Aching Joints? Discover how to get back to the activities you love
Mr David Shardlow, Consultant Orthopaedic Surgeon at Circle Bath Hospital is urging people to get more active to reduce the demand on our hip and knee joints.
“Many of us get aching in our joints, and the prevalence increases with age. For some, it is related to specific activities and may be associated with mild wear and tear changes in the joints. However if you have pain in multiple joints, especially associated with joint swelling, it would be wise to consult your GP, who might wish to consider whether you are suffering from systemic arthritis, of which rheumatoid arthritis is one variant,” explains, Orthopaedic Consultant, Mr David Shardlow
Pain in the knee doesn’t always come from the knee itself, so your surgeon will take a thorough history from you, and conduct a physical examination, in order to diagnose other causes of knee pain, such as hip or back problems. It’s not uncommon to find that patients with knee pain actually need a hip replacement instead.
There isn’t a right age to have a hip or knee replacement, but there is a right time for each patient, and this is a relatively complex decision to be made between each individual patient and an orthopaedic surgeon such as those practising at Circle Bath Hospital. Hip and knee replacements for patients in every decade from their thirties to their nineties are not unusual, but surgeons always take into account the patient’s pain and functional restrictions, the balance of risk versus benefit, and the sustainability of arthroplasty over the patient’s lifetime.
If a previously successful hip or knee replacement becomes painful years after implantation, this can be a sign that it is becoming loose. It certainly merits a consultation with your GP, probably an X-ray, and often an opinion from an orthopaedic consultant.
What patients want is a pain-free hip which functions well. Patients often describe feeling hip pain in the groin, buttocks, upper thigh as well as the outer pelvic bone. Hip replacement surgery is very successful in relieving pain. Patients notice the day after surgery that the pain has gone.
“Total knee replacement is a very prevalent operation - approximately 100,000 primary total knees are added to the UK National Joint Register each year www.njrreports.org.uk.The risk of a surgical complication is around 4 or 5%, varying with increasing age, co-existing health problems and weight*. In large surveys, 80 to 85% of knee replacement patients rate their outcome as ‘good’ or ‘excellent’** and would recommend it to a friend,” says, Orthopaedic Consultant, David Shardlow
The choice to have a unicompartmental (partial) knee replacement definitely requires discussion with your knee specialist. Only a proportion of patients are suitable - arthritis needs to be confined to one part of the knee, most commonly the inner half of the main knee joint. Patients with a fixed deformity at the knee, most often a bow-legged deformity or inability to fully straighten the knee, would be better served by a complete knee replacement which allows correction of the deformity as part of the procedure. However, for those patients where a unicompartmental knee is suitable, it offers a smaller operation (and smaller incision), quicker recovery and better function, which need to be balanced against a higher revision rate compared to total knee replacement.
There are many exciting advances in hip and knee surgery, which as professionals we are constantly evaluating in order that we adopt those with genuine advantages for our patients. One example is the Mako robotic arm-assisted surgery for hip and knee joint replacements. For patients at an early stage, it is possible to take cartilage cells from the knee, multiply them in a laboratory, and re-implant them to repair isolated cartilage defects. Injured menisci (the knee cartilage structures often injured during sport) can be debrided, repaired and even transplanted. Perhaps most exciting is the use of a surgical robot to assist with the bone resection prior to inserting the knee prostheses, which holds the promise of even greater consistency.
Once the hip or knee pain becomes intrusive, perhaps disturbing sleep or impacting on daily activities, it is a good idea to consult a knee specialist. Your GP can help you decide when the time is right, provide advice on non-surgical options and when it is appropriate to progress to seeing an Orthopaedic Consultant. Insured and self-pay private patients can access treatment more directly.
Circle Bath Hospital benefits from world-class, state-of-the-art facilities and is a recognised centre of excellence for hip and knee surgery. Don’t be concerned about a surgical consultation. Even when we consider that surgery would be beneficial to you, we never pressurise patients, and the offer of surgery is always just that, an offer for you to accept or decline.
The best way to preserve our hips and knees is to keep our weight under control and to take regular exercise. Recreational walking, cycling and swimming, and a gym program can all help with weight control, stave off diabetes and osteoporosis, and keep the joints healthy. Many patients find yoga and/or Pilates very helpful. Keen runners should change their shoes regularly to preserve the cushioning effect of the sole.
*For complications - SooHoo NF, Lieberman JR, Ko CY, Zingmond DS. Factors predicting complication rates following total knee replacement. J Bone Joint Surg Am 2006; 88(3): 480-5.
**For satisfaction - Kahlenberg CA, Nwachukwu BU, McLawhorn AS, Cross MB, Cornell CN, Padgett DE. Patient Satisfaction After Total Knee Replacement: A Systematic Review. HSS J. 2018;14(2):192-201.