vitamin D and knee replacement pain

A new study published within the Menopause Journal, has revealed that a vitamin D deficiency in women could lead to increased pain after a knee replacement. It is not the first study to identify a link between a Vitamin D deficiency and musculoskeletal problems.

Vitamin D is known to be crucial for our health. However, many of us simply are not getting enough of it. Here, we will look at what this latest study revealed and other potential causes of pain after a knee replacement.

Studying the link between vitamin D and knee replacement pain

The latest study examined how vitamin D levels affect the functional outcome, as well as pain levels, after a knee replacement procedure. It included results from 226 postmenopausal women in 2017-2019, who had undergone a knee replacement due to symptoms of osteoarthritis.

The women were separated into two groups. One had a Vitamin D deficiency, while the other had adequate levels of the vitamin. It was revealed that those who had a Vitamin D deficiency, experienced negative early functional outcomes after the knee replacement. It was also shown to increase the amount of pain felt after the procedure.

Worryingly, the study also revealed that around 70% of postmenopausal women who were due to undergo the procedure, had a Vitamin D deficiency.

Why is Vitamin D so important?

There have been a lot of studies which have revealed the importance of Vitamin D levels for our health. In terms of our bones, past studies have shown that a deficiency in the vitamin can increase the risk of developing Osteoarthritis, fractures, lower bone mineral density, and cause more severe bone pain.

The job of Vitamin D is to regulate the amount of phosphate and calcium within the body. This in turn keeps the bones, muscles, and teeth healthy. The main source of the vitamin is the sun, making it important to get outdoors frequently.

Vitamin D deficiency can also cause conditions such as Rickets, and other bone deformities.

Other potential causes of knee replacement pain

While a Vitamin D deficiency has shown to increase pain after a knee replacement procedure, it isn’t the only risk factor. The study also revealed that smoking and a high body mass index can play a role in post-operative pain.

Occasionally, pain after a knee replacement could point to an underlying issue. For example, it could suggest a loosening of the implant, or a potential infection. For this reason, it is important to undergo a check-up with the surgeon if pain is an issue after the procedure.

Pain after a knee replacement operation is common. However, typically over-the-counter medications help to eliminate the pain. If your pain doesn’t subside after a few days, consult with your surgeon to determine whether there is an underlying issue.

This new research provides a useful guideline to both health providers and patients. Those who do have a Vitamin D deficiency may want to take supplements to build up their levels prior to undergoing a knee replacement procedure.

hip arthritis and FAI

Femoro-acetabular Impingement or FAI is a relatively recently recognised condition; it was initially described by orthopaedic surgeon Dr Reinhold Ganz who described the condition in 2003 and identified it as a likely cause for the development of hip arthritis in later life.

The condition affects the junction between the rim of the acetabulum (or hip joint socket) and the femoral head and neck; the socket has a fibrous rim called the labrum, which acts as a shock absorber during movement of the joint.

In an attempt to learn more about the condition, researchers from the Mayo Clinic and China carried out a recent study.

Here, we will look at what Femoro-acetabular Impingement is, how it is treated, the link between hip arthritis and FAI and what the new study revealed.

What is FAI?

Femoro-acetabular Impingement is associated with additional bone growing on the front of the neck, giving it an irregular shape, or on the socket.  This irregular shape causes the neck to pinch against the front of the socket, and this can eventually damage the labrum, causing a tear.  This pinching causes pain, particularly when people twist their hip.

There are different types of FAI you can develop. These include Pincer, Cam, and Combined. Pincer impingement affects the socket, as extra bone forms on the rim, while Cam impingement affects the femoral head. Combined impingement means you have signs of both Cam and Pincer impingement.

Symptoms of FAI include pain, limping, and stiffness. Little can be done to prevent the condition, and it isn’t known how many people suffer with the condition. However, it is known that it mostly affects younger patients.

How is FAI diagnosed and treated?

There are several tests which can diagnose FAI. Imaging tests such as an MRI tend to be the first types of tests carried out. They can help to identify any potential abnormalities or damage within the joint of the hip.

In terms of treatment, it will depend upon the severity of the condition and the symptoms experienced. Corticosteroids can be used to control inflammation, while physical therapy can help to improve mobility and strengthen the joint.  Strengthening the core and gluteal muscles is very important and often all that is needed to relieve patients’ symptoms.

If surgery is required, arthroscopic hip surgery is the most common option. This minimally invasive procedure involves removing damaged bone and cartilage. Open hip surgery can also be carried out, but this is rarely done nowadays.

What did the latest study reveal?

A total of 1,893 patients were involved in the latest study into FAI. It revealed that females have an increased risk of the condition. Interestingly, it also discovered that incidences of the condition increased from 2000-2016. This is largely thought to be down to an increase in awareness of FAI.

Older patients who present with the condition

While there is a link between hip arthritis and FAI, it is uncommon in older patients. Those who present with the same symptoms of FAI, are more likely to be showing signs of arthritis. Furthermore, if arthritis is present, arthroscopic surgery wouldn’t be suitable, as the hip is ‘too far gone’ for this to help.

If you suspect you may have Femoro-acetabular Impingement, book a consultation with Mr Simon Bridle today. While he does not treat FAI, he often carries out MRI testing for patients referred by physiotherapists. Older patients will also be able to determine whether the cause of their symptoms is actually regenerative arthritis, where the only surgical treatment is hip replacement.

Living with chronic joint pain

When you are living with chronic pain, life can often seem unbearable. There have been a number of studies carried out recently, looking at the impact the recent lockdowns have had on chronic pain patients. One study, carried out by the University of Liverpool, revealed those living with chronic pain during lockdown have experience increased pain, anxiety, and loneliness.

Currently, pain medications are one of the few treatment’s patients turn to for relief from joint pain. However, new guidelines have been released from NICE, advising against the use of pain medications for chronic pain patients. This includes common pain medications such as painkillers and ibuprofen. Instead, increasing exercise and undergoing CBT are being recommended.

Here, you’ll discover what treatment options are available to patients experiencing debilitating symptoms from chronic joint pain.

Why should pain medications be avoided?

The main reason doctors are being advised not to prescribe pain medication to patients with chronic pain, is due to the side effects they can cause. Opioids in particular are known to lead to severe side effects, including a high risk of addiction.

While pain medications are frequently used to treat chronic pain, there is actually very little evidence to suggest that they work. No studies have shown that pain relief medication helps to improve quality of life or pain in chronic pain conditions.

Exercise and antidepressants could be ideal alternative

According to NICE, exercise and antidepressants could be much more effective treatments for chronic pain patients. While exercising is probably the last thing you feel like doing, it is known to have a positive effect on pain reduction.

When you exercise regularly, it helps to keep the joints moving and the muscles strong. Daily exercise is also known to be extremely important to our mental health. It can aid in weight management, which will also reduce the pressure on the joints.

In terms of what type of exercise you should do, your doctor will be able to advise you of the best exercises to focus on. You could also see a physiotherapist who will be able to create a fitness plan based upon your chronic illness symptoms.

What treatment options are available?

The treatments available for chronic pain, largely depend upon the type you are suffering with. If you have chronic pain caused by Osteoarthritis in the knee or hip, a replacement surgery could help. Hip and knee replacements are a common procedure that are shown to provide significant improvements in quality of life and pain relief.

Booking a consultation with a hip or knee replacement specialist will help you determine whether surgery would be an ideal option for you. It is important to consider the risks and complications, alongside the benefits, before deciding if it is right for you. Call 020 8947 9524 to book a consultation with Mr Simon Bridle.

London hip replacement success

If you are due to undergo a hip replacement, there are numerous things that can impact its success. A recent study has looked into whether your level of fitness could play a role in how successful a hip replacement will be.

Here, we’ll look at what the study found and whether your fitness level could determine how successful your hip replacement is.

What did the latest study find?

The latest study, published within The Journal of Arthroplasty, aimed to determine the impact of a patient’s level of physical activity on the outcome of a total hip arthroplasty.

It is already known that the procedure provides excellent results in terms of functional improvement and pain relief in all patients. However, would being fitter improve the surgery’s success?

The researchers of the study used data from the institutional registry of patients who were having a total hip arthroplasty from 2007 to 2012. Patients who underwent a thorough assessment after the surgery were identified. Satisfaction scores, rates of complication and revision surgical procedure rates were all compared between patients with a higher and lower fitness level.

Interestingly, more active patients believed they would achieve more favourable outcomes than non-active patients before the surgery. After a 2-year assessment, it was revealed that active and inactive patients had similar levels of satisfaction. They also had comparable outcomes.

The non-active patients also experienced an increase in activity two years after the procedure. This could be down to the fact that their bad hip was preventing them from exercising.

Is it important to keep fit before a hip replacement?

Although the recent study doesn’t show a link between lower fitness levels and a poorer outcome, it is still important to keep fit prior to surgery. The fitter you are, the fewer the risks.

Overweight patients are particularly vulnerable to complications from surgery. As a hip replacement is a major surgery, the body needs to be as fit as possible if you want a speedy recovery.

Of course, keeping fit before a hip replacement isn’t always easy. If you are struggling to stay active due to pain or reduced mobility, gentle exercises such as Pilates are a great option. You could also visit a physiotherapist for help getting in shape for the surgery.

Other factors that could impact hip replacement results

Alongside your fitness levels, there are a few other factors that could impact the results of a total hip arthroplasty. The surgical technique used, and the prosthesis material can both affect the success of the procedure. Non-surgical factors also include age, sex, and BMI.

Hip surgeon Mr Simon Bridle will be able to identify and discuss any risk factors you need to be aware of during your consultation. He can also give you a better idea of how successful the surgery is likely to be. Most patients who undergo a hip replacement experience significant improvements in both pain relief and function.

revision hip replacement

A new UK study has discovered that an osteoporosis drug could help to halve the number of revision hip replacements required.

While the majority of hip replacements run smoothly and last for up to 20 years, revisions are sometimes needed. The trouble is this is a major operation that carries significant risks. Therefore, anything that can reduce the chances of patients requiring a revision hip replacement is highly beneficial.

Here, we will look at what the recent study revealed and whether it could be suitable for all patients.

Understanding the latest study

The new study was carried out by the University of Sheffield and the Sheffield Teaching Hospitals NHS Foundations Trust. It included 22 patients in its Phase 2 clinical trial. Bone imaging and bone biopsies were used to determine whether the osteoporosis drug was working.

It was discovered that when the drug was injected, it prevented microscopic wear particles from the replacement joint being absorbed by the bone cells. It is well established that this can lead to the bone around the joint being damaged and loosening the implant.  If the drug prevents this process, this could prevent the bone from being eaten away and reduce the need for a revision surgery.

The researchers believe this breakthrough could help to prevent half of the revision surgeries currently carried out.

What is a revision hip replacement?

The revision hip replacement procedure is much more complex and longer than an initial replacement surgery. Specialised tools and implants are used during the procedure and it requires extensive planning by the surgeon.

There are different types of revision surgeries that can be carried out. It will depend upon the type of replacement needed and the extent of the problem. For example, it could be that just some of the components of the artificial joint need replacing. Or it could be that the entire joint needs to be replaced.

A revision procedure can be more difficult to perform due to damage caused to the soft tissue and bone. It is also associated with more risks than the initial surgery. These include dislocation, infection, damage to the nerves, blood clots and failure of the implant. Your surgeon will discuss the risks with you in detail before you decide whether or not to undergo the procedure.

What does this latest research mean for patients?

Due to how risky and complex revision replacement surgeries are, the new study is good news for both surgeons and patients. However, it is important to note that it was only a small study. The researchers are now going to be carrying out a larger third clinical trial to get a better idea of how effective the drug is

Mr Simon Bridle also urges a further note of caution: “Patients also need to realise that all drugs carry the risk of side effects. This is something that will need to be addressed before the osteoporosis drug can be used to treat patients in the mainstream.”

If you are concerned about your previous hip replacement, call 020 8947 9524 to book a consultation with Mr Simon Bridle today. A revision surgery may not be required but seeking treatment quickly can help ease the pain and discomfort you are currently experiencing.

recovery after hip or knee replacement

Like any surgical procedure, when you undergo a hip or knee replacement, you will need to go through a recovery period. This gives the body a chance to heal and aids in producing the best results.

Recovering from a hip or knee replacement can take a long time. However, there are some things you can do at home to help speed up your recovery. Below, you’ll discover five tips to speed up your recovery and get back to full mobility.

  1. Start your joint replacement recovery before your operation

If you want the fastest recovery, it’s a good idea to make a start before you even undergo the operation. Strengthening up the leg muscles prior to surgery through various exercises, will greatly help to improve recovery. Pilates is a particularly great form of exercise for strengthening the leg and pelvic muscles.

You will also be advised to stop smoking as this can compromise tissue healing after surgery, as well as increasing the risks. Similarly, losing weight can also help to make the recovery faster and easier.

  1. Focus on light exercise

After the surgery, you will need to rest the body for a period of time. However, as soon as you can complete light activities, it is time to start adding exercise back into your routine.

Gentle, light exercise will help to keep the blood flowing throughout the body, improving circulation. Healthy blood flow to the surgical site is important for healing. Light exercise will also help to build up strength in the body.

  1. Look at what you eat

Ensuring you eat a healthy, balanced diet is also important to your recovery. As the body heals, it needs nutrients to recovery. By eating a varied diet packed full of protein, fruits and vegetables, it’s going to help you heal faster as well as feel better overall.

You should never attempt to lose weight or diet during your recovery. Without the right nutrients, healing will be delayed, and you will also be at a greater risk of infection.

  1. Use a physiotherapist

Your surgeon will typically suggest physiotherapy to help with your recovery. A physiotherapist knows exactly which exercises you should and shouldn’t be doing. They will be able to focus on exercises that strengthen the legs and the core.

While you can do light exercises at home, when you use a physiotherapist you know that you are doing the most effective exercises safely.

  1. Follow your surgeon’s advice

The best way to speed up your recovery after a hip or knee replacement, is to follow your surgeon’s advice. It’s tempting to want to skip some pieces of advice, but unless you follow it completely, you won’t get the best results.

While it is possible to speed up your recovery, be mindful not to push yourself too hard. If you ignore your surgeon’s advice or you overdo it with the exercise, it could delay healing and actually slow down your recovery.

COVID and knee surgery

There is a lot of concern about the current situation with the surge in COVID-19 infection, in particular for people who need to attend hospital, or who may be considering surgical treatment.  It does look like the outbreak is starting to come under control and there is a hope that the vaccination programme will allow life to return to normality over the next few months, but it is likely that things will never be quite the same again.

During the first lockdown, private hospitals were contracted to the NHS to help with some of the workload, in particular with urgent surgery, including cancer.  At the moment most private hospitals are not doing planned hip and knee replacement surgery; some Central London hospitals, including BUPA Cromwell are still doing private hip and knee surgery, alongside urgent NHS cancer work.  It is likely to be the Spring before other private hospitals resume non-urgent surgery, so capacity for surgery in the private sector remains limited.

Hip and knee clinic consultations

Mr Bridle is still seeing patients in clinic, with very stringent measures in place to ensure a COVID-free environment.  We are seeing patients face-to-face where necessary, but many appointments are being conducted remotely, especially for follow up appointments, to minimise footfall through the hospital.  This has proved a very good arrangement for patients and specialists and it is likely that far more appointments will be conducted in this way in the future.

The vaccine has given hope that COVID will in due course become a thing of the past. Patients have lot of questions around undergoing treatment and vaccination.

  • Steroid injections are often used to treat painful joints. Patients should not have a steroid injection for two weeks before and two weeks after having the COVID vaccination
  • Steroid injections may increase the risk of being badly affected by COVID; this will be discussed with patients before they have injections. The risks are likely to be very low
  • Patients should not undergo major surgery for two weeks before or two weeks after the vaccination
  • It is very important to stress that vaccination is the priority above almost any other treatment which may be required and if patients are offered the vaccine they should have it

For more advice on the current situation and how it might affect your hip or knee treatment, call 020 8947 9524 to arrange a consultation with Mr Simon Bridle.

hip dislocation

A new study carried out by researchers in Denmark, has revealed the true rate of hip dislocations following total hip arthroplasty. A known complication of the procedure, the study suggests the rate of hip dislocations is up to 50% higher than first thought.

Here, we’ll look at what the study found, alongside patient and surgeon factors that could impact the risk.

Understanding the hip dislocation study

The large cohort study published in The Journal of Bone & Joint Surgery, included all hospital contacts in Denmark within two years, who had a total hip arthroplasty. It had a five-year inclusion period and is believed to have revealed the true rate of hip dislocations.

The researchers wanted to develop a more comprehensive and thorough method for assessing the actual incidence of dislocation. Between 2012 to 2014, 31,105 patients underwent a total hip arthroplasty in Denmark. The researchers discovered that 1,861 dislocations occurred in 1,079 total hip arthroscopy procedures. This corresponds to a 2-year incidence of 3.5%. Over 40% of the patients identified, suffered at least two dislocations. The majority were also found to suffer dislocations within three months of the procedure.

As well as looking into the incidence rate of dislocations, the study also looked at the causes of dislocation. Several patient-led and surgical-led factors were identified.

Patient-led factors

The following patient-led factors were discovered to link to dislocation risk:

  • Age
  • Gender
  • General health

Patients aged 65 and under had a lower risk, whereas those aged 75 and over had an increased risk of dislocation; men were shown to have a lower risk than women; patients in good health also had a reduced risk.

An additional patient-led factor not mentioned in the study is spinal problems. Patients who suffer with stiff spines and previous spinal fusion are also known to have an increased risk of dislocation.

Surgeon-led factors

The surgical factors identified in the study included the surgical approach used and the femoral head size.

A lateral surgical approach, cemented fixation and a larger femoral head size were all linked to a lower risk of dislocation. The majority of patients included in the study underwent a posterior approach as that is the most common method used in Denmark.

There is a relationship between poor component position and instability. The use of MAKO robotic assistance has been shown to improve the accuracy of implantation. This innovative technology creates 3D models that are patient-specific in order to help pre-plan the procedure. The surgical team are able to accurately plan the position of the components, to fit the patient’s own anatomy and the robot helps the surgeon to execute the plan

Patients who are planning on undergoing a hip replacement need to be aware of the risks of dislocation. This latest study highlights the surgical and patient-led factors which can help surgeons identify the risks involved.  This is important information, as the ability to identify high risk patients helps the surgeon to approach the surgery to minimise the risk of dislocation in each particular case.

hip implant longevity

Undergoing a hip implant procedure can be daunting. However, the surgery can help patients to drastically improve their quality of life. Like any surgery, a hip implant doesn’t come without its risks and complications. It is important to be aware of the pros and cons before deciding whether or not it is the right option for you.

One factor to consider is how long a hip implant will last. Here, we will look at the factors which impact hip implant longevity.

What impacts the wear rate of hip implants?

Recent data shows that the majority of hip implants can last up to 25 years. However, there are a lot of factors which can impact the wear rate of hip implants. In a recent study, engineers from the Rice University looked to identify how well implants stand up throughout their expected lifecycle.  They discovered wear debris is the main cause of long-term implant failure.

Wear debris consists of tiny particles from the bearing (the moving parts), which mix with the synovial fluid. The body reacts to this debris with an inflammatory response, which can eventually damage to bone and lead to loosening of the implant. There are a number of things which can contribute towards wear debris including:

  • The position the components are placed
  • The properties of the bearing material
  • Activity levels of the patient

The position the components are placed, and the properties of the bearing material pose the largest risk. It is only to a small degree that patient activity levels can potentially contribute.

Some materials are known to have a lower risk than others. For example, Mr Simon Bridle uses a X3 Polyethylene (Stryker), which is known to have a very low wear rate. In terms of the position components are placed, using MAKO robotic assistance has been demonstrated to increase the accuracy of component position and it is hoped that this will further reduce the wear rate.

While patient activity levels don’t appear to be as important, Mr Bridle advises that some activities should be avoided. For example, patients should avoid long distance running and other extended repetitive impact exercises. Most sporting activities on the other hand are absolutely safe to carry out and are encouraged for people’s general wellbeing.

Are hip implants suitable for younger patients?

Due to the risk of wear and tear, younger patients may worry about undergoing a hip implant. It is worth noting that modern hip implants are likely to last much longer than older implants.  The best way to give the hip the best chance of getting people back to normal activity and lasting a long time is to use tried and trusted implants, with low wear bearings and putting them in as accurately as possible.

Prior to carrying out a hip implant procedure, Mr Bridle will consider all risk factors relating to the specific patient. All risks and complications will then be discussed to allow the patient to make the best decision to fit their circumstances. Call 020 8947 9524 to arrange a consultation with Mr Simon Bridle at his London hip clinic.

knee replacement risks

A new study has revealed that knee replacement surgery carried out with a tourniquet is more dangerous than other methods. According to the results, patients could be as much as 73% more likely to develop serious complications after the procedure.

Here, we’ll look at what this latest study found and what it means for patients.

Understanding the study

The study, carried out by researchers from the University of Warwick, assessed data from 41 past clinical trials. After combining multiple studies from across the globe, it was revealed that using a tourniquet is more dangerous for patients. It included a total of 2,819 patients, with 5.9% experiencing serious complications.

There is a 73% increased risk of suffering from serious complications after the procedure when a tourniquet is used. The study found that if tourniquets were removed from the procedure completely, it could prevent 1,987 serious complications in UK patients each year. So, what is the tourniquet method and why is it more dangerous?

Why do we use a tourniquet for knee surgery?

The tourniquet is a tight inflatable cuff, wrapped round the top of the thigh, to stop bleeding during surgery.  Surgeons find the surgery easier when there is no bleeding into the wound.  It is usually used for around an hour while the procedure is being performed. However, as the study points out, it has shown to greatly increase the risks of surgery.

Just some of the complications reported through the tourniquet method, are nerve damage, pulmonary embolism and stiffness in the joint. Avoiding the use of a tourniquet, on the other hand, have shown to reduce post-operative pain and speed up the patients’ recovery.

Mr Bridle no longer uses a tourniquet for the vast majority of his knee replacements, choosing instead to focus on alternative methods which reduce complications. Modern anaesthetic techniques, in particular spinal anaesthesia, reduce bleeding. Pain can also be managed in alternative ways, including nerve blocks and the use of local anaesthetic around the knee.

The recent introduction of robotic assisted surgery has been shown to reduce post-operative pain, allow more rapid rehabilitation and achieve better function.

Of course the majority of patients experience no complications after their knee replacement. However, like any procedure, there are risks and complications involved, so reducing the risk, including avoiding the use of a tourniquet, is certainly in the patients’ best interest.

If you are considering undergoing a knee replacement operation, book a consultation with Mr Bridle today.