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| HONORARY PROFESSOR McNICHOLAS |
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Elective Orthopaedic Surgery Elective Orthopaedic Surgery l Trauma Surgery Knee Surgery l Hip Surgery l Spine Surgery l Foot Surgery
I have experience of the treatment of knee osteoarthritis by distal femoral and proximal tibial osteotomies using opening and closing wedge techniques and hemicallatosis by external fixator. I have been shown osteocondral autograft transfer techniques but my experience was fortunately limited to cadaveric specimens. However, in clinical practice I prefer using microfracture techniques due to the lack of donor site morbidity. I am trained in the use of autologous chondrocyte implantation techniques, and enrolled in the MRC trial of its use for chondral lesions, participating in the ACTIVE Trial from 2006-8. From 2008-9, I took part in the SUMMIT Trial of of Articular Cartilage Repair Using Matrix-induced Autologous Chondrocyte Implantation (MACI) mini-open technique versus microfracture. Genzyme’s MACI® is the most commonly performed second-generation Cartilage regeneration procedure. Since 2009, I have been a consultant to Genzyme and I am now a member of the Medical Advisory Board to Genzyme Worldwide that held its first meeting in Zurich recently helping to define the operative technique for arthroscopic MACI insertion. I have developed an arthroscopic technique for the management of patello-femoral instability due to trochlear dysplasia (malformation of the kneecap joint)which was a world first, previous techniques involved a formal open surgical approach which were far more painful for the patients and took longer to recover from. The outcomes of my first five cases with up to three year follow-up are to be presented to BASK in Cardiff and at ISAKOS in Brazil and EFORT in Copenhagen next year. The paper describing the technique and its early outcomes is being written in collaboration with Prof John Fairclough of the University of Cardiff. I have been trained in primary arthroplasty of the hip and have used a number of cemented, cementless, and hybrid systems. During my training I gained much experience in revision surgery for aseptic and infected loosening, and the management of periprosthetic fractures. I have learned techniques to manage acetabular and femoral bony deficiencies. I have assisted at proximal femoral osteotomies for the management of osteoarthritis, and carried out Ficat decompression for early avascular necrosis. I have had exposure to elective spinal surgery both during the pre-fellowship neurosurgical attachment, in Raigmore Hospital and during my attachment to the Tayside Regional Spinal Surgery Unit. I have carried out cervical and lumbar prolapsed disc and spinal decompression surgery, and have experience of cervical, thoracic and lumbar spine fusions. My current practice with neck and back pain is limited to the assessment, investigation, diagnosis and conservative management of these problems. For the 3% of patients who fail conservative, non-operative treatment I would refer them onto my Consultant Spine Surgery Colleagues. I have treated problems of the foot and ankle by orthotic and operative means including surgical management of common problems of the forefoot such as painful bunions, hallux valgus, hallux rigidus and hammer toe deformities. www.mcnicholaskneeclinic.co.uk
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