1. 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

2. 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

3. 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

4. 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

5. 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

6. How do hips present Trauma is rare
May complain of pain in certain positions or with or after certain activities
Clicking

7. How to examine a hip patient
Gait
SLR
Flexion Rotation
Lateral hip pain
Trendelenberg stance

8. What when and who should I refer to
Pain in hip region
Unresponsive to allied health input
Early
Hip arthroscopic / replacement surgeon

9. 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

10. Cam Impingement

11. 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

14. 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

15. Latest things in the hip
Pre op 3D CT
Exact fit anatomic THR
Matches length and off-set
Better functional result
Longer life

18. The Sports Orthopaedic Clinic
Thank You
The Sports Orthopaedic Clinic at Spire Gatwick Park Hospital

19. 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

20. 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

21. 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

22. How to examine an acute knee injury
SLR - ROM - Hyperextend
Patella
Joint lines
Collaterals
Cruciates - Ant or Post Drawer / Lachman
Modified McMurray

23. 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

24. 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

25. 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

26. How soon can I replace Newer designs Still not as good as hips
When they need it – no point in suffering
Consider partials

27. 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

28. The Sports Orthopaedic Clinic
Thank You
The Sports Orthopaedic Clinic at Spire Gatwick Park Hospital