How does N-Stride work?
Injecting the knee with high concentrations of “good proteins” extracted from the patient’s own blood helps to block cartilage destruction in the joint. This produces a reduction in pain and an improvement in mobility. Ongoing cartilage destruction may be slowed.
What is N-stride made from?
N-stride uses the patient’s own blood, which is processed to concentrate white blood cells, platelets and plasma proteins.
Is everyone suitable for treatment?
N-stride has been shown to be most effective in people with mild to moderate osteoarthritis of the knee.
Minimally Invasive Hip Replacement
Is Minimally Invasive Hip Replacement suitable for older patients?
Yes, it is suitable for most types of patients with the possible exception of people who are obese or very muscular.
Is it safe to get up on your feet so quickly after surgery?
Yes, it is a good idea to mobilise as soon as possible after surgery under supervision of a physiotherapist.
How long will my new hip implant last?
On average, a hip replacement lasts around 15-20 years. It is no different with minimally invasive hip replacements as it is just the type of surgery that differs, rather than the implant itself.
How quickly will I be able to go home after surgery?
You can normally go home three to five days after your operation. You will need some kind of walking aid (frame or crutches) and your physiotherapist will recommend exercises to strengthen your knee.
How can I prepare for my operation?
It is a good idea to stay as active as you can as strengthening the muscles around your knee will aid your recovery. Gentle exercise is best – swimming and walking. Your physiotherapist will also suggest some exercises to help you prepare for surgery.
What is arthroscopic washout?
Sometimes you may be offered alternatives to surgery. In days gone by an arthroscopic washout and debridement was performed, but it did not give lasting results. Now, arthrscopic surgery is only used in knee arthritis to remove loose bodies that are troublesome or if the knee is locking due to a cartilage tear.
Customised knee replacement
Why are custom implants better than normal implants?
They are individually designed for you based on your personal anatomy. Because they are custom fitted to you, the surgeon doesn’t have to compromise on fit. This means there is less likelihood of pain after surgery. More of your healthy bone and ligament can be preserved which means you have more treatment options in the future. Custom implants are designed to mimic the natural shape of your knee for improved movement and function.
How long will it be before I can get back to normal?
Recovery varies from one person to another. On average most people return to their normal day to day activities within six weeks. More physical activities like sport can take up to three months.
How long does the operation take?
Total knee replacement is a standard procedure. It takes between 60 and 90 minutes.
Revision joint replacement
Why do I need revision replacement surgery?
Over time, hip and knee replacement implants can wear and fail. This may be due to lifestyle factors, such as your weight or involvement in high impact activities, or it may simply due to the fact that implants have a maximum lifespan of 15-20 years. When an implant starts to fail it can become loose and cause pain, instability and loss of movement. Revision replacement surgery can reduce or alleviate these symptoms.
How long does the operation take?
Revision replacement surgery normally takes two to three hours. The surgeon may follow the incisions made when you had the original replacement surgery although they may be longer to enable all of the old components to be removed. The original implant will be removed very carefully to preserve as much bone as possible. Cement that was used to fix the implant in place will be removed. Bone surfaces will be prepared for the new implant, which may entail adding metal plates and platforms to compensate for any bone loss.
Will I experience complete relief from pain after surgery?
Not in every case. If it is not entirely alleviated, your pain levels should improve significantly.
Foot & Ankle
How will I know if I’m suitable for surgery?
You need to talk to your doctor who will discuss your individual symptoms, lifestyle and general state of health. Generally you will normally be advised to try other non-invasive treatments before choosing a surgical route as it carries a greater risk of complications.
What are the post-surgical symptoms to look out for that might indicate there are complications?
If you notice any signs of infection you should talk to your doctor immediately. These include heat in the area of surgery, redness, pain or an unusual smell. Antibiotics will normally resolve the problem.
Is it normal to have bleeding from the site of the surgery?
A certain amount of blood loss is normal. However, sometimes blood can collect under the skin causing a swelling. This is called a wound haematoma and it may require further surgery to drain the blood.
Platelet rich plasma (PRP)
What types of injuries are most commonly treated with PRP?
PRP injections are commonly used to treat chronic muscle or tendon injuries, such as tennis elbow, Achilles tendinosis, plantar fascilitis and rotator cuff injuries, as well as knee osteoarthritis.
Does it hurt?
There is normally a sensation of mild discomfort during the treatment, which lasts 30-40 minutes. Afterwards there may be a temporary increase in pain, swelling and bruising.
Am I likely to experience complications?
It is common for people to experience a temporary worsening of symptoms but these normally improve as the injury heals. There is a small risk of infection at the site of the injection.
Will it hurt?
There is a certain amount of pain and discomfort during the procedure. The doctor carrying out the procedure will ask you to advise them of your pain levels and can adjust the treatment to manage this.
Will I need to stay in hospital?
No, you can go home after the treatment and should be able to resume your normal activities immediately. It is best to avoid doing anything too strenuous for around 48 hours.
What should I do if I’m in pain after the treatment?
If you do experience any pain after shockwave therapy, it is fine to take paracetamol but avoid taking anti-inflammatories like ibuprofen as this can interfere with the body’s natural healing process.
Orthotics & braces
Should I use my foot orthotics continuously?
Your feet and legs may have been functioning abnormally for many years and it may take a little time to correct this. Wearing an orthotic all day every day is not recommended at first. It is better to build up by around an hour each day to allow your body time to adapt.
How long do orthotics last?
On average they last around five years, although they can last much longer. Some orthotics are made from softer, foam materials and these tend to last for a shorter time, typically around 12 months.
Is it right for the orthotic to feel uncomfortable?
Your body will take a little time to adapt to the orthotic and there may be a degree of discomfort at first. However, the orthotic shouldn’t be consistently uncomfortable. Talk to your doctor if you are experiencing ongoing discomfort.
Is it a good idea to exercise if I have hip pain?
If you are participate in regular sports activities and notice something isn’t quite right, the best thing to do is stop and seek guidance from a specialist.
Following diagnosis, gentle exercise is generally good as it builds muscle and strengthens your joints. However, too much exercise or exercising too hard can exacerbate the pain. It is essential to warm up thoroughly before exercising and stretch afterwards. Try low impact exercises like swimming or cycling rather than high impact activities like running.
When does pain in the hip need urgent medical attention?
You should seek urgent medical help if:
- you have had a fall or accident
- your leg is deformed, badly bruised or bleeding
- you’re unable to move your hip or put weight on your leg
- you have a temperature and feel unwell
Can taking supplements help with osteoarthritis of the hip?
There is some evidence to suggest that glucosamine and chondroitin sulphate may help to ease the symptoms of osteoarthritis to some degree and they do not cause side-effects.
Vitamin D and calcium may be recommended supplements for general bone health.
Are there any ways of minimising the risks of hip surgery?
You will be given antibiotics to minimise the risk of infection and blood thinners to minimise the risk of blood clots after surgery. Your doctor will discuss other ways of minimising the risk of complications.
Am I too old for hip surgery?
Age is not normally a barrier to having hip surgery, providing you are in a reasonable state of health and readiness for surgery. Talk to your doctor who will carry out an assessment.
How will I manage if I live alone?
Significant numbers of older people who have surgery live alone. Sometimes a friend of relative might be able to come and stay with you for a while until you are back on your feet. Or it might be possible to arrange for home help, or a stay in a rehabilitation unit.
Will a sporting injury to the knee heal by itself?
It may do depending on the nature of the injury. However, if it does not heal completely you may be left with chronic pain or restricted movement. It is always a good idea to get medical advice if you suffer an injury or have an accident.
How can I tell the difference between the pain of osteoarthritis and a torn ligament?
The pain of a traumatic injury like a torn ligament is sharp and sudden. You are likely to know exactly when the injury occurred. By contrast, the pain of osteoarthritis is a dull, ongoing pain, which worsens over time.
How can I protect my knees from injury?
If you are playing sport or running, it is important to know when to stop. The more tired you get the more susceptible you are to injury. Also, maintaining a healthy body weight avoids putting too much strain on the knees.
Are there risks associated with keyhole surgery?
All surgery carries some risk. In the case of knee arthroscopy or keyhole surgery, the possible risks include:
- blood clots
- bleeding inside the knee joint
- damage to cartilage, meniscus, blood vessels, ligaments or nerves
- knee stiffness
How long does it take to recover from knee replacement surgery?
You should be able to resume your normal activities without the need for crutches or a walking frame within six weeks of surgery. It may take three to six months for the pain and swelling to subside.
Is there anything I can do to avoid ankle injuries?
To avoid injuring the ankles, doctors recommend maintaining a healthy weight, avoiding exercising while you are tired or in pain; wearing well-fitting shoes that are appropriate for the activity you are doing and warming up properly before exercising.
I tore a ligament and it is taking a long time to heal, is that normal?
Unfortunately, it can take a long time for ligaments to heal – sometimes as much as two years. In the meantime, keep doing whatever strengthening exercises have been recommended.
My son injured his ankle during football practice, what should I do?
Follow the RICE procedure outlined above – Rest, Ice, Compression, Elevation. Fractures and sprains that go undiagnosed or aren’t treated properly can lead to long-term ankle problems, such as weakness, repeated injury and arthritis.
If I have to have a plate or screws, will they need to be removed in the future?
No, generally screws and plates will not be removed unless they start to cause problems, such as pain, irritation or infection.
Will I have surgery under general anaesthetic?
It will depend on the nature and severity of the injury. Some treatments can be carried out under local anaesthetic, which carries a lower risk than general anaesthetic.
Will I be able to move around after ankle surgery?
You should not put weight on your ankle until you are advised by your doctor that it is safe to do so. In the meantime, you will be able to use crutches or a special protective boot or cast to enable you to move around. It is important not to do too much too soon as you could risk damaging your ankle further.
How painful are stress fractures?
Stress fractures occur most commonly in the foot or ankle. Normally the pain develops gradually and worsens if you put weight on the area. The site of the injury may be swollen and painful to the touch.
How can I tell if I have a stress fracture?
X-rays won’t always reveal a recent stress fracture. You may need to have an MRI scan or nuclear bone scan using a small amount of radioactive material.
How can I prevent stress fractures?
Build up exercise gradually particularly when embarking on new sports or training regimes. Wear well-fitting sports shoes. Ensure you are getting enough vitamin D and Calcium. Take regular breaks and stop exercising when you are tired.
What is a bone graft and why do I need it?
A bone graft is sometimes used if the fractured bone doesn’t heal properly. It is either a natural or a synthetic bone that is transplanted to stimulate the broken bone to heal.
Is there anything I can do to reduce the risk of fractures?
Keeping your bones healthy and strong for as long as possible is the best way to avoid fractures, particularly as you get older. It is important to eat a healthy balanced diet with plenty of calcium, which is found in dairy products, and green leafy vegetables. Exposure to sunlight, as well as eggs and oily fish, provides Vitamin D, which is also important for bone health. Weight-bearing exercise – walking, running, dancing – will cause your bones to become stronger and denser.
Why have I developed a bone marrow infection?
If you have a compound/open fracture, bacteria can get in and affect the bone or bone marrow. This can become a chronic infection, which may require hospitalisation. You may be treated with antibiotics or surgery.
Pelvis and acetabulum
Will I make a full recovery?
The serious nature of acetabular fractures, coupled with the risk of complications, means you may not be able to achieve the same level of activity after surgery that you had before your injury.
Why won’t the surgeon operate immediately?
You may need time to stabilise after a serious injury and to prepare for surgery. During this time you may be placed in skeletal traction to help immobilise the fracture and prevent further injury.
Why do I need a CT scan as well as an X-ray?
The pelvis is a complex structure. A CT scan allows the surgeon to see a detailed cross-section of the pelvis and enables them to plan your operation beforehand.
Limb reconstruction and leg lengthening
Will it hurt?
Immediately after surgery you may be given an epidural, or patient controlled analgesia, which allows you to press a button to feed pain-relieving drugs straight into your blood. After the initial pain has subsided you will be given pain-killing tablets. You will need to continue taking these once you are discharged from hospital.
As the bone stretches alongside the nerves, muscles and blood vessels you are likely to experience some pain. This can be relieved with painkillers or by adjusting the rate at which the nail is lengthened. Talk to your doctor if you feel the pain is too much. You should avoid taking anti-inflammatories (ibuprofen) and aspirin as they can interfere with bone healing.
How long will I need to stay in hospital?
You will normally need to stay in hospital for about a week after surgery. You will be shown how to use the handset and given physiotherapy exercises to keep your joints and muscles mobile.
Do I have to give up smoking?
Smoking is known to delay bone healing and increase the risk of complications. For this reason, you are advised to quit smoking prior to surgery. Talk to your doctor about support to help you do this.