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Interview with Keith Tucker

Interview with Keith Tucker

Posted on: 11-12-2018

 

Keith Tucker is Chairman of the Orthopaedic Data Evaluation Panel (ODEP) and the Beyond Compliance (BC) advisory group, and a member of the NJR implant performance committee. He is a retired consultant orthopaedic surgeon previously employed at the Norfolk and Norwich Hospital, 1978-2012.

 

Can you tell us a little about how and why you entered the world of orthopaedics?

As a medical student (1963-8), I found orthopaedics and trauma interesting. As an A&E SHO I found fractures the most interesting part of the work. I knew I wanted to do surgery and I knew I had manual dexterity. I had to do an orthopaedic job for the FRCS and so applied to work as SHO to the pioneer of THR, Ken McKee. The rest took care of itself. Registrar at Addenbrooke’s and the SR on the Pott rotation. Appointed to Norwich in 1977 as a general orthopaedic surgeon with a paediatric interest.

 

What about your particular specialities – to what extent did you steer a deliberate path?

The patients I saw determined my path. I took over the McKee firm at the N&N, which meant I did a lot of hips and revision. I was also responsible for paediatric orthopaedics for a large part of East Anglia (single handed) for 30 years.

 

You chair the Beyond Compliance Advisory Group. Can you explain the role of Beyond Compliance?

Beyond compliance has been set up to assess the risk of new implants and monitor their progress for at least the first 3 years of their life so as to try and prevent the well documented problems of the past or at least minimise the damage if they perform badly.

 

You also Chair the Orthopaedic Device Evaluation Panel (ODEP). Can you tell us about the role of ODEP – does it provide a “Which Report” for Orthopaedic devices?

ODEP benchmarks hips, knees and now shoulders at 3,5,7,10 and 13 years against an agreed standard and then publishes its results. It is used worldwide.

 

How do ODEP and Beyond Compliance sit with respect to the roles of NICE, MHRA and the NJR with respect to implant certification and evaluations?

It was set up by NICE but they are no longer involved with the running of either system. They seem to have disowned  us and rarely seek our advice. MHRA are stakeholders in BC. BC works with NJR data and many firms use data from NJR in their ODEP submissions.

 

Beyond the certification and evaluation of novel techniques and devices, what are the barriers to adoption and how can we accelerate patient access to novel technologies?

Many surgeons are fed up with manufacturers selling unproven implants. If a manufacturer has something good they need to persuade the surgeons and the procurement officers in a hospital.

 

What do you believe are the most significant technological developments that have benefited patients during your career and why?

a) Arthroscopy (I was one of the first to use an arthroscope in the UK). Arthroscopy revolutionised the management of knee pathology, particularly meniscal tears. Previously, the teaching was to remove the whole meniscus through a large incision and keep the patient in a cast of massive bandage for 2 weeks or so. Arthroscopy helped sew the seeds for the day surgery culture.

b) The development of contemporary total knee replacement replacing the hinge designs where the results were often poor and often associated with significant complications. The number done these days bear witness to their success.

c) Interlocking nails. Before interlocking nails were available most patients with a femoral shaft were treated with bed rest and traction for up to about 3 months in hospital. With interlocking nails the patient is nowadays often home in a day or so provided they do not have other pathologies to keep them in hospital.

In terms of non technological advances the most important by far is the introduction of the biologics in the treatment of inflammatory arthritis. Only a few years ago, our operating lists invariably had a patient with rheumatoid arthritis on it for either spine, hip, knee, shoulder, elbow, hand or foot surgery. The numbers of rheumatoid arthritis patients requiring surgery has dropped amazingly and this terrible disease has been tamed without any worrying side effects in the vast majority of patients.

 

What developments do you envisage are yet to come in the next couple of decades?

Machine learning  should make it possible to be able to compare one x-ray with another with absolute precision. That is to say if a hip replacement has moved out of line by no more than a millimetre or so it could be measured. This is not possible with standard x-rays. Machine learning should make radiostereometric analysis (RSA) redundant.

 

Who has been the person or people that you have found most inspirational and influential to your career development?

J. G Taylor, Consultant Orthopaedic Surgeon, Norwich. A completely dedicated surgeon who looked after his patients with great care and whose standards were exemplary.

My trainees who challenged my knowledge and thinking and set the pattern for what I found was the most enjoyable part of my career, teaching.

 

Drawing upon your career experience, what is the most valuable advice you would pass on to others?

To potential trainees: It will be tough and there will be days when you worry that you have not done as well as you might. Don’t do it unless it fascinates you and you genuinely want to help people. You will have to work very hard but it is likely to be inwardly and academically very rewarding.

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