same day rehab after hip replacement

NICE has released new guidelines recommending patients who undergo a hip replacement to begin rehab on the same day as their procedure.

The new guidelines found under Joint Replacement: Hip, knee and shoulder, sets out the care of patients before and after joint replacement surgery. Here, we’ll look at why this new guidance has been published by NICE and what effect same day rehab can have on patients.

What are the new guidelines?

The new guidelines have been introduced by the National Institute for Health and Care Excellence (NICE). The body consulted with the Association of Trauma and Orthopaedics Chartered Physiotherapists during the development of the guidelines. They reference patient care before and after planned hip, knee and shoulder replacements, providing information for both patients and surgeons.

The latest guidelines relate to the importance of rehabilitation in recovery. Now, it is being recommended that patients undergo rehab on the same day, or at least within 24 hours of their operation. This should be offered to the patient by an occupational therapist or physiotherapist.

The rehab should include post-surgery exercise advice, alongside guidance on certain lifestyle choices such as smoking and weight management. This will help to aid in achieving the best outcomes.

Why is same day rehab after hip replacement important?

There are a number of reasons why same day rehab is important for hip replacement patients. According to research, it helps to achieve better outcomes.

The goal of any surgery is to achieve the best outcome. However, often the recovery process determines how well it goes. Early rehab can help to improve the range of movement within the joint, ensuring it isn’t stiff or uncomfortable. It can also help to strengthen up the surrounding muscles and reduce pain after the surgery.

The recovery for a hip replacement can be difficult. In some cases, you may need help to walk again. Rehab can help to get you back walking quickly after the procedure, reducing downtime.

Other factors that can aid in a speedy recovery

As well as same day physical therapy, there are some other factors that can aid in a speedy recovery from joint replacement surgery. Making sure your home is prepared in advance so you can simply rest and recover for example, is a good idea. Make sure anything you need is within easy reach and the home is clean and tidy.

You’ll also want to avoid returning to sports and more strenuous exercise for at least six weeks. This includes activities such as swimming and golf. While gentle exercise is important for your recovery, doing too much too soon could prove damaging.

Taking care of yourself and making healthier lifestyle choices will also help. This includes quitting smoking and eating a healthy diet. Focus on foods which are known for their healing properties.

Overall, same day rehab is important for hip replacement patients. The earlier patients get moving, particularly walking, the better the outcome will be. The new research will prove useful for both patients and surgeons when determining the most effective recovery plan.

revision hip surgery

A new study has revealed that the more hip replacements a surgeon has carried out, the better the results will be. This may not be groundbreaking news, but it does highlight the importance of patients choosing an experienced surgeon.

Experts have been advising patients for years to check how many procedures your surgeon regularly performs. However, this new research backs up the advice. Here, we’ll look at what the study found and why experience counts when it comes to hip replacements.

Understanding the study

The new study assessed 12,100 operations which were conducted in Västra Götaland between 2007 to 2016. Out of these, 6713 were primary hip replacements.

The researchers looked into the number of procedures that resulted in complications within 90 days and the experience of the surgeons involved. These included both surgical and medical complications such as blood clots, pneumonia, hip dislocation and wound infections.

Patients who had been treated by resident physicians gave a slightly reduced satisfaction score. This was compared against patients treated by specialist surgeons. However, the differences here were very minor.

The study concluded that experience does play a role in results with patients undergoing a hip replacement.

Length of experience doesn’t always matter

Interestingly, while the study did reveal that the frequency that surgery is performed matters, the length of experience was shown to be less important. The length of experience didn’t show to have much impact on pain levels or health gains for patients.

So, patients should look out for surgeons who are regularly performing hip replacement procedures. However, they don’t need to worry too much about how long the surgeon has been providing the procedure according to the study.

The trouble with inexperienced surgeons

So, why is an experienced surgeon important? You won’t just receive the best functional results with a more experienced surgeon, you’ll also reduce the potential complications involved. Many patients have made the mistake of opting for a less experienced surgeon. This can lead to an increased risk of complications, as well as potentially lead to less effective results.

The thesis was published in Sweden and argues that a quality register for joint replacement surgery should be established in Sweden, following the model in countries like the UK. “The annual volume of operations per surgeon and personal feedback are pieces of evidence that may help further to improve the situation a bit for patients undergoing hip replacements.”

You can also judge how experienced the surgeon is via your consultation. Have a list of questions ready about the procedure and what you can expect, particularly in relation to potential risks and complications and how they will address them if they arise.

Choosing a hip replacement surgeon that performs revision surgery can also be a good indicator of their experience. Mr Simon Bridle has a very low complication rate in his own primary replacement procedures and he is frequently referred patients with failed joints where the surgery was performed elsewhere and has built a multidisciplinary team (MDT) to deal with these often challenging problems.

For more advice on hip replacement or revision surgery, call 020 8947 9524 to arrange a consultation.

hip replacement for back pain

A new study has revealed that a hip replacement could also ease back pain. Experts have been looking into the connection between hip and back pain for many years and this recent study investigated whether patients suffering from back pain could benefit from a hip replacement procedure.

So, does this mean all patients with back pain can expect to find relief from a hip replacement surgery? Below, you’ll discover more about the study and what it means for patients.

What is a hip replacement?

A hip replacement procedure aims to replace a worn-out hip joint with an artificial one. They are most commonly carried out on older patients, although increasingly younger patients require surgery, and the joints are designed to last for approximately 25 years for the majority of patients.

After undergoing a hip replacement, patients report a significant decrease in pain and a great improvement in mobility.

Hip or back pain?

Hip arthritis and back pain often go together, as London hip surgeon Mr Simon Bridle explains. Patients with arthritis hips often have arthritis in their spine. This link is confirmed in the new study, carried out by New York City researchers from the Hospital for Special Surgery, which revealed some interesting results. It followed 500 patients who had undergone a hip replacement procedure.

It was discovered that more than 40% of patients had pain in their hips and lower back prior to the operation. However, one year after the procedure, a staggering 82% reported their back pain had gone completely.

The only negative discovered was that patients who have undergone spinal surgery, have an increased risk of complications during a hip replacement. In fact, the risk was found to be five times higher, which should be a consideration for specialists when identifying the best treatment option.

How does a hip replacement ease back pain?

The main reason a hip replacement can ease back pain is that it makes the joint more mobile. Many patients discover their back pain was worsened due to an immobile hip joint. This places strain on the back, causing a lot of discomfort. So, once the hip joint has been replaced and it is more mobile, this automatically removes the extra strain from the back.

Will a hip replacement eliminate all back pain?

The new findings do show the majority of patients experience a reduction in back pain. However, it’s important to be aware that this isn’t always the case. Undergoing a hip replacement isn’t guaranteed to eliminate your back pain.

That being said, a hip replacement is an outstanding procedure which can greatly help patients to live a happier, more mobile life. Even if it doesn’t aid in eliminating back pain, it still helps patients achieve a better quality of life.

If you have been experiencing both hip and back pain, a hip replacement could be an ideal treatment option. However, it is important to book a consultation with a specialist to determine whether or not it’s the best option.

Anterior Approach to Hip Replacement

The anterior hip replacement is not a new concept in joint surgery, but in recent years it has become more popular, partly due to it being promoted as ‘less invasive’, with surgeons even promising patients they will be up and about in a much shorter timescale compared to traditional hip replacement.

As a result, patients often present at their consultation, requesting this type of surgery, but it is important for them to be fully informed of both the potential advantages and the disadvantages of the anterior approach to hip replacement. In fact, two recent large-scale studies have indicated a higher complication rate.

The difference between anterior hip replacements vs the traditional approach

The main difference between these two approaches is the location of the surgical incision. The anterior hip replacement entails an incision at the front, anterior meaning ‘front’, whereas a traditional hip replacement will usually involve an incision either at the side, known as a lateral incision, or from the back which is a posterior incision.

There are fewer muscles situated at the front of the hip and the surgeon can access the joint between them, rather than having to cut through muscle fibres or detach the muscles from the bones and then repair them at the end of the operation. The length of the incision is the same, but the anterior approach is considered to involve less damage to the muscles and soft tissues in the hip, making it ‘minimally invasive’ in comparison to other approaches.

The advantages of the anterior hip replacement

Incurring less trauma to the muscles and soft tissues of the hip during surgery is thought to result in less post-operative pain and an easier recovery in the initial weeks after surgery, making it seem more advantageous in comparison to traditional hip replacement.

However, as with any surgical procedure, there are always potential complications and recent large-scale studies have found that the anterior hip replacement approach could actually have a higher risk of complications and it is important patients are fully informed of these before making a decision on surgery.

Understanding the disadvantages of the anterior hip replacement

Last year’s Frank Stinchfield Award in The Bone and Joint Journal was given to a large-scale comparison of prosthetic joint infection rates. Comparing the direct anterior and non-anterior approach total hip arthroplasty, a review of 6086 patients found a higher rate of infection in the anterior approach.

Published in the March issue of the Journal of the American Medical Association, a study of over 30,000 Canadian hip replacement patients looked at major surgical complications within one year of the initial procedure. The study’s authors found a ‘small, but statistically significant increased risk of major surgical complications’, such as infection requiring surgery, dislocation, or a need for revision surgery.

An easier, less painful recovery will obviously be highly attractive to patients and that’s often perceived as one of the main benefits of the anterior approach, but a recent study casts doubt on the validity of this claim. In a study published in the Journal of Arthroplasty earlier this year and the recipient of the AAHKS Clinical Research Award, there was no evidence found of superior early patient-reported pain scores after anterior hip replacement and there were no differences found between the anterior, posterior or lateral approaches beyond one year, ‘indicating that patients reach similar final symptom states, regardless of surgical approach’.

Between surgeons themselves, the anterior approach is perceived as more technically challenging and it is essential that you choose a surgeon has undergone extensive training and has a great deal of experience in this approach if you’re still considering this option.

For more advice on the advantages and disadvantages of the anterior approach compared to traditional hip replacement, call 020 8947 9524 to arrange a consultation with London hip specialist Mr Simon Bridle.

benefits of a hip replacement

A new study has revealed the surprising benefits of undergoing a hip and knee replacement. It has long been known that joint replacement surgery can reduce pain and improve quality of life. However, now it’s been revealed that it could also benefit your marriage too.

The study carried out in Quebec, Canada, was inspired by a thank you note a surgeon received from the wife of his patient. Here, we’ll look at what the study found and the benefits a hip replacement can provide.

Understanding the study

After receiving a letter from a satisfied spouse of one of his patients, a Canadian surgeon decided to look further into the effects joint replacement surgery has on relationships. The wife had revealed the surgery had improved their marriage and her own quality of life.

It was revealed that spouses often have to become a caregiver within the relationship when joint issues occur. This, in turn, leads to lower marriage satisfaction, poorer quality of life and, in some cases, depression.

The study included 33 couples who were aged 68 on average. The spouses largely reported the benefits of the surgery were the ability to partake in social activities together and not seeing their partner in pain. They were also able to resume their own normal life without taking on the role of a caregiver.

The effect that pain and discomfort have on patients

The main reasons marital problems can occur when a patient is awaiting a joint replacement is pain and discomfort. Arthritis within the joints can prove to be extremely painful. Not only does this cause the patient misery, but it can also limit the range of motion and disrupt their daily routine.

The pain and discomfort felt can take a huge toll on the patient. It can lead to issues with mental health, such as depression. It can also force their partner into a more caregiving role in the relationship.

Patients will also start to avoid doing the things they once loved, such as heading out to social events. It really can impact every aspect of their lives, which is why hip and knee replacements can prove to be an invaluable treatment option.

The benefits of a hip replacement

There are a lot of benefits that come from undergoing a hip or knee replacement procedure. As well as the newly discovered marital benefits, it can also:

  • Ease pain
  • Improve mobility
  • Increased independence
  • Increased life satisfaction

The quality of life attained after a hip or knee replacement has often been the focus of researchers in recent years. One study found meaningful improvement in quality of life lasting at least five years’ after the operation.

So, if joint pain is affecting you – and those closest to you – a hip or knee replacement could be the answer. Arrange a consultation to discover the benefits of a hip replacement.

covid 19 and joint replacement surgery

Yesterday, we saw long queues form on our high streets as many non-essential shops reopened after three months of lockdown. As we move towards something approaching a normal life, attention is also turning towards what’s happening with the healthcare sector – both NHS and independent. Last week, a report from the NHS Confederation, which represents leaders from across the healthcare sector, warned that NHS waiting lists are likely to double to 10 million people by the end of the year.

Furthermore, the NHS still has their contract with private hospitals in place at the moment, meaning that theatre capacity for private patients will also be impacted and significantly reduced compared to normal, depending on how much theatre time the NHS actually take up. Mr Simon Bridle recently wrote to his patients, explaining what impact this will have on his private surgery practice.

“It is not yet clear how the private hospitals are going to allocate theatre time to individual surgeons and patients. They are faced with a large number of operations needing to be done across multiple different specialties. We have been engaged in ongoing dialogue with the hospitals, which has not been easy, as the situation seems to change on an almost daily basis!

“We are hopeful that a prioritisation procedure will be developed to enable fair distribution of resources.  We are lobbying hard for joint replacement patients to be given high priority.  It is accepted that delay is not good for these patients, so I am hopeful in this regard.

“It may be that some operations are offered at fairly short notice, but please bear in mind that the infection control pathway will include two weeks of isolation before admission.”

COVID 19 and joint replacement surgery

In terms of patient safety and COVID 19, Mr Bridle also covered the hard work that private hospitals have been undertaking to make elective hip and knee replacement procedures as safe as possible.

“Our understanding around COVID 19 and how to work safely in hospitals has increased enormously over the last three months. With appropriate infection control pathways, the risk of performing planned orthopaedic surgery is very small and you may feel the risk is worth taking,” hip surgeon Mr Bridle explained. “Although we think the measures that we are taking make the risk of infection as low as possible, it could still occur and some patients may decide to defer surgery for the time being.”

For more advice, get in touch with Mr Bridle’s PA Adriana by calling 020 8947 9524 or emailing bridle@fortiusclinic.com.

hip replacement consultation

Hip replacements are one of the most common joint replacement surgeries. When performed correctly, the procedure can help patients to return to a pain-free, better quality life.

Prior to undergoing the procedure, it is helpful to learn as much about it as you can. While there is plenty of information and advice to be found online, there are some questions you might not think to ask at your consultation.

How many hip replacements has the surgeon carried out?

You may not think to ask how many hip replacements the surgeon has carried out. It is logical to expect them to have experience if they are working as a joint replacement surgeon. However, knowing how many procedures they have carried out can help you to determine the level of risk involved.

Ideally, you will want to see how many replacements they have carried out over the past year. An interesting study carried out in Canada has revealed that surgeons who have carried out fewer than 35 hip replacements per year, were more likely to experience a higher rate of complications.

While the surgeon should be able to tell you, you can also find this information out online. The National Joint Registry is the largest knee and hip registry in the world. You may find it useful to look over the information provided in the registry prior to your consultation.

Which type of material will be used for the replacement?

Hip replacement materials don’t come in a one size fits all approach. There are hundreds of different types of prostheses to choose from. Therefore, it is a good idea to ask your surgeon which type of material they will be using.

Once you know what material is being used, you can research it on the Orthopaedic Data Evaluation Panel. There you will find numerous materials marked with a rating. Ideally, you will want the surgeon to use a material which comes with a 10A* or better rating.

What risks and complications can arise?

While nobody likes to think about what could go wrong during a procedure, there are risks and complications you should be aware of. The most common risks include infection, one hip may sit slightly further down than the other, and dislocation of the replaced joint.

The surgeon will be able to assess your individual risk factor. Being aware of what could go wrong helps you to prepare in advance.

How long will the joint replacement last?

How long your hip replacement lasts will depend upon several factors. Generally speaking, patients can expect their replacements to last around 25 years. However, the surgeon will be able to give you a more accurate timeline based upon the type of replacement used.

Undergoing a hip replacement can be daunting. The consultation gives you the opportunity to ask the surgeon questions about the procedure and what you can expect. The above are some of the questions you might not have thought to ask but which could prove useful prior to the procedure.

Despite the current COVID 19 crisis, Mr Simon Bridle is still available for consultations. He will be able to see clinically urgent cases in his clinics, but most consultations will be remote by telemedicine, either telephone or video link. Appointments can be arranged by contacting his PA Adriana, or by contacting the appointments team at Fortius Clinic, Parkside Hospital or St Anthony’s Hospital.

Contact details:

Adriana: 020 8947 9524 or bridle@fortiusclinic.com
Parkside Hospital: 020 8971 8026
St Anthony’s Hospital: 020 8335 4678 or 020 8335 4679
Fortius Clinic: 020 3195 2442

surgery risks and COVID-19

Recently, we took a look at what the future of elective surgery could be in light of the COVID-19 pandemic. Hospitals and surgeons here in the UK are obviously watching closely the experience in other countries and reviewing the data on potential increased surgical risks at this time.

A large international study has just been published in the Lancet Online, looking at the risks associated with Coronavirus infection after major surgery.  This multi-centre study gathered data from 235 hospitals in 24 countries on patients who underwent surgery after a Coronavirus infection was confirmed within 7 days before or 30 days after surgery.

Encompassing 1,128 patients, the study found that postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Risks were higher with emergency surgery, male patients, patients over 70, patients with cancer or other serious health problems and patients undergoing major surgery.  One interpretation that the study authors drew was that the thresholds for surgery should be higher than in normal circumstances for these groups, particularly in men aged 70 years and older.

For more advice, Mr Simon Bridle is still available for consultations, either by telephone or video link. Consultations can be arranged by contacting his PA Adriana, or by contacting the appointments team at Fortius Clinic, Parkside Hospital or St Anthony’s Hospital.

Contact details:

Adriana: 020 8947 9524 or bridle@fortiusclinic.com
Parkside Hospital: 020 8971 8026
St Anthony’s Hospital: 020 8335 4678 or 020 8335 4679
Fortius Clinic: 020 3195 2442

joint replacement risks

For the most part, joint replacement surgery is effective at helping patients live a pain-free, more mobile life. However, like any surgery, it does pose several risks and complications.

While relatively rare, infection can occur after a knee or hip replacement. This is a devastating risk which requires immediate treatment.

Celebrity Olly Murs has recently revealed his struggle with an infection which occurred after his knee replacement. The metal plate within his knee became infected, causing the star to be rushed to hospital. Obviously experiences like this are very worrying and could cause you to think twice about undergoing the procedure. However, it is important to stress the risk of infection is minimal.

Below, you will learn more about infections brought on after a joint replacement and the importance of risk management prior to the procedure.

What causes an infection after knee or hip surgery?

There are numerous potential causes of infection after a knee or hip surgery. The most common is when bacteria enters the wound. It is estimated that one in every 100 patients will develop an infection around the implant, or within the wound.

Infections can occur at any time after the treatment. Some are present immediately after the surgery, while others make take weeks, months or even a year to appear. Some patients are deemed at an increased risk of infection including those with:

  • Diabetes Mellitus
  • Obesity
  • Immunity deficiencies
  • Immunosuppressive treatments

An infection could also occur if bacteria enters the body through a separate procedure such as a root canal.

The symptoms of an infection

If the hip or knee does become infected, you will experience several symptoms. The wound may appear red and feel warm to the touch. There may also be swelling, alongside increased pain and stiffness around the joint.

When the body is infected, you will also commonly experience fever, chills and night sweats. If you notice any of these symptoms after undergoing the procedure you should contact your surgeon immediately.

Assessing the joint replacement risks

While infections do occur, there are ways to minimise the risks. Ensuring you choose a reliable and experienced surgeon is of paramount importance. They will be efficient in risk management, ensuring measures are taken to reduce joint replacement risks.

MRSA screening will be carried out to ensure patients are not at a high risk of infection. The hospital or clinic will also be cleaned extensively. Generally speaking, private hospitals tend to be much cleaner than public ones. This is because most offer patients’ private rooms rather than open wards. They also tend to focus more on elective surgeries.

Patients who are discovered to have an increased risk of infection can also be placed onto antibiotics. This will prevent infection, alongside attending follow up appointments for monitoring.

Hip and knee replacements are generally considered a safe and effective procedure. However, patients do need to be aware of the risks involved so they can take precautionary measures if needed. The risk of infection is low and can be reduced further if you ensure you choose an experienced and qualified surgeon.

Despite the current COVID 19 crisis, Mr Simon Bridle is still available for consultations. He will be able to see clinically urgent cases in his clinics, but most consultations will be remote by telemedicine, either telephone or video link.

Appointments can be arranged by contacting his PA Adriana, or by contacting the appointments team at Fortius Clinic, Parkside Hospital or St Anthony’s Hospital.

Adriana: 020 8947 9524 or bridle@fortiusclinic.com
Parkside Hospital: 020 8971 8026
St Anthony’s Hospital: 020 8335 4678 or 020 8335 4679
Fortius Clinic: 020 3195 2442

elective surgery post Covid

In mid-March, all non-urgent elective surgery was cancelled in both the NHS and private sector in response to the COVID-19 pandemic. With numbers of infections and related deaths falling daily, Health Secretary Matt Hancock recently announced that some healthcare services would resume over the next few weeks.

Certain areas were to be prioritised, including cancer care, acute cardiac surgery, cardiology services and the management of patients with severe heart failure and stroke services. In a letter to NHS trusts from NHS England’s chief executive, a further directive was that hospitals should also restart routine elective procedures where additional capacity was available, prioritising those with long waits.

So, what does this mean for planned hip and knee replacement surgery? As London hip & knee replacement surgeon Mr Simon Bridle explains, performing major surgery during a pandemic is potentially high risk, with one small scale study from Wuhan, China, that found 20% mortality rates in patients that underwent major surgery during the height of the pandemic there.

Both private and NHS hospitals will need to adopt brand new infection control processes to minimise these risks. These clean hospitals will be called green centres, with hospitals that treat COVID-19 patients deemed blue and the principle is try and keep green and blue apart.  Patients admitted to a green hospital will need to isolate prior to their admission and have a negative COVID-19 swab prior to admission.  Green hospitals will have very stringent infection control policies and pathways in place.

The exact role of the private sector is unknown at this moment. The NHS’s contract with the private sector that is currently in place will end in June. It may well be that in some areas, the NHS will choose to use private hospital as green centres for elective surgery.

Although we hope to resume joint replacement in some patients in the next few weeks, it may be some months before joint replacement surgery is carried out as a matter of course. Patients’ individual risk will be analysed and this will inform decision making between the surgeon and patient about proceeding to surgery, bearing in mind that many patients are in pain and losing their mobility and independence as a result of joint deterioration. Patients will have to accept a small increased risk, which will be weighed against those of not going ahead with surgery at this stage.

To discuss how we are planning to deal with the COVID-19 pandemic and the implications of delaying joint replacement surgery in more depth with Mr Simon Bridle, he is currently offering remote consultations, either by telephone or video link, and face-to-face consultations when necessary. Consultations can be arranged by contacting his PA Adriana by calling 020 8947 9524 or emailing bridle@fortiusclinic.com.