Warwickshire Hip & Knee Clinic Treatments

A total hip replacement (total hip arthroplasty) is an operation consisting in replacing both the acetabulum (socket) and the femoral head (ball) parts of the hip joint.

Hip replacement is currently the most common and successful orthopaedic operation resulting in a significant improvement in the quality of life in most cases.

Modern day prostheses are manufactured from titanium or stainless steel, come in different designs and can be fixed to the skeleton with or without cement. The bearings can be made from ceramic or metal, for the femoral side, and ceramic or polyethylene on the socket side.

The operation can be performed through different approaches that are defined by their relation to the joint. Hence the hip can be entered from the back, side or front and these constitute the posterior, lateral and anterior approaches that are the most utilized.

There are multiple variations of these approaches and over recent years there has been a proliferation of minimally invasive approaches that have been developed in order to reduce the damage to the muscles around the hip, post-operative pain, speed up the recovery and improve the cosmetic appearance of the surgical scar.

So far, these novel approaches have failed to show any advantage over the traditional ones, other than a smaller size scar, and if anything, there is some evidence that in some cases they can lead to of a higher incidence of complications such as dislocations and fractures.

Two decades ago, navigation systems entered the scene. More recently, the possibility of performing the surgery assisted by a robotic arm has become a reality. The purpose of both, navigation and robots, would be to introduce an increased level of precision for joint replacement in the hope that this leads to better results. Although both generated lots of interest and hold great potential, current evidence suggests that they have yet to prove that, except in the hands of some enthusiasts, they have had a significant impact on the outcomes when compared to traditionally done hip replacements.    

A modern hip replacement of a good design, with the right bearings, performed by a competent surgeon through his preferred approach is expected to have a survivorship of more than 95% at 10 years. Ultimately, the expectation is that in many cases the new hip will last for much longer and that you will forget that you carry a prosthetic hip.

The current variety of stem and cup designs, bearing options and approaches should not lead you to confusion. Such a variety of options available means that an experienced surgeon should be able to come out with a tailored plan for a hip replacement that better meets your needs based on age, gender and activity levels.

The most common complications of hip replacement are infection, in less than 1% of patients, dislocation in up to 3% of cases in the first two years after surgery, and deep vein thrombosis (DVT) and pulmonary embolism (PE) that occur in between 0.6% and 3% of patients.

During the consultation, I shall take the time to talk to you about these complications when discussing the operation and to inform you about the measures I intend to take to minimize the risk of these occurring.

When choosing a surgeon, it is important that you stay away from sensationalist front pages on tabloids that are of questionable reliability and often driven by financial interest from manufacturers, private healthcare organizations or individual surgeons.

Any patient looking for hip a surgeon in England should take advantage of the information available from the National Joint Registry that gets published online on a yearly basis under the heading “NJR surgeon and hospital profile” that is of open access to the members of the public. Read More Here 

Hip resurfacing is an alternative type of surgery to hip replacement. This involves removing the damaged surfaces of the bones inside the hip joint and replacing them with a metal surface, hence, resurfacing is a more bone preserving procedure than hip replacement.

The fact that the femoral head does not get sacrificed and is closer to the size of the natural ball of your hip results in a decreased risk of dislocation. There is also evidence that a hip resurfacing results in a more normal walking pattern than a hip replacement. In addition, if it ever fails, in many cases the conversion to a primary hip replacement should result in an easier operation than revising a hip replacement.

Some of the complications of hip resurfacing are the same as those of hip replacement, namely, infection, dislocation, and venous thrombo-embolic events. As already mentioned, the risk of dislocation after resurfacing is less than after hip replacement.

Other complications such as fracture of the femoral neck, late loosening of the socket component and, more significantly, those related to the metal ions and particles released from the joint, are more specific of resurfacing and potentially more serious.

Many of the patients that carry a resurfacing are found to have elevated metal ion levels in blood and serum, the significance of this is still poorly understood. In addition, the metal particles released from the bearings can cause devastating damage to the tissues around the resurfacing, both bones and muscles can be affected. As a result of this adverse reaction to the metal debris patients can experience, pain, swelling and loss of mobility. Furthermore, this can also lead to loosening of the components, fracture of the femoral neck, and more rarely of the socket, often requiring rather complex reconstructive surgery.

A knee replacement consists in resurfacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the joint.

Depending on how many of the three compartments of the knee need addressing you may need a partial or a total knee replacement.

The operation typically results in substantial postoperative pain during the first few weeks and requires vigorous physical rehabilitation to regain the mobility of the joint.

During the early stages of the recovery period, you may need to use mobility aids such as walking frames, crutches and canes.

Following this initial period, it is advisable that you carry on with the rehabilitation exercises for a minimum of twelve months since it can take up to one year or even longer for the new knee to reach its full potential after the operation.

The most common complications of knee replacement are infection, in 1% of patients and deep vein thrombosis (DVT) and pulmonary embolism (PE) that occur in 0.6% to 3% of patients. During the consultation, I should take the time to talk to you about these complications when discussing the operation and to inform you about the measures I intend to take to minimize the risk of these occurring.

Other complications include nerve injuries and persistent pain or stiffness that occurs in 8–23% of patients. Prosthesis failure occurs in approximately 2% of patients at 5 years.

Obesity results in increased risk in complications when undergoing a knee replacement. The morbidly obese should lose weight before surgery and, if medically eligible, would probably benefit from bariatric surgery.

Two decades ago, navigation systems entered the scene. More recently, the possibility of performing the surgery assisted by a robotic arm has become a reality. The purpose of both, navigation and robots, has been to introduce an increased level of precision for joint replacement in the hope that this would lead to better results. Although both generated lots of interest and hold great potential, current evidence suggests that they have yet to prove that, except in the hands of some enthusiasts, they have had a significant impact on the outcomes.   

The current variety of total and partial knee replacement designs available mean that an experienced surgeon should be able to come out with a personalised plan to better meet your needs based on the extent of the disease, age, gender, level of activity and expectations.

When choosing a surgeon, you should stay away from sensationalist front pages on tabloids that are of questionable reliability and often driven by financial interest from manufacturers, private healthcare organizations or individual surgeons.

Any patient looking for a knee surgeon in England should take advantage of the information available from the National Joint Registry that gets published online on a yearly basis under the heading “NJR surgeon and hospital profile” that is readily accessible by the members of the public.Read More Here 

Primary hip and knee replacements, and hip resurfacing, can fail in time for a variety of reasons that include wear, loosening, infection or fracture.

I have a special interest in failed Metal on Metal hip replacements and Resurfacings and some years ago I started a “Groin Pain” clinic at UHCW NHS Trust where I monitor, investigate, and treat these patients. A big proportion of my earlier clinical research had been on this subject.

Another area of interest of mine has been the management of infected hip and knee replacements. Fifteen years ago, I started a multi-disciplinary musculoskeletal infection group at UHCW that is currently well established and has led to our Trust becoming the regional hub, at the center of a regional network, for the management of peri-prosthetic joint infection (PJI).

Whether a prosthesis failed due to an infection or not, revising a hip or a knee replacement is highly specialised and often complex surgery requiring extensive training and access to sophisticated equipment, implants, and hospital facilities. In most cases the old prosthesis must be removed and replaced with new implants.

The surgery is usually long, and the risk of complications is higher than after a primary operation. Patients often spend the first 24 to 48 hours after the procedure in the high dependency/ critical care unit.

As a high volume and experienced hip and knee revision surgeon I regularly get patients referred to me by orthopaedic colleagues from my department, other Trusts in our region, and from abroad. Read More Here