robotic-assisted knee replacement in Bristol

Robotic-assisted knee replacement now available for Mr Webb’s Bristol patients

Knee replacement techniques and instrumentation have undergone constant improvement since this type of orthopaedic surgery was first performed. The introduction of robotic-arm assisted technology is the latest development in this field and Mr Jonathan Webb is delighted to be able to offer this innovative technology to his patients.

He has been performing this surgery since January 2018 in his London practice and now Bristol patients are able to experience the many benefits of the Mako Robotic-Arm Assisted Technology, including greater accuracy, shorter hospital stays, quicker recovery and increased patient satisfaction.

The technology can be used for both partial and full knee replacements. Prior to your operation, a 3D CT scan is taken on your body and the data fed into the Mako software.

How robotic-assisted knee replacement works

At the start of the surgical procedure, Mr Webb can utilise the additional information provided by the MAKO in planning exactly where to place the components of your knee replacement so as to make the ‘fit’ as comfortable as possible.

Having established what he feels is the ideal placement for each individual patient, Mr Webb uses the robotic-arm assisted technology to guide surgical tools to shape the knee to accept the new replacement. During the surgery itself, Jonathan is always in control of the robotic-arm but guiding it to within millimetre accuracy.  Clinical data points to a shorter stay in hospital being required and a speedier recovery process when you return home. There also is evidence that patients feel less pain in the early phase of recovery.

The Chesterfield Hospital in Bristol is the latest Nuffield Hospital in the UK to take delivery of the Mako technology. To find out more about the potential benefits of this technology and whether you’re suitable for a robotic-assisted knee replacement, call 08450 60 44 99 or email laura.claremont@nuffieldhealth.com to arrange a consultation with Mr Jonathan Webb.

knee injury diagnosis

New mini MRI scanner could improve knee injury diagnosis

Magnetic Resonance Imaging: it’s a thing of medical brilliance. A large tube packed with strong magnets that shoot out radio waves, its ability to safely and effectively visualise tissue has transformed the field of medical diagnosis since its development in the 1970s. An MRI scan can get to almost any part of our bodies, particularly the brain, the spinal cord, breasts and other internal organs.

One part of the body where the MRI scanner can fall short, however, is the knee. Due to the size of the scanner, certain key components of the knee are tricky to pick out on current MRI technology. And due to the effectiveness of MRI scans in other, more life-threatening conditions, people in need of a knee scan are being put at the end of a long waiting list.

However, that wait could be getting shorter in future, if a research study recently conducted by scientists at Imperial College London bears fruit. They’ve produced a prototype of a miniature MRI scanner designed to be fitted around the knee. And not only does it work better on the knee than its larger counterpart, but it’s also small enough to be based or rented out to your local clinic or even your GP surgery.

Why do standard MRI scanners find it hard to examine knees?

While an MRI scan can easily pick out the components of other parts of the body, it’s a lot trickier with the knee. And that’s because of the way water molecules are arranged in our tendons, ligaments and meniscus. Those structures are mainly made from collagen, a protein which knits itself into fibres.

As those fibres cling onto water molecules extremely tightly, they show up as blocks of black on a standard MRI scan, giving off the impression that there is more fluid around the knee than there actually is, which makes it tough for medical staff to make a call on the actual state of the area.

Introducing the Magic Angle

Due to the reduced size of the prototype scanner, however, the research team claim it can deploy what they call a ‘magic angle’ – the ability to come at the joint from a whole new perspective which produces a sharper, brighter image. This is achieved by a specially-designed magnet, which can whizz around the knee area and help build up a fuller picture – something that a standard scanner simply can’t do.

The prototype scanner has already been tested out on goats and dogs (as both animals can suffer knee injuries similar to those found in humans), and the results were extremely positive. Now the research team are looking forward to trying it out on humans within the year – and if all goes well, potential knee problems could well be picked up on without a trip to the hospital, which could take a lot of work and expense out of the NHS and help doctors come to a swifter and more accurate knee injury diagnosis.

knee replacement checklist

Now you can predict if your knee replacement will last

Out of the many factors that can determine whether a knee replacement surgery procedure will work, one of the most important issues is the timing of the operation. While other considerations also have an impact – such as age, weight, health, mobility and levels of pain – the stage of your life that you’re in when you have the op can be the most critical factor of all.

Why is this? Well, if you have a knee replacement too early, it can be a real psychological blow: you may feel that the new joint is a huge downgrade when compared to the knee you had before, and totally unsuitable for your day-to-day lifestyle.

But if you leave it too late, progressively worsening knee pain and lack of mobility can have a significant impact on quality of life. Furthermore, you may find the muscles around the knee area start to deteriorate or become deformed as they overcompensate, making the recovery period when you finally undergo surgery more challenging than it needs to be.

Put your joints to the test

A recent development announced by scientists at the Universities of Bristol and Sheffield may help practitioners and prospective patients get the timing right, thanks to an online test called the Patient Decision Support Tool for Joint Replacement – which could prove to be an absolute boon in the field of joint replacement.

At present, the current system in place offers patients general information about the risks and benefits of the procedure, but there’s absolutely nothing resembling a bespoke service when it comes to taking into account the wide range of factors that determine the need for a joint replacement.

This new test – which is based on data collected from more than a million UK patients that have had knee or hip replacement surgery – will predict how successful the new knee or hip will be, and whether the chances of pain can be reduced and day-to-day function will be improved.

The test – which will be taken online – will be plotted on a sliding scale from zero (where it is worse than before) to 48 (which will indicate a marked improvement).

Plan to succeed

But it doesn’t stop there. Other data that the Patient Decision Support Tool for Joint Replacement is aiming to provide includes an estimate of recovery time, the likelihood of a need for repeat surgery within a decade, and even the chances of dying in the 12 months after the procedure. Armed with this extra information, the research team surmises, patients will be able to make informed decisions about if and when to go ahead with a knee or hip replacement – or at least alter certain lifestyle choices well in advance.

While the test hasn’t been made available to the general public yet, I’m very keen to see what it’s all about – from a personal as well as a medical basis. While there is extremely little difference from one knee to another, it’s the extra circumstances – weight, body shape, age, lifestyle choices, etc – that can really come into play in a successful TKR procedure, and it would be very good to know what a test such as this will flag up.

best UK knee replacements

The best – and the worst – knee replacements have been revealed

Due to an ageing yet active population and a leap in technology, more and more people are being given knee replacements. Patients are understandably more concerned with the skill and experience of their surgeon, but there is also a range of different prosthetic implants that can be used. Now, a large-scale UK study has been carried out in the performance of different prosthetic implant combinations.

Unsurprisingly, what with the range of products, some knee replacements work better than others – and the recent study conducted by researchers at the University of Bristol has looked into the quality and performance of the most commonly used replacements, concluding that certain brands of joint replacement have more than double the benchmark level of failure after ten years, while others are three times more likely to need replacing than their better counterparts.

However, the good news is that the vast majority of knee implants used by the NHS – 89% of them – are deemed to perform better than standard.

The research team compared different brands and models of implants, which were implanted into over 1.7 million British patients between April 2003 and December 2016 and tracked whether follow-up surgery was needed after the procedure. In particular, they were looking for the types of implant that exceeded a failure rate of 5% – the benchmark level set by both the NHS watchdog the National Institutes for Health and Care Excellence (NICE) ODEP – the Orthopaedic Data Evaluation Panel.

The joint last implants

After scouring the data, they found seven models which failed to make the cut – with the worst performer being the Preservation Unicondylar fixed knee replacement, which was used in 398 operations and had a failure rate of 15 per cent. The list in full:

  • Preservation Unicondylar (15%)
  • Oxford Partial Knee Unicondylar (11.54%)
  • MG Uni Unicondylar (10.03%)
  • AGC Uncemented (7.76%)
  • NexGen Cement (7.13%)
  • Rotaglide + Cement (5.61%)
  • Profix Cement (5.03%)

While the research revealed that knee replacements were more prone to failure than their hip counterparts, it also revealed that the majority of knee replacements used in the UK were far more durable.; 51 were below the 5% threshold, and 16 of them had failure rates lower than half the benchmark.

As a patient – or potential patient – what can you do to ensure you get the best shot of a long-lasting and successful knee replacement? After all, it’s not as if you can run your finger down a shelf and pick out the one you like. Your best defence – as with all surgical procedures – is to be fully prepped. Ask your knee surgeon which implant is being used, and definitely ask about its success rate.

female ACL injury

Contraceptive pill could help protect women from ACL knee injuries

Everyone in the sports medicine community is aware that, due to a combination of hormonal and physiological reasons, women are far more prone to female ACL injury, but the truth is far more jaw-dropping:  women are actually eight to ten times more likely to suffer from an ACL injury than men. The knock-on effects are ruinous: recent studies have concluded that nearly half of women sports participants are forced to abandon their athletic careers, and between 20 and 50% of female athletes go on to develop arthritis within ten to twenty years.

So, it goes without saying that the race is on to bridge the gap between the sexes when it comes to an ACL injury, and the latest development comes right out of the left field: the potential benefits of the contraceptive pill.

Could the Pill cure your ACL ills?

According to a study recently published in America’s Physician and Sportsmedicine journal, female athletes are being advised to go on the pill to avoid career-ending injuries – with the apparent protective effect of the drug particularly potent in teenage sportswomen.

The study, conducted by a research team from Brown University in Rhode Island, compared rates of injury among 82,874 sportswomen taking oral contraceptives during the 12 months prior to the injury, and compared it with the same number of women not on the pill. According to the findings, a total of 465 women in the oral contraceptive group required surgical reconstruction of the ACL over the ten-year period of the study, compared to 569 in the control group. Which means that out of the entire study group, the women who were using oral contraceptive were 18% less likely to damage their ACL.

More surprisingly, when the data on female athletes aged 15 to 19 were analysed, the conclusion was that a whopping 63% of women in that group using the pill were less likely to suffer an ACL injury.

So, what’s the reason for this?

The research team at Brown believe that the lower and more stable hormonal levels that are brought on by the pill help to keep the ligaments firmer. “Young athletes use oral contraceptives for a variety of reasons, including regulating their menstrual cycle and/or preventing pregnancy,” said Dr Steven DeFroda, leader of Brown’s research team. “It’s likely that oral contraceptives help maintain lower and more consistent levels of oestrogen and progesterone, which may lead to a periodic increase in laxity and subsequent risk of tear.”

Of course, it needs pointing out that this is an observational study, so no firm conclusions can be drawn about cause and effect – and the authors point to several limitations, such as not assessing participation in particular sports or their activity level which may explain why some women tore their ACLs and others did not.

They also note that the study did not distinguish between athletic, recreational, or accidental ACL injuries, and only looked at women with injuries that were managed with surgery. So, while it’s an interesting potential solution to the rampant levels of ACL injuries in women, a study which tracks athletes over time to see whether those who take oral contraceptives have fewer ACL injuries than others will be needed.

infection after knee replacement

Infection after knee replacement: new research could help identify those most susceptible

Knee replacement surgery has become a common procedure, with over 110,000 of them carried out per year in the UK, and for the vast majority of people, it’s a pretty straightforward operation with nothing but benefits when the recovery period is over. However, the biggest problem for surgeons (and especially patients) is the risk of infection in the treated area, which could lead to serious complications down the line. It must be stressed that the risk is extremely minor, but at present 1% of patients run the risk of deep infection in the knee area, which can have some pretty nasty knock-on effects.

However, new research funded by the National Institute for Health Research (NIHR) has taken steps to identify which groups of people are most likely to develop a severe infection after knee replacement surgery and therefore need the joint replacement redone.

Zoning in on the risk factors

The study – the largest of its kind – was conducted by researchers from the Musculoskeletal Research Unit at the University of Bristol, who combed the records of the 679, 010 people who had undergone knee replacement surgery in England and Wales between 2003 and 2013 and tracked their progress in the year after their procedures, zoning in on the data of those who had suffered a knee infection.

According to their findings, the groups of people most at risk from needing their joint replacement redone due to infection include patients under 60 years of age; males; those with chronic pulmonary disease, diabetes, or liver disease; and people with a higher body mass index.

The research team didn’t stop there: they also deduced that the reason for surgery, the type of procedure performed and the type of prosthesis and its fixation also influenced the risk of needing revision surgery for an infection.

A clearer picture for practitioners

The goal of this research is to arm practitioners with a honed and refined set of guidelines, in order to help them zone in on the patients who will be most at-risk and prepare themselves to nip any future complications in the bud – be they early on in the post-surgery period, or years later.

It goes without saying that these findings could be a boon for the knee surgery community and future patients alike. Knee replacement surgery is a costly and time-consuming procedure, but having to re-do it is even costlier. And with the number of procedures rising year-on-year due to an ageing population, every re-done procedure means a longer wait for those desperate for their own knee procedure. By identifying possible raised risk factors for infection after knee replacement surgery will help practitioners to develop strategies to minimise the risk.

Call 0203 195 2443 to arrange a consultation with Mr Jonathan Webb and he will discuss all potential risks and complications including infection after knee replacement surgery before you make the decision to go ahead.

weight loss before knee replacement surgery

New study finds ideal weight loss target for obese patients before knee surgery

If you’ve been classed as morbidly obese (which according to the NHS is a BMI of over 40) and you’re awaiting knee replacement surgery, you’ve already been told that losing weight is a must. Makes perfect sense: after surgery, your knee will be temporarily weaker until it completely mends, and the more weight you can keep off it, the better.

The question is; how much weight should you be aiming to lose to maximise your chances of a short recovery period? Many medical experts advise patients to lose between five and ten pounds before going under the knife, but a new study claims that for the full benefit, you should be aiming at dropping 20 pounds beforehand.

The study, conducted by a research team from the Geisel School of Medicine at Dartmouth College in New Hampshire, involved data harvested from 203 patients who were either 100 pounds over their ideal body weight, had a BMI of over 40, or had a BMI of 35 and also suffered from high blood pressure or diabetes prior to their total knee arthroplasty procedure.

Well worth the (loss of) weight

The team tracked the study group’s weight loss regime in the three-month run-up to their surgery and discovered that in the three months leading up to their TKA procedure, 41% of the patients lost at least five pounds, 29% lost at least 10 pounds and 14% lost at least 20 pounds. After the surgery, 27 patients were no longer morbidly obese, although 23 of those were still severely obese (with a BMI between 35 and 40).

The research team presented their findings t the annual meeting of the American Academy of Orthopaedic Surgeons last month, and reported that – when compared to patients who did not lose 20 pounds – the patients who did had a 72% possibility of being discharged to a rehab facility and 76% lower odds of staying in the hospital for at least four days.

Ten pounds isn’t enough

While there were no differences in operative time or physical function improvement for the two groups, the researchers noted that losing five or ten pounds did not make a difference for any outcome.

“Twenty pounds is the magic number, based on our evidence,” claimed study leader Dr Benjamin Keeney. “This is even after accounting for age, gender, and other diagnoses besides obesity, as well as baseline physical and mental function.” He pointed out that the people who lost twenty pounds and reaped the benefit of an improved outcome were still very obese at the time of surgery – and that most of them even gained a lot of that weight back afterwards – but even so, the temporary loss of weight still led to a better outcome.

“What this study is telling us is that morbidly obese patients who lose at least twenty pounds before knee replacement are going to come home from the hospital faster and are much less likely to go on to be discharged to a facility,” he claimed. “This is a concrete goal, instead of telling patients we won’t operate unless they get a BMI of 40 – which for some patients can be a loss of 50 to 100 pounds.”

For more advice on how best to prepare for knee replacement surgery, call 0203 195 2443 to arrange a consultation at Mr Jonthan Webb’s London orthopaedic clinic.

ACL Reconstruction Surgery London

New therapy could slow down bone loss after ACL reconstruction surgery

An Anterior Cruciate Ligament reconstruction is a very effective procedure that can put right years of punishment on the knee, but there’s a downside – people who have undergone ACL reconstruction often face bone and muscle loss immediately following the procedure, due to enforced inactivity and other factors.

However, research from the Houston Methodist Hospital which was published last month points towards a solution: a combination of blood flow restriction (BFR) therapy and traditional rehabilitation efforts, geared towards slowing bone loss and reducing return-to-function time.

The study involved 23 active and young patients (with an average age of 23) who had undergone ACL reconstruction, who were put into two groups. While both groups received the same rehab protocol, one group received BFR therapy: namely, they exercised with an 80% arterial limb occlusion using an automated tourniquet.

What is blood flow restriction therapy?

BFR therapy does pretty much what it says on the tin: a surgical tourniquet system which resembles a blood pressure cuff is applied to an injured arm or leg, which temporarily reduces blood flow to the limb while the patient exercises. The reason for this is to allow the patient to work the muscles without the risk of putting excessive weight on the limb in question while activating the muscles on that limb. It’s a relatively new method – one which has its supporters and detractors.

After both groups were measured for bone mineral density, bone mass, and lean muscle mass, the research team concluded that the addition of BFR therapy to standard rehab exercises was found to prevent muscle mass loss in the whole leg and thigh in the post-operative limb compared to rehab alone. Not only that, but the addition of BFR also appeared to minimise losses in bone mineral content and preserve bone density in the limb compared to standard rehab alone.

Tied to be fit

“Providing BFR as part of the rehabilitation efforts following ACL surgery appears to help preserve the bone, recover muscle loss and improve function quicker, according to our research,” said Bradley Lambert, the lead researcher. “BFR is a suitable additive therapy to ACL rehabilitation for the purposes of minimizing the loss, and enhancing the recovery of muscle, bone, and physical function.

“While further research is needed to fully illuminate the physiologic mechanisms responsible for our results, these findings likely have wide-ranging implications for fields outside of ACL rehab alone such as injury prevention, age-related muscle and bone loss, military rehabilitation, and potentially space flight,” said Lambert.

We have known about the effects of blood flow restriction as a means of improving muscle recovery for a while now – particularly in situations where the joint cannot be loaded heavily as it heals. But the idea that the technique can make an improvement in the bone mineral density recovery is a new revelation and definitely worth looking into further.

The downside of BFR is that it’s heavily reliant on outside help and is only usually available in a professional setting – but if you’re in rehab and the technique is available to you, it’s definitely worth taking up with your support system.

knee arthritis surgery London

How exercise can help with knee arthritis

The last thing you might feel like doing in the aftermath of a knee OA procedure is to kickstart a workout programme, but two separate studies released last month pointed out that you should only sit on the sofa with your leg up for so long.

The first study – from Queen Mary University in London and published in the journal Osteoarthritis and Cartilage – has demonstrated that mechanical forces experienced by cells in joints during exercise prevent cartilage degradation, by suppressing the action of inflammatory molecules which cause osteoarthritis.

Squash the pain away

 

As the study points out, exercise – even the simple stuff, such as a brisk walk – ‘squashes’ the cartilage in joints such as the hip and knee. And this mechanical distortion is detected by the living cells in the cartilage, which then blocks the action of inflammatory molecules associated with conditions such as arthritis.

The researchers are hoping that these findings will help in the search for treatments for arthritis, which affects over three million people in the UK. And the researchers are even suggesting that the results may lead to a whole new therapeutic approach known as mechano-medicine, in which drugs simulate the effect of mechanical forces to prevent the damaging effects of inflammation and treat conditions such as arthritis.

Future complications? Walk them off

But what about the risks of agitating a post-op knee with exercise? Well, the other study – compiled by Northwestern University in Chicago – claims that there is no direct link between knee pain and daily walking, or other forms of low-intensity exercise. Furthermore, people with knee OA who undertook less than ten minutes of brisk walking per day are boosting their chances of preventing disability in later life.

The study, which was published in the American Journal of Preventative Medicine, involved 1,500 people between the ages of 49 and 83 from the rolls of America’s Osteoarthritis Initiative, who were given accelerometers and tracked between 2008 and 2014. And according to their findings, the research team found that those who managed less than ten minutes of moderate-to-vigorous activity per day found it easier to perform daily tasks than those who lived a more sedentary lifestyle.

When the exercise levels were raised a notch, the findings were even more positive: participants who managed an hour of moderate-to-vigorous activity per day had an 85% reduced risk of mobility disability – which was defined by the researchers as being unable to safely cross the street in time – and a 45% reduction of daily living disability, which is defined as having difficulty in bathing and dressing without help.

Speaking as someone affected by knee arthritis, I can vouch for the benefits of exercise as a coping mechanism, as it has definitely helped my knee. After a year of strength training, I’ve got to the point where I have been able to run 4K – with minimal aftereffects, I might add. Given that I was on the point of undergoing knee replacement prior to this, I feel the results are pretty impressive – and if you’re in the same boat as me, I’d advise you to embrace an exercise regime under the guidance of your doctor or knee specialist.

diet and knee osteoarthritis

Could a low carb diet relieve the pain of knee osteoarthritis?

We know all about the pros and cons of a low-carb diet: on the plus side, it’s the best way to kickstart fast weight loss – and weight loss in the best places, such as the abdomen. It also increases the levels of HDL cholesterol (the ‘good’ cholesterol), whilst decreasing blood sugar and insulin levels, and may even help lower blood pressure.

But according to a new report from the University of Alabama, which has been published in the Pain Medicine journal, there may be another incentive to dump the carbs, particularly if you have knee problems: a randomised controlled study they conducted recently points to the possibility that a low-carb diet could relieve pain for people who have knee osteoarthritis, particularly if you’re up there in years.

While there are medical and procedural ways to deal with knee OA, they’re costly to health bodies and can bring on side-effects for the patient – which means that the global medical community is now focusing attention on the beneficial links between a low carb diet and knee osteoarthritis symptoms.

Three diets, one outcome

The study, led by Dr Robert Sorge, Director of the PAIN Collective in the University of Alabama at Birmingham Department of Psychology, involved 21 adults aged between 65 and 75 who suffered from knee OA. One group of seven were put on a low-carb diet; the others were split into a group which took part in a low-fat diet regime, while the remaining seven continued their regular diet.

Every three weeks into the 12-week study, the research team analysed the participants’ functional pain — the pain they endured while undertaking daily tasks — as well as their self-reported pain, quality of life, and level of depression. They also took blood samples and examined them for oxidative stress – the chemical imbalance between the production of free radicals and the body’s antioxidant properties, which is seen as a useful marker of biological ageing.

Less carbs, less pain?

The results? According to the research team, the group in the low-carb group reported a reduction in functional pain levels and levels of self-reported pain, when compared to the groups on the low-fat and regular diets. Not only that, but the participants in the low-carb diet also showed less oxidative stress and lower levels of leptin, a hormone with important metabolic functions.

“Our work shows that people can reduce their pain with a change in diet,” said Dr Sorge. “Many medications for pain cause a host of side effects that may require other drugs to reduce. The beneficial side effects of our diet may be things such as reduced risk for heart disease, diabetes and weight loss — something many drugs cannot claim.”

While it’s clear that further study is required – preferably with a much bigger sample group – I think this could be very interesting. An amazing physiotherapist I work with is on a crusade to promote low carb dieting in the recovery phase. I’m starting to wonder if cutting out the carbs and switching to low carbs such as lean meats, fish, eggs, leafy greens, cauliflower, broccoli, nuts, seeds, nut butter, coconut oil, olive oil, and dairy products (and even tofu and tempeh) – is the way forward, both to recommend to my patients but also to adopt myself and combat my own knee osteoarthritis.