Mr Paul Jairaj FRCS Orth Consultant Orthopaedic Hip and Knee Surgeon 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 paul.jairaj@sportsortho.co.uk www.sportsortho.co.uk

Mr Paul Jairaj FRCS Orth Consultant Orthopaedic Hip and Knee Surgeon 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 paul.jairaj@sportsortho.co.uk www.sportsortho.co.uk