North East Hip and Knee Surgery

Jonathan Loughead
Consultant Orthopaedic Surgeon

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Hip Pathology

The hip is a ball and socket joint, normally the surfaces of the joint are covered in smooth slippery cartilage which allows free movement of the joint.  In patients with Osteoarthritis of the Hip the smooth cartilage has begun to wear away and the joint becomes painful and stiff.  Early treatment involves staying as active as possible, weight reduction if necessary and pain-killers / anti-inflammatory drugs.  If Hip Arthritis has become severe then it is best treated with Hip Replacement (removing the damaged joint surfaces and replacing them with artificial ones).  This is either done by resurfacing of the hip or more conventional Hip Replacement.

Hip anatomy drawing

 Labral Tear

Around the edge of the socket (acetabulum) there is a rim of cartilage (labrum) which increases the depth of the socket.  It is possible for this cartilage to be damaged either as a result of an injury or because of an underlying abnormality in the shape of the hip joint.  The most common abnormality is called Hip Impingement (FAI).  Labral tears can also occur when the socket is under-developed and is too shallow (Dysplastic Hip).

Labral tear

It is often possible to treat a problem from the labrum or from impingement using hip arthroscopy ("Keyhole Surgery").

Femoro-Acetabular Impingement (FAI)

This is a condition which has only been identified and treated for the last 5 to 10 years, hence many GP's and some orthopaedic surgeons are not familiar with it.  The best person to evaluate this as a potential source of problems around your hip is an orthopaedic surgeon with a special interest in early adult hip problems and hip arthroscopy.

There is an abnormality either in the shape of the femoral head (ball) or the acetabulum (socket).  On the femoral head we frequently see a bump which means it is not a perfect sphere and this bump acts as a "Cam" over time damaging the cartilage inside the hip joint and the labrum.  The socket may be too deep and as a result repeatedly catch on the thigh bone as the hip is moved around ("Pincer"), over time this results in damage to the labrum around the socket.

Drawing of Hip Impingement

It is not clear what causes  the hip to develop abnormaly but minor Cam and Pincer problems are regularly seen on hip xrays, and are often noted in patients who have developed hip arthritis.  Some patients who have an excessive range of movement within the hip may also develop similar problems e.g. dancers, hypermobile joints.

Over time some patients with impingement develop restricted movements of the hip, clicking or pain.  It is important to distinguish it from other sources of pain around the hip such as: low back pain, hernia, piriformis syndrome, trochanteric bursitis, or groin strains.  Diagnosis is acheived with history and examination, and also with xray examination of the hip.  Minor changes on the hip xray can be difficult to identify and the hip xray can also be normal with FAI.  Most patients will undergo an MRI scan of the hip after an injection of dye and local anaesthetic into the joint. A CT (CAT) scan may also be required.

Treatment is with physiotherapy and avoiding precipitating activities.  Stretching may worsen the symptoms so should be avoided.  Pain-killers, anti-inflamatory tablets or cortisone injections may be used.  If the symtoms to do not settle it may be possible to teat the impingement surgically.  This is most often performed using hip arthroscopy, although occasionally open surgery is required (Ganz surgical dislocation).

Information on surgery for FAI is available from the National Institute for Clinical Excellence (NICE).

National Institute for Clinical Excellence

Information on open surgery for FAI

Information on Hip arthroscopy for FAI

 

Hip Rehabilitation

 

 

Knee Pathology

The knee is a modified hinge joint.  The surfaces of the joint are covered in smooth, slippery cartilage which allows free movement of the joint.  In addition there are two discs of cartilage within the joint (menisci) and ligaments.

 

Knee anatomy

Knee arthritis occurs when the smooth surface cartilage of the joint has been progressively damaged, and causes gradually worsening pain and stiffness.  It is common affecting 10-20% of people in the UK over the age of 65.  It can be inherited or follow an injury but often the cause is not known.  The diagnosis is normally reached with an xray, although an MRI is sometimes used.

The discs of cartilage or ligaments can also be damaged, and occasionally the damage to the surface cartilage is localised to a small area.  The diagnosis of injury to these structures is made through a combination of assessment by a doctor or physiotherapist and MRI scan.

Knee arthroscopy can be used to treat the following conditions:

Early management of knee arthritis is with modifying your lifestyle or job, weight reduction if necessary, physiotherapy and pain-killers / anti-inflammatory drugs.  If knee arthritis has become severe then it is best treated with replacement of the damaged surface cartilage using a knee replacement.  This either takes the form of a total knee replacement (where all the joint surfaces are replaced) or partial knee replacement (where only the affected part of the knee is replaced).

Information on Total Knee Replacement is available from the British Orthopaedic Association:

Information on Total Knee Replacement

 

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