Surgeons begin orthopaedic profiling for hip and knee patients

Surgeons at Southampton’s university hospitals have pioneered an ‘orthopaedic profiling’ system to fit patients with the most effective hip or knee replacement.

Led by Jeremy Latham, a consultant hip surgeon at Southampton General Hospital, a team of clinicians, scientists and engineers set to work on patients who require revision surgery because their original replacements have failed.

But instead of just removing and replacing failed artificial joints, they run the materials through a series of unique laboratory tests to find out why a particular type of material has failed in an individual.

The development follows widespread concern in the last few years over the effectiveness of metal-on-metal hip replacements, with research suggesting that more than a quarter of some devices fail within five years.

“The last few years have been very difficult, particularly for patients with failing metal-on-metal hip replacements but, by looking in great detail at the reasons why they've gone wrong, we hope, in the future, to be able to tailor treatment to the individual,” said Mr Latham.

In partnership with Professor Robert Wood, director of the national Centre for Advanced Tribology (nCATS) at the University of Southampton, the team has adopted techniques used to study corrosion in the legs of oil rigs in sea water to help understand the causes of failure in some joint replacements.

They also have access to a cutting-edge measuring tool, developed in Southampton, to produce instant 3D readings of wear and damage, while a specialist in surface bacteria – biofilm – is able to examine devices for evidence of hidden infections or allergic reaction which can cause joint replacement failure.

Meanwhile, Professor Richard Oreffo, chair of musculoskeletal science at the University of Southampton, who is pioneering work with surgeons to develop stem cell techniques for hip replacement, is working with the team to develop a test to find out whether or not a particular patient will react to the materials in a joint replacement before surgery.

Mr Latham said: “Previously, patients with failed replacements had them removed and then replaced with similar devices. Tests only showed how the devices failed and not why.

“But, with our approach, we hope to be able to build profiles specific to each patient to the point where we can say ‘we are sure that a certain type of implant won’t work for you because you might react to it, but a different one will work perfectly well because you won’t react’.

“It is all about creating bespoke treatment by matching the implant to a patient rather than patient to implant.”

He added: “Additionally, as an NHS, clinician-led service, not only are we giving patients the assurance of continued follow-up care with us, we are creating a huge cohort of patients which will, over time, give us unprecedented levels of effectiveness data.”

Southampton Orthopaedic Centre for Arthroplasty and Revision Surgery (SOCARS), based at Southampton General Hospital, consists of two academic leads, seven surgeons, two physicians, six scientists, four radiologists, a pathologist, a microbiologist and an expert in trace elements.

Posted on Tuesday 12 February 2013