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An inflammatory arthritis that predominantly affects the spine, Ankylosing spondylitis (AS) can also lead to fatigue and eye problems. Other joints may also be affected by pain and swelling.
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This is a condition which can cause pain and inflammation in your joints. There are a number of different types of arthritis ranging from osteoarthritis, rheumatoid arthritis, gout to other inflammatory arthritis.
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The joint surfaces of the bones in the knee are covered by hyaline cartilage. Damage to this cartilage is known as a chondral injury. Deeper damage involving the cartilage and bone is known as an osteochondral injury.
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Gout is a complex form of arthritis that is characterised by repeated, sudden attacks of pain, swelling and redness of your joints. The most commonly affected joint is that of your big toe.
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Hypermobility describes the ability of joints to move beyond its normal ranges of movement. It is most commonly seen in young females and in the majority of cases, hypermobility does not give rise to symptoms. In fact, it can be advantageous in certain professions. For a minority of patients however, hypermobility may give rise to joint pains.
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Given its relative proximity, lower back pain can sometimes be mistaken for hip pain. Lower back pain is very common and although it can be distressing, it is rarely linked with serious conditions. It often gets better on its own but you may need to be assessed if the pain is persistently severe or progressive.
Patient Information Leaflet from Mr Kosuge →
British Association of Spine Surgeons →
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Osteoarthritis is the commonest form of arthritis and is often explained as ‘wear and tear’ of your cartilage. Whilst this is accurate, it is also an oversimplification of the disease. Please click on the below for further information.
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Rheumatoid arthritis is the second commonest form of arthritis. Advancement in pharmaceutical technology has lead to a dramatic reduction in patients who require surgery. Please click on the below for further information.
HIP
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Avascular necrosis (or osteonecrosis) of the femoral head can be related to alcohol abuse, smoking, steroid use or injury.
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The ball and socket of the hip joint(s) has not developed normally in developmental dysplasia of the hips (DDH). Left untreated, it can lead to early onset osteoarthritis.
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This describes a spectrum of injury around your groin but most commonly, part of your adductor muscle(s) or tendon(s) are injured.
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The hamstrings are a group of three muscles that run along the back of your thigh. The hamstring muscles start at the sitting bone at the lower back part of your pelvis and end by attaching to your bones behind and just below your knee. Hamstring injuries often happen in people who play sports that involve sprinting with sudden stops and starts.
Patient Information Leaflet from Mr Kosuge →
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The labrum is a ring of cartilage that forms a seal around your hip joint. Tears in the labrum often occur in patients in which there are pre-existing structural abnormalities such as in impingement or dysplasia. Less often they occur after trauma, or over-usage during high-intensity repetitive activities.
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This is a condition that leads to a burning sensation or pain down the lateral side of your thigh. It is caused by irritation or compression of the nerve supplying the sensation to the skin of the thigh.
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This is the commonest indication for a hip replacement in the UK. The articular cartilage covering the bones of your hip joint wear away with this condition:
Patient Information Leaflet from Mr Kosuge →
American Academy of Orthopaedic Surgeons →
American Academy of Orthopaedic Surgeons (Animation Video) →
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There are three main causes of a snapping sensation arising from your hip - (1) Iliotibial band; (2) Iliopsoas tendon; (3) hip joint cartilage or labrum. Treatment varies according to the cause of the snapping.
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The trochanteric bursa is a fluid-filled sac found over the prominence over your outer hip bone. This sac can become inflamed, leading to pain.
Patient Information Leaflet from Mr Kosuge →
KNEE
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A condition seen in runners, rowers and/or cyclists, in which the causation is thought to be related to a friction-like mechanism around the outer side of your knee.
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Have you been diagnosed with a meniscal tear? Please click on the below for further information.
Patient Information Leaflet from Mr Kosuge →
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The commonest joint to be affected by osteoarthritis is the knee. The articular cartilage covering the bones of the knee joint wear away in this condition. Further information on osteoarthritis in the knee, along with other forms of arthritis in the knee (second link):
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A focal area of cartilage damage in the knee joint. The severity of the damage can vary from being a surface injury to the cartilage, to a deeper injury involving the bone that the cartilage normally covers:
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Otherwise known as ‘jumpers knee’, this is a condition that affects the tendon which connects the bottom of your kneecap to you shin bone at the front. Please click on the following for more information.
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A common condition seen, particularly in young female patients. A number of reasons may contribute as causes and treatment is aimed at addressing any underlying causes.
Patient Information Leaflet from Mr Kosuge →
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Three of your hamstring tendons attach to the inner side of your shin bone (tibia), just below your knee. This area is referred to as the Pes Anserinus and when the bursa associated with the Pes Anserinus is inflammed, the condition is known as Pes Anserine Bursitis.
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Inflammation in the bursa sitting between your skin and kneecap is known as pre-patellar bursitis. The following are useful resources on how to manage pre-patellar bursitis:
Patient Information Leaflet from Mr Kosuge →
Treatments
HIP
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Non-operative management options for dealing with pain around your hip:
Chartered Society of Physiotherapy →
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Are you planning on having a hip joint injection? It can be used to determine how much pain is coming from your hip joint (diagnostic) in cases where the source of your pain is not clear (e.g. referred pain from your back) or to try and relieve pain that is known to arise from the hip joint (therapeutic). Please click on the below for further information.
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Used to treat avascular necrosis, core decompression is a surgical procedure that involves surgical drilling into an area of dead bone near the joint. This reduces pressure, allows for increased blood flow, and slows or stops bone and/or joint destruction. This can be augmented with cell or bone grafting into the area of concern.
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Are you contemplating a hip replacement for your pain? A selection of pre- and post-operative radiographs of Mr Kosuge’s patients are available here. Please use the following resources to help you make an informed decision.
Patient Information Booklet from Mr Kosuge →
Versus Arthritis patient information booklet →
American Academy of Orthopaedic Surgeons (Animation Video) →
International Cartilage Regeneration & Joint Preservation Society (Animation Video) →
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Hip replacements may fail for a variety of reasons, leading to the need to re-do the hip replacement. This specifics of a revision hip replacement depends on what the cause of the original failure is but generally speaking, this is a major procedure.
Patient Information Leaflet from Mr Kosuge →
American Academy of Orthopaedic Surgeons →
American Association of Hip and Knee Surgeons (Patient Guide) →
International Cartilage Regeneration & Joint Preservation Society (Animation Video) →
KNEE
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Non-operative management options for dealing with pain around your knee:
Chartered Society of Physiotherapy →
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Knee injections are aimed at relieving pain arising from your knee joint. A number of different materials may be injected, each with different mechanisms of action, and the location of injection may vary according to the underlying problem. The efficacy of some injections are debatable and Mr Kosuge advises these options should be considered carefully. Please book an appointment if you wish to discuss and explore these options:
Steroid:
Hyaluronic acid:
American Academy of Orthopaedic Surgeons →
International Cartilage Regeneration & Joint Preservation Society →
Platelet-Rich Plasma:
American Academy of Orthopaedic Surgeons →
International Cartilage Regeneration & Joint Preservation Society →
Arthrosamid:
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Is ‘key-hole’ surgery a management option for your knee problem? Find useful information about ‘key-hole’ surgery, how to prepare and what to expect.
Patient Information Booklet from Mr Kosuge →
American Academy of Orthopaedic Surgeons →
Royal College of Anaesthetists →
International Cartilage Regeneration & Joint Preservation Society (Animation Video) →
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Performed through ‘key-hole’ surgery, the torn part of the meniscus may be trimmed away in a procedure called a partial meniscectomy. This is the commonest way of dealing with a symptomatic meniscal tear.
Patient Information Booklet from Mr Kosuge →
International Cartilage Regeneration & Joint Preservation Society (Animation video) →
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The alternative to trimming the torn meniscus is to repair it by stitching the tear. This is reliant on the tear healing over time and so is only appropriate for certain types of tears.
Patient Information Booklet from Mr Kosuge →
International Cartilage Regeneration & Joint Preservation Society (Animation video) →
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A procedure in which multiple ‘holes’ are made in the underlying bone of the damaged cartilage. The aim of this procedure is to promote bleeding, followed by healing with scar tissue that replaces cartilage.
Royal Orthopaedic Hospital NHS Foundation Trust →
International Cartilage Regeneration & Joint Preservation Society (Animation video) →
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Is a knee replacement being discussed as a treatment option for you? A selection of pre- and post-operative radiographs of Mr Kosuge’s patients are available here. Please use the following resources to help you make an informed decision.
Patient Information Booklet from Mr Kosuge →
Versus Arthritis Patient information booklet →
American Academy of Orthopaedic Surgeons (Animation Video) →