The Great Debate provided a refreshing change from most courses and conferences. It is an industry-sponsored, two-day event held in central London where advances in hip and knee arthroplasty are debated. The course chairmen, Professor Justin Cobb (Imperial College, London) and Andrew Shimmim (Melbourne, Australia), introduced a variety of hot topics including surgical approaches, taper failures, implant design choices, registries and new technologies.
The meeting has a unique format in that an international panel of high quality speakers each gave short presentations on an element of each topic. A ‘challenger’ then took over the session to give a counterpoint view. With the panel of faculty on stage, each topic was debated to a very high level. Interaction was strongly encouraged with the audience participants, and through an advanced AV system the audience were not only able to ask questions, but they were also able to text questions to the chairman in real time. Credit must be given to the chairmen who managed the discussions that often veering off on tangents in such a way as to allow for very interesting and entertaining debates.
Of particular note in the hip day were the discussions on trunnion-related problems, and that this may possibly may be the new ‘Titanic’ in hip surgery. After a history lesson from Richard Field on how trunnions gained their name from cannons, the spelling of ‘trunnionosis’, or even ‘trunionosis’ was hotly debated until totally abandoned when it was decided by the panel that it is actually the taper that is the problem (not the trunnion), and the more accurate name for the predicament is actually ‘taperosis’ instead! Modern bearing surfaces were discussed, as were the merits of alternative approaches to the hip. Peter Howard informed us ‘How to become an outlier’ in the hip and knee registries (using a variety of unproven implants seems to be the way), and Professor Aldinger explained just how efficient Germans can be by explaining how he and his team had revolutionised arthroplasty at his hospital.
The knee day was dominated by the discussion surrounding the seemingly never-ending quest to find an answer as to how to improve satisfaction after knee arthroplasty. Why do some people just not do so well? The discussion regarding kinematic versus mechanical alignment continues, and Dr Romagnoli from Italy showed how he can replace all three compartments in the knee with three different unis – not for the faint of heart! The debate then ended with a discussion on new technologies, including patient-specific instrumentation and even patient-specific prostheses.
There were difficulties at times with the AV system but when it worked well it allowed the debates to become extremely interactive. In my opinion, The Great Debate provided an alternative format that succeeded in educating and entertaining its audience. I would thoroughly recommend your attendance at what is a unique day.
