Saturday, 5 March 2011

THE KRYPTONITE REVOLUTION ?


A few months ago, whilst chatting about nothing in particular, a local rep mentioned this new product to me - it is a bone cement called Kryptonite which can be used during sternal closure and which sets
to  its final bone hardness in 24-48 hours. A thoracic surgical colleague of mine suggested that male cardiac surgeons (who consider themselves supermen) might feel their powers ebbing away if they handle this stuff - Superman might do I said, but WE are untouchable!

When I attended the annual meeting of European Association of Cardiothoracic Surgery in Geneva in September last year, I made a beeline for the Kryptonite trade stand. I just had to see this stuff. Sure enough, it works and does what it says on the tin - after 20 minutes the initially gooey cement had set to a rock like hardness. Wow, I thought - the end of dehisced sternums (not that this particular superman sees many sternal dehiscences!!)  According to the guy on the stand, units are using this stuff to aid sternal closure in obese patients - and as we all know the numbers of patients with BMIs over 30 who are referred for cardiac surgery are going up. At £300 a pop, it wasn't cheap but complications of sternal closure are terrible, risking patients' lives and very expensive to treat.
Kryptonite popped back into my consciousness recently when a physiotherapist asked me how safe was it for a patient with a lower limb neurological disorder who I had operated on recently to apply her weight on to a walking frame. The advice we normally give is for all patients to avoid straining the sternotomy wound for up to 6 weeks which is when we are confident that reliable bony union has occurred. The need to protect what is essentially a fracture lies behind the need for patients to avoid many activities in the first few weeks after cardiac surgery. This means that patients cannot return to full independent living for a few weeks.   This has profound health economic consequences as many of the elderly we operate on live on their own and invariably spend many extra days in an acute hospital bed whilst social services and/or relatives get their act together. If the use of Kryptonite can, in addition to avoiding sternal breakdown, lead to us being able to discharge many patients earlier,  then £300 is actually cheap at the price!