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Radicular Pain

Radicular pain refers to referred pain from a nerve root entrapment in the back, this may be due to a herniated intervertebral disc as well as other mass lesions and/or forms of spinal instability. The pain is usually experienced over the buttock area with radiation into the lower leg and foot. The character of pain Read on … !

Hand Surgery

Both surgeons at the Cape Joint Surgery maintain a keen interest in hand surgery, a sub-speciality in orthopedics which overlaps with plastic surgery to some extent and requires meticulous technique and soft-tissue management. Dr Engela was involved with the Groote Schuur Hospital hand clinic for many years and was the driving force behind the establishment Read on … !

Knee surgery

The Cape Joint Surgery surgeons are both super-specialist fellowship trained knee surgeons with extensive experience in the diagnosis of adult knee problems as well as knee problems in children. We perform both elective- as well as trauma-related knee surgery. This includes the management of meniscal injuries as well as knee ligament injuries such as anterior Read on … !

Hand Problems in Adults

Non-traumatic hand problems in adults are extremely numerous and both diagnosis and management are challenging. Some of the most common conditions are discussed below. Even these fairly straightforward problems are unfortunately prone to misdiagnosis and injudicious surgery.

Ganglion Trigger Finger Carpal Tunnel Syndrome Ulnar Nerve Entrapment Arthritis of the thumb and fingers Dupuytren’s contractures Nerve Read on … !

Knee problems in adults

Knee problems in adults often arise when the knee joint undergoes a degenerative process due to repetitive wear and tear as the patient ages. Young adults usually injure one- or more of the stabilizing ligaments such as the ACL or the collateral ligaments during traumatic events such as rugby tackles or other twisting injuries at Read on … !

Knee problems in children

With knee problems in children, it is imperative that back-and hip problems are excluded as the cause of referred pain to the knee. Various hip problems commonly cause knee problems and pain in children.

Septic arthritis/osteitis is a potentially devastating condition involving infection of the knee joint or the surrounding spongy bone. A healthy child, Read on … !

Hip Pain

Hip pain often presents a diagnostic problem to a referring doctor, for two reasons. Firstly, what the patient describes as “hip pain”, may involve pain in the groin, pain over the lateral thigh as well as pain in the buttock, sometimes radiating down the leg. Secondly, patients who present like this, may have problems which Read on … !

Hip Pain in Adults

Hip pain in adults must be differentiated into pain of the various regions around the groin and upper thigh. While age at presentation is extremely important with hip pain in children, painful adult hip conditions may occur throughout a wide age range, depending often on the predisposing factors.


Groin pain in adults:

Femoro-acetabular impingement

Read on … !

Hip Pain in Childhood

Hip pain in children / pathology may often presents with knee pain (referred pain) and every child that presents in such a way should have been examined and possibly imaged. Children are are notoriously unable to distinguish between specific locations of pain around the hip. Hip pathologies in children occurred at different times of their Read on … !

Total Hip Replacement

A total hip replacement is a very successful procedure for patients with arthritis of the hip. Arthritis of the hip can be caused by osteoarthritis, inflammatory arthritis, or secondary arthritis due to an injury or deformity. Hip fractures are often treated with a hip replacement if screw and plate fixation can not be done.

Minimally Read on … !

Thumb Arthritis

Thumb Arthritis or Arthritis of the base of the thumb (carpo-metacarpal arthritis or CMC OA) is the most common site in the hand to be affected and has a good outcome after surgery should conservative treatment with splinting and cortisone injections not be successful.

All other joints of the wrist and hand can be involved Read on … !

Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis consists of a spectrum of inflammatory arthropathys which affects children (girls in the early teenage years more often than boys). The patients present with synovitis of various joints (usually a polyarthropathy (more than one joint involved), although initial presentation may be in the form of a monoarthropathy). The wrist-, knee-, and ankle Read on … !

Idiopathic Chondrolysis

Idiopathic chondrolysis is a condition which was initially described in Cape Town. It occurs in teenage girls and, as the name suggests, the cause is unknown. The patient presents with a stiff hip, usually held in flexion and adduction as well as x-ray changes consisting of joint space narrowing and osteopenia around the hip. The Read on … !

Hip Tuberculosis

Tuberculosis (TB) of the hip joint, Hip Tuberculosis, is common in the Western Cape and should be considered in the differential diagnosis of any child with a limp and/or a stiff hip. With Hip Tuberculosis, the hip is found to be stiff, usually held in flexion and adduction. ESR is usually significantly elevated and various Read on … !

Transient Synovitis

This condition, Transient Synovitis, features prominently in the differential diagnosis of septic arthritis of the hip. Patients present arrival at the same age and with a similar symptom complex (limp, inability to weight bear and hip pain). The hip is often held in a flexed, abducted and externally rotated position and the child will never Read on … !

Slipped Upper Femoral Epiphysis (SUFE)

Slipped Upper Femoral Epiphysis occurs most commonly in overweight teenage boys and the pathological process involves slippage of the proximal femoral epiphysis relative to the neck of femur through the hypertrophic layer of the growth plate. These patients present with hip pain or, on occasion, knee pain, as well as a stiff hip, which deviate Read on … !

Septic Arthritis/Osteitis

Septic Arthritis/Osteitis is a devastating condition which may affect children of all ages, however, the most common incidence is in a seven-year-old male patient. The child presents with rapidly increasing pain around the hip, refusal to walk as well as “pseudo-paralysis” (weakness of the leg muscles which is not of neuromuscular origin). The hip is Read on … !

Perthes Disease

Perthes Disease occurs most commonly in five-year-old male patients, who present with a insidious onset of a limp and a painful hip. On examination, the hip is stiff and painful. These patients commonly present with knee pain and this should be watched for. The disease process involves bone death of the femoral epiphysis (the most Read on … !

Hip Dysplasia

Hip Dysplasia in children may develop an abnormally shaped hip joint while in their mother’s uterus. At birth, all children should be examined by a paediatrician, who will be able to determine whether the child’s hips are dislocated or not. A dislocated hip at birth is not managed surgically, however, if conservative treatment methods fail, Read on … !

Hip Problems

The Cape Joint Surgery surgeons are both super-specialist fellowship trained hip surgeons with extensive experience in the diagnosis of hip arthritis, other adult hip problems as well as hip problems in children. We perform both elective- as well as injury-related hip surgery. The practice performs total hip replacement procedures in private as well as in Read on … !