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).