Orthopaedic specialists associated with the Institute for Orthopaedics and Rheumatology (IOR) and based at Mediclinic Winelands Orthopaedic Hospital have established a full-service multidisciplinary team to support the Limb Reconstruction and Lengthening Unit.

Dr Franz Birkholtz, a specialist orthopaedic surgeon within IOR and Mediclinic Winelands Orthopaedic Hospital has more than 20 years of experience within the limb reconstruction and musculoskeletal infection environment. He provides input on the value that such a unique, dedicated unit within the private sector can offer both the orthopaedic environment as well as the broader community.

This unit encompasses a number of related orthopaedic services such as limb lengthening and trauma reconstruction. Trauma may include complex fractures, non-unions, bone defects and mal-unions and are treated using the latest technologies and care pathways to salvage limbs and restore the patients to the highest level of function. As a gentle note to how deeply he regards his patients, Dr Birkholtz feels that with each patient it is possible to fix ‘Humpty Dumpty’, a tender reference to the damage incurred by each.

Other services include deformity correction for complex three-dimensional abnormalities in the structure and alignment of limbs. Correction demands detailed digital planning and then devising a bespoke strategy for each patient using technologies like 3D printing, computer hexapod external fixation, guided growth and targeted internal fixation techniques.

In reference to reconstructive amputations, Dr Birkholtz acknowledges that not all limbs can be salvaged. “When it is time to amputate, we use the power of specialised surgery and our specialised reconstructive multidisciplinary team to provide the most functional outcome possible. Our international collaboration means that advanced techniques like osseointegration (bone-anchored prosthesis) is becoming a reality for our patients,” he explains.

In addition, the team performs reconstructive foot and ankle surgery including specialised techniques such as off-loading external fixators, hexapod devices and 3D printing, which have made reconstruction of difficult foot and ankle conditions like Charcot Foot, bone loss, significant deformity and arthritis a reality.

An important and ever-increasing focus for the team is musculoskeletal infection (also known as bone infection or osteo-myelitis), which can have devastating consequences for patients and require all the skill and care this unit and the multidisciplinary team can muster in order to try and ensure the best possible outcome for each patient.

Multidisciplinary care teams (MDTs) have become the standard of care for various clinical conditions. This unit is no different as they are vital in ensuring that all the facets of a patient’s healing journey are addressed by specialists in their field. Cohesive care leads to care pathways with measurably better clinical outcomes and happier patients. For the limb reconstruction and lengthening unit at Mediclinic Winelands Orthopaedic Hospital, the care team consists of many team members including specialised nursing and wound care, physiotherapists, a psychologist, dieticians, occupational therapists, a clinical prosthetist and orthotist, orthopaedic limb reconstruction specialist and team members from his practice as well as representatives of Hospital Management.

This detailed approach expands to focus on the continuum of care, where patients are being treated, across their clinical needs rather than per specific event. Dr Birkholtz explains, “Traditional medicine tends to look at medical care in terms of events, ie consultations, operations etc. But of course, a patient’s health journey is more than just individual events managed by separate service providers in isolation. I believe it is much better to view the healing journey as a sort of care pathway where the patient and her/his care team embark on a journey together which will include specific care events, but along a pathway that leads to a long-term outcome. For this reason, it is then important that the care be rendered in a team which includes members of the specialised care team (MDT), but also the patient’s usual care team (e.g. their family doctor) and indeed their non-medical support structures like family.”

For Mediclinic Winelands Orthopaedic Hospital, a strong relationship with IOR also allows for better outcomes. IOR is a Specialist Institute dedicated to musculoskeletal care, research and education at the highest levels of excellence. It encompasses a platform comprising multiple highly specialised medical practitioners supported by their multidisciplinary care teams.

The three pillars of the IOR include:

Clinical Excellence: This is the high level of care that is rendered to our patients in our award-winning hospital by specialists who are well recognised by peers and patients as experts.

Research: Measuring what we do and using that information to fine-tune our care offering ensures that our patients benefit from scientific advances and that they get the most up to date care based on evidence.

Education: By sharing our knowledge and skills with colleagues around the globe, we don’t just improve the outcomes of other patients worldwide. We also improve our own understanding of our field. It is indeed true that to teach a concept simply, you have to understand it fundamentally.

“It is with these three pillars as a background, that our patients can expect excellence as a minimum standard,” Dr Birkholtz emphasises.

With such a broad referral base for their patients, it is vital to adopt technology to facilitate engagement with other specialists requiring input from their patients. He expands, “Healthcare is rapidly accelerating into the digital space. Although it can be scary at times and can also have the risk of sometimes decreasing personal interaction between the patient and doctor, it opens the opportunity to engage with patients and doctors in a completely new way.”

“Telemedicine and Telehealth are concepts that are playing an increasing role in how we engage with colleagues and patients. It potentially breaks down geographic barriers that existed in the past, and improves access to highly specialised expertise like we have at the IOR.”

He continues, “I am actively pursuing and developing better technologies to improve our reach and abilities in this field. These include dedicated software platforms and Augmented Reality solutions. Individually, but also as the IOR, we can add tremendous value by providing a platform for collaboration and support to practitioners and their patients, to optimise decision-making.”

“My motto in this context is the following: ‘Leveraging technology, experience and care to improve the world: one limb at a time’. The unit’s mission is to share our experience and provide our home-grown South African excellence to patients, regardless of whether they are local, regional or international. We empower surgeons to become better at what they do. When I operate a patient, I help that patient. When I improve a surgeon, I help all of her/his patients. That is how we really create an impact.”