Hip replacement in Lebanon, Anterior minimally invasive total hip replacement in Lebanon, Minimally invasive hip replacement in Lebanon, Knee replacement in Lebanon, Joint replacement in Lebanon, Toe surgery in Lebanon

MY EXPERIENCE WITH HIP SURGERY

I am indebted first to my patients, then to the medical profession, including my students, and last but not least to the community at large for their recognition of my commitment to Hip Surgery.

Being entrusted nationally and regionally as a hip expert is a great privilege and I shall remain grateful to my patients and my colleagues for their trust.

Since my early years in orthopaedic surgery my main interest has been the hip joint, and still is, while maintaining a close adherence to the holistic perspective (refer to Mission & Vision) thanks to a continued education in all related fields.

My surgical activities have taken me worldwide where I have gained leading-edge experience in my area of expertise. I have reached a stage of my career where I certainly commend a high competence regarding all possible hip problems.

Well after being among the first regional surgeons to have introduced cementless hip replacement via a transgluteal approach in the early 1990s, a technique which still dominates the market today, I have, more recently, initiated the development of what is considered today the most gentle access to the hip joint, namely the Anterior Minimally Invasive Surgery used in highly specialized centers around the globe, a ‘state of the art’ tissue sparing technique for total hip replacement allowing rehabilitation to be much faster and more complete.

I have also gained a wide exposure to complex situations like revision surgery of failed primary total hip replacement. I belong to the small circle of surgeons being capable of revising a failed primary total hip in most circumstances without detaching or cutting through musculature or tendons. In doing so, rehabilitation is much faster and postoperative pain and limping are reduced. In my service, revisions have enjoyed large steps forward leading to reproducible solutions for difficult femoral and acetabular reconstructive problems that would have been impossible to solve just a decade ago. Surgical techniques I have recently implemented to allow immediate mobilization with full weight bearing in the treatment of major structural acetabular bone defects (Paprosky III) could not be imagined only a few years ago.

With the continuous worldwide success of athroplasty there is an increasing demand for hip replacement in the young adult, raising the bar in terms of functional expectations and postoperative physical performance which has lead surgeons and engineers alike to develop the concept of bone preservation “high function - low wear prostheses” in an effort to preserve the bone stock and respect the soft tissue envelope of the hip joint. This concept is best represented with Minimally Invasive Hip Replacement and Hip Resurfacing.

My experience with Hip Resurfacing spans a period of 15 years. Hip Resurfacing is an attractive bone preserving alternative to Hip Replacement in the younger patient which has lead to excellent results that were equal or even superior to those of Hip Replacement while preserving the entire bone stock of the proximal femur. Unfortunately, the popularity of Hip Resurfacing was lately tarnished among the public and the medical profession alike, following the emerging worldwide concerns about metal-on-metal articulations and the recall of several metal-on-metal hip implants from different manufacturers. The spectrum for Hip Resurfacing has thus significantly narrowed and the consensus recommendation for all metal-on-metal users today is “take a time out” until better and safer metallurgical options and tribological data will be made available. Instead, Anterior Minimally Invasive Hip Replacement, a technique using bone preserving implants combined to a soft tissue sparing approach, becomes the golden standard for the treatment of virtually every patient requiring an artificial hip.

MY EXPERIENCE WITH KNEE SURGERY

As well as hips, I am also passionate about knees. The more I learn about knees and the more I get convinced that every painful knee deserves an expert opinion. But knee disorders are so common that patients and health care providers alike, might sometimes think a painful knee is “no big deal” and is best treated with a "small intervention". Consequently some are overtreated while some are undertreated. Needlessly.

If the appropriate treatment is not matched to the appropriate patient, even the smallest meniscal tear can have huge consequences with the passage of time. In the surgical treatment of the osteoarthritic knee, nothing is a "small intervention", even an apparently minor condition needs to be carefully assessed and treated with precision and anticipation.

Surgical treatment of the osteoarthritic knee is considered when pain is no longer responding to simple measures. Three options have stood the test of time:

• REALIGNMENT PROCEDURES
  Their aim is load transfer from the ‘sick’ to the ‘healthy’ compartment in a knee joint with preserved range of movements and good quality residual cartilage.
• UNICOMPARTMENTAL KNEE REPLACEMENT (UKR or Partial Knee Replacement)
  Can be an effective treatment for isolated osteoarthritis affecting the medial or lateral compartment, using a minimally invasive technique to:
  • Facilitate the patient’s recovery
  • Provide less pain
  • Provide shorter hospital stay
  • Provide quicker rehabilitation
• TOTAL KNEE REPLACEMENT (TKR)
  TKR becomes the treatment of choice once the damage inside the knee joint involves more than one compartment and the weight bearing articular cartilage is depleted. The apparent success of TKR, which has become a standardized and reproducible technique thanks to improved instrumentation, has narrowed the field of Realignment Procedures and UKRs. As the number of total knee replacements increased, so did the problems associated with revision surgery. Complications of TKR are rare, but if they occur they can be very serious and difficult to treat.

My philosophy in the treatment of the osteoarthritic knee involves an increased awarness in the role of the surgeon who, while trying to be as conservative as possible to preserve bone, shall improve his patient selection criteria in order to match the ideal procedure to the ideal patient, so that the results of realignment procedures and UKR become superimposable on those of TKR at 10 years follow-up.

Mastering the technique of UKR and Realignment Procedures can, in carefully selected patients, avoid un-necessary TKRs, and lead to results comparable to those of TKR at 10 years, yet with a shorter rehabilitation and superior functional results.

UKR and Realignment Procedures are truly minimal invasive surgery while TKR, at least in its actual form, is not.

However, TKR becomes clearly superior to any other surgical option once a certain degree of intra-articular wear has been exceeded.

Although TKR is not a truly minimally invasive procedure, several technical options are available to help significantly decrease the operative time and postoperative pain:

• a modified medial approach
• a cementless total knee prosthesis
• a custom-built CT-based instrumentation to perform the distal femoral and proximal tibial osteotomies

As the number of TKR has increased over the past decade, so has the number of revisions. Revision Total Knee Arthroplasty for the treatment of failed primary TKR has benefited by huge advances in both prosthetic and nonprosthetic technical arenas and I can say my orthopaedic service has ridden this wave to greater success than was ever thought possible.

MY EXPERIENCE WITH FOREFOOT RECONSTRUCTION

Forefoot surgery has become better known only recently; and up until now has often presented many disadvantages, such as a painful postoperative period or deformity recurrence. The emergence of new techniques, notably the Scarf first metatarsal osteotomy and the Weil osteotomy of the lesser metatarsals, has helped to dramatically improve the treatment of static forefoot disorders. Likewise, the great toe osteotomy has been an important evolution.

All these techniques are based on a release both in the transverse and sagittal planes where we achieve a balanced transverse and longitudinal decompression of the forefoot. It is because of this ‘release’ that these techniques are now practically painless for the patient. A complete patient support system has been developed during and after the surgery, using a footwear design that enabled our patients to recover their physical independence just a short period after their operation.

My mentor in forefoot reconstruction is Dr Louis Samuel Barouk from Bordeaux who introduced these techniques to France in the early 1990s then around the world thanks to his training courses in Bordeaux and his worldwide traveling including AUBMC where he was invited as a guest speaker on more than one occasion. I quote him: “ The functional and esthetic aspects in forefoot reconstruction are both major concerns. Functional, because the techniques of the Scarf, Weil and BRT osteotomies extend joint conservation surgery to its present day limits. Esthetic, because we’re lucky enough to operate on French women who are extremely demanding about the esthetic of their feet, as they are for their footwear and general appearance”.

I am sure most of you have noticed that Lebanese women, not unlike their European counterparts, pay extreme attention to footcare and are most discerning about the esthetic of their feet. Hence, their concern and inquiry about the advantages of Forefoot Reconstruction. I would like to thank all who kindly agreed to contribute to the illustration of this site with their own pixels taken before and after their operation.




A scarf joint in the dining room ceiling of the Fluela Hotel in Davos, Switzerland