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Surgical Management of Joint Pain- Hip & Knee
Arijit Ghosh
Consultant Hip & Knee Surgeon
University Hospitals of Leicester
Nuffield Health
Knee Pain
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
Non Surgical Mx of Arthritic Pain
Pharmacological
• Paracetamol, NSAIDS, opioids
• Glucosamine &
• Chondroitin
Weight loss,
Physiotherapy,
Exercise
Injections
Non Surgical Mx of Arthritic Pain
Pharmacological
• Paracetamol, NSAIDS, opioids
• Glucosamine &
• Chondroitin
Weight loss,
Physiotherapy,
Exercise
Injections
Non Surgical Mx of Arthritic Pain
Pharmacological
• Exercise- strength training, aerobics etc
• Physiotherapy- stretching and muscle strength
• Weight loss
Weight loss,
Physiotherapy,
Exercise
Injections
Non Surgical Mx of Arthritic Pain
Pharmacological
• Steroids,
• Viscosupplementation (synvisc, durolane- hyaluronic acid)
• PRP
• Before TKR
Weight loss,
Physiotherapy,
Exercise
Injections
Non Surgical Mx of Arthritic Pain
Pharmacological
• Steroids,
• Viscosupplementation (synvisc, durolane- hyaluronic acid)
• PRP
• Before TKR
Weight loss,
Physiotherapy,
Exercise
Injections
Non Surgical Mx of Arthritic Pain
Pharmacological
• Steroids,
• Viscosupplementation ( synvisc, hyaluronic acid)
• PRP (Platelet Rich Plasma)
• Before TKR
Weight loss,
Physiotherapy,
Exercise
Injections
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
Surgical Management of OA Knee
• Depends on age- realignment osteotomy
Indications:
• Younger age group
• Lower BMI
• Preserved lateral compartment
• + activity/manual worker
Surgical Management of OA Knee
• Depends on age- realignment osteotomy
Surgical Management of OA Knee
• Depends on age- realignment osteotomy
Surgical management- Arthroplasty
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
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
Total Knee Athroplasty
What do I tell my patients about a TKR?
• When to have a TKR?
• Outcome of a TKR
• What to expect
Knee Pain
Knee Pain Sports Injuries
• Ligament Injuries
• ACL/PCL/PLC/MCL
• Meniscal Surgery
• Tendinopathies
Knee Pain
Knee Pain
• Sports Injury chronic
• Ligament- tendonitis
• Runners knee
• ITB syndrome
• Chondromalacia
Knee Pain
Knee Pain
• Paediatric Knee
• Anterior Knee pain
• Trauma-
• OCD, meniscus
• Patella realignment surgery
Knee Pain
Summary knee pain mx
What else could it be?
• PVNS
• Malignant Lesion
• Infection
• Hip Pathology
Surgical Management of Hip pain
Lumbosacral
cause
Trochanteric
bursitis
Hip OA
Tendinitis/psoas
impingement
Piriformis
syndrome Femoroacetabular
impingement
Surgical Mx of the Young Adult Hip
Total Hip Replacement
Thank you