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Management of the Painful Hip

Tel: 08445 617131 E-mail: clinic@sportsortho.co.uk Website: www.sportsortho.co.uk. The Sports Orthopaedic Clinic. Management of the Painful Hip . Mr Paul Jairaj MB ChB, FRCS ( Tr&Orth ) Consultant Orthopaedic Hip and Knee Surgeon. Paul Jairaj.

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Management of the Painful Hip

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  1. Tel: 08445 617131 E-mail: clinic@sportsortho.co.uk Website: www.sportsortho.co.uk The Sports Orthopaedic Clinic Management of the Painful Hip Mr Paul Jairaj MB ChB, FRCS (Tr&Orth) Consultant Orthopaedic Hip and Knee Surgeon

  2. 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

  3. 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

  4. Hip Updates • The Painful Hip • Role of Hip Arthroscopy in Delaying THR • Custom Made THR

  5. Where does hip joint pain go? • Groin 51% • Lateral 45% • Low Back 42% • Deep Hip 58% • Knee 45%

  6. 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

  7. 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

  8. Femoroacetabular impingement

  9. 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

  10. 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

  11. Hip Investigations • X-rays - evidence of a bump or osteophyte • MRI or MR-arthrography • 3D CT • Hip Block Injection

  12. Treatment • Rest and cause-avoidance/ Analgesics and NSAIDs / weight loss • Physiotherapy - regain hip control • Ultrasound-guided steroid injection • Hip arthroscopy • Hip replacement

  13. Hip Arthroscopy • 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

  14. Rehabilitation • Vital importance to success of procedure • 4 stages geared towards range of motion strength and core stability proprioception sports specific function

  15. Hip Replacement • Younger patients • Choice of Prosthesis - resurfacing - uncemented • Choice of Bearings - ceramic - metal • Custom Made

  16. Symbios Total Hip Replacement • Pre op 3D CT • Exact fit Anatomic THR • Matches length and offset • Better Functional result • Longer life

  17. The Sports Orthopaedic Clinic THANK YOU Tel: 08445 617131 E-mail: clinic@sportsortho.co.uk Website: www.sportsortho.co.uk

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