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  • New patient referrals and enquiries call : +44 (0)20 8909 5114
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To protect you, your family and the staff of RNOH Private Care, we now have the facilities to offer video consultations. Your consultant will tell you if your appointment is to be carried out in this way and their practice secretary will provide you with all of the information you need to do this.

If you are asked to attend RNOH Private Care outpatient centre for your appointment, please ensure that you read the information below and follow any social distancing instructions when you arrive at the hospital:

CORONAVIRUS INFORMATION

If you have symptoms of coronavirus infection (COVID-19), however mild, do not leave your home for 7 days from when your symptoms started. The symptoms are:

  • new continuous cough and/or
  • high temperature

You do not need to call NHS 111 to go into self-isolation. If your symptoms worsen during home isolation or are no better after 7 days, contact NHS 111 online. If you have no internet access, call NHS 111. For a medical emergency dial 999. You can find the latest information and advice at www.gov.uk/coronavirus.

Do: 

  • wash your hands with soap and water often – alcohol gel is effective against respiratory viruses
  • cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
  • put used tissues in the bin immediately
  • try to avoid close contact with people who are unwell

Don't

  • touch your eyes, nose or mouth if your hands are not clean

By James Donaldson
Consultant Orthopaedic Surgeon
Joint Reconstruction Unit

Patient-specific hip and knee replacements are a relatively modern concept and are increasingly being used in an effort to improve clinical and functional results and long-term implant survival.

Patient-specific instruments (PSI) are custom made on a case-by-case basis, specific to both the anatomy of the patient and the surgical plan created by the surgeon.

Each patient requires pre-operative cross-sectional imaging with either a low dose CT scan or MRI. Computer software is then used to generate a virtual, or 3D printed, model of the patient’s anatomy, which allows the surgeon to accurately plan the position, size and orientation of the implant. Once the plan is finalised engineers work with the surgeon to design the patient specific instrumentation and/or implant to be used during the surgery.

Knee arthroplasty

In the knee, customised cutting blocks are manufactured from a pre-operative three-dimensional model of the knee and lower limb. This allows the surgeon to plan the procedure in great detail making adjustments to the proposed bony cuts in

any plane (sagittal, coronal and axial). Custom cutting guides, that accurately fit the patient’s anatomy, are then 3D printed and sterilized for surgical use (Fig 1A).
The PSI guide can take into account bony deformities (Fig 1B) or abnormal knee shapes and sizes. The guide allows the joint to be prepared to accommodate a pre-determined implant size in the optimal position. The proposed benefits include a more reproducible and accurate postoperative alignment, decreased surgical operating time, faster patient recovery and a more efficient surgical procedure.

Hip arthroplasty

PSI again aims to improve the accuracy of the surgical procedure and reconstruct the hip to as near normal as it can be. The more accurate positioning of both the femoral and acetabular components should result in improvements in the patient’s functional outcome and recovery, as well as reduce potential complications including leg length inequality, abnormal muscle tension, dislocation and peri-prosthetic fracture.

Similar to the knee, patient-specific cutting blocks and guides are created to cut the femoral neck and to optimize the acetabular preparation and cup implantation. Orientation, size, rotation, offset and leg length can all be optimised during the delivery of the pre-operative patient-specific surgical plan.

Revision surgery

Revision hip and knee reconstruction is becoming increasingly common and brings with it its own unique surgical challenges. Bone loss, infection, component malposition, soft tissue and muscle deficiency all add an extra element of complexity.

Greater accuracy and the execution of a more detailed pre-operative plan are crucial in the revision setting. Advances in technology and implant design allow a bespoke solution for individual patients to be made, making use of available bone and filling defects with porous bone-adhering titanium. In this way, many joints can now be reconstructed that may have previously been deemed un-reconstructable (Fig 2).

The surgeons on the Joint Reconstruction Unit at the Royal National Orthopaedic Hospital receive referrals nationally and see some of the most complex primary and revision hip and knee cases in the UK. They have unparalleled experience with cutting-edge technologies, both from an academic and clinical perspective, including patient-specific instruments and components.

For more information contact please contact the Royal National Orthopaedic Hospital Private Patient Unit: 020 8909 5114