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