They say a surgeon never forgets their first surgery – and Paul Haslam is certainly no exception. It was 1996 and he was a junior doctor at a hospital in Sheffield, he recalls without hesitation. He was hooked.
“It was just brilliant,” says Paul, now an accomplished consultant orthopaedic surgeon specialising in knee surgery in Doncaster in south Yorkshire and at Sheffield Children’s Hospital. “You just fall in love with surgery. You know, absolutely, that this is what you want to do.”
He now performs about 100 knee replacements and 80 anterior cruciate ligament (ACL) procedures a year, adding up to several thousand surgeries in his career to date. It is no surprise that he enjoys giving surgical trainees under his supervision every appropriate opportunity to operate.
“All surgical registrars, all they want to do is get stuck in and operate,” he says. “I have a rule whereby, pretty much, the registrar does everything. I try to stand back and let them do the operations and I assist. Giving that opportunity to people is a great feeling – and you know their theatre experience will be good.”
He recently bumped into one of his former trainees who is now a consultant general surgeon; another is a professor of orthopaedic surgery. “That’s really nice, when you see people come through at that level,” he says. He went under the knife himself recently, after injuring his thumb skiing. “I went to my own hospital and one of my colleagues did it, so I experienced life on the other side of the fence,” he says. “It was good!”
Originally from Manchester, Paul was the first person in his family to opt for the medical profession and moved to Sheffield for his studies. “I have been on the wrong side of the Pennines for a long time now but I’m still a Man United fan,” he says, laughing.
The “simplicity” of orthopaedics appealed to him from the outset. “When you start out, you want to fix fractures,” he says. “You can see a bone is either broken or it’s not; if it’s broken, you’ve got to decide if you stick it in plaster or operate. Then it’s either really well fixed or it ain’t. There’s instant feedback.”
He did post-qualification training at “a fantastic orthopaedic unit” in Derby Hospital, where one surgeon, Tim Wilton, was voted the best knee surgeon in Britain. Derby still holds happy memories for Paul. “I remember one of the consultants gave me a paper to present at a European meeting,” he says. “Then you apply for your registrar jobs and one of the prerequisites is presenting [a paper] at a European meeting. So he knew he was giving me a leg up. Things like that stay with you.”
Paul went back to Sheffield for registrar training, during which he somehow found time to co-author an undergraduate text book, A Crash Course in Orthopaedics and Rheumatology, in 2003. A lot of his content has survived two decades of revisions to the book, he says. From 2004-2006, he did postgraduate fellowships in Melbourne, New Zealand and Sydney, “a great experience”.
Returning from Sydney, he was appointed at Doncaster Royal Infirmary, affectionately named ‘Donnie’. He deepened his expertise in orthopaedics way beyond mending broken bones and refers back to the origin of the word, from ‘orthos’ meaning ‘straight’ and ‘paed’ meaning ‘child’.
“With orthopaedics, you can go right back to birth or even pre-birth; before a person is even born, you can know they’ve got a dysplastic hip that will need attention,” he says. “We see a lot of very old patients who have osteoporosis and there is everyone in between.”
He has held a range of roles at Donnie, including two stints as clinical director, one of which was during the Covid-19 pandemic. During that period, he successfully operated on the femur of a 110 year-old local lady, who was able to walk out the door after recovery. Sadly, three members of staff at the hospital died during the pandemic, a reminder of the incredibly difficult working environment.
“It was a strange time,” says Paul. “It was a national emergency, it was our moment to step up, but it got very difficult. You had to have a rota four layers deep because one would go off sick, two would go off, three would go off and the fourth person might be available. That was a challenge.”
Alongside his public and private work in Doncaster, Paul was invited in 2019 to join a new team at Sheffield Children’s Hospital specialising in paediatric knee conditions, both traumatic and congenital. Run by Nicolas Nicolaou, a consultant paediatric orthopaedic surgeon, it brings together paediatric-trained orthopaedic surgeons and knee-trained orthopaedic surgeons to collaborate on difficult cases.
Their cases involve complex knee ligament reconstructions on young children, procedures that can take several hours and involve using a patient’s own tissue – an autograft – or tissue from a deceased person, known as allograft. “In these congenital cases, everything is abnormal so it’s pioneering work,” says Paul.
“We’ve certainly got the biggest series of congenital knee ligament reconstructions in the UK; I suspect when we write it up, it might be the biggest in the world. There are over 40 of them in the series – and these are not common conditions.”
The Sheffield team gets referrals from all over the UK and beyond, and has the only paediatric knee fellowship in the UK recognised by the European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA). It also runs the only recognised paediatric knee course in the world, with specialist contributors from around the globe.
On a “standard working day” in theatre, Paul will do four surgeries, though it can sometimes be as many as six. Alongside a week-on, week-off schedule with the NHS, his private practice and work in Sheffield, he has worked as consultant knee surgeon at the Tarmeem Orthopaedic and Spine Day Surgery Centre in Abu Dhabi. He credits colleagues, including his NHS secretary, for keeping it all on track.
“I heavily rely on a team of people who organise me,” he says. “Technology has had a big impact. When I first started, a junior doctor had to type out all our trauma admissions, print it on a sheet and present the cases. Then the theatre staff would have to put them on their list. It was absolutely bonkers duplication.”
Paul helped to introduce Bluespier, Clanwilliam’s theatre management software, to Doncaster hospital and recognises its value in eliminating duplication, streamlining processes and saving time. Remote access to the system is also valuable, he says.
“You could see exactly what’s been brought in, and when. You can plan your surgical list from home and change the list in order to get a tricky case done first when you’re fresh, for example. I can do lots of things that I just wouldn’t have been able to do prior to this.”
Electronic or printed operation notes, prescriptions and patient discharge letters help improve transparency and safety for patients. Paul was also involved with the National Ligament Registry, a database of information about ACL reconstruction and repair in the UK, which was set up in 2018.
“When you have a vast amount of data like that, it is a really powerful tool for research and development and for identifying any problems with kit and techniques. It drives change and improvements,” he says.
He says knee surgeries are getting more complex, increasingly involving work on the medial collateral ligament (MCL) as well as the ACL. Recognition of cruciate ligament injuries in paediatric patients has risen exponentially, particularly in girls, mirroring the rise in popularity of women’s football.
Paul himself spent a decade coaching football at local club Tickhill Juniors and is also a keen golfer, playing off a 12 handicap. His wife Audrey is from Co Leitrim in Ireland, so trips to visit her family often include some Irish golf courses. Outside work, unusually, he also has one-eighth share in two pubs, The Jolly Tap in Barnsley and The Mallard on Moorthorpe Station in Wakefield.
“A mate of mine had some uni mates who set up a brewery, Jolly Boys Beer, and he asked us to invest in a pub company,” he says by way of explanation. “It’s a difficult business to be in and I’ve not had a penny in dividends from it, but it is great fun.” Just not as much fun as that first surgery.
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