Posted By Jeffrey Watt David During training years ago a hospital physiotherapist from the RVH Belfast described this MH operation in the context of a 6 figure claim that the nurse successfully won for damage to her back. I do not re,member any of the details as this was about 10 years ago, sorry. Nurse may have been from GB not NI. Kind regards Jeff

Posted By Adrian Clifton David More fuel for the fire. What do you think the outcome would be if the patient was to suffer further injury, when the nurse was unable to hold the suspended leg long enough causing the surgeon to make a mistake. This would almost certainly result in court proceedings, but also think of the Press reports and prosecution for failing to take "reasonable care of others affected by your activities". As today is Sunday, it may be church bells I can hear ringing, but it could be the panic alarm! Adrian

Posted By markl David This issue was raised by an HSE visit we had recently and I've looked for possible solutions on the Internet but couldn't find anything. Could you provide any details for possible suppliers of equipment? Thanks in advance Mark

Posted By John Lewis David My employer actually makes and markets various knee and hip repair solutions. Our Marketing Department train surgeons to install these implants. As a result, I have done risk assessments on the process from the viewpoint of our own people and the likelihood of them injuring themselves assisting the surgeons. We actually do the training on cadavers but the principle is the same. In none of the sessions I have attended (and assisted with as part of the RA) has there been a manual handling issue as regards the surgery. The most "violent" part of the op' is the dislocation of the hip and this is left to the surgeon. The ones I have spoken to do this themselves in theatre as well. There are stories of surgeons employing their own Igor characters, but I've never met one. The hip patient is arranged in the most appropriate position for the operation, which is either on their back or on their side with the hip to be replaced uppermost, depending on the type of implant and the surgeons preference. Knee replacements are done with the leg either flexed or hanging off the operating table to get best access. With the leg flexed someone has to hold the foot to prevent it sliding, but all cuts are done with very precise jigs so there is no absolute need to prevent movement altogether. There is no need for long term support at arms length. Obviously I can only speak for my companys products; other manufacturers may have special jigs to assist. Given the number and variety of gadgets and gizmos we make worldwide I can only assume that if there were a problem, we would make a "fix" to get round it and we don't. I hope this helps. Surgeons I have spoken to do seem to have favourite product ranges and lines. From the patients point of view that is not a bad thing because of the experience he will have gained over the years, and the consequent likelihood of a him doing a good job.

Posted By markl John If you could, could you elaborate a little more on the process you have witnessed (I appreciate that it's quite a full account already but do you have any other details that might be relevant)? The HSE's main area of concern is static postures whilst a patient is being prepped for surgery (which is something they have come across in other Trusts)- the leg has to be elevated to 'paint' iodine over the area to avoid infection during the operation - which can take 20 - 30 minutes. I must admit I have not witnessed the task myself being new to the NHS and the description given by threatre staff differs your account as the leg continues to be elevated throughout the operation, which may be explained simply by custom and practice of the surgeon involved, but some operations require the leg to be tilted whilst being held aloft to allow the surgeon more direct access depending on the area they are operating on. As I have said I have not witnessed it so the input from someone who has with an H&S hat would be useful.

Posted By David Osborn John, Many thanks for this I had an idea which may sound a bit bizarre (but hey, what are chat forums for if not to publicly embarass yourself!) I was wondering about something along the lines of a support which could go under the patient's lower leg (from heel to calf), supported with a leather or fabric strap worn around the neck and perhaps the back (a bit like an usherette's icecream tray ! ). This would distribute the weight and allow the nurse or porter to maintain a more upright posture and keep the weight central. Obviously the whole contraption would have to be sterile or autoclavable for reuse. It would have to be easy to remove the leg from this device because at some stage in the process the person holding the leg has to back off (still holding the leg - this is where the "arms-length" bit comes in) so that the surgeon can get in to sort out the drapes. So this device wouldn't totally sort out the problem but might alleviate it a bit. Perhaps you could bounce the idea of your colleagues who've seen the leg prep being done and see if they think it's practical? Anyone else got any input ? David

Posted By David Osborn Mark - thanks for that. The idea of a stirrup from the ceiling sounds like a good idea. On reflection, my idea of supporting the leg from heel to calf would probably be a non-starter on medical grounds. My wife (ex nurse) put me firmly in my place when I told her about it last night. "Most likely cause a thrombosis" she said, closely followed by "don't dabble in things you don't understand". Well that's telling me ! But it does make the serious point (which I'm always telling students on my courses) that H&S practitioners without any medical qualifications shouldn't "cross the line" and make suggestions with medical implications. So I guess we'll need to see what the medics come up with. You're absolutely right - it is a niche in the market. Maybe John's Company or a similar one will try and come up with something suitable. David