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.

Self-Pay Market for Hip and Knee Replacements

The Coronavirus pandemic has caused havoc across the healthcare sector. As hospitals were required to focus on COVID patients, millions of non-emergency operations were cancelled or put on hold.

Patients who were scheduled for elective – although often much-needed – procedures such as hip and knee replacements have been particularly affected with delays and cancellations. This has led to many arthritis sufferers seeking private surgery. Here, we’ll discuss the rise in the self-pay market during the pandemic.

Patients face a wait of up to two years for procedures

One of the main driving factors behind the rise in the self-pay market has been the significant delays patients face for procedures. As the NHS has had to focus on dealing with the COVID crisis, non-urgent operations have had to be put on hold. In some cases, patients have even been told that their procedures cannot be carried out for another two years.

Patients who are waiting for joint replacement procedures typically live in pain with significant restricted mobility. The prospect of waiting another two years surgery can therefore be devastating. This is one of the main reasons why patients are choosing to head down the self-pay route.

Private hospitals are considered safer during the pandemic

Another reason COVID is driving an increase in private care, is because it is perceived as a safer option. Private hospitals treat a smaller number of patients and are not admitting emergency patients. It is much easier to establish COVID free pathways and having mainly private rooms mean that they are better able to keep people socially distanced than in an acute NHS hospital, who are likely to be looking after COVID patients.

Understandably patients are concerned about going to hospital during the pandemic, worrying that they are at risk of COVID-19 due to potential exposure to other patients. Booking the procedure privately is seen as a safer option.

Fears over second lockdown

It is looking increasingly likely that there will be a second national lockdown. The first lockdown obviously caused a significant backlog. So, if a second lockdown is introduced, it could once again lengthen the time patients need to wait to receive their treatment. So, to avoid having their hip replacements delayed once again, patients are turning to self-pay options.

Due to widespread NHS rationing of treatments and record long waiting lists, the self-pay market was soaring prior to the Coronavirus crisis and had seen a doubling of growth between 2014 and 2018 to £1.1bn. At the beginning of the year, market analysts LaingBuisson forecasted that this would continue to grow to £1.3bn by 2021.  These figures will need to be readjusted to account for a global pandemic, however it feels safe to say that self-pay hip and knee replacements will only become a more attractive option in the future.

hip replacement alleviates poor sleep

A bad hip isn’t just uncomfortable, it can also significantly impact your quality of life. Over time, the hip can start to wear down, making it more vulnerable to impact. One solution you may have considered, is to have the hip replaced.

Hip replacements are a common treatment option, particularly amongst older patients. The question is, how do you know if you need one? Below, you’ll discover 5 signs you may need a hip replacement you’ll want to pay attention to…

  1. The hip is very stiff

One of the most common signs you may need a hip replacement is if it is very stiff. It isn’t uncommon to experience stiffness in the joint every now and again, but if it’s affecting your daily life it’s a problem.

For example, if you find it difficult to put your shoes and socks on, particularly on one foot, it could be an indicator you need a new hip. Additionally, you’ll also potentially hear and feel clicking, popping or grinding in the hip.

  1. You suffer with pain in the groin and thigh area

Perhaps the easiest sign to watch out for that you may need a hip replacement, is pain. Pain around the hip can occur in a number of areas.  If your pain is in the groin, thigh or knee, it could be a sign there is something wrong with the hip joint.

You’ll know there is a problem if you find it difficult walking or carrying out daily activities without pain.

  1. It disturbs your sleep

When there is a problem with the hip joint, it can make sleep particularly difficult. The pain often keeps patients awake, contributing to fatigue and lowering quality of life. When hip pain and discomfort is ruining your sleep, it could be a sign you need surgery as often a hip replacement alleviates poor sleep.

  1. The one leg test

A simple test you can carry out to see if you do have hip issues, is the one leg test. This involves standing on one leg for around one minute. If you struggle to do this, even when holding onto something for support, it’s a clear sign you could have a hip issue.

  1. You don’t get any relief from other treatments

Finally, another sign you may need a hip replacement, is that you don’t get any relief from other treatments. The majority of hip troubles don’t require a hip replacement. They will respond to different types of treatment like physiotherapy or medication.

So, if your hip problem isn’t going away after trying different treatments, a hip replacement could be required.

These are just 5 signs you may need a hip replacement. The general takeaway is that if your hip isn’t affecting your quality of life or stopping you doing daily tasks, you likely won’t need a replacement. However, it is a good idea to book a consultation with a hip specialist if you are experiencing any issues. During your consultation with Mr Simon Bridle, he will be able to identify the cause of the problem and recommend the best course of treatment. Appointments can be arranged by contacting his PA Adriana on 020 8947 9524 or email bridle@fortiusclinic.com.

non-surgical hip treatments

Hip replacement is an extremely effective way to eradicate pain and improve mobility for patients with hip arthritis. However, they aren’t always the only option available. If you want to sort your hip troubles out without going under the knife, there are some non-operative alternatives you’ll want to consider first.

Here, we’ll look at some of the best alternatives to hip replacement surgery available.

Conservative therapies could delay need for hip replacement

A clinical study conducted in Norway, has revealed that conservative therapies could delay the need for hip replacement surgery. However, it only applies to those suffering with osteoarthritis.

The cluster randomised trial developed a program based on international treatment recommendations. This included a three-hour patient education session, alongside 8-12 weeks of individually created exercises supervised by physiotherapists. There were 393 patients included in the study and 284 of them took part in the specialised program.

Just 64% completed the program and went through a 12 month follow up. This revealed the majority had seen significant improvement. So, conservative therapies could delay the need for a hip replacement in those with hip osteoarthritis.

Injections to relieve hip pain

Another non-surgical hip treatments option is for patients to undergo injections to manage inflammation. These include corticosteroids and hyaluronic acid injections. They are good for patients suffering from inflammation in the lining of the joint.

You will also find newer stem cell injections available at some clinics too. These consist of injecting stem cells into the hip to help it develop additional bone or cartilage. However, there is very little evidence to support the effectiveness and safety of these injections – we covered this in more detail in an earlier blog post.

Unfortunately, injections can sometimes make the problem worse, rather than better. For this reason, many experts advise against them. If you are considering injections, make sure you talk to a specialist hip surgeon beforehand.

Cartilage transplant

A surgical alternative is to undergo a cartilage transplant, if there is only a small area of cartilage damage. Cartilage will be grown by a specialist team before it is inserted into the damaged area. The cartilage may also be placed to encourage the bone to produce more cartilage naturally. This remains an experimental procedure and at the moment is not likely to be a useful technique in patients with established osteoarthritis.

Partial replacement

A partial replacement is another option if the area of cartilage damage is only small. However, this will still involve going under the knife and having smaller artificial parts fitted. This technique is not well established, so has to be used carefully and is only likely to be useful in a very small proportion of patients.

As you can see, there are alternatives to full hip replacements. The recent study has shown how effective conservative treatments can be. However, if the damage is extensive the best option remains a full replacement. Always talk to your surgeon about the options available to see which would best match your needs – to arrange a consultation with leading London hip surgeon Mr Simon Bridle, contact his PA Adriana on 020 8947 9524 or email bridle@fortiusclinic.com.