Orthopaedic innovation

Orthopaedic and trauma care has always been subject to new ideas and approaches to care. Those who first saw the Thomas' Splint being used when someone was injured during the building of the Manchester Ship Canal in the late 1800s  would have been amazed by its simple design and potential to save both limb and life. Innovation does not, however, always begin in the places we would traditionally expect it to. Circular external fixator devices are still a relatively new innovation in the treatment of fractures, limb reconstruction and limb lengthening in most parts of the world. This is surprising given the relative simplicity of the idea that a frame made from circular rings, connected to rods and per cutaneous wires, can provide a much more stable frame and better bone healing and regeneration than other types of fixator. one of the Professor  had been experimenting with external fixation designs and distraction osteogenesis in Kurgan, Western Siberia since the 1950s, but it was only in the 1980s that it became known and was used elsewhere. The evidence of the benefits for this approach to skeletal stabilization and osteogenesis continues to increase but debate about its disadvantages also linger.

Innovation usually aims to make healthcare delivery more effective, more efficient, safer, cheaper or more sustainable, with benefits to patients through enhancement of life expectancy and improvement in quality of life. A well-known example of this in orthopaedic surgery is the total hip replacement (THR). Pioneered by one of the professor in the 1960s (although the development process was begun by other innovators decades earlier), the procedure is considered a major success in the improvement in quality of life for suffers of arthritis. THR is now one of the most commonly performed surgical procedures. Such product innovation is often driven by science and technology, through trial and error and through experimentation. Sometimes it is driven by industry's desire for profit and, often, by clinicians for the benefit of their craft, but mainly for the benefit of patients. A few weeks ago I heard about a new approach to THR which both surprised and delighted. we heard that it uses a relatively small incision and preserves the muscle and ligaments which provide stability to the hip joint. The surgery is performed without dislocating the joint. What seemed important  at the time was that this meant that patients could walk within a few hours of surgery  and that the ‘hip precautions’ we associate with caring for the patient following THR are deemed unnecessary because risk of dislocation is reduced. This significantly challenged any view that the journey commenced by professor had all but reached the end of the innovation road and that hip replacement surgery was likely to change little in the coming decades. This new approach, then, seems to have the potential to change the way post-operative care is provided, allowing patients to recover and go home even more quickly than they do already.

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