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.

Exeter hip replacement

The Exeter hip replacement stem (the part which is fitter into the thigh bone) is celebrating its 50th year anniversary. The implant has now been used in over 2 million patients across the world, making it one of the most widely used and successful stems on the market.

Here, we’ll look at the Exeter hip replacement and how it came to be one of the most successful treatments of its kind.

What is the Exeter hip replacement?

The Exeter hip replacement is a cemented femoral hip system. It is designed to be used in all types of patients, including revision procedures. The stem has changed very little over the years, underlining the success of the design.  The last modification was in 1988, when the trunnion (the top of the stem is fitted) was modified for a number of reasons, including to allow the use of ceramic heads.

It offers a variety of stem sizes, lengths and offsets, ensuring that the implant fits the patients’ own anatomy, so can be used for a wide range of patients. The system has been so successful that it has earned a special commendation award from the British Orthopaedic Association. It is considered by many to be the gold standard in hip replacement techniques, offering patients a hip which reproduces their own anatomy, gets them back to normal function and has a good chance of lasting a very long time

Where it all started

The Exeter hip replacement was developed by engineer Dr Clive Lee from the Exeter University, and Robert Ling, a Professor and NHS surgeon.  The problem with artificial hip is that they eventually loosen.  We now understand that this is largely as a result of the wear debris which they produce, eventually damaging the bone supporting the implant.  The Exeter was originally designed with a polished surface and a taper.  We now know that this loads the cement in a way that it is much less likely to fail, so the bone is much less vulnerable to any wear debris which is produced.

The first implant using the Exeter hip replacement technique, was carried out on 27 November 1970. It has now been used in over 2 million patients and has shown to have a 99% success rate in patients after 23 years according to a 2016 study.

The benefits of the procedure

There are a lot of benefits associated with the Exeter hip replacement method. Its long-term effectiveness is by far one its biggest benefits, with many studies and the UK National Joint Registry confirming that this stem has a very good chance of delivering a good chance of long-term success for the patient. This means of course means that patients are less likely to require revision procedures later in their life.

The cost of producing the implant is relatively low compared to other systems, which makes it a good choice in the current economic climate. It has been shown to be just as effective in younger patients as it is in older ones, with good long term survival even in this demanding group of patients.

Mr Simon Bridle recommends the Exeter hip replacement to his patients. To learn more about this procedure and its benefits, call 020 8971 8026 to book a consultation today.

Knee osteoarthritis non-operative treatments

Knee replacement is an extremely effective treatment for patients with knee arthritis. It is however major surgery, with some risks, which your surgeon will always discuss with you before deciding to proceed to surgery. Non-operative treatment is an important part of managing knee arthritis. A number of treatments are available to reduce pain and improve function. Non-operative treatment is also helpful in helping patients decide when they are ready for surgery. Here we’ll look at some of these treatments and how effective they are.

Study finds steroid injections don’t speed up progression of OA

Steroid and other injections are often used. There have been concerns that steroids can damage the joint and that they may lead to surgery being required sooner. Previous studies had suggested that steroid injections could actually speed up the progression of the disease.

A new study looking at this has found that steroid injections for the treatment of knee osteoarthritis do not hasten the need for a knee replacement. This study, carried out by the Boston University School of Medicine, revealed steroid injections don’t speed up the progression of OA.

This latest research included two large cohort studies. It followed those with knee OA who were receiving either hyaluronic or corticosteroid injections. Rates of radiographic progression, X-Ray visible joint damage and total knee replacements were analysed. A total of 792 knees were analysed, with 647 patients undergoing corticosteroid injections. The other 145 patients were receiving hyaluronic injections.

The study found that patients undergoing Hyaluronic injections were more likely to have a knee replacement. However, patients receiving corticosteroid injections didn’t show any signs of radiographic progression and did not have an increased risk of needing a knee replacement. The authors concluded that steroid injections don’t speed up the progression of OA like previously suggested.

Understanding non-operative options

In patients with osteoarthritis, a total knee replacement is typically used as a last resort. There are many non-operative treatments available which have shown to have huge success at treating the condition.

Physiotherapy

Physical therapy has shown to provide clinical benefits to those with knee osteoarthritis. A new study has shown that after a year of physical therapy, the majority of patients had less pain and better mobility.

Weight loss

Another thing that can help patients is weight loss. In those who are overweight, the additional weight can put a lot of pressure onto the joints. Studies have shown that overweight patients suffering with knee osteoarthritis, often experience pain relief and enhanced mobility when they lose weight.

Shockwave therapy (ESWT)

This is used increasingly for patients with tendon problems. A recent study has shown that ESWT can also be effective in helping patients with knee arthritis. They looked at patients with arthritic knees and resulting deformity. Interestingly, ESWT was shown to decrease pain in up to 95% of cases and improved the function of the joint. This study raises hoe that this treatment modality may help patients with knee arthritis.

As you can see, there are a lot of non-operative treatments available for patients suffering with knee OA. The new findings in these recent studies confirm the role of non operative treatment and where these modalities fit in, helping patients to achieve relief, without going under the knife.

hip replacements

As we age, our risk of falls increases. Sadly, so too does our likelihood of suffering an injury from a fall. However, a new study has found that the key to cutting the risk of falls could be a knee or hip replacement.

Here, we’ll look at what a knee and hip replacement involves and what the new study revealed about their effectiveness at reducing falls.

What is a knee or hip replacement?

A knee or hip replacement involves replacing the damaged joint and replacing it with prosthesis. The procedures are most commonly carried out on older patients with osteoarthritis. However, younger patients may also need to undergo a knee or hip replacement for a variety of reasons.

Knee and hip replacements are known to reduce pain, increase mobility and help patients return to an independent lifestyle. According the recent study, they can also cut the risk of falls.

Hip replacement study

The recent study, published within the American Academy of Orthopaedic Surgeons, looked at data from over 500,000 patients suffering from osteoarthritis. All of the patients had undergone either a knee or a hip replacement. The researchers compared the fall rates to those who hadn’t undergone a replacement procedure. It was revealed that those who underwent the procedure, had a much lower fall rate than those who didn’t.

Not only did the study prove joint replacement surgery reduces the risk of falls, but it also found it reduces the fear of falling too. Patients who had undergone a knee or hip replacement were found to be a lot less worried about falling than those who hadn’t.

So, a knee or hip replacement benefits the patient both physically and mentally. The authors of the study also provided tips for patients to prevent their risk of a fall after surgery. The key advice all patients should follow includes:

  • Removing any loose rugs
  • Covering sharp corners of tables and countertops
  • Installing motion sensor night lights
  • Installing handrails near stairs and in bathrooms

Patients are also advised to wear a communication device at all times to ensure they can receive help quickly if they do suffer a fall or injury.

Other benefits of knee and hip replacements

As well as preventing the risk of falls, knee and hip replacements also offer a number of other benefits. The main benefit is that a joint replacement can significantly reduce pain.

The damaged areas of the joint are removed during the surgery, completely eliminating the diseased joint. It is this which causes the pain, so once it has been removed, the pain is no longer there. The replacement joint provides pain-free mobility, enabling patients to walk around much easier.

This new study highlights the importance of knee and hip replacements in older patients. Falls are a major risk as we age, and they can cause a lot more damage compared to when we were young. Therefore, undergoing a knee or hip replacement could help patients to reduce their risk of falls, protecting their long-term health.

Call us on 020 8947 9524 to arrange a knee or hip replacement consultation with Mr Simon Bridle.

Bilateral Hip Replacement

Undergoing one hip replacement procedure can be daunting enough. However, for some patients, a double hip replacement may be recommended, where both hips are painful and badly damaged by arthritis.

While less common than a single (unilateral) hip replacement, having both hips replaced at the same time (bilateral), can deliver significant benefits to some patients. Here, we’ll look at when two hip replacements may be better than one and what to expect from a bilateral procedure.

What is a bilateral hip replacement?

Hip replacement involves replacing the femoral head and the acetabulum, using artificial parts made of ceramic, metal or a mixture of both. A bilateral hip replacement can be done as a staged, or simultaneous procedure.

With a staged procedure, the hip joints will be replaced one at a time. After the first procedure, the second replacement will be carried out a few weeks later.  In a simultaneous procedure, both hip joints are replaced at the same time.  This approach is cheaper and overall the hospital stay, recovery period and cost is less.

Generally speaking, a simultaneous procedure isn’t recommended for older patients or those who have other underlying health problems. If both your hips are very painful, you should talk to your surgeon to discuss the risks and benefits of each method. They will be able to advise the best technique to match your circumstances.

Why might you need two procedures in one?

A number of conditions can damage the joint, leading to the need for replacement surgery, including osteoarthritis, osteonecrosis, developmental dysplasia and rheumatoid arthritis.  Osteoarthritis in particular frequently affects both hips.  Studies have revealed that 42% of those suffering with Osteoarthritis have it in both hips and of these, around 25% go on to need both hips replaced.

Recovery and results

Patients who undergo a simultaneous procedure will typically need to stay in hospital for a couple of days longer than after one hip, typically 4 or 5 days. Patients are mobilised as soon as possible – on the day of surgery, or the following day.  Pain control techniques are very important to allow this.  Early movement, along with blood thinning medication reduces the risk of clots, which is one of the most significant risks of hip replacement.

Physical therapy is key to achieving best results. A trained physiotherapist will teach you stretches and exercise to improve the mobility of the joints. Recovery time and results will depend upon a number of factors such as age and overall health.

Despite their benefits, double hip replacements are quite rare. Patients who are experiencing pain and mobility issues in both joints should speak to a hip specialist to discuss your treatment options. Mr Simon Bridle will be able to talk through the staged and simultaneous techniques and advise you of which one is better suited to you.