Knee replacement surgery – common questions answered

knee-701327_960_720If you have been suffering with a knee condition, the chances are you may wish to consider having an operation to correct the problem. Knee replacement surgery is an option for people who have damaged their knees significantly, usually via a sporting injury or through another type of accident.

As with any type of surgery, it is a big decision to make, and you will naturally have a lot of questions. Here are some answers to help you through some of the common questions by people considering whether or not to have knee replacement surgery.

What age is the ‘right age’ for this type of surgery?

There is no optimum age, the decision of whether or not this surgery is right for you must be taken by assessing your case on an individual level. Some people may have suffered an injury in their youth, which has brought the need to address the problem earlier in their life; others may simply be suffering from age related ‘wear and tear’ of the joints and may be much older when making this choice.

What type of anaesthetic is used during the operation?

This depends on the surgeon and on the nature of the work that needs to be done to conduct the operation. There are a variety of different methods available, ranging from full general anaesthetic to more localised options, and these can be discussed at length with your surgeon.

It is important to remember, anaesthesia is much safer nowadays compared with how it used to be. Your surgeon will be in possession of your full medical history so will be able to consider the most appropriate option for you and your case.

How long is the recovery period after surgery?

Generally speaking you should expect to be mobile again after just a couple of days – albeit with the aid of crutches to help support your weight. In the hours directly after you operation you can expect that physiotherapy will begin, you will be asked to stretch and bend your knee so that it does not stiffen more than can be helped.

The full healing process will differ depending on the age and health of the individual and also the complexity of the replacement. Most people will undergo several weeks, if not months, of physiotherapy before they are fully recovered.

What questions should I ask at my Birmingham hip replacement consultation?

consultationA hip replacement consultation can be quite daunting, especially if you haven’t undergone surgery before. Many people find that, whilst there are lots of questions floating around in their head before and after the consultation, when they are actually sitting in front of the surgeon who might be able to give them the answers to those questions, their mind suddenly goes blank.

Here, Birmingham hip surgeon Mr Manoj Sikand offers some advice on the best questions to ask your hip replacement surgeon.

Is there anything I can do at home to prepare for my hip replacement surgery?

Your surgeon should inform you about how long you need to fast for in the run-up to surgery (generally around six to eight hours), and advise you to stop smoking – if appropriate – at least six weeks before the date of your operation.

However, you may need to ask this question to find out what you can do to get the best from your hip replacement operation – there may be some special exercises you could do to strengthen your muscles, and if you are overweight it might be that shedding a few pounds will minimise the risks of surgery and improve the outcome.

How can I get my house ready for my return from hospital?

This question allows you to find out what you can do to ensure that your life is as easy as possible when you return home after your hip operation. It may be that a temporary rearrangement of your home will be helpful, ensuring that you don’t need to negotiate stairs for the duration of your recovery.

You could also do a pre-surgery shop, in order to stock up on supplies that might come in handy after the hip replacement.

How well does hip replacement work for someone like me?

The question here is really – how much can I expect my life to improve after hip replacement, bearing in mind my age and any pre-existing medical conditions. Hip replacement surgery can be life changing, and will almost certainly improve your quality of life, but to what extent will depend on many factors.

Other questions you may ask

  • What is the approximate length of stay in hospital?
  • What is the infection rate after hip surgery?
  • What is the rate of clot formation in legs?
  • How long does it take to get to back to unaided walking, driving swimming etc?

For some more questions please visit the FAQ section of my website.

If you have any questions you would like to ask about hip replacement surgery in Birmingham, please contact us.

How do I choose the best hip surgeon for me?

choosingIf you are undergoing a hip operation privately, choosing the best surgeon for the job can be a difficult process. There are lots of orthopaedic surgeons around, and it can be hard to decipher which one would be the most suitable for you.

Here, Birmingham hip surgeon Mr Manoj Sikand offers some pointers on how to choose the right surgeon for your hip operation.

Look for the initials after his/her name

In order to work as a consultant surgeon on the NHS in the UK – and you cannot legally practise privately unless you have attained a consultant level – you need to have passed all the exams necessary to become a Fellow of the Royal College of Surgeons (FRCS). So FRCS should be the minimum letters you are looking for at the end of your surgeon’s name.

Most specialist surgeons will also pass further exams in their chosen specialty. For hip and joint surgery, these are Orthopaedics and Trauma exams, so a good hip surgeon should have the letters FRCS (Orthopaedics and Trauma) after his/her name. This is a sign that your surgeon is an expert in this field.

Find out about his/her experience

Qualifications are all well and good, and are a good indicator of expertise, but experience is also key. If you can, find out when your surgeon qualified, and whether they have been continuously in practice since then.

At the consultation stage, you could also ask how many times he/she has performed this particular operation, and what his/her personal complication rate is. If the surgeon has performed the operation many times and has a low complication rate, this is a positive sign.

Another question to ask is: What are his/her results like? If you aren’t satisfied with the answer he/she gives you, or if you just want to know more, you can look them up on the National Joint Registry (NJR).

You can see Mr Sikand’s results here

If you would like to know more about hip replacement in Birmingham, please contact us.

When can I fly after hip or knee surgery?

800px-Aeroplane_-_Faro_-_The_Algarve,_Portugal_(1470399788)There has been a flurry of news stories recently about an elderly grandmother who was unable to fly home from Disneyland, Florida, with her family after having emergency hip replacement surgery during her trip.

The airline, Virgin Atlantic, does not allow passengers to fly within ten days of surgery. According to the article in the Daily Mail, the lady in question, Pamela Pointer, was told by airport staff that they would not make an exception for her, despite being shown a note from her surgeon, deeming her fit to fly.

She flew home four days later, but missed Christmas with her family.

Who decides if you are fit to fly after surgery?

According to Birmingham hip surgeon Manoj Sikand, the decision really lies with the airline, although doctors can make recommendations, which may or may not be heeded.

The Civil Aviation Authority (CAA) has issued a guide advising the period between surgery and flying, depending on what type of surgery you have undergone. Interestingly, this guide states that you may need to wait as long as three months before flying after an operation to replace a joint such as a hip or knee.

What are the dangers of flying after surgery?

Whatever surgery you have had, you are at increased risk of deep vein thrombosis (DVT), which is a blood clot that forms in the deep veins of the body, often in the legs.

If you have had hip surgery or knee surgery, you are at especially high risk of DVT when flying, which is why many airlines, including the one Ms Pointer was flying with, prefer to stick to policy and leave a sensible gap between surgery and air travel.

Flying and surgery

If you are expecting to have a hip replacement or knee operation in the next year, and also plan to travel abroad, Birmingham hip surgeon Manoj Sikand recommends that you wait to book your flights until you have a date for your hip or knee surgery, and then leave as long a gap as possible between the operation and the flight.

If you can leave three months between any knee or hip surgery and flying (particularly long haul flights), that would be the safest option, but if it is urgent that you fly out as soon as possible after your operation then you would be best advised to check the airline’s policy on flying and surgery.

Study shows patients benefit from education prior to hip surgery

doctor ipadA study presented at the February meeting of the American Association of Physical Therapy has shown that giving patients one-on-one counselling with a physiotherapist and access to a custom web portal before knee or hip replacement surgery is beneficial in terms of preparing them for surgery and its aftermath.

Patient education

Whilst Birmingham hip surgeon Manoj Sikand and his colleagues have long been aware that patient education is key in improving results, there has been much debate about the best way to deliver it. This study, carried out by a team at the Hospital for Special Surgery (HSS) in New York, aimed to find out whether patients would benefit from additional one-on-one support prior to surgery.

The research

The study followed 126 patients undergoing hip or knee replacement surgery due to osteoarthritis between February and June last year (2015). All patients attended a group education session before surgery. The patients – who had an average age of 61 – were then randomised into two groups.

In one group, patients received one-on-one education classes with physiotherapists and were given access to a specialist informational web portal, in addition to attending the group session. The control group had no access to the web portal and received only the information given in the group education class and a leaflet about what to expect post surgery.

The results

Questionnaires were distributed among all 126 patients, to assess patient satisfaction and patient-reported functional outcomes – which measured pain, stiffness and function pre and post operation.

According to lead investigator Dr Rupali Joshi, “Significantly more patients who attended the extra one-on-one counseling session with the physical therapist before surgery indicated that they were better prepared to leave the hospital after surgery and were overall more satisfied with the preoperative education they received.”

Of the patients in the control group, almost 70% said they believed they would have benefited from further education prior to surgery.

Interestingly, those patients who had attended the one-on-one sessions also needed fewer physiotherapy sessions in the hospital and met physiotherapy discharge criteria sooner – this includes the ability to get out of bed, walk and go up and down stairs independently.

When to think about revision hip replacement

Like any surgery, total hip replacement has its risks, and one of the risks is that the procedure may need to be revised at a later date. These days, artificial hips are designed to last for between 20 and 30 years, so you can usually expect to be free from hip pain for some time – perhaps for the rest of your life, depending on your age at the time of surgery.

However, the human body is a complicated organism, and sometimes things do go wrong. If you are suffering from problems as a result of your hip surgery, Birmingham hip surgeon Mr Manoj Sikand offers revision total hip replacement. Here are some reasons why total hip replacement might be necessary:

Damage to the prosthesis or liner

Over time, both the prosthesis (hip replacement) itself and the liner that aids smooth motion within the socket may wear down. In some instances, the liner may become torn, or the prosthesis damaged due to injury. In this case, revision hip replacement may be necessary. If the problem is with the liner, it may be possible to replace this without replacing the whole prosthesis.

 

Other problems with the prosthesis

Sometimes the prosthesis may become loose from its attachment to the bone or socket. This may or may not cause pain, but patients usually say that they can sense something is wrong with the hip. Some patients describe it as a feeling that the hip might “give out”.

There is also the (rare) possibility that the prosthesis itself might be defective in some way and require replacing.

Problems with the original surgery

Again, this is very rare, but if you are suffering from continued hip pain after total hip replacement surgery, there is a possibility that there was a problem with the surgery that has resulted in an infection, or that the prosthesis may not have been properly implanted.

If you have previously undergone hip replacement surgery and are suffering from pain in the hip, thigh or groin region, find that your mobility is limited or have a sense that something is not quite right with your replacement hip, Birmingham hip surgeon Manoj Sikand can help to diagnose and resolve the problem.

Hip procedures explained

When most people hear ‘hip operation’ they think hip replacement, but – perhaps not surprisingly – it’s a bit more complicated than that.

If you’re suffering from hip problems that are affecting your ability to carry out everyday tasks, then hip surgery might be necessary, but which operation you have will depend on a number of factors; your diagnosed hip problem will of course be the most important of these, but your age and how active you are will also come into play.

There are three major categories of hip operation, although this is not exhaustive. Here are the top three explained:

Total hip replacement

This is the best known and probably the most common operation for hip problems. It is generally thought of as a procedure for older patients, and although that is not necessarily the case, it is true that some of the other options available nowadays are less suited to the older population.

In a traditional hip replacement procedure, a long incision (between 10 and 12 inches) is made on the side of the hip, and the muscles are split to give the surgeon a good view of the hip itself. The femoral head (the part of the joint that fits into the socket) is then removed and replaced with a metal stem, topped with a metal or ceramic ball.

The procedure can take several hours and is usually performed under general anaesthetic. Once your operation is complete you will need to spend a few days in hospital in order for the surgical team to assess your recovery.

Minimally-invasive total hip replacement

Minimally-invasive total hip replacement is a similar procedure to traditional hip replacement surgery, but special instruments are used in order to perform the operation through smaller incisions.

There are two types of minimally-invasive hip replacement – single-incision surgery, in which one incision of between three and six inches is made in the hip, and two-incision surgery, in which two smaller incisions are made: one two-inch incision over the groin and one one-inch incision above the buttock.

Two-incision surgery may take longer than traditional hip replacement surgery, and the length of hospital stay is similar, but the advantages of minimally-invasive hip surgery are reduced pain and a quicker recovery time.

Minimally-invasive hip replacement is best suited to younger, fitter patients.

Hip resurfacing

Hip resurfacing is similar to traditional hip replacement, but instead of removing the femoral head completely, it is trimmed and capped with a metal covering. The damaged cartilage and bone from the socket is also removed and replaced with a metal shell.

As a general rule, candidates for hip resurfacing are younger, often larger-framed patients who have strong, healthy bones and lead an active lifestyle.

You will need to have a full consultation with Birmingham hip surgeon Mr Manoj Sikand to find out which – if any – of these procedures is suitable for you.

Hip procedures explained

When most people hear “hip operation” they think hip replacement, but – perhaps not surprisingly – it’s a bit more complicated than that.

If you’re suffering from hip problems that are affecting your ability to carry out everyday tasks, then hip surgery might be necessary, but which operation you have will depend on a number of factors; your diagnosed hip problem will of course be the most important of these, but your age and how active you are will also come into play.

There are three major categories of hip operation, although this is not exhaustive. Here are the top three explained:

Total hip replacement

This is the best known and probably the most common operation for hip problems. It is generally thought of as a procedure for older patients, and although that is not necessarily the case, it is true that some of the other options available nowadays are less suited to the older population.

In a traditional hip replacement procedure, a long incision (between 10 and 12 inches) is made on the side of the hip, and the muscles are split to give the surgeon a good view of the hip itself. The femoral head (the part of the joint that fits into the socket) is then removed and replaced with a metal stem, topped with a metal or ceramic ball.

The procedure can take several hours and is usually performed under general anaesthetic. Once your operation is complete you will need to spend a few days in hospital in order for the surgical team to assess your recovery.

Minimally-invasive total hip replacement

Minimally-invasive total hip replacement is a similar procedure to traditional hip replacement surgery, but special instruments are used in order to perform the operation through smaller incisions.

There are two types of minimally-invasive hip replacement – single-incision surgery, in which one incision of between three and six inches is made in the hip, and two-incision surgery, in which two smaller incisions are made: one two-inch incision over the groin and one one-inch incision above the buttock.

Two-incision surgery may take longer than traditional hip replacement surgery, and the length of hospital stay is similar, but the advantages of minimally-invasive hip surgery are reduced pain and a quicker recovery time.

Minimally-invasive hip replacement is best suited to younger, fitter patients.

 

Hip resurfacing

Hip resurfacing is similar to traditional hip replacement, but instead of removing the femoral head completely, it is trimmed and capped with a metal covering. The damaged cartilage and bone from the socket is also removed and replaced with a metal shell.

As a general rule, candidates for hip resurfacing are younger, often larger-framed patients who have strong, healthy bones and lead an active lifestyle.

You will need to have a full consultation with Birmingham hip surgeon Mr Manoj Sikand to find out which – if any – of these procedures is suitable for you.

Why might you need knee replacement surgery?

Knee replacement surgery is perhaps a less well-known procedure than hip replacement, but since the operation was first performed in the late 1960s it has become one of the most successful of all joint replacement procedures.

There are many reasons why patients come to Mr Manoj Sikand for knee replacement in Birmingham, but these are the most common:

Osteoarthritis

Osteoarthritis is the most common form of arthritis, affecting many of the larger joints of the body, including the hips and knees. Osteoarthritis causes the cartilage that cushions and protects these joints to break down, causing pain and limiting the movement of the affected joints.

Anyone can develop osteoarthritis; it can be hereditary, but can also be caused by lifestyle factors such as being overweight, or damage to the joints from previous injury. The condition is characterised by pain, stiffness and swelling in the affected joints, possibly accompanied by a grinding sensation as you move.

If you suffer from osteoarthritis affecting one or both of your knees, you could be a candidate for knee replacement surgery in Birmingham.

Rheumatoid arthritis

Rheumatoid arthritis is an auto-immune condition, which inflames the lining of the joints affected. It causes pain, swelling and stiffness in the joints it affects, which are usually the joints of the hands and feet, although it can affect the knees, which is when knee replacement surgery may be appropriate.

Rheumatoid arthritis tends to be symmetrical, which means if you have rheumatoid arthritis of the knees, both knees will probably be affected. The disease is most common in women aged 15-44.

Post-traumatic arthritis

Post-traumatic arthritis occurs when cartilage begins to wear out on a joint that has previously suffered injury, as a direct result of that injury. The injury could be sports related, or due to a car accident or other trauma. Once a joint has been injured, its mechanics are altered, making it more prone to wear and tear.

If you have previously suffered an injury to your knee and are currently experiencing pain, swelling and stiffness in that knee, you may be a candidate for knee replacement in Birmingham.

‘Too young’ for hip replacement?

Hip replacement surgery is traditionally seen as a procedure for older people, but anyone of any age can suffer from hip pain, and if hip pain is interfering with your daily activities then you should see your doctor.

Who is a candidate for hip replacement surgery?

Anyone could be a candidate for a hip replacement, if they have joint problems. From young mothers to athletes, hip pain doesn’t discriminate and if you are struggling with pain in your hip joints, hip surgery can help you to make a return to your previous form.

Even classically trained dancer Craig Revel Horwood underwent hip surgery aged 48, returning to his position as a judge on Strictly Come Dancing within a week (although usually surgeons recommend a recovery period of at least four weeks, and 38-year-old dancer Angela Towler, of the Rambert Dance Company, had a hip replacement in 2013 and was back on stage later that year.

When does hip pain become serious?

When it starts to interfere with your ability to carry out normal, everyday activities, hip pain is a problem that you should consult your doctor about. Consultant orthopaedic surgeon Manoj Sikand, who performs hip surgery in Birmingham, suggests the following indicators that might prompt you to book an appointment with your GP:

  • Hip pain that prevents you from sleeping
  • Difficulty going up and down stairs due to hip pain
  • Pain medication having little effect
  • Trouble moving from sitting to standing

What sorts of hip surgery are available?

Mr Sikand offers the following types of hip surgery in Birmingham:

  • Total hip replacement
  • Hip resurfacing – this is often suitable for younger, more active patients
  • Minimally invasive hip replacement
  • Revision hip replacement
  • Surgical treatment for arthritis
  • Sports injury treatment

For more information or to book a consultation for hip surgery in Birmingham, please contact us.