Minimal Invasive Partial Knee Replacement
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msk AUTUMN 2012 FROM ORTHOPAEDIC SERVICES AT THE HOSPITAL OF St JOHN & St ELIZABETH MINIMAL INVASIVE PARTIAL KNEE REPLACEMENT HJE LEADS THE WAY WITH OUR NEW UNIT ONE-STOP SHOP FOR HYPERMOBILITY ROTATOR CUFF TEARS POINTS TO ADDRESS KEINBOCK’S DISEASE LOSS OF WRIST ACTION AND CHRONIC PAIN FOCUS ON TENNIS: ANALYSING A TENNIS STYLE AND WRIST ACTION CAN HELP TREAT PAIN BACK PAGE: A FULL LIST OF OUR SPECIALIST UNITS ANKLE SPRAINS: WHAT TO LOOK FOR, WHEN TO REFER, WHEN TO WAIT CONTENTS OUR ACHIEVEMENTS TINA CELEBRATES WITH US ON 4 AND OUR AIMS CASUALTY FIRST’S ANNIVERSARY V star and local FOCUS ON ANKLE SPRAINS FOR 2013 resident Tina T Hobley joined us 6 to celebrate Casualty elcome to the Winter Edition First’s !rst birthday. SPORTING HAND & of MSK magazine. Even The Holby City W actress is a great WRIST INJURIES though the year is drawing to a close, the Hospital is still supporter of St John’s forging ahead. Hospice, which receives 8 most of its funding from Works to install a new the Hospital. OUR LEADING KNEE UNIT CONSULTANTS 256-slice state-of-the-art Following a hugely CT scanner, which will successful launch in o!er the very best September 2011, the 10 quality images and private walk-in centre more advanced clinical treated more than 6,000 PARTIAL KNEE REPLACEMENTS patients in its !rst year. applications, will be Just under half the completed by the patients attending the 12 New Year. urgent care centre su"er This £1.2m investment from an orthopaedic COMPLICATIONS IN TOTAL in our Imaging Department complaint, including KNEE REPLACEMENT comes less than a year after fractures and sprains. we became the "rst private The uptake of this year’s £5 #u vaccination 14 hospital in the UK to have a o"er has been huge, 3T MRI. with adults and ROTATOR CUFF TEARS As the o#cial medical facility of UK Athletics, we were children from the age delighted at the success of the 2012 GB Olympic team after of three being o"ered 15 many of the medal-winning track and "eld athletes were the vaccine. treated at the Hospital. Even with this $ massive demand, HYPERMOBILITY: OUR ONE STOP SHOP Our reputation, especially in Orthopaedics, is spreading. average waiting times A record 293 GPs attended our Annual Symposium to still remain only a few 16 hear lectures from 15 of our leading consultants. We plan to minutes, winning many build on this success and the extremely positive feedback by new fans, including KIENBOCK’S DISEASE hosting a special hot topics Annual Symposium in March. Tina who is married Meanwhile, last month, 266 healthcare professionals with three children – attended our Hypermobility Seminar. The Hypermobility Unit, Isabella, 13, Olivia, 4 18 and led by Professor Rodney Grahame, is the UK’s only private 2-year-old Orson. specialist unit and is already attracting international interest. ST JOHN’S HOSPICE Before cutting We are also launching a Knee Unit. This will complement the cake, Tina said: our wide range of world-class orthopaedic services – we have “We have not had to 19 many specialist consultants and boast the Spine and face anything serious Shoulder Units as well as the world-renowned London Foot other than the typical BERG BALANCE ASSESSMENT and Ankle Centre. challenges that every family faces. That said, The success of the Hospital allows us to fund our on-site Holby City’s Tina Hobley and St John & St Elizabeth CEO David Marshall cut " it’s comforting to know 20 hospice, St Johns, which has just launched London’s rst the anniversary cake with Casualty First Consultant Andre van Nierop that we are so close to palliative care ambulance service. Our Hospice@Home service places like the Casualty OUR SPECIALIST UNITS & CONTACTS scooped the prestigious Domiciliary/Home Healthcare First facility.” Provider 2012 at the Laing Buisson Independent Healthcare Your fast-track referral service Our experienced Awards, beating hundreds of rivals. doctors and nurses are Casualty First is increasingly being used as a fast-track referral service by able to treat all minor I thank you for your support in 2012 and wish you a Merry physiotherapists and other health professionals. Referrals to consultants from illnesses, accidents and Christmas and a Happy New Year. this doctor-led service are accepted by all major health insurance companies, injuries and uniquely Kind regards, with most patients being seen in our outpatient department within 24 hours treat children from the of visiting the centre. DAVID MARSHALL CHIEF EXECUTIVE age of one. 2 3 ANKLE SPRAINS " WHAT TO LOOK FOR, WHEN TO REFER, AND WHEN TO WAIT The majority of ‘problem’ MR MARK DAVIES ankles do have signi!cant potential for improvement BA (Oxon) MBBS FRCS (Orth) with appropriate assessment Clinical director and consultant including MRI and ultrasound. orthopaedic surgeon It is essential to refer a of the London Foot and Ankle Centre problem ankle if symptomatic after two months. When Tel: 020 7078 3800 making the referral to a foot Email: and ankle specialist surgeon, [email protected] you need to list occult injuries Website: How should an ankle – all the fractures, OCD www.londonfootandanklecentre.co.uk sprain be managed? (osteochondritis dissecans) Achilles or peroneal pathology. ODo not immobilise the joint. Begin %exibility (range of motion) he spectrum of injuries exercises as soon as they can be tolerated without excessive Clear indications for labelled ‘ankle sprain’ is pain. It is thought that functional stress stimulates collagen ankle surgery broader than any other Guidelines replacement. Very few ankle sprains require T term used in orthopaedics. for OAdvise a person with a sprain or strain to seek further medical surgery acutely, but some will Recovery can take two days or a advice if there is: fail to get better and require year and some patients will never assessing Lack of expected improvement after following basic home surgery – impingement fully recover. This article is written management guidelines (for example, if they continue to have OCD, instability, for example. to provide a comprehensive guide a sprained di$culty walking). Chronic ankle instability to assessing and managing an Worsening of symptoms (for example, increased pain or increases the risk of further ankle sprain, highlighting the ankle swelling). injury and weakness. key indicators for referral to an Concern regarding the nature and extent of the injury. One of the few absolute orthopaedic surgeon. OReview a sprain after a few days to assess muscle contractile indications for surgery in function, depending on the severity of the injury. patients with a sprained ankle The value of early assessment is an inferior tibio-!bular Assess the severity of the injury, including: It is important to make an joint third-degree sprain that OPain, swelling, bruising and range of movement. assessment as soon as possible Is there a fracture? causes widening of the ankle OAbility to bear weight, balance, gait. after the injury takes place. Palpate The ability to walk on the foot usually excludes a fracture. Consider mortise. To restore the ankle OTreatment measures already tried. the ankle for tenderness and neurovascular compromise if the patient reports a cold foot or describes mortise, the distal tibio!bular O Are there any complicating factors? consider what lies underneath. Early the symptoms of paresthesias. When considering whether a patient can articulation must be screwed ! OPresence of pain or bony tenderness elsewhere may indicate a X-ray is bene cial. If there is huge bear weight, you should apply a lower threshold to older patients. together. possible fracture. swelling, severe pain and inability How long to watch and wait? When the sprained ankle does not heal. Sometimes, surgery is ODeformity of a limb, or postural abnormality. to bear weight, you need to be very Up to 40 per cent of patients with ankle sprains remain symptomatic six required if the initial diagnosis OEvidence for, or indication of, damage to nerves or circulation. suspicious of a potential fracture or months after their injury. Any patient still troubled with the ankle giving was incorrect. For example, ! OWhether the person is taking medication (e.g. anticoagulants) # highly signi cant soft-tissue injury. way or swelling after two months of physiotherapy is likely to be su ering missed syndesmotic injuries which may a#ect the injury. The history of an ankle sprain from a remedial occult injury. This indicates there may be: can be disastrous and early OAny complicating illness (e.g. neuropathy, bleeding disorder, is usually that of an inversion-type OA fracture or avulsion not noted on standard radiographs intervention is very bene!cial. or history of deep vein thrombosis). Neuropathy or lack of twist of the foot followed by pain and ODamage to the articular surface of the talus ATFL and calcaneo!bular sensitivity of the foot puts the person at increased risk of $ swelling. An individual with an ankle OLateral ligament insu ciency ligament (CFL) are best treated complications. sprain can almost always walk on the OTendon injury surgically. foot, albeit carefully and with pain. OSynovial impingement 4 5 ANALYSING A TENNIS STYLE AND WRIST ACTION CAN HELP TREAT PAIN MR NICHOLAS GODDARD One makes the diagnosis on the it is head-heavy or head-light, can MB BS FRCS nature of the symptoms. Did the have a knock-on e"ect up the problem come on suddenly or is limb. New strings and di"erent ennis can there a more insidious slow onset tension can result in problems with undoubtedly of symptoms tending to imply an the elbow. T lead to various overuse problem? How long have It is therefore relevant to look problems, the symptoms been present? How at what may have changed and particularly with the hand severe are they? What exactly are then gradually eliminate those and wrist, but it is interesting they and what treatment has taken possible causative factors and so to note that the majority of place so far? improve symptoms.