Day 3: Stanmore

Wednesday morning we were met for breakfast at our hotel by Professor Haddad. We ate and chatted briefly before being shown to a car that would take us to Stanmore

About 30 minutes outside of London (by car at 7am), Stanmore is one of the most unique hospitals I have ever seen. It was apparently erected rather quickly during Workd War II as a temporary hospital away from London Center. While the intention was for it to be temporary, it became busy enough that rather than scrapping it, it continued to be added onto over the years. What’s been created is a patchwork of poorly designed huts covered in corrugated metal and plywood… A far cry from the traditional elegant British architecture. 

The main Orthopaedic wing is actually a long hallway that slopes downhill quite substantially making patient bed transport a challenge. In order to go from the wards to the operating theatres and back patients often need to be wheeled outside. While today was a beautiful sunny day, I was assured that this was usually not the case during the rainy season (March through November) or winter (December through February). 

Alas, Stanmore as we know it will reportedly look very different in 5 years as the NHS has now dedicated funding to rebuilding Stanmore from the ground up. From what we saw of the quality of the care and thought at Stanmore, they certainly deserve a top notch facility. 

Our main host at Stanmore was Professor John Skinner. We started the day there at a Multidisciplinary Team (MDT) conference to review patients that have been referred to Stanmore for an opinion about their painful total joint, as well as follow up surveillance on patients with total joint prostheses that have been identified as “at risk” based on clinical outcomes. 

Once done with MDT, we were taken to the Stanmore-based London Implant Retrieval Centre. This laboratory takes in explanted prostheses to provide detailed analysis of the implant in order to determine why it may have failed. The goal is to learn as much as possible from each implant to make all future implants as safe as possible. 

The only thing that rivaled the LIRC’s implant analysis capabilities was their collection of historical prostheses. From what is likely the first hip replacement performed in Great Britain (the Wiles arthroplasty) to the classic Charnley prosthesis, the collection is impressive to see.

After a tour of the lab, and a brief lunch, we were put in a car and headed back to London. We were given a few hours break to ourselves, and then headed in the evening to a meeting of local London hip and knee surgeons to expose us to a greater variety of surgeons. Michael and I were asked to give presentations, and had a wonderfully attentive and inquisitive audience. Michael spoke eloquently about the treatment of periprosthetic total hip fractures, and I presented on open surgical treatment of non-arthritic hip disease. 

After the meeting we had a lovely dinner, again graciously hosted by Professor Haddad, and then headed back to our hotel for the night. 

Day 2: (un)Cemented Total Hip and on to London

The day started off with a traditional English Breakfast at the hotel (which was delicious), followed by an escorted walk to SWLEOC by Tom, a fellow from Croatia. At SWLEOC we were introduced to Mr. Simon Bridle, the consultant we would be working with that day. Mr. Field had planned for us to see a traditional British Cemented total hip arthroplasty on this day, but alas the cards dealt us a complex primary total hip that required a modular pressfit stem. Mr. Bridle remained in good humor throughout and was a great introduction to hip surgery in the UK.

Following our time in the theatre we were given a tour of the research facilities at SWLEOC, an involved project of Mr. Field. Following that we were whisked to the Epsom train station to catch a train to London.

In London we were met at our hotel by Mr. Jon Negus, a fellow at the University College Hospital with our host, Professor Fares Haddad. Jon took us to UCHL to see a periacetabular osteotomy by Mr. Johan Witt. We left right before closure to swing by a restaurant which already had our food laid out for us. In twenty minutes we had eaten with plenty of time to head to the theatre to see “The Book of Mormon.”

After the play we had a pint at the pub and retired to our hotel to ready ourselves for tomorrow’s adventures.

Michael enjoys himself in the lobby of our London hotel

First Day

After taking a moment to refresh myself in the hotel, I headed down to the lobby to meet with Michael Blankstein, the other fellow, and Professor Richard Field, a consultant from SWLEOC. Mr. Field is an exceptionally charming man with a characteristically dry, British sense of humor.

His first task was to take us to the Epsom Downs Racecourse, a short 10-minute walk from our hotel. This is the site of “The Derby” as the British call it. Today, however, it was hosting the “Superhero Family Day” which is a series of races and the crowd can dress up in superhero costumes. In between horse races there are races with kids running on the track dressed as Batman, Superman, etc. It was very cute.

Richard insisted on Fish & Chips for lunch, and a glass of Pimms which, as he described it, is “a girly drink.” It’s a summertime, garden party type drink that is best described as a mix of cola, lemonade, and some alcohol, possibly gin. This was served with orange and cucumber slices. Quite refreshing.

We also learned how to place wagers on the horses and I am happy to say that I came out pretty much even, or slightly ahead. We go to rub elbows with horse owners, and stand at the finish line to hear the roar of the hooves as the contestants sped down the track. It was all very exciting.

Apart from horse racing, Richard also taught us the three levels of interest when surgeons approach new technology. They are as follows:

  1. “Spawn of Satan” – At this stage, the observer determines that whoever is using or has adopted the new technology should be treated like a pariah.
  2. “This is getting interesting” – Once beyond the first stage, the observer begins to consider the new technology as viable, and worth investigating.
  3. “I’ve always thought this was a good idea” – Complete self-deception on the part of the observer. This stage gets to be very popular

After horse racing, we had a lovely dinner at the hotel, discussed the “Brexit” vote, as well as “Donald vs. Hillary” (and if you think America is confused, please take the time to talk to a European…) All in all a lovely first day in England.

Arriving in the UK

It has been almost 30 years since I have been to the United Kingdom. My family took a trip here in 1988. Margaret Thatcher was the British Prime Minister. The Chunnel had not yet been finished. Harry Potter didn’t exist (at least not in published form). Elizabeth II was the Queen (and still is). We visited innumerable attractions around England including the Tower of London, Westminster Abbey, The British Museum, Stonehenge, Runnymeade, and so on. We had stops in London, York, Pilton, and I’m sure numerous other towns that have escaped my memory in the meantime. When we left England we crossed the Channel by boat and came to Paris. I remember the journey being overnight and sleeping on the floor of a large cabin.

I remember being seated in the nonsmoking section of the plane on the flight over, but being one or two rows behind the smoking section. It’s amazing to think nowadays that people used to be able to smoke on plane rides, let alone international flights.

After arriving in London this time, I met my Technicolor Taxi from the Southwest London Elective Orthopaedic Centre (SWLEOC) emblazoned with the National Health System logo. The driver, Bart, told me to sit back and relax. He buckled my seatbelt for me and said “get used to this.” After a 50 min drive past the Hampton Court Palace we arrived in Epsom and the Chalk Lane Hotel. I was finally able to drop my bags and relax after a long journey.

Just starting out…

I thought I would carve out a little space on the web to capture thoughts and experiences during the 2016 British/American Hip Society traveling fellowship. This fellowship is an incredible opportunity to learn about hip surgery from esteemed institutions in the United Kingdom.

The fellowship runs from Monday, August 29 through Friday, September 16, 2016. It includes stops in London, Oxford, Derby, Nottingham, Norwich, Exeter, Manchester, Glasgow, and Belfast.

Hopefully this site can capture the excitement of this opportunity, and highlight the generous hospitality of our hosts in the United Kingdom. Stay tuned for more updates!