11/09/07 – 12/09/07

Chicago

Flying into Chicago on the 6^th anniversary of the Twin Towers attack was unsurprisingly delayed by some heightened security. When we eventually arrived, we joined host Wayne Paprosky at the Central DuPage Hospital in Winfield Illinois. This was a very smart private hospital with the plushest theatre coffee room I have ever seen. Dr Parosky was doing a series of THRs through a mini posterior approach, again with 2 fellows in 2 theatres. He used a stem he has designed called the Epoch, which is a scratch-fit, composite, isoelastic stem with a full coating, requiring power reaming of the proximal shaft. The theory behind the modulus of elasticity is a reduction in thigh pain.

Whilst being driven through Chicago later that evening, we were stopped by the raising of one of the huge bridges, but despite our encouragements, Dr Paprosky was unwilling to recreate the scene from Blues Brothers to prove whether his Merc had “pick-up”.

The following day was spent at Rush Medical Centre in Chicago, starting with the arthroplasty meeting with Drs Paprosky, Jacobs, Galante & Della Vale, a pretty impressive crew, before theatre to see minimally invasive hips & knees performed with instruments designed in their department.

09/09/07-11/09/07

Philadelphia

Pleasant journey by train to Philadelphia. Very nice to not have to remove shoes, belt etc & be able to carry more than 200ml fluid.

Jefferson University Hospital is in the centre of downtown Philadelphia. Off to a flying start on Monday morning with Dr Bill Hozack, whose double list started at 7am. He managed 8 joint replacements (7 hips, 1 knee) by 1pm with the aid of a senior fellow who essentially ran one room (theatre is not a term used here), opening, closing & preparing the femur & acetabulum with Dr Hozack implanting all the components (all private patients). He uses a mini Smith-Peterson incision for most patients which gives a good acetabular exposure but the femoral mobilization looked like it required a few tricks. The beauty of this inter-muscular plane approach was the closure which required only some vicryl sutures to the fascia. Tapered, proximally coated stems were again used with metal on x-linked poly bearings for all but the youngest patients for whom ceramic on x-linked poly was used.

One of Dr Hozack’s colleagues was also running 2 rooms. He had, amongst other cases, 2 revision THRs. Neither required revision of well-fixed cementless stems or cups. One he grafted through the drill holes of the cup for osteolysis & the other was a head & liner change for instability.

They feel that revisions of this sort are becoming more common, with well-fixed components left in situ.

After presenting our talks that afternoon, we were taken to a Philadelphia steak house, with enough meat for a small army, made even more difficult to finish by the fact that Bill had insisted we had Philly “Cheese-steaks” for lunch. These are essentially coronary artery-blocking sandwiches of sliced beef & melted cheese. Small wonder Americans are large (Dr Hozack is not, but he’s Canadian).