From OT Europe

Experts at 18th EFORT Annual Congress to focus on septic defects and small implants

EFORT

Are you challenged by the need to achieve bone healing in an infected environment or, as a knee surgeon, do you have to evaluate the different types of knee replacement surgery that are possible for every patient? If so, two Interactive Expert Exchange (IEE) sessions at the upcoming EFORT Congress in Vienna will provide a deeper understanding of these topics and present various options for the orthopaedic surgeon’s daily practice.

Vienna Congress banner

Septic Defects and Nonunions | Thursday, 1 June 2017 | 10:15 to 12:30

Introduction & Conclusions: Konstantinos Malizos (Greece)

Questions & Presentations

  • Alternatives in the Management of Septic Nonunions and Septic Defects | Konstantinos Malizos (Greece)
  • Indications & Limitations of the Masquelet Technique | Thierry Bégué (France)
  • Indications and Limitations of the Ilizarov Concept | Christof Wagner (Germany)
  • Megaprosthesis in the Septic Defects and Nonunions | Giorgio Maria Calori (Italy)

Discussion on Clinical Cases

Skeletal defects after resection of infected bones or septic nonunion constitute a great challenge for both the patient and the physician. On one hand, the patient will be engaged in a long-lasting treatment and rehabilitation program and, on the other hand, as there is no treatment that has 100% success, the surgeon must wisely choose among several treatment alternatives to successfully eradicate the infection and achieve bone healing. Radical surgical debridement remains the first and most crucial step, followed by the stable coverage of the defect with well-vascularized soft tissue. Autologous bone grafting is the “gold standard” because of its osteoconductive and osteoinductive potential, but is not adequate for all size defects.

Therefore, alternative techniques, like distraction osteogenesis or the Masquelet procedures, will be required. Moreover, depending on the patient’s general health status, the size and the location of the defect and the local tissue conditions, each treatment could be carried out in one or more surgical stages. Successfully eradicating the infection involves also the identification of the bacteria responsible for the sepsis and the use of antibiotics both systemically and locally (via carriers, appropriate resorbable materials or bone substitutes).

This IEE will focus on the indications and limitations of different techniques, the indications for prosthetic implants and will also address the complexity of the whole problem and the need for meticulous planning of all management steps.

Small Implants Update | Friday, 2 June 2017 | 10:15 to 12:30

Introduction & Conclusions: Emmanuel Thienpont (Belgium)

Questions & Presentations

  • The Medial Unicompartmental Arthroplasty | Francesco Benazzo (Italy)
  • The Lateral Unicompartmental Arthroplasty | Jean-Noël Argenson (France)
  • The Bicompartmental Arthroplasty | David Stuart Barrett (United Kingdom)
  • The Patellofemoral Arthroplasty | Jonathan Eldridge (United Kingdom)

Discussion on Clinical Cases

Much controversy remains concerning the optimal treatment for bone osteoarthritis of the knee. The choice among high tibial osteotomy, medial unicompartmental knee arthroplasty (UKA) or total knee arthroplasty depends on cultural habits, surgical expertise with one or the other technique, the choice of the patient and the bias of the patient’s surgeon. A risk analysis based on the age and weight of the patient, the functional outcome desired, the expectations of the patient, the comorbidity and the possible complications are necessary to consider in each case. The quest for better results has led to resurfacing techniques that indeed limit the anatomical changes within the joint, but these can expose the surgeon to more dilemmas and issues. Whenever UKA is considered, many questions arise. What is the condition of the remaining compartments of the knee? Will this patient develop arthritis in those other compartments and need further surgery? Is the bone solid enough to bear the unicompartmental implant? Will the remaining deformity lead to bone overload? Am I, as a surgeon, capable of executing the right cuts in all three planes with a smaller margin of error because of the smaller surfaces of fixation?

Revision rates after UKA are three-times higher because of aseptic loosening, disease progression, instability or unexplained pain. Moreover, one-third of revisions after UKA need stem or wedge augmentation. Preference for UKA should not only be linked to the pursuit of a faster recovery, but also to a better functional outcome. Therefore, keeping healthy parts of the knee should always be considered as an option worth considering.

Finally, new implants and new technologies like navigation and robotics should help surgeons avoid outlier mistakes during bone cuts and offer reproducibility to younger surgeons.

During this IEE, participants will be questioned about the options they face and their reasons for a specific choice to initiate a large exchange among the colleagues in attendance about all considerations in primary UKA and UKA revision, as well as about the key points in the patient’s functional profile.

IEE banner Vienna

The interactivity of the IEE sessions allows a deep analysis of complex situations, which are both challenging and difficult to treat. Diverse approaches, medical choices and specific solutions will emerge from shared expertise to help specialists and senior practitioners improve their daily practice.

The IEEs are paying sessions and preregistration is mandatory up to a maximum of 80 participants on a first-come, first-serve basis. IEE sessions may be attended only if the participant is already registered for the congress. All details to sign-up for any of these sessions are available on the EFORT Congress registration platform.

EFORT

Are you challenged by the need to achieve bone healing in an infected environment or, as a knee surgeon, do you have to evaluate the different types of knee replacement surgery that are possible for every patient? If so, two Interactive Expert Exchange (IEE) sessions at the upcoming EFORT Congress in Vienna will provide a deeper understanding of these topics and present various options for the orthopaedic surgeon’s daily practice.

Vienna Congress banner

Septic Defects and Nonunions | Thursday, 1 June 2017 | 10:15 to 12:30

Introduction & Conclusions: Konstantinos Malizos (Greece)

Questions & Presentations

  • Alternatives in the Management of Septic Nonunions and Septic Defects | Konstantinos Malizos (Greece)
  • Indications & Limitations of the Masquelet Technique | Thierry Bégué (France)
  • Indications and Limitations of the Ilizarov Concept | Christof Wagner (Germany)
  • Megaprosthesis in the Septic Defects and Nonunions | Giorgio Maria Calori (Italy)

Discussion on Clinical Cases

Skeletal defects after resection of infected bones or septic nonunion constitute a great challenge for both the patient and the physician. On one hand, the patient will be engaged in a long-lasting treatment and rehabilitation program and, on the other hand, as there is no treatment that has 100% success, the surgeon must wisely choose among several treatment alternatives to successfully eradicate the infection and achieve bone healing. Radical surgical debridement remains the first and most crucial step, followed by the stable coverage of the defect with well-vascularized soft tissue. Autologous bone grafting is the “gold standard” because of its osteoconductive and osteoinductive potential, but is not adequate for all size defects.

Therefore, alternative techniques, like distraction osteogenesis or the Masquelet procedures, will be required. Moreover, depending on the patient’s general health status, the size and the location of the defect and the local tissue conditions, each treatment could be carried out in one or more surgical stages. Successfully eradicating the infection involves also the identification of the bacteria responsible for the sepsis and the use of antibiotics both systemically and locally (via carriers, appropriate resorbable materials or bone substitutes).

This IEE will focus on the indications and limitations of different techniques, the indications for prosthetic implants and will also address the complexity of the whole problem and the need for meticulous planning of all management steps.

Small Implants Update | Friday, 2 June 2017 | 10:15 to 12:30

Introduction & Conclusions: Emmanuel Thienpont (Belgium)

Questions & Presentations

  • The Medial Unicompartmental Arthroplasty | Francesco Benazzo (Italy)
  • The Lateral Unicompartmental Arthroplasty | Jean-Noël Argenson (France)
  • The Bicompartmental Arthroplasty | David Stuart Barrett (United Kingdom)
  • The Patellofemoral Arthroplasty | Jonathan Eldridge (United Kingdom)

Discussion on Clinical Cases

Much controversy remains concerning the optimal treatment for bone osteoarthritis of the knee. The choice among high tibial osteotomy, medial unicompartmental knee arthroplasty (UKA) or total knee arthroplasty depends on cultural habits, surgical expertise with one or the other technique, the choice of the patient and the bias of the patient’s surgeon. A risk analysis based on the age and weight of the patient, the functional outcome desired, the expectations of the patient, the comorbidity and the possible complications are necessary to consider in each case. The quest for better results has led to resurfacing techniques that indeed limit the anatomical changes within the joint, but these can expose the surgeon to more dilemmas and issues. Whenever UKA is considered, many questions arise. What is the condition of the remaining compartments of the knee? Will this patient develop arthritis in those other compartments and need further surgery? Is the bone solid enough to bear the unicompartmental implant? Will the remaining deformity lead to bone overload? Am I, as a surgeon, capable of executing the right cuts in all three planes with a smaller margin of error because of the smaller surfaces of fixation?

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Revision rates after UKA are three-times higher because of aseptic loosening, disease progression, instability or unexplained pain. Moreover, one-third of revisions after UKA need stem or wedge augmentation. Preference for UKA should not only be linked to the pursuit of a faster recovery, but also to a better functional outcome. Therefore, keeping healthy parts of the knee should always be considered as an option worth considering.

Finally, new implants and new technologies like navigation and robotics should help surgeons avoid outlier mistakes during bone cuts and offer reproducibility to younger surgeons.

During this IEE, participants will be questioned about the options they face and their reasons for a specific choice to initiate a large exchange among the colleagues in attendance about all considerations in primary UKA and UKA revision, as well as about the key points in the patient’s functional profile.

IEE banner Vienna

The interactivity of the IEE sessions allows a deep analysis of complex situations, which are both challenging and difficult to treat. Diverse approaches, medical choices and specific solutions will emerge from shared expertise to help specialists and senior practitioners improve their daily practice.

The IEEs are paying sessions and preregistration is mandatory up to a maximum of 80 participants on a first-come, first-serve basis. IEE sessions may be attended only if the participant is already registered for the congress. All details to sign-up for any of these sessions are available on the EFORT Congress registration platform.