The future of orthopaedic surgery and treatment has changed dramatically over the last 20 years and is set to change further in the coming decade, as there continues to be significant advances in both medicine and biomechanical apparatus. Where once a patient’s only option could be limited to amputation or lifelong deformity, the developments made to date mean that the individual’s quality of life has improved immeasurably.

Mr Pat Kiely, consultant orthopaedic and spinal surgeon at Our Lady’s Children’s Hospital in Crumlin, explained to an audience gathered at Engineers Ireland HQ in Dublin that during his time as a senior lecturer in paediatric orthopaedic surgery in Westmead Children’s Hospital in Sydney, he began to realise the increasing importance of developments in biomedical engineering apparatus as a tool to treat patients. “We were looking at a particular subset of patients, the mechanical environment and how it related to the biological outcome, and what we can learn from that,” said Kiely of his time conducting research in Australia.

“It changed our thinking with regards to the bone biology and the healing interface, whether between an implant/bone or a bone/bone situation, and the importance of this understanding. Trying to understand the mechanical reasons why the biology is failing is one of our biggest difficulties and issues.” Kiely specialised in trauma surgery, but has now moved towards sports and spinal surgery. He spoke at length about the challenges faced when adopting minimally invasive or minimal access surgical procedures.

“Certainly there’s a big drive to minimal invasive surgery and we need technical support from an engineering point of view for that reason,” said Kiely. During his work in Our Lady’s and the children’s hospital in Tallaght, Kiely explains that a lot of the work with which he and his colleagues deal is congenital deformity or deficiency. While the initial issues relating to the child’s condition are important, the real concern is the preferred outcome when the child reaches adulthood. Taking this long-term view is important in deciding on the most appropriate treatment for the patient.

“If a child has a deficiency of 10 per cent but it is likely to become major deficiency in adulthood, you may be better with an amputation. What’s important is the mature discrepancy, not as presented in a five-year-old child. That can be the hardest thing to get across to parents,” said Kiely. He explained how the work of Russian physician and surgeon Gavriil Ilizarov revolutionised the work of orthopaedicians, with the discovery that we can generate new bone if the treatment is managed correctly. While various mechanical devices based on the original Ilizarov apparatus are still used today to correct deformity and lengthen or reshape bones, more engineering developments in this area is helping to ensure a greater success rate among patients.