By Mr Panos Gikas
Consultant Orthopaedic and Sarcoma Surgeon
Honorary Lecturer, Department of Physics, UCL
Mr Panos Gikas is a Consultant Joint Reconstruction and Sarcoma Surgeon based at the Royal National Orthopaedic Hospital. He completed his medical and postgraduate training in London then completed a Seddon Travelling Fellowship in orthopaedic oncology at the Royal Prince Alfred Hospital in Sydney where he further developed his specialist skills in the management of bone and soft tissue tumours and complex joint reconstruction. In addition, he has also completed a clinical fellowship in Geneva in developing the use of the anterior muscle sparing approach to the hip joint before taking up a consultant post at the world-renowned Royal National Orthopaedic Hospital.
He specialises in complex lower limb reconstruction following failed joint replacement, utilising cutting-edge techniques and prostheses in order to achieve the best possible outcomes for patients, for many of whom this is their last chance at limb salvage.
My particular focus within this highly specialised area of orthopaedic surgery is complex pelvic and knee reconstruction, using bespoke designed patient-specific prostheses. Surgery such as this is indicated in patients who have previously undergone primary hip replacements which have now failed, or patients who have undergone multiple failed revision operations or patients with infected prostheses that require revision. These patients, unfortunately, suffer from persistent and progressive symptoms such as debilitating pain and reduced mobility, often resulting in being wheelchair-bound due to their failed prosthesis. Their bone quality is often poor and there is usually a high degree of bone loss which makes salvage surgery technically very challenging.
In my practice, this type of surgery involves careful assessment of the patient’s anatomy using advanced imaging techniques followed by meticulously designed prostheses to match the patient’s anatomy perfectly. These designs go through multiple stages of surgical and bioengineering review and refinement prior to being manufactured. As well as matching the shape of the prosthesis to the patient’s bone, the final product is also specially modified with bio-active coatings and surfaces to promote new bone growth to integrate the prosthesis with the patient’s bone to ensure a strong and stable end result.
The images show just one example of reconstructive surgery performed at RNOH in a patient with a failed revision hip replacement and significant bone destruction in the pelvis, with his prosthesis migrating to sit on the bladder wall. He received a bespoke hemipelvic replacement and went from being wheelchair-bound before surgery to mobilising independently postoperatively.
It is important to highlight that even after successful surgery the most important factor in good recovery is a strict rehabilitation programme to ensure early mobilisation and strengthening. At the RNOH our Physiotherapy Team is specially trained to care for complex patients such as these and are vastly experienced in tailoring rehabilitation to meet and exceed patients’ goals for recovery. At the Royal National Orthopaedic Hospital, we have successfully carried out a vast number of similar reconstructions around the hip and knee joints for patients with a range of problems: failed replacements, infections, tumours, complex anatomy. With improving techniques and implant technology, as well as the support of my team at RNOH we are able to provide a chance for patients who are often told there are no further options available to them.
For more information contact please contact the Royal National Orthopaedic Hospital Private Patient Unit: 020 8909 5114