Scarborough Hospital surgeon demonstrates unique procedure to Chilean doctors

It is a very rare procedure – only three surgeons in Canada are doing it – and Orthopedic Surgeon Dr. Jim Rathbun of The Scarborough Hospital is considered a world leader. It’s the Oxford domed lateral partial knee operative technique, and five surgeons travelled all the way from Chile last month to observe Dr. Rathbun perform this relatively new procedure.

“Lots of people are doing medial Oxfords, but domed lateral Oxfords are very rare. I’m the only one in Toronto doing it,” explains Dr. Rathbun, who has been with TSH since 1973. “I completed 245 domed laterals since 2005, so I have a lot of experience, and the Chilean surgeons are anxious to do it in Chile, where they’ve had quite a bit of experience with medial Oxford.”

The difference between lateral and medial has to do with the side of the knee. The medial refers to the side between the legs, while the lateral is the opposite – the outside of the legs. People needing the domed lateral procedure are what Dr. Rathbun calls ‘knock-kneed,’ the opposite of the more common ‘bow-legged.’

“Patients that are worn out on the lateral side of their knee face a more complicated procedure. That’s why few surgeons are performing it and that’s why many of my colleagues refer their patients to me,” Dr. Rathbun adds.

For the five Chilean surgeons, the demonstration was an opportunity to observe this rare procedure from a leading expert.

“We heard about Dr. Rathbun’s work through Biomet (manufacturer of Oxford knee replacement components) because he’s one of the most important surgeons working with the newer devices, especially the domed lateral,” explains Dr. Jaime Duboy, from the Department of Orthopedics at the Clinica Las Condes in Santiago, Chile. “We’re particularly interested in the domed lateral because it’s a new design. Very few surgeons around the world have this kind of experience. We are familiar with the older designs; that’s why the new design is so attractive to us.”

Dr. Duboy and his Chilean colleagues are eager to use the techniques they learned both observing Dr. Rathbun and hands-on surgery with cadavers as part of their instruction while in Toronto.

“Dr. Rathbun is a wonderful surgeon, and he selected good cases that were well-indicated for us,” Dr. Duboy adds. “We learned a lot, and will bring this home because we have the same kind of patients with the same kind of problems. The domed lateral is a good alternative to a more expensive total knee replacement, which is a far more complicated operation.”

The manufacturer of the domed lateral Oxford knee component, Biomet, arranged the visit.

“Dr. Rathbun has been performing the Oxford knee in Canada for 12 years, and has performed more partial Oxford knee replacements than anyone else,” explains Sandy Murray, President of Biomet Canada. “He has embraced the technology for the domed lateral as an alternative to whatever products are out there, and he is by far the most experienced Oxford user in Canada.”

“Chile has a huge need for this procedure. They’ve already seen the benefits of the procedure carried out on the medial side, so they are at this stage ready to go on to the lateral side,” Dr. Rathbun adds. “I think they got a good grounding in where they will go with this procedure.”