knee OA

UK study finds listening to noisy knees can help with knee arthritis diagnosis

If you’re hearing a snap, crackle and pop and you’re nowhere near a breakfast table, welcome to the world of knee crepitus. It’s a term for the sounds the joint makes, and in a lot of instances it’s nothing to worry about – it’s just tiny gas bubbles that have accumulated in the synovial fluid bursting, which is a natural occurrence.

However, certain sounds can also be the first indications of a damaged knee joint. So, the results of a new study from Lancaster University have caused a lot of people in the medical community to sit up and, well, listen.

The study in question, which was published in the medical journal PLOS ONE last month, has advanced the idea of a new way of diagnosing and assessing knee osteoarthritis, which involves attaching small microphones to the knee and detecting high frequency sounds from the joint components as the person being evaluated does nothing more strenuous than performing simple sitting and standing movements.

Sounding out knee OA

The signals – known as ‘acoustic emissions’, are then analysed on a computer in order to harvest data on the health of the knee. The analysis is based on sound waveforms during different movement phases. It’s the first technique of its kind in the field of knee OA analysis, and the results are encouraging to say the least: not only can the technique distinguish between healthy and OA-afflicted knees, but it also can be used in both a general practice and hospital setting.

The research project has been running since 2013 and has been conducted by a large multi-disciplinary team led by Lancaster University, with assistance from the Universities of Central Lancashire, Manchester and Cumbria, as well as the NHS in Lancashire and Cumbria. It has also leant upon the expertise of two businesses that specialise in technologies for acoustic sensing and cartilage measurement. And the goal is to create a fast, convenient and effective method of detecting the causes of knee crepitus – be they common-or-garden knee OA, chondromalacia patella, patellofemoral syndrome or any other knee-related injury

Faster, bigger, better?

“This work is very exciting because it involves scientists and clinicians working together as a team to develop an entirely new approach,” said Emeritus Professor Goodacre of Lancaster University, who led the research. “Potentially, this could transform ways in which knee OA is managed. It will enable better diagnosis and will enable treatments to be tailored more precisely according to individual knee condition. It will also enable faster, bigger and better clinical trials of new treatments”.

If all goes well, we could be seeing the development and production of a non-invasive and portable device which could be used by the medical community to detect any changes and possible ailments in a patients’ knee with minimal fuss or discomfort, providing a faster, more cost-effective, more convenient and more refined assessment than any other method available at present. We’ll definitely be keeping an ear to the ground on this one.

To arrange a consultation to discuss your knee OA options, including robotic assisted knee replacement, call us on 08450 60 44 99 for my Bristol knee clinic and 0203 195 2443 for my London practice.

prehab before knee replacement

Prehab before knee replacement could lead to better results

We’re all aware of the necessity of rehabilitation after knee replacement surgery, but what about the steps we can take before we even go under the knife? It’s something that’s been on my mind throughout the year, as I’ve been preparing for my own knee replacement procedure later this month. And according to a study in New York that was published in November, it seems that a ‘pre-habilitation’ programme – which involves being counselled by a peer coach – could really help patients and lead to a better, faster recovery.

The study found that using a peer coach – deemed as a patient who has already gone through the procedure and has been trained to provide personalised pre- and post-knee replacement support – can make a huge difference to a patients’ mind-set, can openly discuss what happens before, during and after the operation and steer them towards developing good habits.

It’s a methodology that has worked very well in other areas of medicine, particularly in the field of diabetes. And although the two issues are very different, the thinking goes that both issues require a radical change of lifestyle habits and a positive attitude – and nothing works better than having close contact with someone who has already been through the procedure.

Thirty-one patients were examined during the study, ranging in age from 65 to 89 – all of whom had undergone a knee replacement at least 12 months earlier with a good outcome. They were questioned on a range of issues, notably their experiences with a peer coach. The study group’s discoveries were as follows;

The fear factor

Many patients with osteoarthritis delayed knee replacement for many years, often until the pain became very bad. Not only that, but the majority had no idea about the best way to prepare for knee replacement surgery, and ultimately didn’t prepare at all.

Second-time patients are better prepared

Many of the patients were about to undergo their second knee replacement procedure – and this time they felt they had learned what was expected of them this time around. “Patients with high outcome expectations who had undergone a previous knee replacement learned from their first experience and reported feeling motivated to engage in physical activity for muscle strengthening before their second knee replacement,” said Dr Iris Navarro-Millan, principal investigator of the study. “They expressed that their own experiences made them more informed, self-efficacious and physically active to prepare for their surgery.”

First-time patients are prepared to listen

Understandably, the people undergoing knee replacement surgery for the first time were very keen to listen to other patients about preparation and recovery and being given the opportunity to talk to patients who had gone through the procedure removed a lot of apprehension about surgery.

A thumbs-up for peer coaching

Not only were new patients more than open to the idea of peer-coaching, but the study discovered that certain patients were already doing it off their own bat – and were finding it very rewarding. After all, doctors can only tell you what’s going to happen: people who have already undergone the procedure can tell you what to really expect.

So, what advice would I give you, as someone about to undergo surgery? Well, I’ve been seeing a personal trainer this year – partly to put off having to have the replacement for as long as possible, but now that surgery is imminent, to ensure my muscles are as good as they can be because when it comes to as swift a recovery as possible, you can’t have enough muscle.

Post-surgery, I’ll be able to give advice both as a surgeon and fellow patient. For more advice on knee surgery and robotic knee replacement, call 0203 195 2443 to arrange a consultation.

Robotic Knee Replacement Advantages

Robotic knee replacement advantages and disadvantages

One of the biggest developments in orthopaedic surgery in recent years has been the introduction of ‘robotic joint replacement’. The first misconception that we often have to clear up is that this development does not replace the orthopaedic surgeon and that the robotic arm is not actually performing the surgery independently. Robotic joint replacement technology such as the industry gold standard Mako system is aimed at improving the patient outcome by ensuring more precision.

The Mako Robotic-Arm Assisted Total Knee replacement is for people with mid to late-stage knee osteoarthritis that is causing them pain and a lack of mobility. A CT scan of your knee is taken, which is then uploaded into the Mako System software. A 3D model of your knee is then created, which is used by the surgeon to work out a plan of action.

When it’s time for surgery, the Mako system comes into its own. In theory, the surgeon follows the plan to the letter by guiding the system’s robotic-arm to remove diseased bone and cartilage within the pre-defined area – and best of all, the system ensures that the work needed is kept within the pre-planned boundaries. I can’t stress this enough: the surgeon is always in control of the procedure and can even override their original plans if necessary.

What are the pros of robotic knee replacement surgery?

The most important of the robotic knee replacement advantages is that it gives orthopaedic surgeons the opportunity to create a more bespoke plan of action with greater accuracy than before. Furthermore, it allows surgeons to individually optimise each particular replacement joint, giving them a better chance to create a perfect fit first time, significantly lowering the risk of post-surgical complications and the need for a second procedure. The risk of blood loss is reduced and there is an improvement in safety levels, as the system only allows them to perform the procedure within the area mapped out by their pre-op plan.

For the patient, the two most significant benefits are a shortening in rehab time (as less of an area in the knee needs to recover, due to no superfluous areas have been operated on), and the reassurance of improved safety and a reduction in post-op complications.

What are the cons of robotic knee replacement surgery?

Robotic assisted knee replacement is relatively new technology, particularly in performing total knee replacements, so although the clinical studies performed so far are encouraging, more longer-term studies are needed.

The procedure takes slightly longer to perform than a conventional joint replacement so the risk of infection could be slightly increased, although to what amount is uncertain at present.

More importantly, by leaning harder on a computerised system, some surgeons have already pointed out that any system is only as good as the data it uses and the people who process it, meaning that the quality of the scans used need to be of the highest quality and extra time and resources are going to have to be funnelled into the training of staff to get the optimal effects with the Mako system.

The cost of the procedure is also slightly more than a conventional joint replacement because a CT scan is required of the joint to plan the procedure.

For more advice on the pros and cons of Mako robotic knee replacement, call 08450 60 44 99 to arrange a consultation at my Bristol clinic or 0203 195 2443 for my London knee clinic.

recovery after robotic knee replacement

What is the recovery like after robotic knee replacement surgery?

Robotic joint replacement surgery has been trending across the medical community in the last few years and is an example of how technology is transforming the way hip or knee replacements are being performed. The recent addition of the Mako robotic knee replacement system to both my London and Bristol knee clinics offers patients a number of advantages, including a potentially shortened recovery process.

In a nutshell, the Mako system converts a CT scan of a knee joint into a 3D map, which the surgeon can use to map out a plan of action. Then – with the use of a robotic arm – the surgeon can conduct the procedure with optimal precision, while the system ensures any work is done within the parameters already mapped out.

Naturally, the system is being welcomed by many professionals, as it could potentially take a lot of guesswork out of the procedure and reduce the risk of human error. And those advantages are passed onto the patients; experts claim that recovery times after a Mako procedure could shorten by as much as 30 percent, with a reduced risk of post-op infections and complications, and therefore a similar reduction in requiring a secondary, revision procedure.

While computerised and robot-assisted orthopaedic surgery is a relatively new development, it’s clear that is going to part of the future of joint replacement surgery, so let’s discuss what this all means for knee OA patients – particularly regarding the recovery period.

In the immediate aftermath of surgery, the patient experience will not differ – you will be encouraged to walk with crutches, given advice by a physio on your rehab exercises and by the nursing team on how to manage your wound, and then will be discharged from hospital.

However, experts predict that the Mako system will really come into its own in the secondary phase of your recovery, due to what happened during the procedure. So, let’s break down the potential positives…

Robotic knee replacement: less of an area to rehab

Because the Mako system ensures that the bare minimum area of the affected knee is operated on, with decreased trauma to the soft tissue and bone, there is obviously less of the knee which needs to mend. That – in theory – means that the recovery time is shortened.

In a recent clinical study, Mako patients reported lower pain scores six months after their surgery than those who underwent a traditional joint replacement procedure.

Robotic knee replacement: a greater opportunity for a partial replacement 

A partial knee replacement can preserve healthy anterior cruciate and posterior cruciate ligaments, meaning they end up with a more ‘natural’ joint which is far easier to get along with, speeding up the recovery time dramatically.

Robotic knee replacement: guaranteed bespoke service

In theory, the greater precision in diagnosis offered by the Mako system will allow surgeons to plan procedures in greater detail – and the fact that the system prevents surgeons from straying out of the pre-set parameters means that the healthy parts of the knee aren’t affected, meaning a reduced risk of complications.

For more advice on what to expect from a Mako robotic knee replacement, call 08450 60 44 99 to arrange a consultation at my Bristol clinic and 0203 195 2443 for patients interested in undergoing surgery in London.

return to play and re-injury risk

Footballers could reduce risk of re-injury with extra training before return to play

It doesn’t matter what sport you play, or at what level – the temptation to pull on the boots (or spikes, or cleats, or skis) after an injury is overwhelming. You’ve been put on a course of treatment, and you’ve been given a recovery schedule, but you feel that no-one knows your body better than you do. Big mistake, according to recent return to play research from the Football Research Group at Linkoping University in Sweden.

According to the study, injured footballers who skip a course of practice sessions before returning to full competition are more likely to aggravate their injuries – or even develop new ones – than those who are eased in gradually. And when it comes to the highest level of the game, professional matches have a seven-fold greater risk than practice ones for the returning player.

The research team went right to the top for their study: they examined data on 303,637 matches involving Champions League teams, and that data included 4,805 matches involving players returning to the field after moderate-to-severe injuries kept them in the treatment room at least eight days.

Their conclusions? Injury rates were 87% higher during players’ first match after an injury than they were for typical matches during the season. However, the study also discovered that with each practice session prior to the first match after an injury, players’ risk of another injury dropped by 7%.

So, what entails a proper practice session?

That’s not something the study was concerned with. “While we can’t say anything about the content of those training sessions, our data suggests that if they complete six training sessions after they have been cleared by the medical team to fully participate in all team activities but before they play a game, the risk of injury in that game is only marginally higher than the average risk in matches,” said Hakan Bengtsson, physiotherapist with the Football Research Group and lead author of the study.

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According to Bengtsson, the biggest risk for repeat injury occurred with four practices prior to the first match, and made clear that he and the study team were aware that some players might not be able to wait for six training sessions due to various factors – but the results clearly demonstrate that rehabilitation alone may not be sufficient to prevent repeat injuries, due to the fact that most rehab procedures are conducted alone, away from the healthier members of the squad, and are no substitute for what they go through at the top of their game.

Let your team ease you back in

“When the player returns to full team training, it will be more similar to actual game play” he added. “And thus, full team training offers a better environment for the athlete to build tolerance to what he will be exposed to in matches.”

There’s a lot of truth in what the study team say, from my experience. All professional athletes who suffer an injury and go through rehab are champing at the bit to get back in the game as soon as any sign of progress happens. And even the most prudent coaches and managers don’t like to see their talent on the bench for too long. But in cases such as this, a gradual easing-in process is essential.

For more advice about returning to play after injury, contact sport injury specialist Mr Jonathan Webb. He offers clinics in Bristol (08450 60 44 99) and London (0203 195 2443).

World Rugby injury prevention programme

World Rugby launches new exercise programme developed to reduce rugby injuries

We’re all enjoying the Rugby World Cup, but it’s also good to see that the powers-that-be haven’t given themselves a month off and are addressing some major issues in the sport. And the biggest one of all is injury prevention.

We’ve already discussed the new trials introduced by World Rugby last month, and now – in conjunction with England Rugby and the University of Bath – they’ve launched a new injury prevention programme called Activate, which is designed to put the code at the forefront of injury prevention in contact sports – and according to research already conducted by the University, the programme can reduce the risk of soft-tissue injuries by 26 to 40% and concussion risk for youth players and by 29 to 60% for adults.

Activate, in a nutshell

The Activate programme consists of simple, user-friendly exercises designed to improve general movement control, muscle activation, strength and power. Interestingly, there are several exercises geared towards developing stability and mobility of the head and neck region, with a view to reducing the potential ‘whiplash’ effects that can occur with concussion.

The objective is to encourage coaches and players to regularly integrate Activate exercises into their training sessions and pre-match routines. There are four different versions of the exercise programme: an adult version, and three age-graded versions. Each programme consists of a number of progressive phases, which should be undertaken for a set time before moving onto the next.

The programme has already been (for want of a better word) activated at Skerries Rugby Club in Ireland – a team which just happens to have Mark Harrington, World Rugby’s Head of Technical Services, as its Director of Rugby. “We introduced the youth and adult versions of the Activate programme across several teams at the club during the 2017/18 season. Led by our coaches, the programme has grown to become an accepted part of training sessions and pre-match warm-ups for the players,” said Harrington.

“We have also taken the opportunity to adapt some parts of the programme to better suit our needs and keep things fresh, such as breaking the programme up into parts to be completed during training sessions instead of as a warm-up. Although based on only a few teams, we have noticed that fewer players are turning up to training with knocks while player availability for matches has been better than in recent years. Because of this, we have decided to continue using the Activate programme.”

Minimal set-up, maximum injury prevention benefit

The Activate programme has been designed to take up minimal space – essentially, a third of a rugby pitch, split into four separate zones – and use nothing but cones to mark out zones, and it runs for 15 to 20 minutes for youth programmes and 20 to 25 minutes for the adult version. Many of the exercises are performed individually or in pairs, and it’s up to the coach to decide if balls should be used.

While one coach can manage the Activate session, it is advised that assistants are also deployed to keep the exercises moving, so the coach can focus on the players’ technique. It’s recommended that players should be put through the Activate programme three times a week for optimal results, and it can also be deployed as part of a player’s rehabilitation after injury. And if you haven’t seen it already, it’s worth downloading the manual, which is available on the World Rugby website.

To arrange an appointment with knee injury specialist Mr Jonathan Webb, call 08450 60 44 99.

ACL rehab

Why your quads matter in ACL rehab

We’re all aware that knee injuries are far and away the most common serious injury in the Union code, especially ACL tears. It’s the price we pay for the sport we play: unlike other codes, Union is a succession of grind-it-out, stop-and-start plays which put huge amount of stress on the knees.

Consider the way we tackle – much lower on the body compared to other contact sports – and it’s clear to see why the knees cop the most damage. They can be taken out in an instant, by a player landing on your leg in a ruck, or an opponent shoulder-tackling from the side. Or they can be worn down over the years, especially in the scrum.

Factor in the indisputable fact that the game is getting faster, the players are getting more athletic and the seasons are getting longer, and it’s fair to say that the risk of knee injury looms large over everyone who plays the game, regardless of age, level and ability. And one of the most common injuries is the ACL tear, so let’s talk about it.

The basics of an ACL injury

Located deep within the knee joint, the Anterior Cruciate Ligament is a very important thing indeed. In a nutshell, it stops your knee from rotating too much, helps keep the shin in place, and is a crucial component in maintaining joint stability. But it can be torn over time by repetitive turning and changing direction, and it can also be instantly damaged by any violent impact on the knee during a game.

However, it happens, an ACL tear – from minor to major – is not fun. Symptoms include mild to severe instability, painful swelling and a long layoff from playing and exercising. And there isn’t a one-size-fits-all cure – solutions depend upon the severity of the tear. In extreme cases (or in the case of high-level players who need to recover ASAP) ACL reconstruction surgery will be recommended.

However, in less extreme cases, a period of highly structured rehabilitation is recommended. And while it goes without saying that a complete recovery programme will be designed to strengthen all the muscles in the affected area, it’s the quadriceps which really come into their own.

Why quads matter in ACL rehab

The primary function of the quads is to bend and straighten your knee, but they’re involved in almost every movement your legs go through.  They work in harmony with other leg muscles in order to promote effective movement, running, squatting, cycling and balance. When an ACL injury occurs, all the work the quads put in are cast to the wind – no matter how severe the injury. When you’re out of action, the quads are the muscles which suffer from lack of exercise the most.

A recent study from America spelt out the bare facts recently: according to the study, young athletes who have returned to competition after ACL reconstruction with lower quadriceps strength than before running an increased risk of a second – and more damaging ACL injury.

So, while you’re focusing on the state of your ACL and contemplating a return to play, it’s vital that you take care of your quads.

knee rugby injuries

World Rugby introduce six trials aimed at reducing rugby injury rates

We’re all getting ready for the Rugby World Cup at the end of the month, obviously – but while us fans are working out how to reorganise our sleep patterns right through to the beginning of November, the game has its eye firmly on the future.

After a comprehensive evaluation of the sport and its injury rate by the World Rugby Law Review Group, six new trials have been announced in an attempt to bring the rugby injuries rate down. Depending on their success – or otherwise – we could see certain changes happening to the sport as recently as the 2023 World Cup in France, and the findings could even set the course of the Union code for the rest of the century.

Here are the trials which most concern the sports medical community;

Rugby injuries trial: the reduction of tackle height to the waist

Obviously, this is the big one, and the reasons for it are clear as day: it’s a bid to reduce injuries, and head injuries in particular. According to the Law Review Group’s findings, 50% of all rugby injuries – and a whopping 76% of concussions – occur in tackles.

The concussion rate is particularly alarming: anyone who takes the slightest interest in American football will be aware of the spate of problems retired NFL players are dealing with, and although the Union code isn’t as blatant when it comes to head-to-head contact, the speeding-up of the game and improved physical condition of its players mean that the knocks are getting harder.

Ruby injuries trial: the high tackle technique warning

Simply put, if you put in an upright tackle (i.e., you’re not bent at the waist as you go in), and there is clear and obvious head contact, you’re issued with a warning. If you get a second warning, you automatically serve a one-game suspension.

This rule has been trialled at the World Rugby U20 Championship for the last two years, and it appears to have worked. Over the course of 300 matches, the LRG worked out that an average of 2.5 high tackle technique warnings were issued, and the incidence of concussion in games dropped by more than 50%.

While the other trials are more concerned with sin bins, encouraging players to drop back from the defensive line and reducing defensive line speed, these two trials have attracted the most attention, and for good reasons. As Bill Beaumont, the chairman of World Rugby’s executive committee, pointed out; “World Rugby is unwavering in its commitment to ensuring rugby is as simple and safe to play as possible for all. While injury incidence in the sport is not increasing and concussion incidence is decreasing, we can and must do more to reduce injuries at all levels. This is an important milestone on that journey.

“The next step is to identify in partnership with our unions’ appropriate competitions to run the trials.”

Several unions, particularly those Australia, France and South Africa, are interested in operating one or more of the trials in domestic or cross-border competition, meaning that the possibilities of a safer sport could be in reach over the next few decades. Which can only be a good thing.

For advice, diagnosis or treatment of rugby injuries, call 0203 195 2443 to arrange a consultation with Mr Jonathan Webb

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 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.