Phil

Good evening, everyone, and thank you for joining us. A very warm welcome to our webinar this evening. Thank you for tuning in.

This evening's topic is hip osteoarthritis treatment.

My name's Phil, and I'll be your host for this evening.

I'm delighted to be joined by our expert speaker, Mr Kumar Reddy, Associate Specialist Surgeon.

Tonight's session will begin with a presentation from Mr Reddy, and this will be followed by a Q&A where we answer your questions live.

If you have any questions at any point during the presentation, please feel free to submit them, and you can do this using the Q&A icon, which can be found at the bottom of your screen.

You're welcome to ask your questions anonymously, or you can include your name, but we should point out that if you do include your name, the session has been recorded, so any name shared may be visible in the recording.

To help us get through as many questions as possible during the Q&A, please keep your questions brief.

If you're interested in booking a consultation, we will share all the relevant contact details for you to do this at the end of the session.

Now, without further delay, I will hand over to our expert speaker, Mr Reddy.

Mr Kumar Reddy

Good evening, everyone.

Thank you so much, Phil, for the introduction.

I sincerely thank you, all the guys joining the webinar, for taking your precious time to join this. I will try to make it as brief as possible, so that it will enable you to ask questions at the end of this session.

We're going to talk about osteoarthritis of hips, and what are the treatments that are available.

Hip arthritis is quite a common condition it is a disease affecting the joints, mostly.

Hips, and also the knees the joint surfaces, which are covered by smooth cartilage.

We call it the articular cartilage, in the long term, they get damaged, the cartilages become thin and roughen.

 There would be damage to the joint surfaces, leading to bare bone, resulting in pain, discomfort, stiffness.

These are my disclosures, I'm one of the surgeons at East Kent Hospitals, where my NHS practice is largely at Kent and Canterbury. We recently have been awarded major revision center for knees and I'm one of the deputy chairs of a major revision center at East Kent Hospitals.

Also, I'm a member of the American Academy of Orthopedic Surgeons and British Association Society of Knees. My main interest is hip and knee arthroplasty, and also, I also have special interest in doing revision hips and knee revision surgeries.

The others include partial knee replacements, which are unicompartmental knee replacement, both medial and lateral, and also I do petrolefemoral replacements.

In addition to this, I also do keyhole surgeries when there are meniscal tests in the form of meniscectomies or meniscal repairs.

In this session, what the topics we include are mainly with regard to your consultation and assessment, and with regard to hip arthritis treatment options.

The risks that involved in undertaking a hip replacement surgery, your hospital stay, recovery and the patient edition support tools.

When you've got a lot of pain and discomfort, it is reasonable for you to make a consultation with an orthopedic surgeon so that they can take the history of symptoms, and also examine you with regard to your range of movements, muscle strength, and also to discuss with you what are the suitable treatments that he can offer.

With a view to relieve your pain, and to also improve your quality of life.

You'll also be assessed with regard to the treatment and the investigations that we normally request, which will be in the form of x-rays. If they're inconclusive, then we do requests for an MRI scan.

Well I've explained to you earlier that what is hip arthritis? It is it is a wear and tear of the joint.

Your hip joint is made of the top end of the thigh bone, called the femoral head, which articulates with the socket that we call it as an estabulum, which is in the pelvic bone.

So when the articular cartilage, which is a smooth surface, if it is worn out, then they become thin, roughen, and the areas can be damaged, leading to pain, discomfort, and stiffness.

The most common symptoms are you will have difficulty in cutting your toenails.

Putting the socks, tying the shoelaces, getting in and out of the car, and in and out of the bath. All these are your day-to-day activities which get affected.

Your sleep also gets affected, and your ability to walk any distance also will be limited because of the pain.

With regard to general causes, it is an age-related process, and with regard to obesity, when there are high BMI, where it puts a lot of load on the joints, your joints tend to wear away.

Next one is traumatic where you've got an injury to the hip in the form of dislocation or a fractures that can lead to arthritis.

The other one is loss of blood supply to the femoral head, which results in avascular necrosis, and this can be of several causes. One, it could be traumatic, the other causes being steroid-induced.

Other conditions can also lead to this type of avascular necrosis. We talk about the healthy hip, which I've explained to you that it is covered with smooth arterial surface, which is on my left-hand side on the right, you can see the damaged portion of the articular surface, resulting in arthritic hip.

The features that one can see on the plain x-ray are that you can see reduction of joint space. There'll be marked reduction of joint space, as there is no smooth articular cartilage anymore.

it could be bone-on-bone arthritis. The other features consistent with arthritis are subchondral cysts, osteophyte formation, which are bony prominences around the hip, the main thing is, is a reduction of joint surface.

With regard to treatment options, One is, non-surgical in the form of managing your pain your lifestyle modifications, which are crucial by doing regular exercise, and also, if you're high BMI, to do your best to reduce some weight, and to take a healthy diet and supplements that may help you.

The other important factor is insoles, footwear, and also use a walking stick or a cane. That also will help in relieving the pain. Physiotherapy and exercise also can play an important role in relieving your pain.

Steroid injections, and these are temporary, but they do help, because it's an anti-inflammatory that goes into the joint, and where you get good relief of symptoms.

With regard to surgical management, the main one is hip replacement. Hip replacement is mainly offered To improve the pain, or to get rid of the pain, and to improve your quality of life.

The hip replacement, I can show you in this picture, this is the socket.

I hope you all can see, this is the socket.

Embedded into the pelvic bone, and you get a liner on top of it where you can see the whitish plastic that is going inside the shell, and this is what we insert into the thigh bone.

We make a slot into the thigh bone, and then you broach it.

With sizes, and then whatever's the size that fits in to give stability of the hip, then we insert into the thigh bone.

So this again, you put in a femoral head onto the top and this one articulates with the stabulum, which is the socket.

This is what a hip replacement is.

We used to do hip resurfings in the past, but we're not doing here at the moment because of the metal-on-metal bearings, it can cause metallosis and pseudotumors.

The other one is arthrosis, which people used to do in olden days for infections like tuberculosis and other conditions when the hip replacements were not available.

As I said to you, the hip replacement is made of two parts, the ball and socket, inserted into healthy portions of the pelvis, which is the socket, and into the thigh bone, which is the femur.

The aim is mainly to relieve the pain, to improve the quality of life, and for you to enable to get back to your routine, normal, and non-impact sporting activities.

I can briefly talk to you about the types of hip replacements, which are uncemented, broadly, cemented, and hybrid total hip replacements.

My practice has been mostly uncemented tort lip replacement. I've been doing this for the last 24 years.

very rarely do I cement. I rely mostly on the natural bone to bind it like glue, which we call it an osseointegration, and I believe that it is better in the long term.

There's no hard and fast rule that one is superior to the other. Even hip replacements that are cemented are also lasting.

Also the hybrid total hip replacement, where we do an uncemented socket in the thigh bone, we put cement into the thigh bone. When you notice it's a poor quality bone, then it will be reasonable to cement the thigh bone.

You also have got bearing surfaces, as I have earlier shown you. It's a metal head.

they vary in sizes, between 28 to 36, that out cleats with the plastic, or you can have a ceramic head.

Which is a ceramic head that goes on the top of the Trunnion, this out creates with the socket.

Ceramic head survivorship is much longer when compared to metal hats. Most of us, we do put ceramic heads because of the longevity and the survivorship of the terminal heads.

With regard to risks of joint replacement surgery, during surgery, there can be an injury to the vessel or a nerve, or damage to the tendon.

Or ligament. We do a spare approach, where we don't cut any piriformis tendon, so it's minimally invasive surgery, and we go between the planes and do the hip replacement.

With regard to recovery, during recovery, there can be wound problems, there can be infection. Again, I'm pleased to inform you that the infection rates in this particular hospital is much less when compared to any other national health hospital.

You can develop clots in the veins of your leg that can migrate into the lung. Again, we tend to give you blood thinning tablets, either rivaroxaban, or blood thinning inject rivaroxaban, or epixaban, or edoxaban.

If you're already on anoxaban, we normally continue with edoxaban post-surgery. You can also have anoxapyrin. The normal recommendation for post-hip replacement is for 35 days.

There can be leg length discrepancy, and you can come across it's a ball and socket joint, the ball can come out of the socket and cause a dislocation. Again, it's a very rare entity.

The late complications are aseptic loosening, where the implants can become loose, and it can cause pain, or you can have a periprostic fracture, or a late dislocation. All these complications put together with the hip replacement are less than 5%.

The implants that we use in perendum of paper lock and chori hip replacements, and they are They've been time-tested for the last 30 years, and majority of the implants, their survivorship is 20 years and beyond at least, majority of them.

You're expected to stay about a day or two in the hospital, and If the surgery is carried out in the morning, by afternoon, the physios will come round and If you do not have any, Hypertension, or dizziness, they will try to get you up and get you mobilized.

You may have some discomfort in the leg and feet, swelling, and Most of us, we do expect you to return back to normality in six weeks.

During the recovery period, you're recommended to take some painkillers, and you do have some visible bruising, which would settle down within few weeks.

The physiotherapy we've got a fantastic physio team, where they will guide you with the exercises.

Most of us, we're all happy for you to get back to driving in six weeks. You can also sleep on either side with a pillow in between the knees after six weeks.

In three to six months, you will feel the optimum benefits of surgery. You can return back to playing golf.

Also, we would recommend you continue the exercises recommended by your physiotherapist.

These are hip and knee surgeons. You can see Mr Chipperfield, who's our Medical Director, and Mr Oliver, Mr Thakur and Mr Dunnet.

We've got some patient tools, which are Doctify. This is a website which honestly takes the sincere feedback from the patients they give the surgeons, and also it is on the public domain for you to have a look at the surgeon's feedback given by the patients.

Next one is the Joint National Joint Registry, which is, again, this is a tool. It collects information for both hip and knee replacements from hospitals in England and Wales.

This registry will help to find out which are the best performing implants, and recording your details enables the NJR to link people that I've received during surgery.

If a problem with a specific implant is identified in the future, the NJR will be able to help identify the patients who have received them and alert the respective hospitals and the surgeons who has performed with these implants.

Your details enable you to participate in a feedback survey, and all personal data is treated as extremely confidential at all times.

A copy of the data can be requested in writing to the NJR by yourselves, which they can provide you.

This one is my particular National Joint Registry profile. This is also available for you in the public domain, and these were the surgeries I carried out in the last three years, and you can see the national average on the right, and the procedures I carried out by myself.

With regard to primary hip replacements, the national average is about 131. I carried out about 614. With regard to hip revisions, the national average is 17, and I carried out about 14.

Which is slightly lower than the national average. With regard to total knee replacements, the national average is 155. I carried out about 465. Unicondylar are about 52 national, I performed about 68.

With regard to knee revisions, 14 is the national average, and I did about 24.

We talked about the National Joint Registry.

Thank you so much for listening to this webinar, I would be delighted to take some questions. I'll pass it on to Phil.

Phil

Thank you, Mr Reddy. Lots of useful information to digest there, and I think we can now take some questions from our attendees.

It's worth before we begin on the questions, it's worth me mentioning that, on this slide, you can view pricing details.

That we're pleased to offer free hip pain consultations for a limited period only, as it mentions on that slide there.

Moving on to your questions, firstly, we have one from Dawn who asks, what does an obliterated cartilage mean?

Mr Kumar Reddy

Dawn, with regard to obliterated cartilage, is when you got a smooth cartilage that's covering the smooth surfaces of the bone, which is an article cartilage. When it gets damaged, you get obliteration, and it is The joint space get obliterated, that's what it means.

Phil

Thank you.

This next question's quite broad, from Pauline. What supplements would you recommend?

Mr Kumar Reddy

The supplements that are generally recommended are the glucosamine sulfate with chondroitin, and people do benefit from taking some turmeric with black pepper, and also some try to avoid red meat, as it tends to produce inflammation of the joints.

To take some is supposed to be reducing the inflammation in the joints. These are the things, by and large, people do take glucosamine sulfate with chondroitin and cod liver oil tablets.

Phil

Thank you, Mr Reddy. I think we may have you may have touched upon this briefly in the presentation, but we have Steve here, who asks, how soon after surgery can I play golf?

Mr Kumar Reddy

We normally recommend you take up the golfing activities within eight weeks to three months. three months would be the ideal time, so that you would have got the optimum benefit from replacement it'll be reasonable for you to get back to golfing activities.

Phil

Thank you. An ideal follow-up question here from David, you mentioned impact activities. What sporting activities would be inadvisable?

For example, would tennis be okay?

Mr Kumar Reddy

Impact activities, again, it, these are artificial joints, these are subjected to wear and tear, so that's why we are apprehensive for you to get back to vigorous sporting activities, like, squash, back to football and rugby, but some of the patients have written back to playing tennis, playing gentle tennis, and badminton should be okay, and also playing golf, is you're allowed to do it.

Phil

Thank you.

Our next attendee asks, How long will it be before I can climb stairs again after surgery?

Mr Kumar Reddy

If you've got stairs at home, our physiotherapist will ensure that you do some stairs before you leave the hospital, and once they find that you're safe, I'm more than happy for you to get back to stairs as soon as the pain allows.

Phil

Thank you. Somebody asks what further help is offered if you are unlucky to be one of the five% who experience surgical issues they mentioned that they live two hours away from Benenden.

Mr Kumar Reddy

If you're unlucky, and if you've got a complication as a result of the hip replacement, we need to see what complication you have, and whether it is surgically remediable or not. It would be advisable for you to see the operating surgeon who did the procedure, and to have a frank discussion with him, and he would be in the best position to offer you help, assess you and recommend the treatment that you may well be going to require.

Phil

Thank you.

Susan asks, what metal is used in the hip?

Mr Kumar Reddy

It is a titanium metal that goes inside the thigh bone.

The bearing surfaces, my preferred bearing surface is ceramic on cross-linked or e-poly bearing.

Phil

Thank you.

Our next attendee asks, is cycling advised?

Mr Kumar Reddy

Yes, you can get back to cycling after a period of three months. I don't have any objections with regard to cycling. You can get back to cycling.

Phil

Amber asks What pain relief is recommended if you're not opting for surgery?

Paracetamol and ibuprofen is not touching the pain.

Mr Kumar Reddy

Amber, your GP would be able to advise you with regard to what suitable painkillers you can take, if ibuprofen and paracetamol are not working, then you can try tramadol or codeine-based, and also you can try pain patches, which may help you in relieving some amount of pain.

Phil

Thank you.

This question is obviously addressing post-surgery. I have a four-hour car journey home. Is that okay?

You can break the journey, after an hour or so, a couple of breaks, and it should be absolutely fine to do the journey.

As long as you caught short breaks.

Phil

Our next attendee is Jasper, and he asks.

Seeing as the ceramic head still sits and revolves on a metal rod, essentially, can you still end up with Metallosis?

Mr Kumar Reddy

Jasper, it's very unlikely that it would cause Metallosis, because there's a ceramic head sitting on the trunnion, but if there is a damage to the trunnion, then it can cause Metallosis very, very unlikely.

I've seen metalheads causing metrosis, and also metal on metal bearings, but I'm yet to come across the ceramic head causing metrosis, unless there is, Damage to the ceramic head, and that is articulating with the metal.

Phil

Thanks.

This next attendee is Melvina, and she asks, what type of anesthesia will be used?

Mr Kumar Reddy

The type of anesthesia we generally recommend is spinal anesthesia, so where they put an injection in the back, and they inject closer to the nerves, and it would enable them to numb the legs, and it lasts about between two to four hours. It gives you adequate pain relief, and there are no major complications with so that is the recommended anesthesia that our anesthetists recommend for you. they will also give you a nudge to this, sedation.

So that you won't hear any noises, or surgeons using the saw and the hammer during surgery.

Phil

Thank you.

I'm wondering if it's possible to perhaps combine these two questions, but somebody asks.

Is it advisable or necessary to have someone supporting you at home? then another attendee is saying, do I need to prepare my home for after the surgery?

I guess one addresses, is it advisable or necessary to have someone supporting you at home?

Mr Kumar Reddy

I think it is, it's a valid question, and I think it would be safer and better if you got somebody at home to look after you.

In the first two weeks, once when we do the hip replacements, it's like you developing confidence and Getting back to normality. it's like learning to walk again. if you develop that confidence, as soon as you develop confidence, majority of the patients, within three to four weeks, they get rid of the clutches. By the time we see them in the clinic in six weeks.

Most of them would have got rid of the crutches and walked without any walking aid. I think it is, It's it would certainly help if you've got somebody at home to look after you.

In the first two weeks.

Phil

The next attendee is Alan, who asks, following an initial consultation and any MRI or scans.

How quickly can you be given an operation date?

Mr Kumar Reddy

Following an initial consultation, your consultant will be asking you for plain x-rays for standard hip arthritis.

However, certain cases where you have caught immense pain and the x-rays do not show that significant evidence, it would be reasonable for the consultant to request an MRI scan to see whether there's any marrow edema.

Around the hip or the socket, and it depends on the with regard to operation date, whether you're coming on as a private patient, or through the NHS, we do have an NHS waiting time of about 18 weeks.

I hope I've answered the question correctly.

Phil

This next person is asking, after leaving the hospital, is it possible to have further physiotherapy at Benenden?

Mr Kumar Reddy

You're normally given three sessions of physiotherapy nowadays for rehab, and our physiotherapists will go through with you the type of exercises that you're supposed to do at home, and they will see you at Bellingen. If you're closer to Bendon, that If you can travel, for another three sessions. If not, they will do video links, and also the band will be able to arrange you locally.

Where you're staying, if it is inconvenient for you to travel all the way along, dependent. They will arrange three sessions.

Phil

Thank you, Mr Reddy.

I think this is a follow-up question on supplements. This person says a question about supplements.

I take CBD and vitamin B12, but I have to stop taking them two weeks pre-surgery, yet I can take my prescribed medication all the way today of the operation. Why is this, please?

Mr Kumar Reddy

I'm sorry, I'm not able to answer that question. We normally carry you can take CBD and things, unless your GP or somebody told you not to take it, or they may be interfering with the blood thinners, they might ask you to stop it, like turmeric and things you're not supposed to take.

When post-surgery, because of the you're on blackness for a period of 35 days to prevent any clots happening, that may be one of the reasons, for you To be advised to stop.

Phil

Thank you.

This person's obviously got a very specific amount of steps that they need to go up in their house, so they say, post-surgery, obviously, will I be able to go up about 15 steps as soon as I get home?

Mr Kumar Reddy

You would be it would be difficult because of the pain that you experience, because you're going to stay in the hospital for a day or two, and if somebody could get a bed downstairs, it'll be good, but if you still would like to do the steps, I would advise you to take one step at a time gradually go up the stairs, to do at home.

But you should be able to tell your physiotherapist while you stay in the hospital, and they should be able to make you practice to do the steps before you leave for home.

Phil

Thank you. Pauline asks another question; can you swim breaststroke following title hip replacement?

Mr Kumar Reddy

Some of the surgeons do allow, and I'm one of the surgeons who, I would say, to go for the breaststroke, but some of the surgeons, they're apprehensive because their breaststroke is advised you're advised not to do it because of the risk of dislocating the hip.

If you put enormous forces through the hip while doing breaststroke, there's a good chance it may pop out, which you do not want.

Phil

Thank you. A few further questions here.

Eileen asks, is it possible to use arthrosamide for hip arthritis? Arthrosamide for hip arthritis, we're not licensed yet. We're only licensed to give in the knees. This is a hydrogel polyaclamide injection, but we're not licensed in UK to give in the hip arthritis until recently.

Phil

Thank you.

Teresa asks, would a steroid injection help my hip pain?

Mr Kumar Reddy

It will certainly help in relieving your hip pain, but it's only a temporary measure, it's not a curative, it's an anti-inflammatory, which, majority of the times, it can give you great relief for about six weeks, and you'll be back to square one after that.

Phil

Okay, had some more questions coming in.

What signs or symptoms should I look for which may indicate a problem?

Mr Kumar Reddy

The main symptoms are the pain, stiffness in the joint. you'll find it, as I said to you I said earlier, that you may struggle to do to cut the toenails, to put the socks, tie the shoelaces, and even turning in bed would be very uncomfortable, it keeps you awake also, getting in and out of the car, in and out of the path, would be extremely challenging.

Phil

Thank you.

We have another question here.

After having one title hip replacement, what are the best measures to protect the other hip for as long as possible?

Mr Kumar Reddy

Again, modifications to your life, if one is overweight, just to get the weight down, to maintain that weight in order not to load the other hip.

These are the measures, and also, once we do the hip, your load can be transmitted equally between the two hips, which again, takes the load off the other hip.

When your hip is arthritic, you tend to lower the other hip, because you do not have that much pain. So and also, regular exercise would certainly help in and also, strengthening your gluteal muscles and quadriceps muscles also will aid.

With regard to you not, having the other hip.

Phil

Thank you. This is quite a detailed question, but it's an interesting one.

So Jasper asks, is hip replacement technology, artificial hip materials, quality, capability, strength, and longevity, as well as digital planning and placement, getting much more advanced by the decade.

If so, as such, presumably, it is much better to put it off as long as possible?

Mr Kumar Reddy

Natural hip condition dependent, to benefit from a better future hips.

If you can tolerate the pain, I would always tell everybody to hold off till your pain gets worse, and your quality of life is getting affected. If you can manage the pain, there's nothing like it, but it's your pain and your quality of life.

You want to get back to your normal routine activities. and it also affects a lot of your mental health if you're in a lot of pain.

It's even young patients, when there's evidence of arthritis on the plain x-rays or MRI scans, and your symptoms are consistent with arthritis.

It would be advisable for you to have a joint replacement surgery.

Phil

Thank you, Mr Reddy. I think we have exhausted all the questions. If you could move to the final slide for me, please?

Perfect.

So as a thank you for attending this webinar this evening, as mentioned on the screen there, we have an exclusive offer, which is our free hip pain consultation for a limited period, and you can use the code listed on the screen there.

Obviously, you will receive and also a thank you for attending, you'll receive a callback from your dedicated Private Patient Advisor. You will receive the recording of this session, some treatment information, and pricing.

You'll receive some loyalty points, rewards, via email.

Also, you’ll receive some updates on upcoming news, offers, and events.

After this session ends, you'll receive a short survey. We'd very much appreciate you taking the time to complete this survey as it helps us to improve and tailor future webinars to your requirements.

If you'd like to speak to someone or book your consultation, our private patients team here is available until 8.30pm this evening, and from 8am to 6pm, Monday to Friday.

You can contact them Via the number listed on your screen there in the circle.

We also have upcoming webinars on a wide range of topics, including gynaecology, plastic surgery, and cataract surgery. you can see those on our website, and you can sign up for them there, too.

All that remains for me to say is thank you very much for joining us this evening, and on behalf of Mr Reddy, all of us here at Beniden Hospital, thank you again for tuning in.

We hope to hear from you soon. Take care, and goodbye.

Mr Kumar Reddy

Thank you.