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Surgeon In Brief With John Hardy Consultant, Orthopaedics and Trauma OPN: What made you choose Orthopaedics? JH: My first surgical house job was with David Evans, Brian Andrews and Paul Aichroft at Westminster; all charming and skilled clinicians. My BSc was in neuroanatomy and I was all set to become a neurologist. But I invented a ligament passing device for Paul Aichroft and have never looked back, keeping to the ideals these men taught me, to improve things for both surgeons and patients in Orthopaedics and Trauma.OPN: What are your specialist areas? JH: I still think of myself as an Orthopaedic and Trauma Surgeon. However, 70% of my work is knee surgery and 30% hand surgery largely because of my training and the experience with peripheral nerve surgery.OPN: What are the best and worst aspects of your job? JH: We live in a time of innovation where knee surgeons are beginning to understand the normal biomechanics of the knee and have the tools to prevent degenerate change. What can be better than the prevention of that? The worst aspect of my job is seeing patients who have progressed beyond arthroscopic techniques for help, because of neglect or inappropriate treatment. Then we have to resort to joint replacement surgery.OPN: Are there any developments in orthopaedics that excite you? JH: Tissue engineering will be of enormous benefit in the future to patients who have lost one of the structures that contribute to the biomechanical environment of the knee. It’s in its infancy, but innovators believe in the potential of the current science to be refined well enough to prevent degenerate change leading to osteoarthritis becoming a reality. In the UK, if the scientists and regulators can work together then the innovators will stay and we will not lose them to countries les risk averse.OPN: What are your thoughts on surgeons who receive financial benefits for using a company’s products? JH: There are three aspects to this that will maintain a surgeon’s professional status: Probity to the management of the health care facility a surgeon works at, probity to the patients to which a surgeon has a duty of care and probity towards the company a surgeon offers to work with. This is something I am well aware of as the inventor of the P3 Lavage Tray and as a director of a website (www.orthopaedicsandtrauma.com).
When I recommend the Lavage Tray to my hospitals, it is made clear that I have a beneficial interest in the product - a surgeon must ensure transparency and to avoid, or minimise the effects of, conflicts of interest.
If I recommend a particular product through my website in which I have a financial interest, I inform the patient of that. The GMC is clear in this respect. UK surgeons are criticised for charging higher fees than their EU counterparts, but many of them sell the prosthesis with a mark-up. I prefer to raise my fees in line with inflation - it might make me the most expensive surgeon in the UK but it is still a free market, not one of managed care.OPN: Are patients becoming too knowledgeable on joint replacement? JH: No. Patient education is terribly important. Many of my patients come with newspaper cuttings or printouts from the internet with the latest and greatest innovations. It is our duty as professional experts to translate this innovation to the unique circumstances that each patient finds themselves in. Our primary skills as clinicians are to take a history, examine the patient and come up with a list of diagnoses before offering the treatment options appropriate to the general and the disease specific condition of the patient.OPN: What aspect of the industry would you change, if you could? JH: I have learnt a great deal about the differences between large medium and small companies in the UK and abroad through the 24 years of innovation I have behind me. I would say that the biggest risks to innovation in this country are the risk adverse bean counters that are rightly put in place to manage the finances of a merged company but wrongly get involved in the decisions made in product research development.
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