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

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
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
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
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

stem cell therapy for knee or hip arthritis

All medical care, whether that’s drugs, surgical solutions or devices, should be both safe and effective. In recent years, stem cell therapy has become increasingly in the public eye, particularly in the treatment of arthritis and joint deterioration, and covered widely in the media as the supposed wonder cure. But does it fulfil those two criteria: is stem cell therapy safe and effective?

In a recent article published in the Bone and Joint Journal, Members of the Biologics Association, an international group established to advocate for the responsible use of biologics in clinical practice and to assess the safety and efficacy of biologic interventions, highlighted the growing concern that clinical centres around the world are making “unwarranted claims or are performing risky biological procedures”.

Stem cell therapy is a fast-growing industry around the world with clinics claiming to be able to treat a wide range of conditions, from erectile dysfunction to autism, often with little scientific evidence to back their claims. It is also increasingly advertised as a solution to joint wear and tear.

The premise is that the patient’s own stem cells are harvested, usually from your bone marrow or adipose tissue, processed and then delivered into the affected joint, thereby using your body’s own healing powers to reverse the natural deterioration that occurs over time. Stem cells are able to differentiate into specialised cells, so may be able to replace damaged cells, including cartilage cells in the joint. It is also possible that they can cause growth factors to flood the joint, helping to repair any damage

Is stem cell therapy for knee or hip arthritis safe?

Stem cell therapy using adult stem cells is generally considered safe because the cells are taking from the patient and therefore the risk of a reaction are minimised. Common side effects are usually swelling and pain at the injection site but that is usually temporary.

Treating knee or hip arthritis is less likely to result in complications compared to some of the other uses of stem cell therapy, but there is some research that suggests it may increase the risk of tumours developing.

Is stem cell therapy effective?

Setting aside whether stem cell therapy is safe, the other consideration is its efficacy. Proponents will cite anecdotal evidence of positive results, but no large-scale studies have taken place and some evidence suggests that it doesn’t work any better than a placebo. The challenge is that there is no standard treatment which can be tested – every clinic may follow a different process and there is no guide as to how many stem cells need to be harvested to treat specific conditions.  At the moment evidence that there is any benefit from stem cell treatment is limited, despite some of the claims made.  For this reason, it is important that this therapy is properly evaluated in a scientific manner in properly controlled clinics.

The recent article in the Bone and Joint Journal also pointed out that certain clinics are being less than scrupulous in how they exploit the hype surrounding stem cell therapy and may be guilty of false advertising, making it harder for the prospective patient to evaluate the safety and efficacy of the treatment offered.  Stem cell treatment can be very expensive and it is important that patients understand that this remains a relatively experimental intervention, before agreeing to undergo this treatment.

“Regenerative medicine is one of the most dynamic fields of science and medicine. While cell-mediated tissue formation and repair characterize all of biology, the prospect of specific augmentation of cellular processes through harvest, processing and transplantation remain in their early stages of development… The challenge facing regulators is to balance increasing calls for faster access to medical products, while protecting the public from unnecessary risks including delayed effective treatment, adverse events and financial loss.”

During this current unfolding situation with Coronavirus, 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 on 020 8947 9524 or email

Coronavirus and private healthcare

The advent of Coronavirus has resulted in the immediate and complete cessation of all private, elective surgery and medical care, with the agreement made in March between the private healthcare sector and the NHS. The independent sector agreed to reallocate almost all of its hospital capacity to the NHS, involving 8,000 hospital beds, over 1,000 more ventilators and many thousands of nurses, doctors and clinical staff.

As NHS hospitals clear the decks, cancelling all routine operations such as hip and knee replacements for the next three months, it does mean there will be many left in limbo with no idea of when they will be able to undergo a much-needed operation.

Earlier this year, we covered a recently published study that highlighted the importance of joint replacement timing; specifically, leaving it too long could have negative implications, such as a greater risk of surgical complications and potential issues with the effectiveness of the surgery in terms of mobility and function.

So, although the demand for joint replacement surgery will likely not decrease, Coronavirus may impact how we provide patient care in the private sector in the future.

Medical consultations post-Coronavirus

The UK Government’s current Stay at Home policy means we have all had to embrace new technology, such as Zoom, Facetime or Skype, to stay in touch with family and friends or to work effectively from home. Remote consultations, follow-up appointments and access to imaging could all become more widespread in the future to minimise risks for patients.

This will affect both the NHS and the private healthcare sector. From this April, all NHS General Practices in England and Wales were expected to be able to provide online consultations and, from next April, they will be required to provide video consultations.

The General Medical Council’s basic good practice principles should apply to both remote and in-person consultations. The onus on practitioners is to obtain adequate patient consent, ensure patient confidentiality and make an appropriate assessment of symptoms. It is important that the patient is aware of any potential limitations of the clinical assessment that can be made remotely. As practitioners, we must be aware that we are communicating clearly and that we can deliver high-quality audio-visual technology.

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

Parkside Hospital: 020 8971 8026

St Anthony’s Hospital: 020 8335 4678 or 020 8335 4679

Fortius Clinic: 020 3195 2442

hip arthritis

Hip pain is something that many people suffer from and it can be caused by a wide variety of factors. Here we explore some of the common causes of hip pain and look at whether or not these should be cause for concern.

Trochanteric bursitis

This condition results from inflammation of the greater trochanter, which is part of the hip joint. Symptoms include localised pain when sleeping in particular ways or walking up steep gradients. It is possible to seek help for this kind of condition from a rheumatologist, and it is also recommended to take guidance on pain medications and undertake some stretching exercises.

Hip arthritis

This is one of the most common reasons people have hip pain, and it is particularly common in older people. Hip arthritis causes inflammation of the joint which can restrict mobility and cause much discomfort, it also causes the cartilage that protects your hip joint to wear away, leaving it more vulnerable. Arthritis won’t get better on its own, so if you are worried that you may be experiencing it then it is important to seek medical advice.

Simply overdoing it

Some of us are just guilty of pushing ourselves too far and making our joints and/or muscles ache as a result of the activities we choose to do. You may have strained muscles or tendons, which usually get better of their own accord after a few days of causing discomfort. This should, however, act as a gentle reminder that you need to be mindful of your body’s limitations, especially if you’re getting a bit older.

More brittle bones

As we get older, our bones become more prone to breaks and fractures, they become less robust as they age. If you have had a fall or a trip and are subsequently feeling hip pain that you didn’t have before, you may have fractured your joint and will require an X-ray to diagnose this for certain.

Knowing when to ask for help

In the early stages of hip discomfort, advice indicates that it is often possible to manage this with a combination of rest, a change in the intensity of physical activities you choose to do, a course of anti-inflammatory over the counter drugs and targeted stretches/exercises. However, if the pain is not helped by these strategies, or it appears to be worsening then listen to your body and make an appointment for an orthopaedic assessment to get your joint checked out.

knee and hip surgery

Even before the advent of COVID-19, our A&E departments were recording record waiting times and it is the same for many overstretched GP surgeries. Unfortunately, the picture is the same across so many parts of the NHS; demand for services is currently far higher than the available supply.

Long wait for hip and knee surgery

A new report published recently in the Telegraph claims “patients in need of a new hip or knee are increasingly being left in agony for more than a year”, which is a worrying statistic for degenerative conditions such as these, were waiting for a long time before receiving treatment can have a detrimental effect on the effectiveness of the procedure.

The report goes on to explain “the figures show that in 2018/19, 55,251 patients waited at least 18 weeks for hip and knee surgery – a more than doubling from 25,704 such cases in 2013/14.” While this in itself is frustrating it also means that a large number of people who are eligible for a hip or knee replacement are having to wait while experiencing significant pain in their failing joints. According to data published by the Daily Mail, the pain experienced by some is excruciating, and the waiting times are just not sustainable. “Some 19 per cent of those waiting for a hip replacement were in extreme pain. The figure was 12 per cent for those waiting on an artificial knee…The level is so poor it is defined by experts as ‘worse than death’ – more painful than chronic health conditions such as diabetes, heart failure or lung diseases.”

How concerning is this?

To contextualise the scale of the problem, there are around 175,000 hip or knee replacement operations carried out in England, Scotland Wales each year. Eligibility for the procedures is generally because the cartilage that holds the hip or knee joint in place has started to disintegrate or become worn away. There are a variety of different factors that can cause this to occur, but a it generally occurs in older people whose joints have naturally undergone more wear and tear or those who have developed conditions such as osteoarthritis. Some younger patients who are particularly active in high impact sports can suffer as well.

Hip replacements are typically carried out amongst those aged 60 to 80 (although there are increasingly younger patients who are in need of this type of procedure too). Once a patient has reached the stage of needing one of their joints replaced, their mobility will be impaired, and it is likely that they will be in a significant amount of discomfort. The longer they wait, the worse it will become, and the greater the chance of needing further work along the line.

This pressure on the NHS to deliver this type of surgery increases the reliance on the private sector, a development that London orthopaedic surgeon Mr Simon Bridle has noticed in his London hip and knee clinic.

benefits of robotic joint surgery

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

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

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

Who is really in charge?

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

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

Patient safety at the heart of everything

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

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