Obesity and hip replacement surgery: a weighty issue

obesity and hip replacement

Obesity is a serious global concern and has been linked with many different illnesses and conditions, causing excess healthcare expenditure and costing countries in the form of lost productivity. It is believed to affect two-thirds of the adult population in the UK, and according to recent reports, over 1 million people in Britain are claiming sickness benefit as a result of their weight.

There are some operations which patients are advised not to undergo if they are classed as obese, as excess weight is known to affect how well patients can recover from surgery and the NHS’s recent rationing measures will mean that severely overweight and often even mildly overweight patients will just not have access to joint replacement surgery through the NHS.

Interestingly, a recent study has found that total hip replacement surgery is still a more cost-effective option than other means of managing a patient’s pain and lack of mobility as a result of joint wear and tear, whatever the weight of the patient. Results of this Canadian study have been published in The Journal of Arthroplasty and make interesting reading.

 

It is accepted that the risks associated with total hip replacement increase for overweight patients, but the report suggests that despite these risks, the outcomes are still more positive compared with the available alternatives.

Some surgeons feel that it is simply a case of weighing up the risks against the potential benefits. In terms of managing the decision-making process, it is important to fully discuss the risks and rewards with patients in higher risk categories, such as those with a high BMI, so that the patient and surgeon can agree on the most suitable course of action and manage the risks accordingly.

Obesity and hip replacement surgery: using weight as a screening factor for hip replacement

The report authors suggest that obesity, as assessed by the Body Mass Index (BMI), is being used as a screening technique to help manage budget constraints, in the face of limited financial resources.  BMI is one of the factors used by NHS purchasers when assessing patients’ suitability for this type of operation.

Study co-author Edward Vasarhelyi explains that “many developed countries are facing increasing budgetary pressures across the spectrum of healthcare. We have seen changes in funding models, such as bundled care payments. These models have put pressure on clinicians and administrators which, in some healthcare systems, has resulted in the refusal of surgery for patients above arbitrary BMI cut offs.”

Many feel that restricting life-changing surgeries such as total hip replacements for those who are carrying too much weight is not the solution. They recognise that obesity is a challenge for patients and for the NHS and that more needs to be done to reduce the number of people who are classed as overweight.

For patients, making subtle changes to lifestyle can have a marked effect. Paying more attention to what is in the foods we buy and taking steps to cook with fresh ingredients, rather than overly processed meals is a great starting point. Couple this with efforts to exercise more, for example, walking rather than taking the car or bus, and patients will soon notice differences to how they look and feel.

Losing weight before a joint replacement is ideal, as taking steps to try and lose weight will give them a greater chance of a faster, simpler recovery, with reduced complications.  Mr Simon Bridle understands that this is often difficult for people with limited mobility and that patients will decide that the potential benefits of surgery outweigh the risks.

How long does it take to recover from a hip replacement?

hip replacement recovery

Any patient contemplating a total hip replacement procedure will want to know when they will be back up on their feet.  The question ‘how long does it take to recover from a hip replacement’, is probably one of the most commonly asked in Mr Simon Bridle’s London hip surgery consultations.

There is no definitive answer, as each individual differs in terms of their recovery.  Typically patients return to fairly normal day to day activities, including driving, by 6 weeks, but it takes more like three to six months to get back to their normal routine, including sports.  It can even take a bit longer to get back to strenuous sports like skiing.  Successful surgery allows patients to embrace the activities that their hip pain has prevented them from enjoying for many years.

Hip replacement recovery: enhanced recovery

The first phase of patients recovery is while they are in hospital, usually only for 2 or 3 days.  We focus on early mobilization, with techniques to reduce pain and get people back to feeling normal as quickly as possible.

All of Mr Simon Bridle’s patients that are seen at the Fortius Joint Replacement Centre (FJRC) at BUPA Cromwell Hospital follow a standardised Enhanced Recovery Pathway that aims to transform the short-term recovery experience for hip replacement patients. The goals are to ensure a quicker recovery and improved outcome by improving all aspects of the recovery process, from pain management, surgical technique, patient education and return to mobility.

Hip replacement recovery: what happens after I go home? 

Patients go home with walking support, but generally are managing without by 4 to 6 weeks and by then people don’t usually need any painkillers.  The physiotherapists provide an exercise programme for individual patients and physiotherapy is also usually arranged as an outpatient, to supervise rehabilitation.  You can expect to be getting back to a fairly normal day to day life by 6 weeks, including driving.  Light sports like tennis and golf are usually possible by 3 months, but it can be a least 6 months before people get back to strenuous sports like skiing.

Hip replacement recovery: prepare to succeed

The preparation period can be as important as the rehabilitation stage and increase the chances of a successful and quicker recovery. This can cover everything from preparing your home environment and ensuring you have adequate assistance when you return home. Hip pain and lack of mobility may be the reason you’re undergoing joint replacement surgery, but doing your hip exercises and practising mobility techniques beforehand can be invaluable.

Mr Simon Bridle’s physio team at the BUPA Cromwell Hospital are now running a pre-assessment ‘joint school’, to prepare patients for surgery, teach them pre-op exercises etc, which patients find very helpful.

For more information on hip replacement recovery and you, call 020 8947 9524 to book a consultation.

Revision hip replacement rates down due to hip implant material used

Stryker Polyethylene Revision Hip Replacement

Results of a long-term study undertaken in Australia that analysed data from more than 240,000 patients with hip osteoarthritis who underwent total hip replacement surgery have just been published. The objective of the research was to glean a greater understanding of the relative durability of ‘cross-linked’ polyethylene bearings hip implants (ie the moving parts), compared with other materials.

Although total hip replacement surgery is recognised as a very effective resolution for patients who are experiencing long-term and significant osteoarthritis, it is not without its challenges. The current materials favoured for artificial joint bearings will eventually wear, which can damage bone and lead to the artificial joint working loose, meaning a proportion of patients will require revision surgery. Researchers were keen to explore the effectiveness of new bearing materials, and this study, one of the largest of its kind, afforded them the data and time to conduct a very in-depth piece of research.

What are cross-linked polyethylene implants?

To understand the implications of this research, it is important to understand more about what exactly was being analysed. This technique uses different materials than those conventionally used for hip replacement bearing surfaces. The driving force behind needing to find a more durable, hard wearing material was the prevalence of total hip replacements amongst younger patients, those who had led a more active lifestyle – and those who were hoping to continue to engage in more active pursuits once they had recovered from their hip replacement surgery.

The challenge for conventional hip replacement materials was that the greater wear and tear that patients were placing on the artificial joint was leading to more revision surgeries in the years following the initial operation.

Key statistics from the study design are as follows:

  • The study was huge – over 240,000 patient records were assessed
  • It was conducted over 17 years, taking place from 1999 to 2016
  • These contained a mix of cross-linked polyethylene implants and conventional polyethylene (CPE) components: 199,000 of the cases analysed were cross-linked polyethylene bearings and 41,000 cases were CPE bearings

The results are extremely positive in favour of the longevity of cross-linked polyethylene bearings, with the study finding: “As early as six months after hip replacement, revision rates were substantially lower in patients with XLPE [cross-linked polyethylene] bearings. Over 16 years, the cumulative rate of revision surgery was 11.7 percent in the CPE [conventional polyethylene] group compared to 6.2 percent in the XPLE group”.

Implications of these results

What this essentially means is great news for patients in general, but particularly good news for younger patients who would be hoping that their new hip joint(s) would be able to stand the test of time. Owing to the length of the study (looking at data collected over 17 years), researchers were able to conclusively report that they had found that using cross-linked polyethylene bearings in total hip replacement joints provides “a significant reduction in the rate of revision at 16 years following THA for osteoarthritis.”

For patients at Mr Simon Bridle’s hip replacement clinic in London, the good news is that this is the material that he routinely uses in these procedures due to its safety and effectiveness for long-term results. For more information, call 020 8947 9524 to book a consultation.

Nearly 1700 requests for knee and hip surgery were rejected in England last year

private hip surgery alternatives

A recent report published by the Independent outlined a concerning trend of patients not being able to access hip and knee operations on the NHS due to new ‘operation rationing’ that is being enforced. For operations that are widely to considered to be routine, and cost-effective, the report outlines that barriers are being put in the way of patient care, and “GPs are increasingly asked to make ‘exceptional funding applications’ which are judged by local NHS panels, some of which include lay officials with no medical background.” These applications can take a long time to be processed, and have no guarantee of being approved, which leaves patients in limbo, sometimes waiting months to know if they have been accepted for their required procedure.

While they are waiting, conditions such as deteriorating joints will be getting steadily worse and could leave patients in a worse position then when they originally sought medical care. The report cites concerns from leading industry bodies, such as the Royal College of Surgeons. Ian Eardley, senior vice president of the Royal College of Surgeons, explains “the use of funding requests means patients will spend more time in pain with potential deterioration of their condition, thereby generating further costs for a system already under acute financial strain.”

Previously, exceptional funding applications were reserved for non-essential procedures (such as cosmetic requirements such as removal of skin tags and certain fertility treatments) – things that were sought by the patient but that were not clinically necessary. Nowadays it appears that clinical commissioning groups (those in charge of commissioning most of the hospital and community NHS services in the local areas for which they are responsible) are pushing GPs to refer patients via exceptional funding applications for standard, necessary procedures in an attempt to make meagre budgets stretch further.

The term ‘postcode’ lottery is used again, as there are certain criteria that the judging panels will use to help decide which applications are granted and which are refused, and these are not consistent across the differing areas of the country. Factors such as BMI (body mass index) and evidence of physiotherapy in joint replacement applications are required by some panels, but not by others.

The rate in which operations are being refused under this new system is alarming. According to a Freedom of Information (FOI) request report by the British Medical Journal (BMJ), “In 2017-18 a total of 1675 exceptional funding requests (1188 for knee surgery and 487 for hip surgery) were turned down by clinical commissioning groups (CCGs).” This FOI request also shows just how different the regional variance of operation acceptance is.

 

Exploring private hip surgery alternatives

For many patients, the most effective solution to this problem is finding private hip surgery alternatives. The waiting time is significantly reduced; you will have a real choice over your surgeon and when and where the operation is done.  Mr Simon Bridle at the Fortius Joint Replacement Centre at the BUPA Cromwell Hospital offers an enhanced recovery programme, which helps makes the surgery safer and patients are much more comfortable, allowing earlier mobilization and a shorter hospital stay, meaning you can be up and about and back in the comfort of your own home much faster.

As Andy Murray’s hip surgery recovery meant Wimbledon no show, new technology could reduce tennis injury

tennis joint injury tech

Less than 24 hours before the start of Wimbledon 2018, the news broke that Andy Murray was having to pull out of the competition due to his continued recovery from recent hip surgery which he underwent in January this year. The former World Number 1 player had been undertaking a period of rehabilitation to aid his recovery but concluded that competing at Wimbledon was a step too far in terms of allowing his body to heal effectively.

Progress has been slow since then, as Andy pulled out of the Washington Open after gruelling wins to reach the quarter-final. He then withdrew from the Roger’s Cup in Toronto to continue his recovery.

Murray is quoted as saying “I’ve made a lot of progress in the last month, which hadn’t really been the case for the past 10 or 11 months. I was going in the right direction. I would have been putting myself in a situation that I haven’t been able to replicate in training or practice recently. Which is maybe a bit unnecessary to do that at this stage.”

But could sports-related hip problems be a thing of the past thanks to the work of a team of scientists at Coventry University? Researchers there have developed a new technology that could help alleviate joint problems for sports enthusiasts like tennis players.

The pioneering research uses 3D modelling to study how tennis affects the body and joints of players. With the increased knowledge this brings, comes the ability to spot problems before they take hold and can help prevent the development of long-term joint injuries.

How does this tennis joint injury tech work?

The technology requires players to be monitored while wearing a special suit containing 17 different sensors that monitor different areas of the body. The research team from Coventry University explains “This information is used to animate a 3D moving avatar of the player, their skeleton, joints and more than 600 of their muscles, as well as the movement of the ball and racquet. It can give a range of information from the speeds of parts of the player’s body and the racquet, the weight placed on muscles and joints, and the sequence of movement the person goes through as they hit a ball.”

Armed with this level of 3D information, coaches can assess the stresses and strains on different areas of the body and, if needs be, can advise players to adjust their technique to reduce stress on particular areas.

Reassuring for tennis enthusiasts

For those of us who play tennis recreationally or professionally, this technology is a big step forward in terms of mitigating against injuries caused by sustained play.  Playing tennis can cause pressure on the ball and socket hip joint and can lead to a number of problems with the joint itself or the muscles around it. It isn’t just the elite players who are at risk of developing hip problems, it can affect anyone who plays regularly.

As Andy Murray has shown us, once you have undergone hip surgery it is important to get your mind and body ready for recovery, but don’t push yourself too far too soon. Always follow the advice of your orthopaedic surgeon as to when it is safe to resume playing, as they will know the most about the recovery expected from this type of operation and also how this ties in with your personal medical history.

Ensure that you talk to your physiotherapist about your plans to resume the sport as they will be able to factor this into your rehabilitation and give you a realistic timeframe of when you might be able to play again. Finally, when you are back on the courts ensure that you treat your new or modified joints with gentle care, ensure you are warming up sufficiently and are stretching your muscles before pushing them too hard.

Five signs that might mean you need a hip replacement

hip replacement candidate

Hip replacements used to be considered as an operation most suited for the elderly, but this is no longer the case. The average age for patients undergoing hip replacements is getting younger, as more and more people are recognising that they are experiencing joint troubles and are able to proactively do something about it. The same is true for diagnosis of problems such as hip and knee arthritis. Over time, medical professionals are changing their mindset about who is most suitable for this type of operation, and if they are faced with a relatively young patient, who has perhaps engaged in a history of contact sports and is demonstrating the symptoms of hip or knee arthritis, they are quick to start exploring the best ways to diagnose and treat the problem.

Recognising the symptoms is half the battle, and some of the things you may expect to be feeling are as follows:

  1. Stiffness and restricted mobility

We’ve all seen people stand up and groan, or struggle to make a smooth transition from sitting to standing/walking, and although many may regard this to be part of the natural ageing process, it could be an indicator that there is something else affecting your mobility. If you have noticed that bending down to pick things up or put your shoes on it getting more difficult, and you experience pain and discomfort when rising from a seated position, you could be suffering from arthritis in key joints.

  1. Persistent pain in and around the hip joint

Hip pain is usually felt in the groin thigh and often the knee as well.  Pain is a big give away but depending on the severity of the pain (and how adept you are at ignoring the pain) it can go overlooked. The longer it does, the more damage you are potentially causing to a weakening joint. Sometimes this pain can be such that it keeps you awake at night, so if this sounds familiar, don’t put on a brave face as this won’t help it in the long run. Make sure you get it checked out, especially if you’re experiencing any of the other symptoms too.

  1. A grating feeling within the joint

This grating may put your teeth on edge, but it should also make you sit up and pay attention to the problem – the catching sensation is actually the cartilage within your joint breaking down and causing the ends of your bones to grate against one another with no protection.

  1. Trouble balancing on one leg

A simple test to perform at home is checking whether or not you are able to stand on one leg for more than one minute. Test both legs in turn, and if you find that you need the help of another person, a table, chair, or other stability aid to stand for one minute on one or both of your legs, you may have a damaged hip joint.

  1. Non-surgical treatment

The natural starting point with any discomfort, ache or pain is to first try and address the problem with non-surgical approaches, including physiotherapy, exercises, painkillers etc. If you feel you have exhausted everything and nothing seems to make an improvement to how you feel and how much mobility you have in your joints, it is probably time to speak to a hip replacement expert to discuss what the surgical options are.

Make sure hip arthritis isn’t your golf handicap

golf and hip arthritis

As we bask in the longest heatwave since 1976, this summer has also brought a wealth of sporting favourites, which we are continuing to enjoy as we soak up the sunshine. First came the football World Cup, followed by the opening of the tennis championship, Wimbledon, and the British Open Golf at Carnoustie in Scotland. As with all sports, there are those of us who love to watch and some of us who love to participate, and with any sporting hobby comes the risk for participants that we may suffer from wear and tear on the body parts that are in regular use with these pursuits.

Golfing is no exception to this. Golfers will often walk in excess of five miles around an average course, while carrying heavy golfing bags and using a significant amount of core strength in pursuit of the perfect drive. Although there are many health benefits associated with golf, it puts unavoidable strain on particular muscles, joints and ligaments over time as well.

The early warning signs of arthritis are decreased mobility when taking your swing (a motion that any golfer will tell you uses the whole body to perfection, but your hips are an integral part of this action), coupled with aching in the hands or wrists, trouble bending down to pick up the ball or pain when lifting your golf bag onto your trolley. Not only that, walking the full course may become increasingly painful if you are starting to develop problems in your knee or hip joints.

If you believe you may be suffering from hip arthritis and you’re a keen golfer, although this may not be the best news you’ve had, it certainly does not mean the end of your golfing pursuits. There are a number of ways you can continue getting pleasure from golf, even if you’re starting to feel the tell-tale signs of arthritis creeping in.

Golf and hip arthritis: warm up properly first

This advice may take you straight back to school PE lessons, where the class were instructed to warm up properly (and warm down again afterwards) when undertaking any form of exercise, but this continues to be solid advice. It is good for everyone as it helps prepare the body for exercise and reduced the chance of sustaining an injury, but for people suffering from joint pain, a gentle warm-up is highly recommended.

Golf and hip arthritis: make adjustments to your swing

This may sound easier said than done, especially if you have spent years perfecting your technique, but this could make the difference between having to retire from golf and continuing to enjoy it. Assuming you’re a right-handed golfer, when taking your swing, your left foot will be angled out somewhat, to give you the balance required to take it effectively. If you also turn your right foot outwards, this can significantly reduce the strain on your right hip and lower back. Lifting your left heel up as you take the swing will also help alleviate some of the pressure on your hip joints.

Golf and hip arthritis: change your golf balls

The density of the balls you’re using can also have a big impact on how much ‘kick back’ you get when your club makes contact with them. Lower compression balls are recommended for people who are suffering from joint problems like arthritis, as they absorb much more of the energy and take the impact away from the joints.

Remember, golfing is a great source of exercise and when undertaken correctly, can continue to be something you can enjoy and benefit from, even if your joints are experiencing some difficulties. Joint arthritis doesn’t mean the road to golfing retirement, but it is your body’s way of telling you that you need to make some small changes to continue getting the best from it.

If your golf game is still suffering, call 020 8947 9524 to arrange a consultation with a hip arthritis specialist.

Could silver be the solution to joint replacement infections?

joint replacement infection

Many people suffer from pain in their joints, which can be caused by a variety of reasons including genetic composition, lifestyle choices and the career choice. There are many people who undergo total hip or knee replacement surgery in the UK every year, as it is one of the most common ways of treating those who are in serious pain or who are suffering from restricted mobility, but the current materials don’t always suit everyone.

Artificial hip or knee joints can be crafted from a number of materials, ranging from ceramic materials to metal alloys and hard-wearing plastics. Their materials have been chosen after extensive testing of their suitability as a replacement joint, and how people tend to react to the materials when they have been inserted into their body as a replacement for the original joint. While most people react well to these materials, there are still isolated cases where people react to the materials or to the operation more generally and can develop complications after surgery.

Joint replacement infection is rare – “there are 80,000 knee replacements a year in the UK and around 1 per cent become infected”– but for those who do suffer an infection following this type of surgery, it can be serious – and in very extreme cases could even lead to amputation of the infected limb. This is extremely rare, however, with “around 2 per cent of those with an infected joint face amputation” however, it is enough to mean that research is still being undertaken to try and reduce this risk even further. As such, scientists are continuing to test different materials, to ensure that all suitable options are being utilised and the best possible patient care can be delivered.

Precious metal – not just purely decorative

One of the lesser known (by the general public) components in the world of orthopaedic surgery is the use of artificial joints that are coated with silver. Silver is well known for its anti-bacterial properties – i.e. if patients are suffering with repeated infections in the area where they have had a joint replaced, then a silver-coated joint is likely to give them the best possible chance of not developing a joint replacment infection.

Orthopaedic Product News reports “there is growing evidence that the traditional use of antibiotics to treat infection is becoming less effective due to an increase in antimicrobial resistance. The use of silver in medical implants has been demonstrated to be successful in fighting infection and may offer solutions for controlling infection cases in patients with [total knee or hip replacements].”

It is widely agreed that there is good evidence to suggest that in complex situations involving chronic joint replacement infection, silver is a useful adjunct and does probably improve chances of infection eradication.

The important thing to ensure is that these problems are managed in a multi-disciplinary team environment, with input from surgeons, microbiologists etc. If the problem can be spotted and treated quickly, it reduces the risk that it will become serious. If it does though, it is reassuring to know that there are solutions available to help treat infection and implant components that can be used that mitigate against the possibility of infection recurring.

Duke of Edinburgh’s hip replacement in his 90s highlights rise in older patients undergoing this surgery

joint surgery recovery

Life expectancy for men and women in the UK has been increasing steadily over time and, as of 2012, the life expectancy for men in Britain stood at 79 and women at 82.2 years.

With greater life expectancy comes greater expectations about what is achievable later in life. People are now doing more, and expecting more, from their bodies and minds, as summarised in the Government report from the Office for Science: “with the steady rise of life expectancy in the UK, as elsewhere, and the rising number of older, and very old, people, there is a need to capture quality as well as quantity of remaining years lived.”

With this change in mindset comes a greater number of people who are requesting, or being recommended for, joint replacements.

Joint replacements later in life

The Duke of Edinburgh is a great example of how joint replacement much later in life can significantly improve quality of life for those whose joints are deteriorating. The Duke, aged 96 when he had his operation, was pictured looking healthy and mobile at Prince Harry and Meghan Markle’s wedding in May, having only recently been under the knife for a total hip replacement.

The Duke is one of many much older patients to opt for joint surgery later in life, in fact “there were 851 male patients aged 90 or over who underwent the procedure in 2016, according to figures from the National Joint Registry, which covers both private and NHS patients across England, Wales, Northern Ireland and the Isle of Man”.

What to expect from joint surgery recovery in older age

Typically, patients can expect that in the first four to six weeks following a hip replacement they will need the assistance of crutches or a walking frame to get around. As they continue to heal, the can generally expect to be resuming normal activities within two to three months following the procedure.

For much older patients, they will need to be a bit more patient when it comes to joint surgery recovery, as healing can take longer the older you get, but the most important thing is to take things one step at a time, be patient and to ensure you follow the rehabilitation recommended by your orthopaedic surgeon.

Change in mindset and materials

Years ago, joint replacements were not considered suitable for much older patients, as it was believed that they were too old to really benefit from the stress of surgery. Not only that, the quality of life that it could bring to a much older patient was considered significantly less compared with younger patients. 90-year olds nowadays are often remarkably fit and therefore joint replacement for disabling arthritis of hip / knee can transform their lives and significantly improve their quality of life.

Coupled with this change in mindset, modern anaesthetic and surgical techniques make surgery much safer, with a much shorter hospital stay and much better prognosis for full recovery.

Mr Simon Bridle advocates the adoption of an enhanced recovery programme (ERP), for all patients who are deemed suitable for this approach. This approach aims to ensure that patients are fit and well enough to be discharged as soon as possible after having their operation as research has shown that this means a shorter recovery time.

Mr Simon Bridle performs hip and knee replacements at the Fortius Joint Replacement Clinic at the Bupa Cromwell Hospital, where the approach to patient care is based on the principles of enhanced joint surgery recovery. The principle of this approach is that patients often recover best in the comfort of their own homes when supported by an interlocking network of family, support and multidisciplinary professionals.

NICE working committee is working on new guidelines for joint replacement surgery

joint replacement surgery guidelines

The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care. Founded in 1999, NICE was tasked with the remit of reducing ‘variation in the availability and quality of NHS treatments and care’. Since then, NICE has also taken on responsibility for ‘developing public health guidance to help prevent ill health and promote healthier lifestyles’, and the organisation has recently been asked to write a clinical guideline on primary hip, knee and shoulder joint replacements.

The necessity to craft guidelines such as this stem from the Getting It Right First Time (GIRFT) initiative, initially an orthopaedic initiative, which has been rolled out all across the UK in a number of specialities. GIRFT is responsible for improving the quality of medical care by ensuring as much consistency as possible in the way in which operations and aftercare are carried out.

Why were these guidelines required?

The key reasons why guidelines have been created in this area as follows:

  • Hip and knee joint replacement surgery is very prevalent, with tens of thousands of these operations being carried out in the UK every year
  • There is a great deal of variance in how these operations are done, with surgeons choosing different operative techniques and different materials, with huge variations in implant costs.
  • Aftercare programmes are similarly varied, with different advice given to patients from different practices. NICE’s aspirations from these guidelines are that “identifying the best approach for recovery and rehabilitation will enable all healthcare professionals to offer more effective and efficient treatment.”

The guidelines will assess nine key areas linked with hip and knee replacement surgery and will aim to make recommendations in as many of these areas as possible:

  • Assessment and shared decision-making
  • Preoperative rehabilitation
  • Anaesthesia
  • Tranexamic acid
  • Preventing infection
  • Wrong implant selection (left, right and incompatible components)
  • Joint replacement surgery
  • Postoperative rehabilitation
  • Long-term follow-up and monitoring

So, what does this mean for orthopaedic surgeons?

The answer really depends on the methods of practice that they favour at the moment. Some will need to adjust their methods while others will carry on as normal, within the boundaries of the new guidelines. Interestingly, these guidelines indicate that conventional ‘tried and trusted’ components put in with a conventional approach have great results and it is expected that this will form part of the recommendations moving forwards.

This is a market that has benefited from a lot of innovation and component testing over the years, and because of the vast number of these procedures that are carried out each year, there is a lot of available data to look at the relative strength and weaknesses of any new approach. It is important to remember that any new way of working – whether that is methodological, product driven or relating to aftercare – needs to be thoroughly tested and only the best will be recommended moving forwards.

NICE summarises, “it is important that all healthcare professionals, including surgeons and allied health professionals, and commissioners are involved in the entire care pathway (from community to hospital) to ensure people receive the best care, recovery, rehabilitation and follow-up monitoring after these common orthopaedic procedures.”

The guideline is due to be published in 2020 and we await its findings with interest.