benefits of robotic joint surgery

The utilisation of robotic surgery across all medical specialties is on the increase, with surgeons believing they are able to offer greater benefits to patients by utilising robotic technology. Although this sounds really encouraging, with patients benefiting from a wide variety of factors, there is currently limited data in support of these practices.

Researchers have been studying data from a huge amount of records held by the Michigan Surgical Quality Collaborative, a partnership between the hospitals and Blue Cross/Blue Shield of Michigan. The focus of this partnership is collecting and analysing data that focuses on quality improvement for surgical care. Researchers have been able to study “clinical registry data for 169,404 patients from 1 January 2012 to 30 June 2018, who underwent robotic, open or laparoscopic procedures at 73 hospitals across Michigan.

Despite the benefits being hard to prove with the current big data sources, very many surgeons are advocates of this technology. The perceived benefits to orthopaedic surgeons include greater accuracy of joint implantation, lower risks of there being complications with surgery (in particular with joint dislocation and the overall leg length for hip replacement), better functional outcomes and faster rehabilitation – especially for patients who have had knee replacement surgery.

Who is really in charge?

One of the perceived concerns with robotic advances in surgical technology is the level of autonomy that the machine has. Some are worried that the decision making is moving away from the surgeons into programmable robots, and there is some degree of concern with this. Orthopaedic surgeon Michael Suk, MD, chief physician officer at US medical company Geisinger, reassures that this really shouldn’t present a cause for concern, “The thing to keep in mind is that the robots involved in the surgery are not completely autonomous. They’re controlled by the doctor, which allows doctors to combine their knowledge and judgment with the precision and control of a robot. The robot isn’t doing the surgery—the doctor is, but with the help of the robot.”

Orthopaedic surgeons are utilising a robotic surgical arm known as Mako. It is designed to help increase precision and accuracy, enabling surgeons to carry out their work faster and to a more precise degree. The really clever thing about MAKO is just how precise it is able to carry out the tasks it is programmed to do.  And it is able to benefit surgeons who carry out both knee replacement surgery and hip replacement surgery. “Mako is extremely precise—it allows doctors to do partial knee replacements two to three times more accurately than conventional partial knee replacements. Mako hip replacements are shown to be four times more accurate and reproducible than conventional hip replacements.”

Patient safety at the heart of everything

Medical regulators are keen to stress that, as with every advancement in medical practice, this will be vigorously analysed and tested to ensure that it is working in the best interests of the patient. As always, patient safety is at the forefront of any new initiative. Helpfully, with many surgeons exploring this new technique and working with Mako technology, the available data is growing and will enable researchers to continue to assess the benefits of robotic joint surgery and any potential weaknesses it presents.

To discover more of the benefits of robotic joint surgery, call 020 8947 9524 to arrange a consultation with Mr Simon Bridle at his London joint replacement clinic.

joint replacement timing

“Don’t put off until tomorrow what you can do today.” Although Benjamin Franklin, one of the founding fathers of the United States, wasn’t specifically talking about knee or hip replacement surgery, it seems this sentiment is very apt. A new study has revealed that as many as nine in ten of us who suffer from osteoarthritis in our knees ignore the problem for much longer than we should.

The report, published in the Journal of Bone and Joint Surgery, looked at the knees of almost three and a half thousand patients, almost a third of which went on to have knee joint replacement surgery in the research time period. Over double that number (over 2,800) opted not to have knee surgery, despite researchers believing they were medically eligible for it.

Joint replacement timing

The report warns that joint replacement timing, and leaving it too long specifically, can negatively impact how effective the surgery will be. The longer you leave it, the greater the risk that there may be complications of elements of the surgery that would simply have left you with a better quality of life if they had been done earlier. The report authors explain that there are a wide variety of implications that can occur for putting your head in the sand and ignoring the need for joint surgery. These include:

  • Greater risk of complications with surgery
  • Higher likelihood of needing revision surgery further down the line
  • Potential issues with the effectiveness of revision surgery
  • Reduced mobility compared with those who opted for surgery earlier
  • Other health problems caused by the lack of mobility in the joints, such as weight gain, depression, etc.

Hassan Ghomrawi, an associate professor at Northwestern University Feinberg School of Medicine is one of the lead investigators on this research, and he explains: “When people wait too long, two things happen… The osteoarthritis causes deterioration of their function. Some of them wouldn’t be able to straighten out their legs, affecting their walking and mobility. When you can’t get exercise, you can start to develop other health problems such as cardiovascular problems. You may also become depressed. The overall impact can be huge.”

Taking steps to address the issue

Medical professionals believe that there is an educational role here to help patients understand the impactions of delaying surgery. With a greater understanding of how delaying surgery could impact on them and their lives in the future, there may hopefully be a positive shift towards fewer patients waiting until it is too late.

Although there is probably never a ‘convenient’ time to choose to have major surgery such as this, understanding the implications of delaying is critical to ensuring that you’re not doing lasting damage to troubled, failing joints.

To find out more about optimal joint replacement timing and whether you’re suitable for surgery at this time, call 020 8947 9524 to arrange a consultation with Mr Simon Bridle.

skiing after a hip replacement

Hip and knee replacement surgery can be life-changing for those who are suffering from deteriorating joints. The pain and limited mobility are likely to have been holding you back from many things that you enjoy, and the operation can restore a great deal of this back again. For some patients, just walking around again, being able to go up and down stairs or undertaking gentle exercise is rewarding enough, whereas others may wish to return to much more strenuous leisure pursuits.

Skiing is one of these pursuits that we discuss with a number of our patients. For those who have enjoyed winter ski holidays for many years, they can worry that needing a hip or knee replacement might signal the end of this pastime. Encouragingly, this is not often the case.

Whether or not you can ski after a knee or hip replacement largely depends on your level of competency before you had your operation. If you were already a competent skier then there is no reason why, in time, you can return to skiing again. If you are a complete beginner, then it is really advisable to choose a different hobby to learn. Learning to ski after you have had a hip or knee replacement is not a very sensible choice as all novice skiers take their fair share of bumps, falls, knocks and jolts – none of which are ideal for a replacement joint.

Skiing after a hip replacement: walk before you can run – so to speak

It is important to understand that you will need adequate time to recover from hip or knee replacement surgery. As a rule of thumb, you shouldn’t consider an activity such as skiing for at least three to six months after you have had the operation and, even then, you should be prepared to take it nice and easy. A ski holiday this soon after surgery really should involve nothing more strenuous than building your strength back up on nursery slopes. If you push yourself too hard, too soon, then you risk damaging your joint and wishing you had been more patient.

Skiing after a hip replacement: take sensible precautions

If you decide to ski, there are also decisions during the trip you can make which limit the risk to your new joint. Check the weather reports and avoid icy conditions. If you become tired, call it a day, as you are much more likely to fall when fatigued.

In summary, skiing is a sport which gives a lot of pleasure to many people. Being able to enjoy the snow, the speed, the scenery and the overall experience is something that many of us enjoy; although it is not without risk for anybody. Anyone can injure themselves skiing, no matter how careful or experienced they are. For patients who have had a hip or knee joint replaced, the main concern is a bad accident can cause a more complicated problem than if the patient had not had a replacement. For skiers who have had replacement joints, it is a case of weighing up the level of risk and making an informed choice whether or not returning to the slopes is the right decision for them.

For more advice on skiing after a hip replacement, call 020 8947 9524 to arrange a consultation with London hip expert Mr Simon Bridle.

hip labral tear treatment

It’s the time of year when we are all making new year’s resolutions and trying to put in place plans and strategies to be healthier in the upcoming months. For some of us, this doesn’t just mean something like a gentle jog, it can mean something much more strenuous – marathon training. Most marathon training programmes last 16 weeks so this week sees runners competing in the London Marathon starting to ramp up their preparation.

Although competitive running has many health benefits, it puts a great deal of stress on your joints, which can lead to long-term problems if not managed correctly. One very common running-related problem is hip pain, which is often attributed to an inflamed labrum, or hip labral tear. The labrum is a fibrous rim on the socket of the joint, which is liable to damage in some situations.  Runners suffering from a labral tear actually describe it as “a dull, burning sensation that wouldn’t go away”, rather than a more traditional ‘tear’ that is instantly obvious and causes a sharper, more immediate pain. Some people don’t even know that the tear has occurred when it first happens. The problem with this kind of pain is that, to a certain extent, people can get used to it and learn to push through the discomfort. This is the worst thing you can do for a labral tear as this will be making the problem worse and prolonging/exacerbating the pain in the longer term.

So, what exactly is a labral tear or inflamed labrum?

To begin to understand more about the problem, we need to start by understanding what the issue is and how it occurs. The labrum is a cartilage ring that stabilises the hip joint. It behaves as the hip’s natural shock absorber, so really gets put to the test with high impact sports such as long-distance running, HIIT training, basketball and so on.

The causes of these different conditions are also very similar, they tend to be caused by really pushing yourself when undertaking a sport such as running but while not ensuring that you are taking time to build up the muscles suitably at the same time. Strength training is very important for looking after the joints of athletes such as runners. If people take the time to build up the muscles around key joints then this will pay dividends in the long run as it will help them absorb as much ‘shock’ as possible.

Hard to pinpoint the problem

Diagnosis can be tricky, especially without consulting orthopaedic experts, as the symptoms of a labral tear van be very similar to a joint which is just struggling with early-onset osteoarthritis or inflammation of the joint.

Here at the Fortius Clinic, we see a lot of patients – particularly younger patients – who have been keen runners and who are now struggling with inflammation of the labrum or a labral tear. In some cases, patients can get better with appropriate physiotherapy and a tailored rehabilitation programme. It does not necessarily mean the end of their running ambitions, but it is time to take stock and make sure you’re looking after your joints appropriately. Physiotherapy can help build up the muscles around the joint and provide the dexterity and support that the joint needs. If this approach isn’t successful though then patients will need to consult a hip surgeon specialising in hip arthroscopy to discuss if they do need an operation.

yoga and hip replacement

Hip and knee replacement surgery was once thought of as something which tended to be something just older people needed. This is no longer the case, with the increasingly active lifestyle that people are choosing sometimes having negative side effects on their joints. There are some pursuits that put more strain on joints than others, and recently it was revealed that those who practice yoga are putting their hips under a significant amount of pressure.

Concern with sports which push the joints into unnatural positions

Leading physiotherapist Benoy Matthews, who is a member of the Chartered Society of Physiotherapists, shared insights recently that he is seeing a trend of yoga teachers in their forties who are in need of hip replacement surgery, due to the unnatural positions that they are forcing their hip joints into, and the regularity in which they are doing this.  He believes it is all about getting the balance right.

Activities such as yoga are undoubtedly good for some joint and muscle complaints and can be beneficial to help keep the body fit and supple. But for those who are pushing their bodies too far – such as yoga teachers who practice the sport day in day out – the effect is that it is causing their joints to deteriorate.

As Matthews explains, “we all know about the health benefits of yoga – but, like anything, it can cause injury. We can’t put it on a pedestal.” He is keen to stress that when practising something such as yoga it is important to listen to your body’s limits. If you strive for a position that you want to be able to master, his advice is not to push yourself too far. Listen to your body and only push yourself within reason, or you might find that the damage you are causing to your joints will set you back significantly in the longer term.

Everything in moderation

Orthopaedic surgeons and sporting specialists alike are in agreement that it is all about taking a sensible approach to being active and looking after your joints. With yoga, in particular, benefits are “it improves flexibility, strength and balance and can be beneficial for people with high blood pressure, heart disease or stress.” But for those who are teaching yoga (or practising yoga daily), it is important to understand that this could be causing damage to joints that may ultimately result in the need for hip replacement surgery much younger than many may expect. It is thought that there are around 10,000 yoga teachers in the UK, so not an insignificant number who this could affect.

Whilst yoga teachers are the focus of Matthews’ assessment, this pattern is also seen amongst those who regularly undertake sports such as ballet, gymnastics and athletics such as hurdles. The word of warning here isn’t just for yoga enthusiasts, but for anyone who is undertaking these kinds of leisure activities.

For more advice on hip replacement and the benefits of robotic-assisted hip replacement, call 020 8947 9524 to arrange a consultation at Mr Simon Bridle’s London hip clinic.

hip replacement and golf

Over the past decade, there has been a marked increase in younger, more active people needing total hip replacement surgery, and this increase, in part, is thought to be due to the physical activities that people are choosing to do in their spare time. People who regularly play sports such as golf, tennis, athletics, gymnastics are much more likely to have put significant strain on their hip joints. The reason for this is the amount of stress that these joints are regularly subjected to.

Golfers put a lot of pressure on their hips while swinging clubs, tennis players struggle similarly. Those who choose athletics such as hurdles also find the motion of the stride really pushes their hip joints to the limit.

Hip replacement surgery is recommended for many who are now suffering from degenerating hip joints. The surgery is highly successful and often will revolutionise life for those who have been struggling with pain, limited mobility and restrictions in terms of what they can do/enjoy in their spare time. A new study has looked at hip replacement and golf and discovered some interesting findings.

Looking at the impact on the golfing community

According to a report published recently in Golf365, one in nine golfers who underwent hip replacement surgery went on to play the same amount of golf as they were able to before they began experiencing hip difficulties. Not only that, just under half said they were actually able to enjoy more. The results are from a survey commissioned by Europe’s biggest online golfing community, HowDidiDo. The community comprises almost half a million golfers, 3,500 of whom had hip replacement surgery.

The hip replacement and golf survey was designed in collaboration with orthopaedic surgeon Peter Hughes, who is Medical Officer and Orthopaedic Surgeon to the R&A, the ruling body for golf worldwide outside of America and the organiser of The Open. In summary, the survey “looked to establish how arthritis affects players before replacement and how they cope and continue to play; how their game and handicaps deteriorate, or not; how their game responds to the replacement; how long it takes to get back to practising and competitions; how much they improve; and what facilities clubs have to help them return to playing. Further questions covered general physical and mental health.”

Hip replacements offer new lease of life for golfers

Armed with this wealth of new data, researchers were able to assess how soon golfers felt ready to return to the sport and the ease at which they made the transition back into sport. Results were encouraging, suggesting that almost two-thirds were able to take shots just three months after their operation. Over three quarters were competing at club level again within six months. Most encouragingly, “70 per cent said they rarely or never felt pain during or after golf – a hugely impressive statistic given they had each undergone some form of joint replacement.”

Despite this research reflecting the golfing community, the same outcomes could be expected amongst those who regularly enjoy sports which push their joints into unnatural/extreme positions. If you’re worried about the health of your hip joints and are concerned that they have become damaged or worn, this does not necessarily mean that you will no longer be able to enjoy the leisure pursuits that you enjoy.

For more advice on hip replacement and golf, call 020 8947 9524 to arrange an appointment at Mr Simon Bridle’s London hip replacement clinic.

steroid injections for hip pain

For those suffering from hip or knee pain, it had long been thought that before going down the surgical route, steroid injections could provide some relief caused by the discomfort of joint osteoarthritis. New research has been published that challenges this belief, suggesting that cortisone injections could actually be doing more harm than good.

Steroid injections are an anti-inflammatory drug that can help numb the pain in deteriorating hip and knee joints. The NHS website explains that “steroid injections in joints are intended to relieve joint pain by reducing inflammation. In the UK, you may be offered this type of injection if you have moderate to severe pain from osteoarthritis.”

The new research has been published by the Boston University School of Medicine, whose findings suggest “that the treatment could speed up a joint’s disintegration and force patients to have total knee or hip replacements.” There is also a higher complication rate in joints following this type of injection, with one in ten hip replacement patients in the study in 2018 experiencing complications and four per cent of those with knee complaints.

The study, comprising data from over 450 US patients, indicates that complications such as “stress fractures, progressive osteoarthritis or even the collapse of joints” were experienced more so by those who had undergone treatment with steroid injections.

Report authors are pushing for greater access to information for patients who are recommended steroid injections. With greater knowledge comes greater opportunity to challenge and to decide whether or not the treatment is something they wish to progress with. Dr Ali Guermazi who lead the research explains “what we wanted to do with our paper is to tell physicians and patients to be careful, because these injections are likely not as safe as we thought.”

Mr Bridle concurs with these concerns and believes that hip and knee steroid injections can sometimes be beneficial to patients, but must be used sparingly. Typically, the kind of patient who would benefit the most from steroid injections is those whose symptoms are not bad enough to consider a full joint replacement. They can also help mask the pain for those who have important events in the near future that they are not able or willing to miss, such as golfing or a holiday. Not only that, much older patients who are not considered suitable for surgery can benefit from the pain relief offered by this type of treatment.

Steroid injections for hip pain

Steroid injections can also sometimes be used as a diagnostic tool. When administered into the joint they can help surgeons ascertain whether or not it is the joint that is the primary source of the pain and mobility issues. When used in this way it can help guide whether or not joint surgery is a suitable and effective next step for the patient.

It is important that if steroid injections are used as part of patient care or as part of a diagnostic assessment, they must be used in moderation. Mr Bridle’s approach is to give no more than two or three steroid injections before switching to an alternative approach or different kind of treatment.

This research is important as it has raised important questions about the possible side effects of cortisone injections, however, the small sample size indicates that there is a strong case for follow up research, with a larger base. The NHS recommends that realistically, “large-scale, long-term studies are needed to give us an accurate picture of the possible risk of joint damage after injections.” Until that data is available, surgeons are best to do as Mr Bridle does, and proceed with caution.

For more advice on the appropriate treatment for alleviating joint pain, call 020 8947 9524 to arrange a consultation at Mr Simon Bridle’s London joint replacement clinic.

revision joint replacement

In an interesting new study published by the National Joint Registry (NJR), data has been shared showing a league table of the best- and worst-performing areas of the UK if you are considering an NHS hip replacement.

The assessment looked at 430 UK hospitals, comprising 145 NHS trusts running 250 hospitals in the UK, as well as 181 private hospitals.

The objective of this piece is not to name and shame hospitals that are underperforming, but rather to look at where the shortcomings are and to ensure that lessons are learned. That said the full list of the 10 worst-performing hospitals in the research can be accessed here.

Higher rates of revision joint replacement surgery tend to indicate that complications were most often due to infections taking hold after surgery or failures due to inadequate supervision of junior doctors.

Using medical data to improve practice

The positive outcome to take from this research is that it can be used to great benefit of the weaker performing hospitals. Those hospitals are able to use the data to look at why things are not going as well as expected and to help guide improvements. One of the weakest-performing hospitals in the report has already reported to be “ensuring supervision of non-consultant surgeons” as a direct result of this data. Another hospital reports having taken measures to combat higher than expected rates of infection following surgery, explaining that “measures had been introduced to reduce risks of cross-contamination, including ring-fencing beds used for planned surgery, and screening patients before operations.

All surgeons have data held by the National Joint Register on their practice and part of a surgeon’s appraisal process is to reflect on their results and, in particular, their complication rate. Every surgeon will have a complication rate as no surgery is without risk, but minimising the chance of complications occurring should always be the aim.

As with any data analysis, there are reasons behind the data that need to be assessed before the ‘true’ picture can be fully understood. Some of the weaker performing hospitals in this study report an older than average patient profile, which helps explain some of the patterns seen. The medical director of the NJR explains what this means for the report and the associated data “there are many potential reasons why a hospital may be found to have a higher revision rate than expected and the reason for drawing this matter to their attention is to encourage an urgent and thorough review of the hospital’s practice. There is an agreed process to enable appropriate action to be taken to review units which fall below expected performance thresholds.”

Reassuringly for Mr Bridle’s patients, his NJR data yields a positive picture, with low revision rates for both hip and knee replacement surgery. Not only that, on the whole, hip replacement surgery is a very successful type of operation and the vast number that are performed each year means that surgeons are able to continually advance techniques and reduce revision rates. Data in support of this shows that “patients can be reassured that the rates for revision joint replacement have fallen every year since 2011”.

Mr Simon Bridle will be able to discuss all the potential risks and benefits of a hip or knee replacement in full during a consultation. Call 020 8947 9524 to arrange.

Risk of revision hip surgery

A hip replacement is an operation that has been carried out for decades. It is a cost-effective procedure, with well-established benefits, in particular, relief of pain and getting people back to normal function.

Total hip replacements are being carried out on more and more younger patients, thanks to a variety of factors which have made this age group more requiring of this type of procedure, including more active lifestyle choices and advancements in medical knowledge and processes.

A recent study, looking at data from the Dutch Arthroplasty Registry (LROI), set out to explore the risk of revision hip surgery in patients undergoing this type of operation, with a particular interest in understanding whether or not there are any differences for younger patients. The term ‘revision rates’ means how many patients had repeat or follo- up surgery following the initial operation.

Data from almost 20,000 patients was analysed, making this a statistically robust assessment. All patients whose data was examined were younger than 55 years old and had undergone a total hip replacement in the Netherlands between the years of 2007 and 2017. This data was then scrutinised looking for any difference in the following areas:

Potential risk of revision hip surgery factors:

  • Age
  • Sex
  • Diagnosis
  • ASA-classification
  • Surgical approach
  • Fixation method
  • Bearing type
  • Head size
  • Year of surgery

The research concluded that “the risk of revision hip surgery in patients younger than 55 years depends on surgical approach, head size and bearing type. The anterior approach resulted in a decreased risk of revision, whereas the use of ≥38 mm heads and MoM bearings resulted in an increased risk of revision for any reason.” So, a variety of factors could be expected to affect the longevity and risk of revision in younger patients.

Total hip replacements in younger patients have helped many people live with a better quality of life, with reduced/lack of pain and much greater levels of mobility than they were able to achieve prior to opting for the treatment.

According to results of a much smaller study, the prognosis for younger patients living with total hip replacements was positive, with researchers concluding that “today, among the patients still living… 46% of the original hip implants were still in place and functioning. In addition, many of the patients who died in the interim did so with their original implant in place. Overall, 63% of the original hip replacements were functioning at the latest follow-up or at the time of death.”

Risk of revision hip surgery study conclusions

Despite being just a small cohort of 69 patients, these patients were the perfect demographic to complement the bigger research conducted in the Netherlands. This research was conducted with data of patients who had a total hip replacement when they were aged between 18 and 49 years old. Researchers then checked in at regular intervals with the patients to see how they were getting on.

Ultimately, a total hip replacement in a younger patient has a tougher job to do – the patient will likely live longer and put more stresses and strains on the new joint compared with a much older patient. This said, the results of these recent studies are encouraging, suggesting advancements in technology, surgical skill and knowledge are all helping increase the longevity of total hip replacements in younger patients.

To discuss the potential risk of revision surgery, choose an expert. Call o20 8947 9524 to book a consultation with leading London hip specialist.

private hip surgery

There has been a significant shift from the NHS to private delivery of hip operations in recent years, which has been the focus of a new study undertaken by researchers from Newcastle University and Queen Mary University of London. The study, which has just been published in the Journal of the Royal Society of Medicine, comprised data from NHS-funded private hip surgery in England during a ten-year period, from 2003/4 to 20012/13.

The figures are surprising when looking at trends between 2007/8 and 2012/13. The number of patients who had their hip replacement undertaken in an NHS hospital declined by 8.6% whereas those treated by private providers saw an increase of 188%.

Ultimately, the concern is that with such a marked increase in patients being treated privately, this is reducing available capacity on the NHS. Researchers are concerned that “continuing the trend towards private provision and reducing NHS provision is likely to result in risk selection and widening inequalities in the provision of elective hip operations in England.” This shift was even more exacerbated when data from wealthy and poorer areas was examined; with an even more significant number having treatment in a private hospital in the affluent areas (increasing to a 288% increase).

This is a trend that many surgeons believe is inevitable. Private hospitals will naturally lean towards the simpler, less risky cases, those that are felt to be best suited to a non-NHS environment. Report authors explain “the researchers found that private providers favour fewer extremes of ages compared to NHS providers. These patients, the researchers say, may represent more complex operations or associated co-morbidities that are excluded by private providers.” By comparison, the NHS hospital environment offers access to a much broader range of specialist medical staff, who are able to assist in more complicated cases and higher-risk patients.

What this means for the NHS

What researchers suggest we need to be mindful of is ensuring that this trend does not affect the access to appropriate health care, as per the 2012 Health and Social Care Act. Professor Allyson Pollock, Director of the Institute of Health and Society at Newcastle University, is concerned that this trend points to just that – a lean towards inequality in the provision of patient care. She believes: “If the trends here continue, whereby private provision substitutes for NHS direct provision, with risk selection favouring less deprived patients, then widening inequalities are likely.”

One argument is actually that by carrying out the less complex cases within a private hospital environment this is more cost-effective. It means that surgeons in the NHS are effectively freed up to focus on the more challenging cases. Surgeons agree that despite the trend towards a growing number of patients choosing a private provider for their hip operations, the NHS will always offer a vital role in supporting complex surgery and surgery on less fit patients.