surgical management of joint pain- hip & knee€¦ · arijit ghosh consultant hip & knee...
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Surgical Management of Joint Pain- Hip & Knee
Arijit Ghosh
Consultant Hip & Knee Surgeon
University Hospitals of Leicester
Nuffield Health
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Knee Pain
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Knee Pain- Osteoarthritis
Symptoms
• Pain
• Pain on exercise
• Pain at rest
• Pain at night
• Stiffness
• Difficulty with ADLs
• Exacerbations
• Swelling, deformity
Investigations:
• X-ray
• MRI
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Non Surgical Mx of Arthritic Pain
Pharmacological
• Paracetamol, NSAIDS, opioids
• Glucosamine &
• Chondroitin
Weight loss,
Physiotherapy,
Exercise
Injections
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Non Surgical Mx of Arthritic Pain
Pharmacological
• Paracetamol, NSAIDS, opioids
• Glucosamine &
• Chondroitin
Weight loss,
Physiotherapy,
Exercise
Injections
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Non Surgical Mx of Arthritic Pain
Pharmacological
• Exercise- strength training, aerobics etc
• Physiotherapy- stretching and muscle strength
• Weight loss
Weight loss,
Physiotherapy,
Exercise
Injections
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Non Surgical Mx of Arthritic Pain
Pharmacological
• Steroids,
• Viscosupplementation (synvisc, durolane- hyaluronic acid)
• PRP
• Before TKR
Weight loss,
Physiotherapy,
Exercise
Injections
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Non Surgical Mx of Arthritic Pain
Pharmacological
• Steroids,
• Viscosupplementation (synvisc, durolane- hyaluronic acid)
• PRP
• Before TKR
Weight loss,
Physiotherapy,
Exercise
Injections
![Page 10: Surgical Management of Joint Pain- Hip & Knee€¦ · Arijit Ghosh Consultant Hip & Knee Surgeon University Hospitals of Leicester Nuffield Health . Knee Pain . Knee Pain- Osteoarthritis](https://reader034.vdocuments.site/reader034/viewer/2022042803/5f4dee6c0c4a8b35c13afd18/html5/thumbnails/10.jpg)
Non Surgical Mx of Arthritic Pain
Pharmacological
• Steroids,
• Viscosupplementation ( synvisc, hyaluronic acid)
• PRP (Platelet Rich Plasma)
• Before TKR
Weight loss,
Physiotherapy,
Exercise
Injections
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Surgical Management of OA Knee
• Depends on age, function, extent of OA
• Not always Total Knee Replacement
• Options:
• Realignment Osteotomy
• Partial Knee Replacement
• Total Knee Replacement
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Surgical Management of OA Knee
• Depends on age- realignment osteotomy
Indications:
• Younger age group
• Lower BMI
• Preserved lateral compartment
• + activity/manual worker
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Surgical Management of OA Knee
• Depends on age- realignment osteotomy
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Surgical Management of OA Knee
• Depends on age- realignment osteotomy
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Surgical management- Arthroplasty
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Derby Unicompartmental Knee
Arthroplasty Meeting
Restoration of normal
biomechanics – Tibial axial
rotation and femoral roll back
similar to normal knee (Patil et al , JBJS Am 2005)
Feels more like normal knee (Bert
JM. UKR. Orthop Clin North Am, 2005)
Better knee flexion and near
normal gait (Amis et al, JOA 2013)
Benefits of UKA
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Derby Unicompartmental Knee
Arthroplasty Meeting
• Higher patient satisfaction rate
• 2.5 times more likely to meet patient expectation
• Better functional results
• Shorter hospital stay
Benefits of UKA
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Total Knee Athroplasty
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What do I tell my patients about a TKR?
• When to have a TKR?
• Outcome of a TKR
• What to expect
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Knee Pain
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Knee Pain Sports Injuries
• Ligament Injuries
• ACL/PCL/PLC/MCL
• Meniscal Surgery
• Tendinopathies
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Knee Pain
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Knee Pain
• Sports Injury chronic
• Ligament- tendonitis
• Runners knee
• ITB syndrome
• Chondromalacia
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Knee Pain
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Knee Pain
• Paediatric Knee
• Anterior Knee pain
• Trauma-
• OCD, meniscus
• Patella realignment surgery
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Knee Pain
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Summary knee pain mx
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What else could it be?
• PVNS
• Malignant Lesion
• Infection
• Hip Pathology
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Surgical Management of Hip pain
Lumbosacral
cause
Trochanteric
bursitis
Hip OA
Tendinitis/psoas
impingement
Piriformis
syndrome Femoroacetabular
impingement
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Surgical Mx of the Young Adult Hip
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Total Hip Replacement
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Thank you