Knee surgery Nick Bowman Orthopaedic Consultant Tunbridge Wells Hospital

Introduction Who I am Where I’m from/have done What I do Referrals and what I can do for your patients Anything else

Education School, Edinburgh/Tunbridge Wells Medical school, Edinburgh University BSc (hons) Neuroscience 1999 London and SE Thames training Diploma orthopaedic engineering Cardiff 2008 FRCS (Tr and Orth) Edinburgh 2009 CCT 2012 Fellowships

Roger Brighton-Sydney Knee arthroplasty Hip arthroplasty Revision arthroplasty ACL / arthroscopy trauma

Arthroscopic sports injuries-Sydney Danny Biggs Knee (and shoulder) ACL/arthroscopy Trauma

St George Private Hospital

Blacktown Public Hospital

Fellowships Sydney 2010-2012 Knee surgery – Leo Pinczewski ACL reconstruction Knee arthroplasty osteotomy

Mater Misericordiae Hospital

Knee fellow Tunbridge Wells 2012-13

Consultant appointment- September 2013 Started Jan 2014

Knee pathology Knee injuries Knee arthritis Everything else ( that’s in the knee….)

Examination of the knee

History Careful and detailed history Exact mechanism of injury required Valgus Contact? Pop or twang or crunch hyperextension

History continued Injury swelling Instability OA Pain Start up/inclines/immobile pain

Examination of the knee Look Feel Move Special tests

Examination of the knee Look Skin colour Scars Muscle wasting Swelling Deformity

Examination of the knee Feel Skin temperature Tenderness Swellings - effusion & lumps Crepitus

Feel where? Joint line Meniscal injury Collateral ligaments OA Quads tendon Patellar tendon (distal pole) Back of joint (Baker’s cyst, aneurysms)

Examination of the knee Move Range of movement (normal 0-135) Fixed flexion e.g.15-120 Compare with other side Ligament testing - collaterals & cruciates Agony test = painful crepitus on stressing one compartment

Special tests Collaterals McMurray’s – menciscal injury Lachman’s test / pivot shift test (ACL) Ant and post drawer (cruciates)

Lachman

Other “knee” injuries Unusual presentations Children Often minor trauma

How about this one? 8yr old Fit and well Trampoline injury …..

This 12 year old boy Seen in AE Twice “groin sprain” ……

REMEMBER THE HIP IN KIDS!!!!!!!

Cruciate ligament injury Meniscal injury Patello-femoral instability Referrals Interests Knee Injuries Cruciate ligament injury Meniscal injury Patello-femoral instability Multi-ligament injury (knee dislocations) Fractures (plateau/ distal femur/patellar

Interests Arthritis

Contact

Referrals CCGs Not black and white Patients not keen on surgery… Opinion

Contact Details THE KNEE CLINIC: ADMIN@KNEESURGERYCLINIC.CO.UK Website : WWW.KNEESURGERYCLINIC.CO.UK Private Secretary: ALISON/JULIE/LIZ – 01892 546111 NHS Sec: CHRIS MARSHAL Tel: 01892 635730 Email: chrismarshall@nhs.net

Clinics Tunbridge Wells Hospital (knee clinic and fracture clinic) Sevenoaks Hospital Maidstone Hospital Spire Tunbridge Wells

Thank you for your attention