CHONDROTOXICITY OF INTRA-ARTICULAR INJECTIONS OF LOCAL ANAESTHETICS:

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

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

@ChesterKnee

Sports Knee 2017Warwick Orthopaedics @ Hilton St George’s Park, 20 & 21 November 2017

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

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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

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CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

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… fast forward (2015):

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

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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

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… the stem cells are DOA!

CHONDROTOXICITY OF INTRA-ARTICULAR INJECTIONS OF LOCAL ANAESTHETICS AND STEROIDS

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CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

VB CKC UK

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

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 (no published evidence of knee chondrolysis).

• 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 - Old School Orthopaedics vs. OrthoBiologics?

• See you next year for the sequel!

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

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CHONDROTOXICITY OF INTRA-ARTICULAR INJECTIONS OF LOCAL ANAESTHETICS AND STEROIDS

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TO BE CONTINUED!IN THE MEANTIME:

THANK YOU FOR YOUR ATTENTION

CHONDROTOXICITY OF INTRA-ARTICULARINJECTIONS OF LOCAL ANAESTHETICS

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