1. Knee surgery Nick Bowman Orthopaedic Consultant
Tunbridge Wells Hospital

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

3. 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

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

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

6. St George Private Hospital

7. Blacktown Public Hospital

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

9. Mater Misericordiae Hospital

10. Knee fellow Tunbridge Wells 2012-13

11. Consultant appointment- September 2013
Started Jan 2014

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

13. Examination of the knee

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

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

16. Examination of the knee
Look
Feel
Move
Special tests

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

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

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

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

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

30. Lachman

34. Other “knee” injuries Unusual presentations Children
Often minor trauma

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

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

39. REMEMBER THE HIP IN KIDS!!!!!!!

40. 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

43. Interests
Arthritis

45. Contact

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

47. Contact Details THE KNEE CLINIC: ADMIN@KNEESURGERYCLINIC.CO.UK
Website :
Private Secretary: ALISON/JULIE/LIZ –
NHS Sec: CHRIS MARSHAL Tel:

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

50. Thank you for your attention