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Hip and Knee Channel
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Hip Conditions, Hip Surgery, Knee Conditions, Knee Surgery
Hip Conditions, Hip Surgery, Knee Conditions, Knee Surgery

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Early Knee and Hip Arthritis

There is evidence that identifying early changes in Knee and Hip Arthritis not only helps patients to manage symptoms but can help prevent progression of arthritis.

In the knee Intervention includes non-operative measures such as improving your fitness with non impact exercises such cycling and swimming, improving your balance, core, hip and knee strength, thereby improving loading of your knee and reducing symptoms.

Surgery may be indicated if there is localised area of cartilage loss such as the example below: cartilage transplant, microfracture, the use of bone marrow are all examples of what we have available now

In the hip, early intervention with repair of the labrum (chondro labral tears) through hip arthroscopy and osteoplasty has been shown to help with symptoms and may prevent progression of hip arthritis
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Minimally invasive Hip replacement

Many patients ask about minimally invasive hip replacement surgery, but what they REALLY want is be pain free and mobile as soon as possible e.g. being up and about the day of the surgery. I have seen several patients based in the USA who have been to see me, asking about the Anterior minimally invasive hip replacement approach, but have been really pleased with what I have to offer in terms of an optimally invasive posterior approach (size of incision is proportional to the size of the patient!!)- patients don't care about the size of the scar which heals side to side anyway (not top to bottom!).
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A major challenge for clinicians is tailoring the most appropriate treatment strategy to the individual patient. We need as much information as possible from the patient and using technology.

Well done to all my team for the Best Poster Prize at the British Hip Society Meeting recently (March 2015), for research into how we can improve the way we assess the extent of arthritis, and therefore point patients in the right direction,  whether it's minimally invasive surgery or state of the art physio treatment.

Watch this space! 
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Meniscal or soft cartilage tears of the knee are very common clinical problems presenting with localised pain in the knee joint particularly with sudden twisting movements of the knee. This is an intra-operative video of a patient who has a knee meniscal tear being treated by key hole surgery of the knee (Knee Arthroscopy)
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Hip Impingement

This is a patient who has right hip impingement secondary to a previous avulsion fracture of rectus femoris- he presented with groin pain and weakness. Classical hip impingement signs. My registrar is shown here demonstrating how we can best isolate rectus femoris with resisted hip flexion with the knee straight.

The plan is to excise this area of non union using keyhole techniques- Hip Arthroscopy, but open anterior hip surgery may be required. 
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2014-06-29
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Knee pain and Knee arthritis (osteoarthritis)

Patients with mild to moderate knee arthritis may benefit from the use of a variety of non-operative techniques including a knee offloader (see below) but the key is selecting/ directing patients to this versus a whole variety of other non-operative treatment or in appropriate patients, keyhole, conservative, minimally invasive surgery or partial knee replacements.
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2014-06-29
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Hip Arthroscopy for Hip impingement & Groin Pain

Did a re-do (revision hip arthroscopy/key hole procedure- see intraop pic below) for a patient who had persistent groin pain after a hip arthroscopy done somewhere else a few years ago. Had established that she had a combination of pathologies- psoas tendon inflammation, chondro labral tear, persistent pincer and cam impingement! Very satisfactory patient outcome thus far- these are the cases that really help to sharpen up one's diagnostic skills as these patients present with a variety of symptoms- of groin pain, sharp clicking pain, aching discomfort and activity related hip/outer aspect hip pain
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Hip and Knee Surgical outcomes:

Attended the 15th EFORT congress in London. David Stanley lectured on "Patient Safety and Healthcare Innovation". Highlighted how surgeons need to really know their patients and their own surgical outcomes, not just the reported outcomes in the orthopaedic literature.

Felt I had to look up my own data in the National Joint registry.

www.njrcentre.org.uk 

Quite a lot of data, but one parameter was Hip and Knee revision rates. 1 revision hip in 253 (0.4% v 0.8% nationally) and 1 revision knee in 242 (0.4% v 0.5% nationally). Pleasing results, but what's even more important is patient reported outcomes, a more precise indicator of patient satisfaction. This is what we need to document but difficult to do as many happy patients say thanks but are too busy to fill in our outcome forms!. Actually, this includes myself when I was a patient, sorry Mr Loughran!.
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