mr paul jairaj frcs orth consultant orthopaedic hip and knee surgeon hot hips the sports orthopaedic...
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Mr Paul Jairaj FRCS OrthConsultant Orthopaedic Hip and Knee
Surgeon
Hot Hips
The Sports Orthopaedic Clinic
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
Thank You
The Sports Orthopaedic Clinic at
Spire Gatwick Park Hospital 08445617131
[email protected] www.sportsortho.co.uk
The Sports Orthopaedic Clinic
Mr Paul Jairaj FRCS OrthConsultant Orthopaedic Hip and Knee
Surgeon
Hot Knees
The Sports Orthopaedic Clinic
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
Thank You
The Sports Orthopaedic Clinic at
Spire Gatwick Park Hospital 08445617131
[email protected] www.sportsortho.co.uk
The Sports Orthopaedic Clinic