A hip replacement is a very effective treatment for a damaged or worn out hip joint. This can occur for a multitude of reasons, most commonly osteoarthritis or 'wear and tear'. Other causes include inflammatory conditions such as rheumatoid arthritis, previous trauma or a consequence of childhood hip disorders. When do I need a hip replacement? If you have significant arthritis and pain and stiffness are interfering with your lifestyle. A hip replacement should cure the arthritic pain and improve your mobility, but there are risks of surgery and potential complications. You must have sufficient symptoms so that the benefits of surgery outweigh the risks. What can I expect from my new hip joint? A total hip replacement should abolish your hip pain and usually improves the hip range of movement depending on the pre-operative stiffness. However, a joint replacement of whatever type is not as good as a normal hip joint. There are certain movements to avoid that could lead to a dislocation. Some recreational sports are possible such as tennis, skiing, cycling and swimmimg. Artificial hip joints, like any piece of machinery, wear out. The lifespan of the new joint depends on its use, as well as the components used, bone quality and how well it is implanted. What types of hip replacement are there? There are many different types of hip replacement on the market. The socket is either cemented or 'press-fitted' into place. Likewise the femoral component is either cemented or 'press-fitted' into the shaft of the femur. There are many combinations of bearing surface from the traditional metal on polyethylene, to ceramics and metal on metal bearings. I generally use an Exeter stem which has an excellent track record in all the hip replacement registries worldwide. For more information, visit the Exeter website.

Knee joint replacement is a very effective treatment for the painful arthritic knee. What is the most common type of knee arthritis? Osteoarthritis is the most common type of knee arthritis. Also called wear-and-tear arthritis or degenerative joint disease, osteoarthritis is characterised by progressive wearing away of the cartilage of the joint. As the protective cartilage is worn away by knee arthritis, bare bone is exposed within the joint. Who develops knee arthritis? Knee arthritis typically affects patients over 50 years of age. It is more common in patients who are overweight, and weight loss tends to reduce the symptoms associated with knee arthritis. There also seems to be a genetic predisposition for this condition, meaning knee arthritis tends to run in families. Other factors that can contribute to developing knee arthritis include trauma to the knee, meniscus tears or ligament damage, and fractures to the bone around the joint. When do I need a knee joint replacement? When your day-to-day activities such as getting up from a chair or going up or down stairs are limited by knee pain or you are waking at night with pain. Essentially when pain from your arthritic knee is significantly affecting your quality of life, and you have tried other non operative measures, it is time to consider knee joint replacement surgery. What is a knee replacement? The worn joint surfaces are removed with precise bone cuts and replaced with metal components with a plastic insert as the new bearing surface. Sometimes it is necessary to place a plastic button on the undersurface of a worn knee cap. For a fairly comprehensive overview of knee joint replacement please click here for a link to the Arthritis Research UK website.

Computer navigation surgery is utilising infra-red and computer technology to build up a 3D digital model of the knee and leg alignment. This is used to accurately guide the bone cuts and soft tissue releases required to implant a knee replacement in the correct alignment. Click here for more information Computer Navigated Knee Replacement (PDF, 3.2 MB)

A hip or knee replacement will eventually fail. The reasons for revision surgery are many but the most common is loosening of the implants. Wear of the bearing surface combined with fluid pressure effects around the joint will cause the components to loosen from the bone over time. The usual symptom is pain in a joint that has been previously fine for many years. Revision surgery is more complex than a first time joint replacement. It takes longer and the complication rates are higher. Reconstruction techniques required are dictated by the amount of bone loss encountered.

This is a technique pioneered in Exeter and Nijmegen to restore bone stock at revision hip surgery. Femoral head bone from the bone bank is ground into small pieces using a bone mill. This is then impacted into either the socket of the hip joint or down the femoral shaft using special instruments. The new joint components are then cemented into the impacted bone. Host bone grows into, and replaces this bone over time thereby restoring bone stock.

Many knee conditions can be treated with 'keyhole surgery'. A fibreoptic camera is introduced into the knee via a small 1cm incision allowing inside of the joint to be visualised. Further incisions are then made to allow other instruments to be passed into the knee to do the procedure required. The advantage of arthroscopic surgery is a quicker recovery time. Often a better view is attained of various parts of the knee than at open surgery. Usually procedures are done as a 'day case'. Click here for the Arthroscopy post op instruction sheet. Arthroscopy Post-op Instructions (PDF, 421.5 KB)