policy you have taken out and the surgical and anaesthetic fees quoted. Should you have a short fall in fees please discuss with him the insurer you are with, the nature of your cover and your personal circumstances before making a decision. Mr Hardy will be happy to transfer the notes and investigations to the surgeon of your choice should the difference in fees and your insurer's remuneration be substantial. Private Health Care Private medical insurance is a mine field. The largest section of growth is in the self pay market. If you want insider information on the biggest players in the market place or are fed up with the standard of your cut price managed care package and want cover as a high net worth client it is worth asking your Personnel Manager to browse the link above. Prevention of Infection With governments clamoring to reduce the impact of bacterial infections like MRSA and Clostridium difficele on expenditure and the increasing risk of cross infection of blood born virus Mr Hardy is pleased to announce a development in the reduction of cross infection in surgey that will make a difference.... Showering With Sutures Many of John Hardy's patients ask about showering after surgery with sutures in the wound. Mr Hardy has reviewed the evidence and recommends that there is no additional risk of infection after his operations if you choose to shower. Click here for a full list of Mr Hardy's publications including the references of some of the literature above.
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