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Knee surgery  Nick Bowman  Orthopaedic Consultant  Tunbridge Wells Hospital  Nick Bowman  Orthopaedic Consultant  Tunbridge Wells Hospital.

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Presentation on theme: "Knee surgery  Nick Bowman  Orthopaedic Consultant  Tunbridge Wells Hospital  Nick Bowman  Orthopaedic Consultant  Tunbridge Wells Hospital."— Presentation transcript:

1 Knee surgery  Nick Bowman  Orthopaedic Consultant  Tunbridge Wells Hospital  Nick Bowman  Orthopaedic Consultant  Tunbridge Wells Hospital

2 Introduction  Who I am  Where I’m from/have done  What I do  Referrals and what I can do for your patients  Anything else  Who I am  Where I’m from/have done  What I do  Referrals and what I can do for your patients  Anything else

3 Education  School, Edinburgh/Tunbridge Wells  Medical school, Edinburgh University  BSc (hons) Neuroscience 1999  London and SE Thames training  Diploma orthopaedic engineering Cardiff 2008  FRCS (Tr and Orth) Edinburgh 2009  CCT 2012  Fellowships  School, Edinburgh/Tunbridge Wells  Medical school, Edinburgh University  BSc (hons) Neuroscience 1999  London and SE Thames training  Diploma orthopaedic engineering Cardiff 2008  FRCS (Tr and Orth) Edinburgh 2009  CCT 2012  Fellowships

4 Roger Brighton- Sydney Knee arthroplasty Hip arthroplasty Revision arthroplasty ACL / arthroscopy trauma

5 Arthroscopic sports injuries- Sydney Danny Biggs Knee (and shoulder) ACL/arthroscopy Trauma

6 St George Private Hospital

7 Blacktown Public Hospital

8 Fellowships Sydney 2010-2012 Knee surgery – Leo Pinczewski ACL reconstruction Knee arthroplasty osteotomy

9 Mater Misericordiae Hospital

10 Knee fellow Tunbridge Wells 2012-13

11 Consultant appointment- September 2013 Started Jan 2014

12 Knee pathology Knee injuries Knee arthritis Everything else ( that’s in the knee….)

13 Examination of the knee

14 History Careful and detailed history Exact mechanism of injury required Valgus Contact? Pop or twang or crunch hyperextension Careful and detailed history Exact mechanism of injury required Valgus Contact? Pop or twang or crunch hyperextension

15 History continued Injury swelling Instability OA Pain Instability Start up/inclines/immobile pain Injury swelling Instability OA Pain Instability Start up/inclines/immobile pain

16 Examination of the knee Look Feel Move Special tests Look Feel Move Special tests

17 Examination of the knee Look Skin colour Scars Muscle wasting Swelling Deformity Skin colour Scars Muscle wasting Swelling Deformity

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22 Examination of the knee Feel Skin temperature Tenderness Swellings - effusion & lumps Crepitus Skin temperature Tenderness Swellings - effusion & lumps Crepitus

23 Feel where? Joint line Meniscal injury Collateral ligaments OA Quads tendon Patellar tendon (distal pole) Back of joint (Baker’s cyst, aneurysms) Joint line Meniscal injury Collateral ligaments OA Quads tendon Patellar tendon (distal pole) Back of joint (Baker’s cyst, aneurysms)

24 Examination of the knee Move Range of movement (normal 0-135) Fixed flexion e.g.15-120 Compare with other side Ligament testing - collaterals & cruciates Agony test = painful crepitus on stressing one compartment Range of movement (normal 0-135) Fixed flexion e.g.15-120 Compare with other side Ligament testing - collaterals & cruciates Agony test = painful crepitus on stressing one compartment

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29 Special tests Collaterals McMurray’s – menciscal injury Lachman’s test / pivot shift test (ACL) Ant and post drawer (cruciates) Collaterals McMurray’s – menciscal injury Lachman’s test / pivot shift test (ACL) Ant and post drawer (cruciates)

30 Lachman

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34 Other “knee” injuries Unusual presentations Children Often minor trauma Unusual presentations Children Often minor trauma

35 How about this one? 8yr old Fit and well Trampoline injury ….. 8yr old Fit and well Trampoline injury …..

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37 This 12 year old boy Seen in AE Twice “groin sprain” …… Seen in AE Twice “groin sprain” ……

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39 REMEMBER THE HIP IN KIDS!!!!!!!

40 Referrals Interests Knee Injuries Cruciate ligament injury Meniscal injury Patello-femoral instability Multi-ligament injury (knee dislocations) Fractures (plateau/ distal femur/patellar

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43 Interests Arthritis

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45 Contact

46 Referrals CCGs Not black and white Patients not keen on surgery… Opinion

47 Contact Details THE KNEE CLINIC: ADMIN@KNEESURGERYCLINIC.CO.UKADMIN@KNEESURGERYCLINIC.CO.UK Website : WWW.KNEESURGERYCLINIC.CO.UKWWW.KNEESURGERYCLINIC.CO.UK Private Secretary: ALISON/JULIE/LIZ – 01892 546111 NHS Sec: CHRIS MARSHAL Tel: 01892 635730 Email: chrismarshall@nhs.net THE KNEE CLINIC: ADMIN@KNEESURGERYCLINIC.CO.UKADMIN@KNEESURGERYCLINIC.CO.UK Website : WWW.KNEESURGERYCLINIC.CO.UKWWW.KNEESURGERYCLINIC.CO.UK Private Secretary: ALISON/JULIE/LIZ – 01892 546111 NHS Sec: CHRIS MARSHAL Tel: 01892 635730 Email: chrismarshall@nhs.net

48 Clinics Tunbridge Wells Hospital (knee clinic and fracture clinic) Sevenoaks Hospital Maidstone Hospital Spire Tunbridge Wells Tunbridge Wells Hospital (knee clinic and fracture clinic) Sevenoaks Hospital Maidstone Hospital Spire Tunbridge Wells

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50 Thank you for your attention


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