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New Developments at Wrightington: 3D printing and movement analysis

Puneet MongaConsultant Orthopaedic Surgeon,

Wrightington Wigan and Leigh NHS Trust

This Talk

• Evolution of Surgery / Orthopaedics

• New Developments at Wrightington

• Looking ahead

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The Past and the Present

The Evolution

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The Evolution

PolioRickets

TBOsteomyelitis

Internal fixationJoint replacement

ArthroscopyMicrosurgery

19142015

Orthopaedics

Orthopaedics= Straight Child

Orthopaedia= Word invented by 83 year old Parisian paediatrician Nicholas André in 1741who wrote a self-help book for parents. “The Art of Correcting and Preventing deformities

in Children”

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Family tree of Orthopaedic surgery

Bracemakers: Care of deformities

General surgeons: Pus, open fractures, amputations

Bone setters: Treated Fractures

Orthopaedics

Family tree of Orthopaedic surgery

Orthopaedics

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How did we get here?

The Three Amigos

Anaesthesia: 1846Asepsis: 1867Xrays: 1895

Advent of Anaesthesia

1559

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2011

Advent of sterile surgery, antibiotics

Lister, Glasgow,1867Use of carbolic acid in surgery

Alexander Fleming, St Mary’s,1928

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Use of Xrays

Roentgen, 1895, Wüzberg,Nobel Prize 1901

World WarsProvided critical mass of trauma

WWI and II Orthopaedic knowledge was tried on a mass scale

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Sir John Charnley

1911-1982

Recreation- “Other than surgery, nothing”

•Manchester Medical school•WWII•Closed treatment of common fractures•Compression arthrodesis•Total hip arthroplasty: HMWPE•Greenhouse•Followed every patient to death

BiomaterialsSiliconeHMWPE

Bone cement

Stainess SteelTitamium

Co-Cr

Ceramic

Orthopaedic surgeons

working with Engineers, Dentists,

Industry and Scientists

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The IT revolution

Digital recordsDigital films

Surgical simulationTelemedicine

Robot assisted surgery

3D printing

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3D printing

Current Imaging

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3 D Print

“3D Printing represents a quantum jump in defining and assessing Orthopaedic osteology”

- Al Najjer, Monga; June2014

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Potential applications for WWL

• Research

• Teaching

• Custom cutting jigs for joint replacements

• Custom implants for joint replacement

• 3 D printing service

Movement assessment

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Basic Science research

Movement Analysis

Kinematic Assessment

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Circumduction

Control Pre-op Post op

Trunk Co ordinates; referenced to the local coordinates

Circumduction

Control vs Pre Op 0.002

Control vs Post Op 0.110

Preop vs Post op 0.214

“Surgical stabilization does not completely restore ROM-Monga, Selfe, Browne, Richards. 2012

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Movement Lab @ Wrightington

Supported by WWL Charitable fund.3D high speed HD synchronized camera system

WWL IT support Key

Applications• Upper Limb Movement Laboratory

• Capture and recording of objective movement data

• Aid to decision making in complex cases

• Biofeedback as treatment mode

• Research and Audit

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Looking ahead.

The MSK disease burden

• 15-30% of GP consultations

• Orthopaedic surgeons largest subgroup At the Royal College of Surgeons

• Key in any healthcare economy

• Everyone will see an Orthopaedic surgeon at some point of time!

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Spectrum of Orthopaedic surgery

• Fix fractures

• Sports Injuries

• Hand surgery

• Spinal surgery

• Microsurgery

• Paediatric surgery

• Joint replacements

Maintaining Our Lead Position

• Research

• Development

• Innovation

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Why am I here?

• Showcase what’s new....

• Facilitate and streamline available support

• Personnel

• IT

• Monetary

Go into Orthopaedics? “Don’t. You will be wasting your surgical talent. Flat feet, crooked backs, and a

few cases of joint tuberculosis” -Advice given in 1910

Join the revolution-2015

Thanks