Management of the Painful Hip

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Management of the Painful Hip
Tel [phone] E-mail
clinic_at_sportsortho.co.uk Website
www.sportsortho.co.uk
The Sports Orthopaedic Clinic

• Mr Paul Jairaj
• MB ChB, FRCS (TrOrth)
• Consultant Orthopaedic Hip and Knee Surgeon

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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

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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

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Hip Updates

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

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Where does hip joint pain go?

• Groin 51
• Lateral 45
• Low Back 42
• Deep Hip 58
• Knee 45

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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

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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

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Femoroacetabular impingement
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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

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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

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Hip Investigations

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

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Treatment

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

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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

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Rehabilitation

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

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Hip Replacement

• Younger patients
• Choice of Prosthesis
• - resurfacing
• - uncemented
• Choice of Bearings
• - ceramic
• - metal
• Custom Made

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Symbios Total Hip Replacement

• Pre op 3D CT
• Exact fit Anatomic THR
• Matches length and offset
• Better Functional result
• Longer life

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The Sports Orthopaedic Clinic
THANK YOU
Tel [phone] E-mail clinic_at_sportsortho.co
.uk Website www.sportsortho.co.uk