Are there any risks if I choose to delay knee replacement surgery?

Over time the knee joint becomes worn and damaged, as the cartilage that covers the ends of the bones and allows them to slide smoothly over each other as you walk, run or stand, starts to disintegrate. You may have severe pain, swelling and stiffness and easy movement is affected. Often patients visiting Mr Jonathan Webb’s knee surgery clinic complain that the pain is so severe that it is affecting their quality of life and makes simple, everyday tasks a trial.

This condition is called osteoarthritis and affects most men and women over the age of 60 as part of the natural ageing process. However, it can also affect much younger patients, if they have a predisposition or have suffered an injury to the knee which has hastened the deterioration of cartilage.

What does knee replacement surgery entail?

Knee replacement surgery involves replacing the components of the knee joint with an implant. There are actually two joints in the knee – the tibiofemoral joint between the tibia and the femur and the patelllofemoral joint that joins the kneecap to the femur. These two articulations work as a hinge, which means the knee can straighten and bend, but also allows for side to side movement.

It is possible to undergo a partial knee replacement that aims to retain any undamaged parts of the knee by using an implant to replace just one or two components of the knee. Another option is a knee osteotomy. This surgical procedure can be a more appropriate option for younger patients that are showing signs of damage in just one area of the knee. Either by removing or adding a wedge of bone to the tibia or femur, the aim is to shift body weight off the damaged area of the knee, preserving function for longer.

Early diagnosis of osteoarthritis and the appropriate treatment can make a profound impact on your long-term mobility and quality of life. Remember, oestoarthritis is a degenerative disease, so will only continue to get worse if not treated. However, a knee replacement is major surgery that has a number of potential risks and can involve a significant period or recovery and rehabilitation. Many patients enquire if delaying knee surgery is an option.

Another consideration, particularly for younger patients, is the longevity of the replacement. Statistics from Arthritis Research UK indicate that for 80 to 90 per cent of patients that have undergone a total knee replacement, the implant should last approximately 20 years.

Knee replacement surgery alternatives

There are other surgical and non-surgical treatments, which will often be explored first, but they may only provide temporary relief and the long-term solution will be replacement of the joint.

  • certain vitamins or minerals have been found to be helpful in reducing inflammation and slowing down
  • arthritis
  • anti-inflammatory medication
  • support braces or sleeves
  • physical therapy
  • lifestyle changes, particularly weight loss
  • steroid injections
  • hyaluronic acid injections

During your consultation with Mr Jonathan Webb, he will discuss all your options in full, including the benefits and potential risks, so you can make an informed decision about your future.

Obesity linked to rise in knee replacement surgery

For those desperate to shift the pounds so they can become healthier and more active, life can sometimes seem a vicious cycle. Increased weight puts pressure on the knee, causing discomfort, and wear and tear, meaning exercise can be too painful. Not being able to exercise, though, usually leads to increased weight and more pressure on the knee joint.

New figures on joint replacement surgery for massively overweight patients point to the strain that obesity is causing the NHS. Eighteen thousand patients a year, who are classed as medically obese, require their hips or knees replaced; this is a fourfold increase since 2009 alone.

Since 2009, the number of knee replacements carried out in the NHS in England has risen from 76,071 to 91,436, costing the NHS almost £600 million a year. However, for obese patients the rise in knee replacements has outstripped the national average, going from 3,787 to 15,188.

Why does obesity affect your joints?

The UK is classified as one of the most obese countries in Europe, with over a quarter of adults recording a BMI that puts them into the obese category. If you were to name a health problem associated with obesity, then you might think diabetes or heart disease and it’s true that these are common health conditions that are linked to being massively overweight. However, arthritis is actually a more likely outcome of carrying too much weight.

Arthritis is caused by the breakdown of cartilage in the joints and there are many factors that can contribute to its development. However, it’s an undeniable fact that the more stress you put on the joint, the more likely that you will damage the cartilage; every pound of excess weight translates to four pounds of extra pressure on your knee.

Fat itself can also cause problems, not relating to the pressure the extra weight puts on your joints, as it can cause inflammation, a common factor identified in the development of arthritis. Carrying excess weight actually seems to be even more damaging to the knee than the hips; arthritis of the knee is a more common problem for obese patients than arthritis of the hip.

Knee replacement surgery is an effective procedure for those who are struggling to perform normal activities, but the longevity of knee replacement surgery is currently pegged at 15 to 20 years as long as the knee replacement is not put under ‘undue strain’.

As with much in medicine, not addressing the root cause of the problem means that often surgical solutions can only provide a temporary fix. Looking at alternative options, such as weight loss surgery in advance of joint replacement surgery, might be the answer to providing patients with the best possible quality of life.

Rugby World Cup means more attention on rugby injuries

The drama and spectacle of the opening ceremony, the relief of England opening the competition with a win against Fiji, the shock and awe of Japan’s showing against the mighty Springboks; this World Cup looks set to be a fantastic display of world-class rugby and it’s a good time to take a look at rugby injuries for both the professional and weekend warrior.

Since the game turned professional in 1995, players at every level have had to adapt to a more demanding game to avoid injury; many studies have pinpointed the increase in injuries, the higher the standard of play.

Rugby is a full-on contact sport, so there are a number of potential injuries that can be incurred during a match, from the thigh, hamstring, head, neck and the knee. Although the knee is not necessarily the most common injury in rugby it is certainly among the most serious in terms of time out of the game. We’re going to focus on injuries to the knee.

What are the most common knee injuries incurred during rugby?

The most common knee injuries are damage to the ACL, the Anterior Cruciate Ligament, and the MCL or Medial Collateral Ligament. Both of these injuries result in lengthy time out periods from play or even force full-time retirement from the game.

The ACL is the main ligament that connects the thigh bone to the shin and the MCL is found on the inside of the knee. These ligaments work together to stabilise the knee, particularly from abrupt side-to-side motions. Injuries to the ACL and MCL are usually a result of falling awkwardly in a tackle as the knee moves in an ‘unnatural way’. The ligament becomes overstretched and ruptures – often players report a loud popping noise.

The knee will usually start to swell as blood vessels have also ruptured, but once the swelling has gone down the knee may feel relatively normal but as soon as it is put under pressure, as in a game scenario, it will often feel unstable and ‘give’.

How do we grade ligament injuries?

When players present for assessment of the knee ligaments we grade them depending on our physical assessment and their reporting of side effects.

  • Grade one; the player will report mild tenderness in the knee area, but there is usually very little swelling. This means there has just been a minor tear in the ligament fibres.
  • Grade two; the knee joint feels less stable when it is rotated and there may be more tenderness all around the knee and swelling present. There is more extensive damage to the ligament fibres.
  • Grade three; the knee is very unstable, there is a lot of pain rather than tenderness or discomfort and a large degree of swelling. This points to a complete rupture of the knee ligaments.

If the player has a grade three ligament injury then there are a number of treatment options including ACL reconstruction surgery. For more information on knee treatment options, get in touch to book a consultation at either Mr Jonathan Webb’s Bristol or London clinics.

When can I play again?

The recent high profile injuries to players preparing for the Rugby World Cup highlights the vexed question of when can I play after an injury. Rupture of the Anterior Cruciate Ligament remains a significant knee injury but with modern techniques of surgery and rehabilitation there should be a high expectation that players can return to the field of dreams.

Return to sports after injury

Whilst there are plenty of tests and measurements that can be made to ensure that muscle strength is recovered and movement of the joint is back to normal, there is as yet no specific test that says you are safe to return to playing matches. By and large, athletes will be performing at a very high level from around four months onwards following ACL reconstruction but whilst everyone wants a specific date, the answer as to when you are ready to play is when you are ready!

Experienced physiotherapists will have the best idea as to when the player is performing without any obvious inhibition from their knee, but one of the things I tell all of my patients is that they have to be honest with themselves and to be at a point where they no longer think about their knee when they are training and performing in match type situations. To my mind this is the body’s intuitive signal that the risk of re-injury has returned to the lowest possible level.

Get in touch to book a consultation at either Mr Jonathan Webb’s Bristol or London clinics.

Is running really bad for you?

There is a bit of a myth about whether running is bad for you.

If your joint is healthy and has never had an injury before then, provided you are fit and strong enough, running is good for you. All joints work better when they are being used. The shock absorbing lining of the joint receives nutrients as a consequence of the compression and relaxation effect of any weight-bearing activity.

Running and the knee

If your knee joint has had an injury however, then you just need to be a little more careful. It would appear that the type and volume of impact work that you do following any injury to a knee such as damage to your meniscus or to the lining of the joint can have an adverse impact. Having said that, there is a world of difference between running in properly fitted shoes on a treadmill for ten minutes at a time, right through to the opposite extreme when you play eighty minutes of football or rugby on a hard pitch. There is no question the latter is far more stressful for your joints than the former.

In other words, subject to the support of your treating physiotherapist or orthopaedic knee surgeon, running can still be helpful at keeping your muscles strong and your weight controlled. Both of these effects may far outweigh any potential for aggravating your injury.

An injury doesn’t always mean the end of your running career! If you have suffered a knee injury that is impacting on your ability to exercise or play sport, then book a consultation at Mr Jonathan Webb’s Bristol or London clinics.

Intimate at The Ivy

Jonathan was invited to take part in a series of informal interviews at The Ivy Club, Soho, by Dr Harry Brunjes. The evening raised over £640 for The Injured Players Foundation, and it was great to see so many familiar faces, as well as meeting people interested in finding out more about Jonathan’s career.

Jonathan played for England in 33 test matches, scoring a total of 296 points before he called it a day in 1993 to pursue his surgical career. On the evening he offered plenty of insights and anecdotes into the struggles of balancing two full-time careers and the audience enjoyed asking questions and seeking his opinion on the modern game.

We hope to be invited back!

Fortius International Sports Injury Conference

Jonathan is a founding member of the Fortius Clinic, an orthopaedic and sports injury clinic in central London. This October Fortius are holding the Fortius International Sports Injury Conference (FISIC), at the Queen Elizabeth II Conference Centre in Westminster, at which Jonathan will be speaking.

The conference is aimed at orthopaedic surgeons, physios and sports and exercise medicine professionals. Running alongside the main conference is an allied GP programme, for general practitioners whose practice is not sports injury focused but who see recreational sportsmen and women.

FISIC will cover all aspects of sports injury over the two days, with knee, foot & ankle, shoulder, elbow, hand & wrist, spine, hip & groin sessions, as well as sessions on arthritis in sports, cell therapies, bone health, disability sports, rugby sessions and a session on the adolescent athlete.

If you would like to find out more please visit the website – www.fisic.co.uk – or call the marketing team at Fortius on 0203 195 2434.

The silk solution to knee replacement surgery

An ageing population, rising levels of obesity and more desk-bound jobs are behind the ever-growing rise in knee replacement surgery in the UK. It is estimated that more than 90,000 British men and women a year require knee replacement surgery to combat arthritis and joint pain.

Part of this growth has been the rise in knee replacement surgery required by a younger age group, with patients in their 50s and younger potentially needing this procedure. Up till now, research into the longevity of knee replacements has mainly been conducted in patients in their 70s and 80s and best estimates are that the implants will last approximately 15 years. As a result, technology companies are looking into ways to avoid the need for knee replacement surgery.

Orthox, an Oxford University-backed company, has recently developed implants made of silkworm fibroin. Twenty-five times stronger than high tensile steel, the fibroin is spun into tough, resilient implants that feel and act like cartilage when inserted into the knee joint.

Do I need knee replacement surgery?

Osteoarthritis is a condition affecting the joints; the surface of the joints become damaged, cartilage thins and causes discomfort and decreased mobility. This is often just the result of wear and tear which is why osteoarthritis is such a problem for the senior age group, but younger patients – in their twenties and thirties – that have incurred a sporting injury often see the early onset of osteoarthritis.

The silkworm cartilage implants are not available yet, but trials are due to start at the North Bristol NHS Trust with the hope that these implants could eventually reduce the amount of knee replacement procedures undertaken and, in particular, help younger patients rebuild their cartilage, avoiding the development of osteoarthritis and the need for a replacement knee at a later stage in life.

Mr Jonathan Webb is a leading UK consultant orthopaedic surgeon who specialises in all conditions relating to the knee, with a particular interest in soft tissue injury.

Mr Webb does not currently offer this silkworm technology – call us on 0203 195 2443 to discuss which treatment options Mr Webb offers or to arrange a consultation. Alternatively, please click this link to fill in a contact form and one of the team will be in touch.