CHONDROTOXICITY OF INTRA-ARTICULAR INJECTIONS OF LOCAL ANAESTHETICS AND

STEROIDS - DO WE HAVE A PROBLEM?(JUST ONE MORE THING TO WORRY ABOUT!)

Prof Vladimir Bobić, Consultant Orthopaedic Knee SurgeonChester Knee Clinic at Nuffield Health, The Grosvenor Hospital Chester

@ChesterKnee

11th Oswestry Cartilage SymposiumRJAH, Oswestry, 5th and 6th October 2017

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

… fast forward (2015):

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULAR INJECTIONS OF LOCAL ANAESTHETICS AND STEROIDS

VB CKC UK

… the stem cells are DOA!

CHONDROTOXICITY OF INTRA-ARTICULAR INJECTIONS OF LOCAL ANAESTHETICS AND STEROIDS

VB CKC UK

• Is this serious? Well, seems to be!

• Do we have a problem? Probably, but not at a litigation level. Well, not yet.

• My take home message is: if you have to inject LA after arthroscopy, don’t to it IA, but infiltrate around arthroscopic portals, 10ml max, with the lowest possible concentration (0.20 or 0.25 of whichever -caine). I use ropivacaine or Naropin.

• So, no panic but keep an eye on IA LA publications and: @ChesterKnee and @BioKneeSociety

• DMI? Tricky, tricky, as the cocktail of the usual LA + DM is injected IA. Use sparingly, if you have to.

• IA Steroids? A huge and controversial topic. Orthopaedics vs. OrthoBiologics! See you next year for the sequel!

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

THANK YOU FOR YOUR ATTENTION. TO BE CONTINUED …

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULAR INJECTIONS OF LOCAL ANAESTHETICS AND STEROIDS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULAR INJECTIONS OF LOCAL ANAESTHETICS AND STEROIDS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULAR INJECTIONS OF LOCAL ANAESTHETICS AND

STEROIDS - DO WE HAVE A PROBLEM?(JUST ONE MORE THING TO WORRY ABOUT!)

Prof Vladimir Bobić, Consultant Orthopaedic Knee SurgeonChester Knee Clinic at Nuffield Health, The Grosvenor Hospital Chester

@ChesterKnee

11th Oswestry Cartilage SymposiumRJAH, Oswestry, 5th and 6th October 2017