Mr Bodo Purbach is a consultant orthopaedic surgeon, with a special interest in hip and knee surgery. Mr Purbach graduated from University of Wurzburg, Germany in 1991. He undertook his basic surgical training in Switzerland from 1992 to 1993. He completed his Orthopaedic Residency Programme with Wurzburg University in 1995, followed by specialist training at Oswestry rotation from 1995 to 1996 and then at Wrightington from 1997 to 2000. Mr Purbach has been a Consultant at Wrightington Hospital since 2000. His academic and research interests include blood salvaging methods, joint lubrication models, bone graft substitute and foremost the continuous study of the long-term behaviour of the artificial joint.
OPN: As a specialist in orthopaedic surgery, could you tell us more about your experience and training background in this field?
BP: My name is Bodo Purbach and I am an orthopaedic surgeon with a special interest in hip revision surgery. I practise contemporary hip arthroplasty using the principles established at Wrightington by Sir John Charnley and refined by Professor Mike Wroblewski. The technique represents the Gold Standard in hip arthroplasty. I have a special interest in the complex hip problem arising from deformity, injury or previous surgery. The technique uses bone graft and is equally helpful in revision surgery, where it allows a biological approach to restore and reconstruct bony defects.
Having been trained by Professor Mike Wroblewski, who has carried out an enormous amount of work in 40 years here at Wrightington, in the art of hip replacement surgery, we also have inherited the legacy of hip replacements that have come to their mechanical end. This requires ‘making good’ on the bone defects and the most elegant way to do so is by using bone graft.
OPN: What drove you to choose surgery as a career – and orthopaedics in particular?
BP: I was introduced to orthopaedics in a US Army hospital in Germany as a medical student. It was the challenge of “big surgery” that I found attractive initially, but over time it has crystallised in finding mechanical solutions for destroyed bone or joints.
OPN: Tell us more about your work with the Wrightington Bone Bank and the process of harvesting femoral heads?
BP: The Wrightington Bone Bank harvests femoral heads from patients undergoing total hip replacements. Approximately 550 are harvested every year and these are used for patients requiring revision surgery, particularly revision hip, knee and shoulder replacements. Femoral heads are fresh frozen at -80˚C in dedicated freezers at the hospital. Each stage of the donation process from consent, medical assessment of donors, microbiology and serology testing (tests that look for antibodies in your blood), storage and clinical use of bone is governed by a robust quality system to ensure safety and confidentiality of both the donor and recipient. Since our remit at Wrightington is primary joint replacement surgery of almost all joints, the primary hip replacement offers ‘surplus’ bone that we can utilise in the revision operations that we also carry out in big numbers. Having always been at the forefront of development, bone grafting will also play a role in revision operations around the shoulder and the ankle.
OPN: Could you tell us more about the technical process and what training needs to be undertaken to perform the bone graft.
BP: The two techniques in bone grafting are solid and morselized grafting. There is instrumentation available to ‘process’ a femoral head, meaning to remove cartilage, soft tissues and cortical bone and get to cancellous bone chips, but it can equally be done by hand and saw, which I find more efficient. This can be learnt within a short session and then just needs practicing and honing. Packing of a bony defect requires some ‘finger tip’ feel, but improves with experience.
Solid grafting around the acetabulum is more difficult, but again presents an elegant way of ‘creating’ a bony rim. The results at Wrightington have demonstrated very good outcomes with a technique that restores with bone.
OPN: How will this process benefit orthopaedic surgery in the future?
BP: Bone grafting as a technique is an elegant and biological way to restore bone cavities and put back what has gone missing. We have started to revise elbow replacements where there is really no other way of fixing components into very small bones.
OPN: Can this be developed further?
BP: Bone grafting has been around for three decades now but the fine tuning of technique is becoming the next challenge. The material is very useful, but it is surgical skill that has to be honed.
OPN: Are you currently working with any medical device companies?
BP: We have a collaboration with JointOperations who provide us with tendons, nerves and other biological products. Between us we have organised a number of teaching days with practical hands-on experience how to process bone efficiently. I expect this will grow and become a regular pattern.
OPN: How can hospitals become involved in living bone donation?
BP: Some bone banks do have satellite hospitals and take donations from living bone donations, but there are licensing issues and staffing levels to be considered. For the time being, and with the need for grafting, we at Wrightington procure enough bone for our own purposes and have the opportunity to pass over to other hospitals in the country via our partners JointOperations.
OPN: How do you think the future looks in the field of orthopaedic surgery?
BP: Surgery is not always the answer, but I am certain that the
skills of bone-setting or replacing joints will be required for a long time.