Issue: July 2016
July 08, 2016
4 min read

European physicians seek consensus on perioperative TJA management issues

Experts will meet for the second time to gain consensus, further evidence on topics related to lower limb arthroplasty.

Issue: July 2016
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The European Consensus Group, which consists of orthopaedic surgeons focused on lower limb arthroplasty and other physicians, including anesthesiologists and internists, are scheduled to meet from September 22-23, 2016 in Brussels to discuss preoperative drug optimization, blood management and transfusion, deep venous thrombosis and its prevention, wound management, anesthesiology techniques, and pain and pain treatment in total joint arthroplasty of the lower limbs.

Meeting organizers hope attendees will come to consensus on some of these topics when they meet, so that objective data of some kind are available in areas in which these are now lacking.

The meeting is intended for total hip and total knee replacement surgeons, as well as anesthesiologists and other physicians who are involved in these procedures. Last year, about 150 people attended the initial European Consensus Group meeting. Therefore, organizers hope those numbers will reach 300 in a short time.

Emmanuel Thienpont, MD, MBA
Emmanuel Thienpont

“Then it becomes representative,” Emmanuel Thienpont, MD, MBA, one of three congress chairmen, told Orthopaedics Today Europe.

The other two chairmen are C.M. Samama, MD, of Paris, who is an anesthesiologist, and orthopaedic surgeon Andrea Baldini, MD, PhD, of Florence, Italy.


The format of the 2-day meeting involves experts who present the available evidence on the selected topics for the meeting and then there is subsequent discussion among panelists and attendees about each topic.

“There is always a lot of time for discussion,” Thienpont said.

The program shows between 30 minutes and 40 minutes of discussion is allowed for some topics. Once all of the attendees’ questions are answered, each topic is voted on, he said.

When 66% and 100% of attendees — or a super majority — vote in favor of a particular practice or technique, Thienpont and other meeting organizers consider that strong consensus. They consider it a simple majority when 59% of attendees vote in favor of a topic. It is a majority when 60% to 65% of attendees vote in favor of a topic, but it is a weak consensus.

Whenever the vote is unanimous, “we consider that a guideline for our practice in the future,” said Thienpont, who is an Orthopaedics Today Europe Editorial Board member.

“This is a meeting where everyone discusses and gets up and gives their opinion,” he said.


The plan is for topics that do not gain consensus in 2016 to be revisited at next year’s meeting because, as Thienpont noted, a new study with key data may come out which may foster or allow consensus to be reached.

Preoperative drug optimization is one topic that was on the program for the 2015 consensus meeting that also appears on this year’s program. Thienpont said the orthopaedic community still seeks resolution on the topics in that category, such as the use of immune modulating drugs, cortisone and oral anticoagulation for atrial fibrillation, as well as how to manage anticoagulants used in the patients who bleed or undergo emergency surgery.

According to Thienpont, all of the topics that will be addressed at the September meeting are important, but he expects the most discussion and interaction will be related to the deep venous thrombosis (DVT) topic, which is scheduled to be addressed in the afternoon session on Thursday, September 22. Among the DVT and DVT prevention subtopics are why arthroplasty patients develop DVT, when DVT prevention is not needed, and aspirin, low molecular-weight heparin and oral anticoagulants as DVT prevention modalities. Each subtopic will be presented by a different expert.


Wound closure at issue

Henrik Husted, MD, DMSc, PhD, of Copenhagen, Denmark, is an invited speaker for Friday, September 23 on the topic of the best types of wound closure and bandaging, and whether drains are needed in total joint arthroplasty (TJA).

“This is an ongoing debate” about the practice of using drains in TJA, Husted told Orthopaedics Today Europe.

He is also moderating the blood management and transfusion session which will be held Thursday morning.

“The general idea with this type of meeting is try to find [and] establish a consensus on the more difficult topics,” the ones for which it is difficult to easily say one practice is more effective than another, Husted said.

Henrik Husted, MD, DMSc, PhD
Henrik Husted

“It is level 4 evidence where you have the experts agreeing,” as is the case at a meeting like this, he said, but this is a starting point.

“We are trying to identify the relevant clinical questions we are all dealing with; the difficult patients or the difficult problems, and then we are trying to get some form of consensus,” Husted said.

The ultimate goal of the meeting is for there to be strong consensus on a topic and for that information to eventually be published in a study after the meeting, he said.

Thienpont said the intent of the European Consensus Group involves a process and it will take time to get a sufficient number of the right people to attend the meetings and to want to vote on these topics. He said the group is considering holding a symposium at the European Federation of National Societies of Orthopaedics and Traumatology Congress in 2017 in Vienna to interest even more orthopaedists in attending future consensus meetings. – by Susan M. Rapp

Disclosures: Husted reports he is a paid consultant to Zimmer Biomet for Rapid Recovery. Thienpont reports no relevant financial disclosures but is an advisor on the Rapid Recovery board for Zimmer Biomet, which is a sponsor of the meeting.