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.

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.

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.

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.

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.

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 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.

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.

arthritis and exerciseIt has long since been recognised that dog owners are healthier than those of us who do not own dogs and now the correlation between dog ownership and healthier people is scientifically proven in two recent studies.

A daily walk with your four-legged friend ensures regular, gentle exercise; a recent study found that dog owners walk for 22 minutes more per day on average and, what’s more, they did so at a moderate pace which is just as effective as running in lowering the risk of conditions such as high blood pressure, Type 2 diabetes or high cholesterol.

The responsibility of owning a dog means that you can’t make an excuse of bad weather, either. According to research reported recently in the British Medical Journal, owning a four-legged canine friend is likely to be the catalyst needed to encourage adults to get outside and do some exercise.

When compared with the amount of regular exercise undertaken by non-dog owners, the BMJ reports that “regular dog walkers were more active and less sedentary on days with the poorest conditions than non-dog owners were on the days with the best conditions. In days with the worst conditions, those who walked their dogs had 20% higher activity levels than non-dog owners and spent 30 min/day less sedentary.”

Arthritis and exercise: medically prescribed dogs?

Some researchers have taken these findings one step further and have recommended that the advantage of getting outside for exercise each day is so beneficial; dogs should actually be prescribed to older people as a way of keeping them active and physically fit.

The interesting thing about this research is that although the findings don’t reveal anything that we didn’t know before (taking regular gentle exercise works wonders for your health as you get older) what it does show is the true extent of just how good even 30 minutes of exercise per day can be for your overall health and wellbeing.

It is especially helpful for keeping your weight at a healthy level, as if you’re carrying too much weight as you get older then this can increase the amount of pressure and strain on your joints, which can in turn lead to the development, or increase, of conditions such as osteoarthritis. For osteoarthritis suffers, the surfaces of the joints become damaged and are not able to move as freely as they used to. This is painful and can cause restricted mobility, which in turn can make it harder to exercise. It becomes a vicious cycle.

If you’re already living a more sedentary lifestyle it will be harder to introduce exercise into your routine once your joints begin to cause problems. However, if you’re undertaking regular gentle exercise as you get older, not only should this help keep problem conditions at bay for longer, but if you start to experience the tell-tale signs of osteoarthritis, it will be easier to manage the condition if you’re already leading a healthier, more active lifestyle.

We’re all well aware of the challenges facing funding of the NHS. With the recent election still fresh in mind, the process of how funds are allocated within the NHS has been discussed at length, with almost everyone holding an opinion about which areas are most deserving of retaining, increasing or decreasing funding levels.

With increased pressures on the NHS due to an ever-increasing older population, there is arguably a degree of management required to ensure that those who are deemed most deserving are able to receive access to treatment, ahead of those who are perhaps regarded as less suitable, or less in need of surgery.

So, how can suitability be effectively and fairly judged?

One idea that has been mooted is that those who are prepared to demonstrate that they have done everything they can to ensure that their overall health is as good as it can be, are given preferential access over those who indulge in damaging lifestyle habits. An example of this is the refusal of the NHS to offer orthopaedic treatments such as knee and hip replacements to those who are smokers, or who are classed as obese.

Access to additional NHS funding for joint replacements

When patients require certain treatments on the NHS, doctors can make a request to their local Clinical Commissioning Group (CCG) to receive extra funding for this. According to information sourced by Arthritis Research UK, tens of thousands of these requests were made in the past year, and around half of these were approved. With requests for funding growing year on year, there are a significant number each year that are not able to benefit from this additional CCG funding.

The chief executive of NHS Clinical Commissioners, Julie Wood explains that, “unfortunately, the NHS does not have unlimited resources, and ensuring that patients get high-quality care against a backdrop of spiralling demand and increasing financial pressures is one of the biggest issues CCGs face.” This is exactly why the NHS are having to impose additional criteria (such as being a non-smoker and not being obese) to help identify which patients are most deserving of funding for the operations they require.

Some CCGs have introduced guidelines to help identify the more disabled patients, which means patients will only be approved for hip and knee replacement operations if they are in such pain that sleeping and incapable of performing simple, everyday activities. The concern is that delaying surgery till that point only results in higher treatment costs overall and a less than optimal outcome for the patient.

Ultimately, despite the NHS wanting to offer support, treatment and operations to all who require them, there will always be a limit to what is achievable when demand outstrips supply. While this continues to be the case, the NHS will argue that the only way forward is to set additional stipulations and criteria in which to evaluate patients, so they can try and fairly assess how to prioritise available NHS funding for joint replacements.