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Mr Paul Jairaj FRCS Orth Consultant Orthopaedic Hip and Knee Surgeon

Mr Paul Jairaj FRCS Orth Consultant Orthopaedic Hip and Knee Surgeon. The Sports Orthopaedic Clinic. Hot Hips. Paul Jairaj. The Sports Orthopaedic Clinic Latest management of sports related or joint degenerative conditions Education and Research Faculty – European Surgeon Training

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Mr Paul Jairaj FRCS Orth Consultant Orthopaedic Hip and Knee Surgeon

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  1. Mr Paul Jairaj FRCS OrthConsultant Orthopaedic Hip and Knee Surgeon The Sports Orthopaedic Clinic Hot Hips

  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

  12. 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

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

  14. Thank You The Sports Orthopaedic Clinic The Sports Orthopaedic Clinic at Spire Gatwick Park Hospital 08445617131 paul.jairaj@sportsortho.co.ukwww.sportsortho.co.uk

  15. Mr Paul Jairaj FRCS OrthConsultant Orthopaedic Hip and Knee Surgeon The Sports Orthopaedic Clinic Hot Knees

  16. 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

  17. 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

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

  19. 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

  20. 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

  21. 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

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

  23. 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

  24. Thank You The Sports Orthopaedic Clinic The Sports Orthopaedic Clinic at Spire Gatwick Park Hospital 08445617131 paul.jairaj@sportsortho.co.ukwww.sportsortho.co.uk

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