Knee osteoarthritis non-operative treatments

Knee replacement is an extremely effective treatment for patients with knee arthritis. It is however major surgery, with some risks, which your surgeon will always discuss with you before deciding to proceed to surgery. Non-operative treatment is an important part of managing knee arthritis. A number of treatments are available to reduce pain and improve function. Non-operative treatment is also helpful in helping patients decide when they are ready for surgery. Here we’ll look at some of these treatments and how effective they are.

Study finds steroid injections don’t speed up progression of OA

Steroid and other injections are often used. There have been concerns that steroids can damage the joint and that they may lead to surgery being required sooner. Previous studies had suggested that steroid injections could actually speed up the progression of the disease.

A new study looking at this has found that steroid injections for the treatment of knee osteoarthritis do not hasten the need for a knee replacement. This study, carried out by the Boston University School of Medicine, revealed steroid injections don’t speed up the progression of OA.

This latest research included two large cohort studies. It followed those with knee OA who were receiving either hyaluronic or corticosteroid injections. Rates of radiographic progression, X-Ray visible joint damage and total knee replacements were analysed. A total of 792 knees were analysed, with 647 patients undergoing corticosteroid injections. The other 145 patients were receiving hyaluronic injections.

The study found that patients undergoing Hyaluronic injections were more likely to have a knee replacement. However, patients receiving corticosteroid injections didn’t show any signs of radiographic progression and did not have an increased risk of needing a knee replacement. The authors concluded that steroid injections don’t speed up the progression of OA like previously suggested.

Understanding non-operative options

In patients with osteoarthritis, a total knee replacement is typically used as a last resort. There are many non-operative treatments available which have shown to have huge success at treating the condition.

Physiotherapy

Physical therapy has shown to provide clinical benefits to those with knee osteoarthritis. A new study has shown that after a year of physical therapy, the majority of patients had less pain and better mobility.

Weight loss

Another thing that can help patients is weight loss. In those who are overweight, the additional weight can put a lot of pressure onto the joints. Studies have shown that overweight patients suffering with knee osteoarthritis, often experience pain relief and enhanced mobility when they lose weight.

Shockwave therapy (ESWT)

This is used increasingly for patients with tendon problems. A recent study has shown that ESWT can also be effective in helping patients with knee arthritis. They looked at patients with arthritic knees and resulting deformity. Interestingly, ESWT was shown to decrease pain in up to 95% of cases and improved the function of the joint. This study raises hoe that this treatment modality may help patients with knee arthritis.

As you can see, there are a lot of non-operative treatments available for patients suffering with knee OA. The new findings in these recent studies confirm the role of non operative treatment and where these modalities fit in, helping patients to achieve relief, without going under the knife.

hip replacements

As we age, our risk of falls increases. Sadly, so too does our likelihood of suffering an injury from a fall. However, a new study has found that the key to cutting the risk of falls could be a knee or hip replacement.

Here, we’ll look at what a knee and hip replacement involves and what the new study revealed about their effectiveness at reducing falls.

What is a knee or hip replacement?

A knee or hip replacement involves replacing the damaged joint and replacing it with prosthesis. The procedures are most commonly carried out on older patients with osteoarthritis. However, younger patients may also need to undergo a knee or hip replacement for a variety of reasons.

Knee and hip replacements are known to reduce pain, increase mobility and help patients return to an independent lifestyle. According the recent study, they can also cut the risk of falls.

Hip replacement study

The recent study, published within the American Academy of Orthopaedic Surgeons, looked at data from over 500,000 patients suffering from osteoarthritis. All of the patients had undergone either a knee or a hip replacement. The researchers compared the fall rates to those who hadn’t undergone a replacement procedure. It was revealed that those who underwent the procedure, had a much lower fall rate than those who didn’t.

Not only did the study prove joint replacement surgery reduces the risk of falls, but it also found it reduces the fear of falling too. Patients who had undergone a knee or hip replacement were found to be a lot less worried about falling than those who hadn’t.

So, a knee or hip replacement benefits the patient both physically and mentally. The authors of the study also provided tips for patients to prevent their risk of a fall after surgery. The key advice all patients should follow includes:

  • Removing any loose rugs
  • Covering sharp corners of tables and countertops
  • Installing motion sensor night lights
  • Installing handrails near stairs and in bathrooms

Patients are also advised to wear a communication device at all times to ensure they can receive help quickly if they do suffer a fall or injury.

Other benefits of knee and hip replacements

As well as preventing the risk of falls, knee and hip replacements also offer a number of other benefits. The main benefit is that a joint replacement can significantly reduce pain.

The damaged areas of the joint are removed during the surgery, completely eliminating the diseased joint. It is this which causes the pain, so once it has been removed, the pain is no longer there. The replacement joint provides pain-free mobility, enabling patients to walk around much easier.

This new study highlights the importance of knee and hip replacements in older patients. Falls are a major risk as we age, and they can cause a lot more damage compared to when we were young. Therefore, undergoing a knee or hip replacement could help patients to reduce their risk of falls, protecting their long-term health.

Call us on 020 8947 9524 to arrange a knee or hip replacement consultation with Mr Simon Bridle.

Bilateral Hip Replacement

Undergoing one hip replacement procedure can be daunting enough. However, for some patients, a double hip replacement may be recommended, where both hips are painful and badly damaged by arthritis.

While less common than a single (unilateral) hip replacement, having both hips replaced at the same time (bilateral), can deliver significant benefits to some patients. Here, we’ll look at when two hip replacements may be better than one and what to expect from a bilateral procedure.

What is a bilateral hip replacement?

Hip replacement involves replacing the femoral head and the acetabulum, using artificial parts made of ceramic, metal or a mixture of both. A bilateral hip replacement can be done as a staged, or simultaneous procedure.

With a staged procedure, the hip joints will be replaced one at a time. After the first procedure, the second replacement will be carried out a few weeks later.  In a simultaneous procedure, both hip joints are replaced at the same time.  This approach is cheaper and overall the hospital stay, recovery period and cost is less.

Generally speaking, a simultaneous procedure isn’t recommended for older patients or those who have other underlying health problems. If both your hips are very painful, you should talk to your surgeon to discuss the risks and benefits of each method. They will be able to advise the best technique to match your circumstances.

Why might you need two procedures in one?

A number of conditions can damage the joint, leading to the need for replacement surgery, including osteoarthritis, osteonecrosis, developmental dysplasia and rheumatoid arthritis.  Osteoarthritis in particular frequently affects both hips.  Studies have revealed that 42% of those suffering with Osteoarthritis have it in both hips and of these, around 25% go on to need both hips replaced.

Recovery and results

Patients who undergo a simultaneous procedure will typically need to stay in hospital for a couple of days longer than after one hip, typically 4 or 5 days. Patients are mobilised as soon as possible – on the day of surgery, or the following day.  Pain control techniques are very important to allow this.  Early movement, along with blood thinning medication reduces the risk of clots, which is one of the most significant risks of hip replacement.

Physical therapy is key to achieving best results. A trained physiotherapist will teach you stretches and exercise to improve the mobility of the joints. Recovery time and results will depend upon a number of factors such as age and overall health.

Despite their benefits, double hip replacements are quite rare. Patients who are experiencing pain and mobility issues in both joints should speak to a hip specialist to discuss your treatment options. Mr Simon Bridle will be able to talk through the staged and simultaneous techniques and advise you of which one is better suited to you.

Self-Pay Market for Hip and Knee Replacements

The Coronavirus pandemic has caused havoc across the healthcare sector. As hospitals were required to focus on COVID patients, millions of non-emergency operations were cancelled or put on hold.

Patients who were scheduled for elective – although often much-needed – procedures such as hip and knee replacements have been particularly affected with delays and cancellations. This has led to many arthritis sufferers seeking private surgery. Here, we’ll discuss the rise in the self-pay market during the pandemic.

Patients face a wait of up to two years for procedures

One of the main driving factors behind the rise in the self-pay market has been the significant delays patients face for procedures. As the NHS has had to focus on dealing with the COVID crisis, non-urgent operations have had to be put on hold. In some cases, patients have even been told that their procedures cannot be carried out for another two years.

Patients who are waiting for joint replacement procedures typically live in pain with significant restricted mobility. The prospect of waiting another two years surgery can therefore be devastating. This is one of the main reasons why patients are choosing to head down the self-pay route.

Private hospitals are considered safer during the pandemic

Another reason COVID is driving an increase in private care, is because it is perceived as a safer option. Private hospitals treat a smaller number of patients and are not admitting emergency patients. It is much easier to establish COVID free pathways and having mainly private rooms mean that they are better able to keep people socially distanced than in an acute NHS hospital, who are likely to be looking after COVID patients.

Understandably patients are concerned about going to hospital during the pandemic, worrying that they are at risk of COVID-19 due to potential exposure to other patients. Booking the procedure privately is seen as a safer option.

Fears over second lockdown

It is looking increasingly likely that there will be a second national lockdown. The first lockdown obviously caused a significant backlog. So, if a second lockdown is introduced, it could once again lengthen the time patients need to wait to receive their treatment. So, to avoid having their hip replacements delayed once again, patients are turning to self-pay options.

Due to widespread NHS rationing of treatments and record long waiting lists, the self-pay market was soaring prior to the Coronavirus crisis and had seen a doubling of growth between 2014 and 2018 to £1.1bn. At the beginning of the year, market analysts LaingBuisson forecasted that this would continue to grow to £1.3bn by 2021.  These figures will need to be readjusted to account for a global pandemic, however it feels safe to say that self-pay hip and knee replacements will only become a more attractive option in the future.

hip replacement alleviates poor sleep

A bad hip isn’t just uncomfortable, it can also significantly impact your quality of life. Over time, the hip can start to wear down, making it more vulnerable to impact. One solution you may have considered, is to have the hip replaced.

Hip replacements are a common treatment option, particularly amongst older patients. The question is, how do you know if you need one? Below, you’ll discover 5 signs you may need a hip replacement you’ll want to pay attention to…

  1. The hip is very stiff

One of the most common signs you may need a hip replacement is if it is very stiff. It isn’t uncommon to experience stiffness in the joint every now and again, but if it’s affecting your daily life it’s a problem.

For example, if you find it difficult to put your shoes and socks on, particularly on one foot, it could be an indicator you need a new hip. Additionally, you’ll also potentially hear and feel clicking, popping or grinding in the hip.

  1. You suffer with pain in the groin and thigh area

Perhaps the easiest sign to watch out for that you may need a hip replacement, is pain. Pain around the hip can occur in a number of areas.  If your pain is in the groin, thigh or knee, it could be a sign there is something wrong with the hip joint.

You’ll know there is a problem if you find it difficult walking or carrying out daily activities without pain.

  1. It disturbs your sleep

When there is a problem with the hip joint, it can make sleep particularly difficult. The pain often keeps patients awake, contributing to fatigue and lowering quality of life. When hip pain and discomfort is ruining your sleep, it could be a sign you need surgery as often a hip replacement alleviates poor sleep.

  1. The one leg test

A simple test you can carry out to see if you do have hip issues, is the one leg test. This involves standing on one leg for around one minute. If you struggle to do this, even when holding onto something for support, it’s a clear sign you could have a hip issue.

  1. You don’t get any relief from other treatments

Finally, another sign you may need a hip replacement, is that you don’t get any relief from other treatments. The majority of hip troubles don’t require a hip replacement. They will respond to different types of treatment like physiotherapy or medication.

So, if your hip problem isn’t going away after trying different treatments, a hip replacement could be required.

These are just 5 signs you may need a hip replacement. The general takeaway is that if your hip isn’t affecting your quality of life or stopping you doing daily tasks, you likely won’t need a replacement. However, it is a good idea to book a consultation with a hip specialist if you are experiencing any issues. During your consultation with Mr Simon Bridle, he will be able to identify the cause of the problem and recommend the best course of treatment. Appointments can be arranged by contacting his PA Adriana on 020 8947 9524 or email bridle@fortiusclinic.com.

non-surgical hip treatments

Hip replacement is an extremely effective way to eradicate pain and improve mobility for patients with hip arthritis. However, they aren’t always the only option available. If you want to sort your hip troubles out without going under the knife, there are some non-operative alternatives you’ll want to consider first.

Here, we’ll look at some of the best alternatives to hip replacement surgery available.

Conservative therapies could delay need for hip replacement

A clinical study conducted in Norway, has revealed that conservative therapies could delay the need for hip replacement surgery. However, it only applies to those suffering with osteoarthritis.

The cluster randomised trial developed a program based on international treatment recommendations. This included a three-hour patient education session, alongside 8-12 weeks of individually created exercises supervised by physiotherapists. There were 393 patients included in the study and 284 of them took part in the specialised program.

Just 64% completed the program and went through a 12 month follow up. This revealed the majority had seen significant improvement. So, conservative therapies could delay the need for a hip replacement in those with hip osteoarthritis.

Injections to relieve hip pain

Another non-surgical hip treatments option is for patients to undergo injections to manage inflammation. These include corticosteroids and hyaluronic acid injections. They are good for patients suffering from inflammation in the lining of the joint.

You will also find newer stem cell injections available at some clinics too. These consist of injecting stem cells into the hip to help it develop additional bone or cartilage. However, there is very little evidence to support the effectiveness and safety of these injections – we covered this in more detail in an earlier blog post.

Unfortunately, injections can sometimes make the problem worse, rather than better. For this reason, many experts advise against them. If you are considering injections, make sure you talk to a specialist hip surgeon beforehand.

Cartilage transplant

A surgical alternative is to undergo a cartilage transplant, if there is only a small area of cartilage damage. Cartilage will be grown by a specialist team before it is inserted into the damaged area. The cartilage may also be placed to encourage the bone to produce more cartilage naturally. This remains an experimental procedure and at the moment is not likely to be a useful technique in patients with established osteoarthritis.

Partial replacement

A partial replacement is another option if the area of cartilage damage is only small. However, this will still involve going under the knife and having smaller artificial parts fitted. This technique is not well established, so has to be used carefully and is only likely to be useful in a very small proportion of patients.

As you can see, there are alternatives to full hip replacements. The recent study has shown how effective conservative treatments can be. However, if the damage is extensive the best option remains a full replacement. Always talk to your surgeon about the options available to see which would best match your needs – to arrange a consultation with leading London hip surgeon Mr Simon Bridle, contact his PA Adriana on 020 8947 9524 or email bridle@fortiusclinic.com.

same day rehab after hip replacement

NICE has released new guidelines recommending patients who undergo a hip replacement to begin rehab on the same day as their procedure.

The new guidelines found under Joint Replacement: Hip, knee and shoulder, sets out the care of patients before and after joint replacement surgery. Here, we’ll look at why this new guidance has been published by NICE and what effect same day rehab can have on patients.

What are the new guidelines?

The new guidelines have been introduced by the National Institute for Health and Care Excellence (NICE). The body consulted with the Association of Trauma and Orthopaedics Chartered Physiotherapists during the development of the guidelines. They reference patient care before and after planned hip, knee and shoulder replacements, providing information for both patients and surgeons.

The latest guidelines relate to the importance of rehabilitation in recovery. Now, it is being recommended that patients undergo rehab on the same day, or at least within 24 hours of their operation. This should be offered to the patient by an occupational therapist or physiotherapist.

The rehab should include post-surgery exercise advice, alongside guidance on certain lifestyle choices such as smoking and weight management. This will help to aid in achieving the best outcomes.

Why is same day rehab after hip replacement important?

There are a number of reasons why same day rehab is important for hip replacement patients. According to research, it helps to achieve better outcomes.

The goal of any surgery is to achieve the best outcome. However, often the recovery process determines how well it goes. Early rehab can help to improve the range of movement within the joint, ensuring it isn’t stiff or uncomfortable. It can also help to strengthen up the surrounding muscles and reduce pain after the surgery.

The recovery for a hip replacement can be difficult. In some cases, you may need help to walk again. Rehab can help to get you back walking quickly after the procedure, reducing downtime.

Other factors that can aid in a speedy recovery

As well as same day physical therapy, there are some other factors that can aid in a speedy recovery from joint replacement surgery. Making sure your home is prepared in advance so you can simply rest and recover for example, is a good idea. Make sure anything you need is within easy reach and the home is clean and tidy.

You’ll also want to avoid returning to sports and more strenuous exercise for at least six weeks. This includes activities such as swimming and golf. While gentle exercise is important for your recovery, doing too much too soon could prove damaging.

Taking care of yourself and making healthier lifestyle choices will also help. This includes quitting smoking and eating a healthy diet. Focus on foods which are known for their healing properties.

Overall, same day rehab is important for hip replacement patients. The earlier patients get moving, particularly walking, the better the outcome will be. The new research will prove useful for both patients and surgeons when determining the most effective recovery plan.

revision hip surgery

A new study has revealed that the more hip replacements a surgeon has carried out, the better the results will be. This may not be groundbreaking news, but it does highlight the importance of patients choosing an experienced surgeon.

Experts have been advising patients for years to check how many procedures your surgeon regularly performs. However, this new research backs up the advice. Here, we’ll look at what the study found and why experience counts when it comes to hip replacements.

Understanding the study

The new study assessed 12,100 operations which were conducted in Västra Götaland between 2007 to 2016. Out of these, 6713 were primary hip replacements.

The researchers looked into the number of procedures that resulted in complications within 90 days and the experience of the surgeons involved. These included both surgical and medical complications such as blood clots, pneumonia, hip dislocation and wound infections.

Patients who had been treated by resident physicians gave a slightly reduced satisfaction score. This was compared against patients treated by specialist surgeons. However, the differences here were very minor.

The study concluded that experience does play a role in results with patients undergoing a hip replacement.

Length of experience doesn’t always matter

Interestingly, while the study did reveal that the frequency that surgery is performed matters, the length of experience was shown to be less important. The length of experience didn’t show to have much impact on pain levels or health gains for patients.

So, patients should look out for surgeons who are regularly performing hip replacement procedures. However, they don’t need to worry too much about how long the surgeon has been providing the procedure according to the study.

The trouble with inexperienced surgeons

So, why is an experienced surgeon important? You won’t just receive the best functional results with a more experienced surgeon, you’ll also reduce the potential complications involved. Many patients have made the mistake of opting for a less experienced surgeon. This can lead to an increased risk of complications, as well as potentially lead to less effective results.

The thesis was published in Sweden and argues that a quality register for joint replacement surgery should be established in Sweden, following the model in countries like the UK. “The annual volume of operations per surgeon and personal feedback are pieces of evidence that may help further to improve the situation a bit for patients undergoing hip replacements.”

You can also judge how experienced the surgeon is via your consultation. Have a list of questions ready about the procedure and what you can expect, particularly in relation to potential risks and complications and how they will address them if they arise.

Choosing a hip replacement surgeon that performs revision surgery can also be a good indicator of their experience. Mr Simon Bridle has a very low complication rate in his own primary replacement procedures and he is frequently referred patients with failed joints where the surgery was performed elsewhere and has built a multidisciplinary team (MDT) to deal with these often challenging problems.

For more advice on hip replacement or revision surgery, call 020 8947 9524 to arrange a consultation.

hip replacement for back pain

A new study has revealed that a hip replacement could also ease back pain. Experts have been looking into the connection between hip and back pain for many years and this recent study investigated whether patients suffering from back pain could benefit from a hip replacement procedure.

So, does this mean all patients with back pain can expect to find relief from a hip replacement surgery? Below, you’ll discover more about the study and what it means for patients.

What is a hip replacement?

A hip replacement procedure aims to replace a worn-out hip joint with an artificial one. They are most commonly carried out on older patients, although increasingly younger patients require surgery, and the joints are designed to last for approximately 25 years for the majority of patients.

After undergoing a hip replacement, patients report a significant decrease in pain and a great improvement in mobility.

Hip or back pain?

Hip arthritis and back pain often go together, as London hip surgeon Mr Simon Bridle explains. Patients with arthritis hips often have arthritis in their spine. This link is confirmed in the new study, carried out by New York City researchers from the Hospital for Special Surgery, which revealed some interesting results. It followed 500 patients who had undergone a hip replacement procedure.

It was discovered that more than 40% of patients had pain in their hips and lower back prior to the operation. However, one year after the procedure, a staggering 82% reported their back pain had gone completely.

The only negative discovered was that patients who have undergone spinal surgery, have an increased risk of complications during a hip replacement. In fact, the risk was found to be five times higher, which should be a consideration for specialists when identifying the best treatment option.

How does a hip replacement ease back pain?

The main reason a hip replacement can ease back pain is that it makes the joint more mobile. Many patients discover their back pain was worsened due to an immobile hip joint. This places strain on the back, causing a lot of discomfort. So, once the hip joint has been replaced and it is more mobile, this automatically removes the extra strain from the back.

Will a hip replacement eliminate all back pain?

The new findings do show the majority of patients experience a reduction in back pain. However, it’s important to be aware that this isn’t always the case. Undergoing a hip replacement isn’t guaranteed to eliminate your back pain.

That being said, a hip replacement is an outstanding procedure which can greatly help patients to live a happier, more mobile life. Even if it doesn’t aid in eliminating back pain, it still helps patients achieve a better quality of life.

If you have been experiencing both hip and back pain, a hip replacement could be an ideal treatment option. However, it is important to book a consultation with a specialist to determine whether or not it’s the best option.

Anterior Approach to Hip Replacement

The anterior hip replacement is not a new concept in joint surgery, but in recent years it has become more popular, partly due to it being promoted as ‘less invasive’, with surgeons even promising patients they will be up and about in a much shorter timescale compared to traditional hip replacement.

As a result, patients often present at their consultation, requesting this type of surgery, but it is important for them to be fully informed of both the potential advantages and the disadvantages of the anterior approach to hip replacement. In fact, two recent large-scale studies have indicated a higher complication rate.

The difference between anterior hip replacements vs the traditional approach

The main difference between these two approaches is the location of the surgical incision. The anterior hip replacement entails an incision at the front, anterior meaning ‘front’, whereas a traditional hip replacement will usually involve an incision either at the side, known as a lateral incision, or from the back which is a posterior incision.

There are fewer muscles situated at the front of the hip and the surgeon can access the joint between them, rather than having to cut through muscle fibres or detach the muscles from the bones and then repair them at the end of the operation. The length of the incision is the same, but the anterior approach is considered to involve less damage to the muscles and soft tissues in the hip, making it ‘minimally invasive’ in comparison to other approaches.

The advantages of the anterior hip replacement

Incurring less trauma to the muscles and soft tissues of the hip during surgery is thought to result in less post-operative pain and an easier recovery in the initial weeks after surgery, making it seem more advantageous in comparison to traditional hip replacement.

However, as with any surgical procedure, there are always potential complications and recent large-scale studies have found that the anterior hip replacement approach could actually have a higher risk of complications and it is important patients are fully informed of these before making a decision on surgery.

Understanding the disadvantages of the anterior hip replacement

Last year’s Frank Stinchfield Award in The Bone and Joint Journal was given to a large-scale comparison of prosthetic joint infection rates. Comparing the direct anterior and non-anterior approach total hip arthroplasty, a review of 6086 patients found a higher rate of infection in the anterior approach.

Published in the March issue of the Journal of the American Medical Association, a study of over 30,000 Canadian hip replacement patients looked at major surgical complications within one year of the initial procedure. The study’s authors found a ‘small, but statistically significant increased risk of major surgical complications’, such as infection requiring surgery, dislocation, or a need for revision surgery.

An easier, less painful recovery will obviously be highly attractive to patients and that’s often perceived as one of the main benefits of the anterior approach, but a recent study casts doubt on the validity of this claim. In a study published in the Journal of Arthroplasty earlier this year and the recipient of the AAHKS Clinical Research Award, there was no evidence found of superior early patient-reported pain scores after anterior hip replacement and there were no differences found between the anterior, posterior or lateral approaches beyond one year, ‘indicating that patients reach similar final symptom states, regardless of surgical approach’.

Between surgeons themselves, the anterior approach is perceived as more technically challenging and it is essential that you choose a surgeon has undergone extensive training and has a great deal of experience in this approach if you’re still considering this option.

For more advice on the advantages and disadvantages of the anterior approach compared to traditional hip replacement, call 020 8947 9524 to arrange a consultation with London hip specialist Mr Simon Bridle.