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The Bristol Knee Clinic

The Bristol Orthopaedic Clinic

• The Glen Spire Hospital, Bristol
• St Mary's Hospital, Bristol
• St Joseph's Hospital, Newport
• The Lister Hospital, London

Appointment Bookings:

• Tel: 0117 970 6655


The "Glen" Spire Hospital
Redland Hill
Bristol BS6 6UT

Tel: 0117 980 4080

Bristol Nuffield Hospital at St Mary's
Upper Byron Place
Bristol BS8 1JU

Tel: 0117 970 6655

St Joseph's Hospital
Harding Avenue
Newport NP20 6ZE

Tel: 01633 820300

The Lister Hospital
The Lister Hospital
Chelsea Bridge Rd.

Tel: 01179 706655

News Topic : Full Version

Saudi Arabia

Author: Webmaster     Date: 10/16/2007

"Mr Johnson was very honoured to spend a week as Visiting Professor of Orthopaedics in Riyadh, Saudi Arabia, at the personal invitation of the Director of Orthopaedics, Major General Dr. Faisal Arab."

In April 2007 David spent a week as Visiting Professor of Orthopaedics to Riyadh, Saudi Arabia. David undertook a series of lectures, daily grand rounds and surgical demonstrations.

The lectures were on the latest techniques in knee surgery and joint replacement to all the orthopaedic surgeons from Riyadh. Surgery included knee replacement, arthroscopy and anterior cruciate ligament (ACL) reconstruction. The treatment of knee conditions is more complicated and demanding in Saudi Arabia as patients expect to kneel for prayer five times a day and commonly sit on the floor crossed legged for many hours at a time. This causes particular damage to the inner aspect of the knee and tends to stretch the repair or ligament reconstruction.

A specific knee prosthesis has been developed specifically for this purpose; the “Hi-Flex Knee”. It is specially designed to achieve 150° of knee bend or more. In association with some alterations in the surgical technique of insertion, use of this prosthesis enables patients to kneel and sit crossed legged on the floor. This demands excellent function following surgery and a much greater range of knee motion than is usually obtained in British or Caucasian patients.

The lectures given by Mr. Johnson included the titles:

  • Minimally invasive surgery for Total Knee Arthroplasty
  • Oxinium: A new ceramic metal bearing in Knee Arthroplasty
  • Ligament balancing in Total Knee Arthroplasty
  • Pain Management in Total Knee Arthroplasty
  • Indications for Uni-compartmental Knee Arthroplasty
  • The principles of Knee Replacement and the “Hi-Flex Knee”

David said:

It was an honour, privilege and a challenge to be invited to work for a week as a Visiting Professor in Riyadh. Only later did I understand how rare and unusual it was to be provided with such an invitation, a visa and permission from the Major General who was the Chairman of the Hospital.

The habit of kneeling and sitting crossed legged presents various special and demanding problems for knee replacement and ligament reconstruction in these patients. Culturally it is obviously very important for these patients to regain the full range of motion. Whilst the average UK arthritic patient may well have a range of motion of perhaps 90° which improves to 120° or 130° following replacement, Asian patients demand a post-operative range of 140° or 150°. Such Asian patients commonly achieve this range of motion.

Seeing and working in the superb facilities of Saudi Arabia was in part in stark contrast to the facilities in the UK. Not only were the buildings lined with marble, clean and modern but the staffing levels were greatly superior to the NHS. The orthopaedic wards appeared to have at least one nurse for each patient.

The expertise of the medical staff was excellent with most of the doctors being trained in Canada or Germany. Whilst some of the older and more senior doctors had been trained in the UK it appeared that most of the training was now being undertaken in Germany or Canada.

It is an unexplained phenomenon that patients in Saudi Arabia appear not to get osteoarthritis of the hip very often, and much less commonly than in the UK. This may be related to the cultural habits of kneeling several times each day or sitting crossed legged for prolonged periods.

I was delighted to be given the opportunity to teach and demonstrate many surgical techniques and the new “Hi-Flex Knee”. I very much hope that these techniques and the learning experience will enable patients in Saudi Arabia and elsewhere to regain the full range of knee motion properly and be able to kneel and pray when they wish, or indeed to sit crossed legged on the floor.

Saudi Arabia was a very interesting visit. Perhaps the highlight of the visit was visiting “Kingdom Dates”; the shop dedicated to selling only dates in many different forms, visiting the incomparable medical and rehabilitation facilities at the Sultan Bin Abdulaziz Humanitarian City Hospital, and experiencing a real sand storm in the desert.

There may not be many patients who might benefit from the use of these techniques in Bristol, but in London, Birmingham and elsewhere the desire to kneel for cultural or religious purposes may be much greater.


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