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Sam Rajaratnam FRCS (Tr. & Orth.) Consultant Orthopaedic

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Sam Rajaratnam FRCS (Tr. & Orth.) Consultant Orthopaedic Surgeon Eastbourne D.G.H Horder centre Esperance House Horder centre Able to accept acute-on-chronic problems ... – PowerPoint PPT presentation

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Title: Sam Rajaratnam FRCS (Tr. & Orth.) Consultant Orthopaedic


1
Meeting the challenges of Knee Arthritis
  • Sam Rajaratnam FRCS (Tr. Orth.)
  • Consultant Orthopaedic Surgeon
  • Eastbourne D.G.H
  • Horder centre
  • Esperance House

2
Topics
  • KNEE
  • What is Arthritis of the knee
  • Presenting symptoms
  • Prevention
  • Conservative treatment
  • Operative treatment
  • Latest advances

3
What is Osteoarthritis ?
  • Pain
  • Stiffness
  • Loss of Function
  • Instability giving way
  • Can be Primary or Secondary

4
Causes
  • Primary Osteoarthritis(Family History)
  • Secondary
  • Post Injury and instability
  • Meniscal tears
  • Inflammatory Arthritis
  • Autoimmune Disorders (e.g. Rheumatoid)

5
Desired Effects
  • Control Symptoms
  • Reduce progression

6
Meniscal tears
7
Meniscal Repair
8
Meniscal Repair vs Resection
9
Meniscal tears
  • Diagnose Early (especially in young patient)
  • Preserve as much meniscus as possible
  • Prevent further delamination
  • Prevent Osteoarthritis
  • In young patients refer early
  • RARE FOR MENISCAL TEAR TO HEAL SPONTANEOUSLY
    (RED-RED)
  • MRI CAN MISS TEARS (SIGNAL ARTIFACT) SO
    CLINICAL EXAM IMPORTANT
  • FORCES CAUSING INJURY GREATER IN YOUNG PATIENT
    (MENISCUS LOOSES ELASTICITY WITH INCREASING AGE)

10
  • Treat Ligament Instability

11
Treat Ligament injuries
  • Torn ACL
  • POST RECONSTRUCTION

12
Day Surgical Arthroscopic Hamstring ACL -
Accelerated Rehabilitation
  • Key Changes
  • Pre ACL Rehab
  • Patient education
  • Improved technique
  • Ice cold saline infusion
  • Advanced Local Blockade
  • Physiotherapy services
  • Key to good results
  • Early reconstruction
  • before meniscal damage
  • has occured

13
  • Reduce Weight

14
The Arthritic Knee conservative treatment
  • Glucosamine
  • Chondroitin sulphate
  • Fish oil
  • Visco-suplementation
  • Simple analgesics

15
The arthritic Knee (Antero-medial wear) Most
common pattern. Very Painful
16
Partial Knee replacement
  • Minimially invasive
  • Quick recovery (discharge after 24 hours)
  • Mobile bearing
  • Good 25 year results

17
Isolated patello-femoral wear
  • Pain on walking up down stairs
  • No problem walking on flat ground
  • Patella can lock or catch
  • Patient can complain of knee giving way

18
Patellofemoral replacement
19
Lateral Osteoarthritis
  • Knee Gives way
  • Knock Knee
  • Deformity can progress rapidly
  • Often required total knee replacement
  • (lateral unis have variable results)

20
Combined patterns
  • Most patents have combined patterns of wear
  • May have fixed contractures
  • May have ongoing ligament instability
  • Severe bone defects

21
Newer TKR designs
  • Better bearing surfaces
  • Higher Flexion
  • Better fixation methods
  • Hopefully will prove to improve function and
    longevity
  • (time would tell !! We are embarking on a Biomet
    National trial)

22
Numerous alignment techniques
  • Computer navigation
  • Intramedullary jigs
  • MRI assisted Signature
  • Fundamentally implants need to be aligned well
    for long term implant survival

23
Signature Vanguard TKR
24
Young osteoarthritic knee
  • Difficult problem
  • Options
  • osteotomy
  • Treat instability
  • Unicompartmental knee replacement

25
Osteotomy
26
Young medial osteoarthritis
27
Young Valgus Osteoarthritis
28
Cartilage Repair
  • Suitable for 15 55 year old
  • Discrete area of chondral damage
  • Stable knee (no ligament instability)
  • Medial femoral condylar defects , Trochlea
    groove, Patella
  • Various techniques available

29
MACI ACI
30
Osteochondral grafting
31
Microfracture
32
Chondro-tissue
33
New Cartilage Repair services
  • We are developing Cartilage repair services in
    Eastbourne Horder, so patients normally sent to
    London can be treated locally
  • National trial / Ethics Committee/ Human tissue
    authority - Pending

34
Horder centre
  • Able to accept acute-on-chronic problems
  • Direct choose and book referrals
  • Very short MRI waiting times
  • Consultant run service
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