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

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 bridle@fortiusclinic.com.

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.

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.

Hip and knee replacement surgery can be life-changing for those who are suffering from deteriorating joints. The pain and limited mobility are likely to have been holding you back from many things that you enjoy, and the operation can restore a great deal of this back again. For some patients, just walking around again, being able to go up and down stairs or undertaking gentle exercise is rewarding enough, whereas others may wish to return to much more strenuous leisure pursuits.

Skiing is one of these pursuits that we discuss with a number of our patients. For those who have enjoyed winter ski holidays for many years, they can worry that needing a hip or knee replacement might signal the end of this pastime. Encouragingly, this is not often the case.

Whether or not you can ski after a knee or hip replacement largely depends on your level of competency before you had your operation. If you were already a competent skier then there is no reason why, in time, you can return to skiing again. If you are a complete beginner, then it is really advisable to choose a different hobby to learn. Learning to ski after you have had a hip or knee replacement is not a very sensible choice as all novice skiers take their fair share of bumps, falls, knocks and jolts – none of which are ideal for a replacement joint.

Skiing after a hip replacement: walk before you can run – so to speak

It is important to understand that you will need adequate time to recover from hip or knee replacement surgery. As a rule of thumb, you shouldn’t consider an activity such as skiing for at least three to six months after you have had the operation and, even then, you should be prepared to take it nice and easy. A ski holiday this soon after surgery really should involve nothing more strenuous than building your strength back up on nursery slopes. If you push yourself too hard, too soon, then you risk damaging your joint and wishing you had been more patient.

Skiing after a hip replacement: take sensible precautions

If you decide to ski, there are also decisions during the trip you can make which limit the risk to your new joint. Check the weather reports and avoid icy conditions. If you become tired, call it a day, as you are much more likely to fall when fatigued.

In summary, skiing is a sport which gives a lot of pleasure to many people. Being able to enjoy the snow, the speed, the scenery and the overall experience is something that many of us enjoy; although it is not without risk for anybody. Anyone can injure themselves skiing, no matter how careful or experienced they are. For patients who have had a hip or knee joint replaced, the main concern is a bad accident can cause a more complicated problem than if the patient had not had a replacement. For skiers who have had replacement joints, it is a case of weighing up the level of risk and making an informed choice whether or not returning to the slopes is the right decision for them.

For more advice on skiing after a hip replacement, call 020 8947 9524 to arrange a consultation with London hip expert Mr Simon Bridle.