Transcript Management of the Painful Hip Mr Paul Jairaj

The Sports Orthopaedic Clinic
Tel:
08445 617131
E-mail: [email protected]
Website: www.sportsortho.co.uk
Management of the Painful Hip
Mr Paul Jairaj
MB ChB, FRCS (Tr&Orth)
Consultant Orthopaedic Hip and Knee Surgeon
Paul Jairaj
• Consultant Orthopaedic Hip and Knee
Surgeon
• Trained in London with US and French
Fellowships
• Substantive Consultancy
• Pure Private Practice at Gatwick Park and
London Bridge and the Lister Hospitals
and Harley Street
Paul Jairaj
• Founding Partner Sports Orthopaedics UK
• Latest management of patients with sports
related or joint degenerative conditions
• Education and Research
• Hip faculty for European Surgeon training
• Available Monday to Friday
Hip Updates
• The Painful Hip
• Role of Hip Arthroscopy in Delaying THR
• Custom Made THR
Where does hip joint pain go?
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Groin
Lateral
Low Back
Deep Hip
Knee
51%
45%
42%
58%
45%
Causes of Hip Pain
• Avulsion or Stress Fractures
• Adductor / Iliopsoas / Rectus Muscle Sprain
• Inguinal/ Sports Hernia or other intra-abdominal
pathology
• Spinal origin (referred pain)
• Iliopsoas bursitis / Snapping
• Trochanteric bursitis
• Arthritis
• Osseo-chondrolabral lesion within joint
New evidence
• Labral tears lead to articular cartilage damage
• Femoral Cam and Acetabular Pincer lesions
(femoroacetabular impingement) perpetuate the
process
• Altered gait causes lateral trochanteric or back pain
• Early treatment will slow the onset of arthritis
Femoroacetabular impingement
Hip History
• Trauma (hyperextension or lateral blow)
• Pain in certain positions (sitting or lying on
side) or activities
• May have click or snap or sensation of giving
way / instability
Hip examination
• Appearance, gait, leg lengths
• Tenderness (laterally / groin)
• Cough impulse for hernias
• Range of motion
• Impingement (pain with flexion + int rotation)
• Painful muscle insertions and test against
resistance
• Demonstrable snap (Flex-ER to Ext-IR)
• Spinal examination incl. Neurology
Hip Investigations
• X-rays - evidence of a bump or osteophyte
• MRI or MR-arthrography
• 3D CT
• Hip Block Injection
Treatment
• Rest and cause-avoidance/ Analgesics and
NSAIDs / weight loss
• Physiotherapy - regain hip control
• Ultrasound-guided steroid injection
• Hip arthroscopy
• Hip replacement
Hip Arthroscopy
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Labral debridement / repair
Femoroacetabular Impingement surgery
Loose body removal
Cartilage repair – chondroplasty /
microfracture
• ITB Release/ Snapping psoas division
• Hip instability- Lig. teres shrinkage
• Septic Arthritis - washout
Rehabilitation
• Vital importance to success of procedure
• 4 stages geared towards
range of motion
strength and core stability
proprioception
sports specific function
Hip Replacement
• Younger patients
• Choice of Prosthesis
- resurfacing
- uncemented
• Choice of Bearings
- ceramic
- metal
• Custom Made
Symbios Total Hip Replacement
• Pre op 3D CT
• Exact fit Anatomic THR
• Matches length and
offset
• Better Functional result
• Longer life
The Sports Orthopaedic Clinic
THANK YOU
Tel: 08445 617131
E-mail: [email protected]
Website: www.sportsortho.co.uk