Reflections from BASK 2019
Jon Smith explores the high points from the recent BASK Conference in Brighton.
The British Association for Surgery of the Knee (BASK) is one of the largest surgical sub-specialist organisations in the UK, bringing together knee surgeons with the single aim of improving patient care.
Every year, members gather for an annual conference where they attend presentations on the latest research and discuss current hot topics. This year’s conference was held in Brighton, where much of the talk was about partial knee replacements, something Yorkshire Knee Clinic’s surgeons have strongly advocated.
Confirming the benefits of partial knees
A quick recap in case you’re new to these pages: a knee replacement is in fact a resurfacing of the worn bones of the knee using a metal implant and a plastic replacement of the worn cartilage. The procedure is designed to prevent bone rubbing on bone – the cause of the knee pain associated with osteoarthritis. Knee replacements can be total, where every compartment of the knee is worn, or partial, where only one of the three major components of the knee require resurfacing.
Partial knee replacements have become increasingly commonplace and we’ve seen excellent results over the past few years since the procedure was introduced, but because the procedure remains relatively new, studies are ongoing as to the long-term effects of partial knee replacements.
One of the most anticipated studies is the University of Oxford’s TOPKAT (Total Or Partial Knee Arthroplasty Trial), led by Prof. David Beard. This study is now five years into its assessment of total vs partial knee replacement, and at BASK Prof. Beard revealed that the study has found both to be entirely effective and safe.
Where the right surgical expertise exists, however, the study’s findings show partial to be the replacement of choice because:
- Of the general outcome trend
- More patients achieve a higher outcome (that is, the function of the knee after replacement is better)
- There’s no evidence of increased revision (i.e. re-do) risk
- Patients are more satisfied
- It’s more cost effective
The operative words in the above could well be “where the right surgical expertise exists” because the benefits of a partial knee replacement are greatest and the risks lowest when your knee surgeon has extensive expertise in partial replacements. I should probably point out at this point that, for partial knee replacements, all Yorkshire Knee Clinic surgeons are amongst the most experienced in the UK.
Hope for smokers?
If partial knee replacement took up the lion’s share of the conversation, the biggest eye-opener came from Hemant Pandit’s study of 6,000 patients in Oxford and Leeds. His findings challenge the traditional thinking that we should ration knee surgery to smokers on the basis that smokers fare badly in terms of surgical outcomes and increased risk.
His paper shows that’s not the case and that smoking makes little if any difference save for a slight increase in the risk of a chest infection.
What does that mean practically? Well, it brings into question Clinical Commissioning Group guidelines that suggests that, when I’m sat in my office talking to a patient who’s a smoker, I have to say to him/her that we don’t really want to operate because the evidence suggests they’ll do badly. According to this evidence, I clearly can’t say that anymore.
That’s certainly not to say that smoking doesn’t present many health risks – but a successful knee replacement doesn’t appear to be one of them.
This research is particularly important because knee replacements, as with a number of other procedures, are on the frontline for rationing as the NHS struggles to manage its budget effectively. This study pushes back against one of the key pillars of rationing and offers evidence that we should be offering knee replacements to smokers.
If you would like to explore options to alleviate your knee pain, talk to Yorkshire Knee Clinic now.