Transcript Mr Paul Jairaj FRCS Orth Consultant Orthopaedic

The Sports Orthopaedic Clinic
Hot Hips
Mr Paul Jairaj FRCS Orth
Consultant Orthopaedic Hip and Knee
Surgeon
Paul Jairaj
 The Sports Orthopaedic Clinic
 Latest management of sports related or joint
degenerative conditions
 Education and Research
 Faculty – European Surgeon Training
 Consult Spire Gatwick Park, London Bridge
and the Lister Hospital
Difference
 London trained with US and French
Fellowships
 Private sector inc NHS patients
 Hip Arthroscopy – Prevent Arthritis
 3D Templating for custom designed Knee
and Hip Replacements will restore anatomy
 Anatomic ACL surgery and Computer
Guided Knee Surgery – Accuracy
Learning Objectives
 How do hips present
 How to examine a hip patient
 What when and who should I refer to
 What is femoro-acetabular impingement
 What’s hip arthroscopy all about
 Doctor I have a metal on metal hip resurfacing
 Latest things in the hip
How do hips present
 Groin Pain – Xray shows good joint space
 Trochanteric Bursitis – injection minimal benefit
 Groin strain or hamstring injury – physio no better
 Pulled abdominal muscle - hernia
 Osteitis pubis or piriformis syndrome ?
 Non resolving back and buttock pain (even with
sciatic symptoms) - psychiatric referral
How do hips present
 Trauma is rare
 May complain of pain in certain positions or with or
after certain activities
 Clicking
How to examine a hip patient
 Gait
 SLR
 Flexion Rotation
 Lateral hip pain
 Trendelenberg stance
What when and who should I
refer to
 Pain in hip region
 Unresponsive to allied health input
 Early
 Hip arthroscopic / replacement surgeon
What is femoro-acetabular
impingement
 Contact between fermoral neck and
acetabulum
 Cam and Pincer leads to labral tearing
 Labral tear leads to articular cartilage damage
 Cartilage cannot heal - arthritis ensues
 Arthroscopic intervention slows progression
Cam Impingement
What’s hip arthroscopy all about
 Complex surgery to treat FAI
 many other indications
 Special training required - special skill set
 Rehabilitation is critical to outcome
Doctor I have a metal on metal
hip resurfacing
 Recall of De Puy ASR hip resurfacing
 Slightly different design to the Birmingham hip
 Applies to resurfacing and XL heads
 High metal ion production in first 2 years
 Metal allergy
 Correct orientation of implants
Latest things in the hip
 Pre op 3D CT
 Exact fit anatomic THR
 Matches length and off-set
 Better functional result
 Longer life
The Sports Orthopaedic Clinic
Thank You
The Sports Orthopaedic Clinic at
Spire Gatwick Park Hospital 08445617131
[email protected]
www.sportsortho.co.uk
The Sports Orthopaedic Clinic
Hot Knees
Mr Paul Jairaj FRCS Orth
Consultant Orthopaedic Hip and Knee
Surgeon
Learning Objectives
 How to pick up an acute knee
 How to examine an acute knee injury
 What when and who should I refer to
 The role of arthroscopy
 Do gels and steroids make a difference
 How soon can I replace
 Latest things in the knee
How to pick up an acute knee
 Type of trauma
 Could they continue
 When did swelling occur - < 2hrs or > 2hrs
 Don’t trust A+ E
 Early exam is difficult
 RICE and Crutches
How to examine an
acute knee injury
 SLR - ROM - Hyperextend
 Patella
 Joint lines
 Collaterals
 Cruciates - Ant or Post Drawer / Lachman
 Modified McMurray
What when and who
should I refer to
 Swelling < 2hrs = urgent referral to knee surgeon
 Pain Locking Instability Deformity = ref knee surg
 Tendinopathy = sports physician
The role of arthroscopy
 Washout pointless
 Meniscectomy and chondrplasty effective but
must use radiofrequency
 Usually only one arthroscopy required
 Outcome dependent on articular cartilage
damage
Do gels and steroids make a
difference
 Evidence suggests Hyalgan effective in delaying
joint relacement - best after arthroscopy
 Steroids can temporarily help degenerate joint
but never after arthroscopy
 Glucosamine and Chondroitin Sulphate 1500mg
may be beneficial to mild arthritis
How soon can I replace
 Newer designs
 Still not as good as hips
 When they need it – no point in suffering
 Consider partials
Latest things in the knee
 Anatomic ACL reconstructions
 Old techniques have not prevented arthritis
 Reconstruct according to patient anatomy
which will determine requirement for single or
double bundle reconstruction
 Custom design cutting blocks and implants post
scan for total and partial replacement
 Do partials first followed by total later
The Sports Orthopaedic Clinic
Thank You
The Sports Orthopaedic Clinic at
Spire Gatwick Park Hospital 08445617131
[email protected]
www.sportsortho.co.uk