Returning to sport after hip surgery

Tennis fans have been nervously watching Andy Murray’s progress in recent months, as he has battled with a recurring hip injury which may result in him needing surgery. Based on Murray’s description of the pain he is suffering and how his injury has affected him, there is speculation that Murray is suffering with a labral tear and articular cartilage damage – which will most likely require surgery to fix. This problem is likely to mean that there is a tear in the cartilage that surrounds the socket of his hip joint.

Implications of this diagnosis

The stress that Andy Murray’s tennis career has put on his joints over the years will have been the contributing factor to this damage. The problem may have been exacerbated by extra bone growth has occurred beneath the ball of his hip joint, and this will be limiting the amount of movement possible from the joint.

What this means for Andy Murray is that it will be getting increasingly more painful to move the joint effectively and he is probably suffering from some loss of movement in the joint as well.

This growth can be fixed with a form of keyhole surgery called arthroscopic surgery, whereby surgeons can remove the new growth and hope to restore movement effectively to the damaged joint. It is, however, a tricky operation, one that is far more complex than the same operation on a knee joint, and it typically takes patients a lot longer to recover from, compared with an arthroscopic knee operation.

The concern for many will be whether Andy Murray ever regains his ability to compete at the top level if he chooses to undergo hip surgery. Although the problem he may be suffering cannot correct itself and surgery is probably an inevitability, the implications for his tennis career will be a cause for concern. BBC tennis commentator, Andrew Castle shared his thoughts on Andy Murray’s professional future: “People don’t generally, in sports like tennis, recover from this level of hip injury – assuming it’s either a labrum tear or full-on arthritis that requires a new hip.

Life after hip surgery

For many people, if they have reached the stage where arthroscopic hip surgery or a total hip replacement is required to improve their quality of life, then they will need to be giving some thought to their approach to rehabilitation, so that they give their body the best possible chance of optimum recovery, following the operation.

In recent years, we’ve seen a marked increase in people under the age of 65 undergoing hip replacement surgery. In the UK, around 35 per cent of patients who undergo hip surgery are undertaking regularly sporting activity before their operation, and there is a strong desire to remain active after surgery.

In a presentation at last year’s Fortius International Sport Injury Conference, hip surgeon Mr Simon Bridle addressed the issue of returning to sport after hip surgery. He quoted a 2005 report that suggested that 56 per cent of patients stopped sport post-operatively, with surgeons advising ‘going easy on the artificial joint’.

Concerns about an increased rate of revision surgery has led surgeons to advise patients on which sports are ‘safe’ to return to. Swimming, biking, rowing or golf were considered acceptable whereas contact sports, tennis, squash or running were usually frowned upon. But is there scientific evidence for these prohibitions?

As Mr Bridle concluded in his lecture, modern hip replacements are able to restore high levels of function for patients and there is little evidence that high impact sport increases complication rate. Dangerous sports always carry intrinsic risks whether you’ve undergone hip surgery or not and although a highly active patient may see a higher wear rate, this may be a complication that patients willingly take, balanced against a return to the sports they love.

Severe occupational strain increases risk of hip arthritis

risk of hip arthritis

Osteoarthritis is a condition that results from weakening joint cartilage, as a result of wear and tear over a person’s lifetime. Although this can happen naturally as part of the ageing process, it has long since been believed that undertaking manual jobs that put repeated strain on joints and muscles can lead to long term health problems such as osteoarthritis in joints such as hips, knees and elbows. Now a new study has found a proven link which adds more fuel to this fire.

The research has been undertaken by the German Federal Institute for Occupational Safety and Health (BAuA), and has assessed patients across 5 cohort studies and 18 case-control studies. The report authors conclude that “people who, in the course of their work, put long-term physical strain on their bodies have an increased risk of developing osteoarthritis of the hip. This is especially the case for those lifting and carrying heavy loads over long periods of time.”

The implications of this are serious for individuals working in environments where repetitive motions and heavy lifting are putting strain on their joints. Osteoarthritis in hip joints can be very painful and debilitating, causing a serious impact on a person’s quality of life.

Occupations that carry higher risk of musculoskeletal damage

According to specialist arthritis website,, there are a number of professions where people are at higher risk of developing musculoskeletal problems due to the work they carry out.

Examples include:

  • Individuals who regularly use pneumatic drills – these people tend to have a higher likelihood of developing osteoarthritis in joints such as the wrists, elbows and shoulders
  • Those working in construction – due to the heavy lifting element of many construction jobs, workers are more likely to report osteoarthritis in the hips, knees, fingers and elbows
  • Miners are more likely to suffer from osteoarthritis of the knees and elbows, due to the combination of ground work and lifting.

Prevention is easier than cure

If you’re working in an environment where heavy lifting or carrying are expected as part of the role, it is important to take preventative steps to try and mitigate the risks. Report authors from the BAuA research suggest that individuals should not be attempting to lift loads greater than 20kg without mechanical assistance, and they also recommend that occupations screening of hip joints should be undertaken after 15-20 years (at the very minimum) working within a manual job requiring such tasks.

In fact, new research suggests that it is not just manual workers who undertake heavy lifting/carrying who are at risk of developing musculoskeletal problems – not even orthopaedic surgeons are exempt from issues relating to workplace posture. This warning comes from an analysis of 21 articles involving 5,828 doctors in 23 countries between 1974 and 2016 looking at the disease prevalence for the neck, shoulder, back and upper extremity injuries and any resulting disability.

It suggests that the hunched shoulders that surgeons have while undertaking operations contributes to “four in five surgeons experience significant pain when performing procedures”. Surgeons in some instances are reported to be suffering with greater occurrences of back pain than those working in occupations such as mining or construction, where the assumption would naturally be that they would fall into a higher risk category.

New study focuses on steroid injections for hip osteoarthritis

steroid injections for hip arthritis

Hip replacements are commonplace, with thousands of patients undergoing either partial of full joint replacements each year. In fact, according to the National Joint Registry, the figure for those having total hip or knee replacements each year across England and Wales is now in excess of 160,000.

Before you undergo an operation to replace the joint, there are steps that will be taken to try and mitigate the problem, and to try and give you a better quality of life before you take the surgical step. More and people are asking after the benefits of injectable treatments, which are reported to help ease the pain of a joint that is failing. However, in our opinion, some of these are worth exploring whilst others may provide little more than a placebo effect.

Understanding the limitations of injectables in treating hip arthritis

There are a variety of different treatments for painful joints that can be administered via injection. These include steroids, lubricants, stem cells and many others. While these may garner a lot of publicity, that does not mean to say they are clinically proven to be as effective as they might promise.  There is no evidence that any injection treatment available at the moment will reverse the process, buy somehow re-growing cartilage, as some publicity suggest may be the case.

Steroid injections are commonly given to patients who are suffering with a deteriorating joint, however, it is important that their limitations are understood. Whilst they may ease the pain temporarily, they are only masking the problem. Steroid injections will not repair the joint; they will merely help patients live with the discomfort.

In a report published recently at the Radiological Society of North America (RSNA), following a period of research whereby X-rays of patients who received steroid injections to help them live with joint discomfort, were directly compared with X-rays of patients who didn’t opt for that treatment. The study comprised 102 patients who received two steroid injections, and two control groups of similar scope, with correlating demographics.  They found that “osteoarthritis patients who received a steroid injection in the hip had a significantly greater incidence of bone death and collapse compared with control groups.”  This suggests that the injection may actually cause further damage to the joint.

No need to be anxious about joint replacement surgery

Steroid injection can help control pain in patients where there is no alternative to hip replacement, so even though this study shows that they can cause problems, Mr Bridle thinks that, used judiciously, they do have a role in managing patients with hip osteoarthritis.

Although a hip replacement can sound like a daunting prospect, it is one of the longest standing operations with the first hip replacement undertaken in the 1960s and has been helping people achieve a better quality of life for decades.

Surgeons such as Mr Bridle will ensure you’re in safe hands and have all the information you need to fully understand the process and the recovery period. Aftercare is very important and you’ll be guided every step of the way to make sure that you know what to expect from the recovery time and what exercises to undertake to help the new joint settle in.

‘Tried and trusted’ implants found to perform same as newer implant materials

Exeter Cemented Stem implant replacement materials

Hip replacements have been around for a long time, with the first recorded total hip replacement taking place in the USA in the 1940s. Since this pioneering operation, countless patients have had their quality of life improved by the skill of surgeons who are able to replace a faulty joint with a complete (or partial) synthetic replacement.

Over the years, medical skills have been fine-tuned and different materials have been tested, all in the pursuit of ensuring that the patient receives the best possible treatment and care. Researchers at Bristol Medical School have just completed a comprehensive review of the materials used in modern-day hip replacements, to understand whether or not new innovations have really surpassed the older, more traditional offerings.

The headline findings from this research correlate with views held by Mr Bridle and his team, that “there is no evidence to suggest that any of the newer hip implant combinations, such as ceramic or uncemented, are better than the widely used small head metal-on-plastic cemented hip combination, which has been commonly used since the 1960s.”

Research in the spotlight

The team responsible for this research at the University of Bristol made use of all available data for their evaluation, dubbed the most comprehensive review of this type of information to date:

  • 77 controlled hip trials (selected randomly to avoid any selection bias)
  • 3,177 individual hip replacements
  • A variety of different component combinations used, ranging from metal-on-plastic, ceramic-on-ceramic, ceramic-on-plastic and metal-on-metal. Different joint head sizes were also evaluated.

The results offer patients the reassurance that although medical techniques and patient care have evolved and improved over time, the components that have been used in hip replacement for decades are regarded as leaders in their field.

Tried and trusted for a good reason

Many patients come to us asking about implants; in particular procedures such as custom implants, mini hips and resurfacing, and all the evidence we see suggests that the ‘tried and trusted’ implants work just as well as the newer innovations. Sometimes even better.

Mr Simon Bridle has been working as an orthopaedic surgeon for many years and recommends the following to his patients:

  • He recommends to his patients that an Exeter cemented stem is used. This type of stem is made from hard-wearing stainless steel and has outstanding long term results; this stem should be expected to last up to 30 years once fitted.
  • The stem is attached to the bearing, and Mr Bridle favours a Biolox ceramic femoral head fitted to the stem, with a highly cross-linked polythene, which lines the acetabulum (the socket of the hip bone, into which the head of the femur fits).

To find out more about different joint replacement options, call us on 020 8947 9524.

Obesity crisis driving up joint replacement figures

joint replacement and obesity

According to new data published recently and reported in the Express, Britain now has one of the highest obesity rates in Europe, with around one quarter of the adult population clinically obese. This means that they have a body mass index (BMI) of 30 or above. To put this into context, a healthy BMI should be between 18-25, if you’re in the range between 26 and 30 then that classes as overweight, and 30+ is into the realms of obesity.

The risks of carrying too much weight are widespread. Risks include a greater likelihood of developing conditions such as diabetes, cancer, having a stroke or developing a heart condition. Being seriously overweight also puts a great deal of stress on your joints.

The NHS reports that recommendations for joint replacement surgery are increasing amongst younger people; most shockingly, even in children. This surgery was previously only really required for older people, so this is a worrying trend and something that we need to work hard as a nation to address.

Joint replacement operations on the increase

The number of patients classed as obese, who have either hip, knee or other major joints replaced each year is rising. In fact, over the past three years, it is reported that this has increased by 60%. The fact that a proportion of these requiring joint surgery are children is awful.

Children’s joints are still developing as they grow. Once their natural joint has been replaced with a synthetic alternative, it cannot grow and develop with the child in the same way that their original joint would have done. Although it will undoubtedly help if their joints have been put under so much stress and strain that intervention is required, we need to do something to ensure that this is not happening in the first place.

The other challenge with having joints replaced very young is that the chance of repeat surgery is high. Unlike patients who have joints fitted when they are much older, young patients will suffer wear and tear on an artificial joint over time. For young patients, the likelihood of needing a replacement joint fitted in later life is fairly probable.

Lifestyle choices that increase the need for joint replacement surgery

There are choices we can make in life that can help deter the chance of serious medical conditions arising. Those who undertake high impact sports are more likely to require joint replacement surgery in later life due to the levels of stress placed on their joints.

On the flip side, eating a healthy, balanced diet, undertaking regular, more gentle exercise and not smoking are all choices we can make that help reduce the risk of developing serious ailments later in life. The formula isn’t guaranteed, but those whom adhere to more healthy principles of living tend to have a better chance of avoiding painful or debilitating conditions that can set in in later life, such as osteoarthritis.

The challenges in diagnosing hip pain

If you’ve ever studied a model or picture of how the human body is made up you’ll know just how complex the elements such as our skeleton, muscles, tendons and nerves really are. Our bodies are an intricate mass of interlinked, incredible components that should all work together to enable us to move around effectively. It’s very easy to take this complex structure for granted – until something goes wrong.

If you start to experience pain or discomfort in certain areas of the body it is very easy to diagnose where that pain is coming from and work out how to fix it. However, other areas can be more challenging.

In a recently published article, the phenomenon of ‘hip-spine syndrome’ is explored. Research undertaken by the American Academy of Orthopaedic Surgeons suggests it can be very challenging for surgeons to identify whether the cause of patients’ pain stems from the lower part of the spine or the hip, because of the complexity of that area and how pain can spread from one source to another.

For anyone who has suffered with lower back pain it will be easy to relate to just how painful this can be. Discomfort that might start in your back, may soon have travelled to your hips, pelvis, buttocks or groin. You may find other aches and pains arise as you try to alleviate the pain by using different muscle groups or adjusting your posture. This in turn will put stress on different areas of the body as well, while not always fixing the original problem area.

One example of this is if a patient has developed arthritis in the hip joints, this often manifests itself as pain in the lower back, so it can be very hard to isolate the correct cause of the discomfort.

According to Afshin Razi, an American orthopaedic surgeon and clinical assistant professor at NYC Langone Hospital for Joint Diseases, the similarities of these symptoms cause a real headache for surgeons who are trying to help work out the best course of action for patients “in these instances, similar or overlapping symptoms may delay a correct diagnosis and appropriate treatment.”

To add further complications to the scenario, the outcome could be one of a number of quite serious hip or back complaints:

  • Osteoarthritis in the hip joints
  • Pinched nerves
  • Narrowing of the spinal chord
  • Sacroiliac joint disfunction
  • A stress fracture
  • Restricted blood flow to the hips (a condition called osteonecrosis)
  • Cartilage damage in or around the hip joint

Diagnosing hip pain

The complexity of the challenge means that surgeons have to really work hard to establish the cause of the pain so that they can recommend the most appropriate treatment. A comprehensive review of medical history, tests on how patients are walking (gait analysis), testing the alignment of joints, muscle tests and detailed questioning will all help point the diagnosis in the correct direction.

An orthopaedic surgeon that specialises in a specific area of the body is best suited to providing a correct diagnosis and, from there, advising you on the best treatment or procedure to restore optimal quality of life. To arrange a consultation with London hip specialist Mr Simon Bridle, email or call 020 8947 9524.

Has our love of fitness and exercise put us at risk of needing a joint replacement later in life?  

exercise and joint replacement

We are a nation of exercise-lovers, with many of us undertaking regular workouts at the gym or with exercise classes/groups to keep ourselves feeling and looking healthy. There are many benefits of keeping fit and participating in regular exercise, including reducing the likelihood of suffering from some of the most serious health complaints, such as a stroke, heart disease, diabetes and obesity.

Regardless of these benefits, the results of a research project which has been undertaken over the last 10 years, warn of a hidden danger of exercising too much, and putting stresses and strains on other parts of our body. The research suggests that in reducing the risk of certain conditions, we are in fact trading these against an increased chance of developing others.

Compensating for one by trading against another

With increased levels of exercise comes a risk of increasing the wear and tear on our joints. This isn’t just a problem for those who participate in high impact sports (however their risk is greatest) but it also affects those who do a variety of other sports such as running, basketball, racket sports and athletics.

Joint replacements are on the increase and the recently published research attributes this partly to the exercises we choose to undertake. Hip replacement operations, for example, are becoming more and more prevalent in the UK, with the Express reporting that over 70,000 people undergo hip replacement operations every year.  Many of those who undergo hip replacement operations do so because over time, the hip socket becomes worn and begins to seize up, however there is an increasing trend towards younger people requiring joint replacement operations due to their lifestyle choices.

Orthopaedic surgeons such as Simon Bridle believe that it is all about getting the balance right. For those who are in the early stages of developing joint problems such as osteoarthritis, gentle, low impact exercising can help keep the joint supple, and can avoid the dangers of gaining weight through a decrease in activity levels. There is a direct correlation though with those undertaking high impact sports and the development of osteoarthritis at a younger age. It’s all about understanding your body’s limitations and exercising within sensible parameters. 

Take necessary care when starting or finishing an exercise regime

Cast your mind back to school when your PE teacher will have asked your class to do stretches before and after your PE lesson. For impatient children waiting to get to the fun part, this may have seemed like a waste of time, however, this was teaching good habits that will hopefully have remained with you through your adult life – the importance of properly warming up and cooling down before and after a period of exercise.

Failing to warm up and cool down properly will have short-term and long-term effects on your joints. In the short term, you’ll probably ache much more and feel like you’ve really pushed your body, when in reality you’ve just given your joints and your muscles a bit of a shock that they’ll need time to recover from. It’s the equivalent of waking someone up with a bucket of cold water compared with coaxing them out of bed with a cup of tea. If you warm up and cool down sensibly and properly, you’ll find your ability to undertake exercise should continue for longer that if you push your joints and muscles too rigorously and without the correct preparation.

New algorithm developed that could predict osteoarthritis progression

arthritis researchOsteoarthritis is a degenerative condition that causes cartilage in joints including knees and hips to wear away, causing restricted mobility and slight to severe discomfort. It can currently be managed, but not cured, however, treatment for osteoarthritis is costly, and not helped by the fact that, until now, it has not been possible to predict how the symptoms will progress.

Exciting new arthritis research

There has recently been an exciting new revelation from researchers who have been busy studying the progression of osteoarthritis.

Researchers at the University of Eastern Finland have had a breakthrough in being able to predict the course of osteoarthritis in patients. In a pioneering new study that has been undertaken over the past four years, researchers have developed an algorithm that helps identify what will happen to patients with osteoarthritis, and how they expect the condition to develop.

The implication of an algorithm such as this is that it could help direct and inform treatment of patients suffering from this condition.

Current methods of assessing osteoarthritis

At present, X-rays and MRI scans can be used on patients who are displaying signs of osteoarthritis, and this can help doctors establish how advanced it is and how dense the joint cartilage has become. While this is helpful in terms of evaluating the scale of the problem, it does not give any indication whether it is likely to remain relatively stable or get worse.

The research undertaken by the University of Eastern Finland looked at 21 individuals who fell into three different groups:

  1. Those without osteoarthritis
  2. Those with mild osteoarthritis
  3. Those with severe osteoarthritis

Researchers were focussing specifically on the knee joints of these individuals. Each of the study participants were under the age of 65 and hadn’t had any serious knee injury or knee surgery in the past. The same individuals were involved in the study for four years, and during that time the new algorithm correctly predicted the advancement of cartilage degeneration in each of the three groups.

The algorithm can also be programmed to take into account other factors that can affect the spread of osteoarthritis, such as having procedures such as an osteotomy (a surgical operation whereby the bone is adjusted to align it more accurately with a joint or different bone) or meniscectomy (surgery to remove part of the knee joint called the ‘meniscus’), or the effect of weight loss.

The research has been published and praised by’s scientific report: “[the] algorithm shows a great potential to predict subject-specific progression of knee OA [osteoarthritis] and has a clinical potential by simulating the effect of interventions on the progression of OA, thus helping decision making in an attempt to delay or prevent further OA symptoms.”

Returning to sport after hip replacement

returning to sport after hip replacementIf you’re an active person and enjoy getting outside and exercising, the thought of undergoing an operation such as a hip or knee replacement might seem daunting. People may wonder whether their days of exercising are over, but with the right approach to rehabilitation after an operation, there is no reason why undergoing a joint replacement should stop you participating in the exercise that you enjoy.

At the recent Fortius International Sports Injury Conference, orthopaedic specialist Mr Simon Bridle presented an insightful piece on the changing attitudes, desires and limitations of returning to sport after undergoing a significant joint operation.

Evolving knowledge

Over the years, surgeons have increased their knowledge of how to perform successful hip and knee replacements in humans. Through decades of research and many, many operations, surgeons have been learning about what works well, and what doesn’t, and developing materials, procedures and recommendations accordingly.

In the 1960s, doctors were performing total hip replacements, however these tended to be in elderly and disabled patients, with a view that it was a ‘salvage procedure’, rather than something that would offer them an enhanced quality of life.

Nowadays, there has been a threefold increase in the number of patients in the UK and the USA who are opting for hip replacements, many of whom have a desire to remain active after their operation. With new, much more effective pain relief, patients are often able to push themselves further in the days, weeks and months after a total hip replacement, and begin the road to rehabilitation and recovery.

Getting back on the bike….

…or into the swimming pool, or into your walking shoes….

There has also been a shift in patients’ mentality regarding how active they expect to be following an operation like this. Mr Bridle reports that 35% of hip replacement patients do sport pre-operatively, and the desire to return is major expectation.

Whereas high impact sports come with significant risks of damaging a prosthetic joint, low impact sports can be good for building up your muscles, keeping healthy and maintaining good mental wellbeing too.

The prosthetic joints that replace worn out, arthritic, natural joints have also improved significantly through years of testing, advances in research and the benefit of medical data. The bearings are now designed to minimise friction while ensuring optimum mobility. They are also designed so that they optimise muscle function around the implant site.

So all things considered, recovery and the ability to return to exercising after a total hip replacement is significantly better nowadays than it used to be when it was first introduced. Many patients are seeing high levels of joint functions restored following complete joint replacements. The desire of patients to return to sports is high, and with the right expectations and a structured approach to rehabilitation following the operation, many are able to do so.

Counting the cost of arthritis

cost of arthritisAll ailments cost money to treat, but often the true cost is only known by medical professionals, with the general public unaware what the larger scale costs are of treating and curing conditions. It’s often not until someone does the maths and shares this information publicly that we have any idea how expensive it is to treat, cure and manage different conditions.

That’s exactly what happened recently thanks to the UK’s leading arthritis charity, Arthritis UK, which shared its research into the true cost of arthritis on the nation’s health service. Key findings illustrated by the report include the following:

  • There are over 10 million people in the UK living with arthritis
  • The condition can cause high levels of daily pain and fatigue
  • It is believed that one in six people in the UK currently suffer from either osteoarthritis or rheumatoid arthritis

Cost of arthritis to the UK economy and to individuals

  • Over the next 10 years, the report estimates £118.6 billion will be spent on managing/treating arthritis
  • Those who live with the condition can often feel like they are a burden to their families/carers, suggesting there are secondary impacts of the condition that can sometimes overlooked

It is also reported that arthritis-related conditions cause over 30 million sick days every year, indicating the true scale of the condition for employers who are having to cover this shortfall. Not only that, at a time when professions are struggling to recruit newly qualified workers, yet also risk older members of staff retiring early, it is believed that one in four people with the condition give up work or retire early. This is exacerbating the recruitment/retention challenges experienced by many industries.

We need to start taking arthritis more seriously

The challenge that arthritis suffers face is that due to a relative lack of awareness of the condition, it is sometimes overlooked and considered just a normal part of the ageing process. Whereas aches, pains and general joint stiffness are something that can be expected as we grow older, the comparative discomfort and lack of mobility caused by osteoarthritis or rheumatoid arthritis is severe.

Arthritis UK would like the condition to be regarded more seriously by the UK government and given access to greater levels of funding to help treat and manage the condition. They claim that the condition should be given the same priority as other conditions such obesity, that are managing to build awareness – both of the condition itself and the ways in which to help those who are suffering.

A problem that is unlikely to go away

Unfortunately, osteoarthritis rates show no signs of improving as we move from generation to generation. Decades of medical records combined with some pioneering ancient skeletal assessments allude to a concerning trend with regards to the prevalence of arthritis. Medical Daily reports that “Individuals born after World War II are twice as likely to develop knee arthritis, also known as knee osteoarthritis, than those born in generations before them”.

This recent arthritis study has yet to conclude what is causing the increase, but the rate at which it has been increasing suggest that there is more to this than simply lifestyle factors, such as people living longer and those who are carrying excess weight. Although these undoubtedly have a role to play, the patterns suggest there is more to this than meets the eye.

Arthritis UK would argue that figures such as this compound the necessity for arthritis to be taken more seriously as it is not something that is going to go away on its own.