Marcus is the Clinical Lead of the Department of Orthopaedics at Guy’s and St Thomas’ Foundation NHS Trust and was appointed Consultant Orthopaedic Surgeon in 2002. His practice is exclusively confined to problems in and around the hip joint, with a special interest in surgical treatment of young adult hip disorders.
Marcus is the orthopaedic surgeon in the multidisciplinary service for sickle cell anaemia at Guy’s and St Thomas’ Foundation Trust. This team allows sickle patients to have safe and effective hip replacement surgery, a procedure that, in the past, was much less predictable. He has pioneered the use of un-cemented ceramic on ceramic hip replacements in this patient group.
Recognised as an opinion leader in hip surgery, Marcus gives between 20 and 30 talks a year to local and national meetings on the subjects of ceramic on ceramic total hip replacement, hip resurfacing, hip arthroscopy, hip dysplasia, hip impingement and the orthopaedic complications of sickle cell disease. He is a regular contributor at the British Hip Society, London Hip Meeting, The Great Debate, and The St George’s Revision Forum as well as being a reviewer for a number of orthopaedic journals.
Abstract: Bone and joint complications
Avascular necrosis (AVN) and infection represent the majority of orthopaedic problems in Sickle Cell disease. Avascular necrosis can affect many parts of the skeleton but receives most attention when the femoral head is affected. This is because of the severe pain and disability which result from hip disease, but also due to the availability of effective surgical treatment, namely total hip replacement (THR). Aetiology, pathogenesis and classification of AVN will be presented as well as the key radiological features, particularly of femoralhead collapse. Whilst there have been improvements in the understanding anddetection of osteonecrosis, there are few treatments which seem to alter the natural history of the disease. However, with the advent of specialist centres, multidisciplinary care and advances in biomaterials, total hip replacement is no longer the unpredictable operation it once was and excellent results can now be obtained.
Identifying bone infection continues to be challenging but fortunately has become much easier in the era of MRI and, for the paediatric patients, ultrasound. Features of Sickle bone infection will be discussed as well as guidance for requesting surgical advice. Indications for surgery are few, but include biopsy and culture, drainage of abscesses, and sequestrectomy.