Mirella Falcone

Good evening, everyone, I hope you’re all well and welcome to our webinar on hip and knee surgery my name is Mirella, and I’ll be your host for this evening. Our expert presenter is Consultant Orthopaedic Surgeon Mr Alex Chipperfield. The presentation will be followed by Q&A session so if you’d like to ask a question during or after the presentation please do so via the Q&A icon which is on the bottom of your screen, this can be done with or without your giving your name. If you would like to book your consultation, we have Chelsea Dann from the Private Patients team on hand to take phone calls after the webinar and we’ll provide the number at the end of this session. Please do note the webinar is being recorded. I’ll hand over now to Mr Chipperfield and you’ll hear from me again shortly.

Alex Chipperfield

Hello there, good evening, everyone. Thanks for coming along today and signing in, my name is Alex Chipperfield, I am a Consultant Orthopaedic Surgeon here at Benenden Hospital, I’m here to talk to you today about hip and knee pain or hip and knee replacement surgery really. Normally when we do this there are two of us one of us talks about hips and one about knees, but unfortunately tonight you’ve got me for both so I’m sorry about that. Me, I’ve been a doctor now for the last 25 years, I studied medicine in London, and I trained as a surgeon in the Southeast of England. I then went to Australia and performed to do a fellowship in hip and knee surgery and since coming back from there I’ve been a consultant surgeon performing hip and knee surgery in Kent for the last 12 and a bit years. I’ve started working at Benenden around 10 years ago as part of the orthopaedic consortium, providing hip and knee surgery here. I am a member of the British Orthopaedic Association and hip society and I perform primary and revision hip and knee replacements as part of my routine practice. I suppose I’m what you could call a high volume surgeon when you’re looking for someone who to perform your hip or knee replacement you want to see you want to make sure that they are have enough experience and perform the surgery on a routine basis, these figures that you can see here these give my national joint registry data, the most recent data from the report published this year showing that I perform approximately three times the number of the national average of both hip and knee replacements so I know what I’m doing.

Hip and knee surgery at our hospital. We’re the leading provider of hip and knee treatments in Kent and Sussex if any of you have been to the hospital in the last five years you’ll appreciate that it is a’s a lovely building, it’s all been refurbished and rebuilt in you know around 2017-18, it’s clean, it’s a calm environment, there’s a good team around, there’s an experienced team of surgeons, physios, nurses, theatre staff and all of that leads to very high patient satisfaction rates. One of the things that we’re famous for in the area is the rapid recovery program to get people up and out of hospital as rapidly as possible following their surgery.

I mentioned high volume surgeons, the other important thing is high volume units, you want to have your hip replaced or your knee replaced in in a facility that has the performs these on a regular basis, this again from the national joint registry of this year looking at the number of hip and knee Replacements with Benenden at the top then compared to other local hospitals, whether it be the NHS in the Kent and Canterbury hospital or private hospitals such as the Chaucer Hospital in Canterbury or the Spire down in Brighton and Sussex, so we perform a lot of this kind of surgery here, we’ve got a good unit set up dedicated for this kind of treatment. First thing I’m going to talk about tonight is total hip replacement so we’ll touch on the signs and symptoms of arthritis of the hip we’ll go through the patient journey really just talk you through what will happen in your consultation go through various different treatment options available and then talk about the surgery and how we make things better and we also talk about potential problems relating to hip surgery once we’ve done that we’ll then do the same with knees.

So generally arthritis of the hip wear and tear of the hip tends to be what we call osteoarthritis which is of a gradual onset of no specific single cause it’s when the normally smooth surfaces that glide over each other that form the hip joint they start to wear away exposing the raw bone underneath and you go from a situation where you’ve got a frictionless painless joint that glides into a painful stiff joint that creaks and cracks and causes a lot of discomforts there’s no specific single cause for also arthritis it is multi-factorial there are many risk factors such as previous injury or weight or occupation but the biggest risk factor is family history if you come from a from a from a family that has bad hips or bad knees or both then there’s a high probability that you’re going to end up in the same way later on there is no cure for osteoarthritis there’s no pill that you can take that will make it disappear or go away there are many treatments that you can have for it that allow your symptoms to become manageable and tolerable and most of those symptoms most of those treatments are what we call conservative treatments so treatments that don’t involve surgery joint preserving treatments should all of those conservative measures fail then looking at surgery in the form of a hip replacement in the UK the average age for someone to have a hip replacement is 69 years old, that age is dropping and it’s certainly not a not a limit. I performed hip replacement some people anything from 20 to over a hundred and ultimately boils down to when your symptoms are bad enough and as long as you’re fit and healthy enough to have the surgery.

The consultation itself mainly will involve a lot of talking predominantly you talking to me and what’s called taking a history so listening to the story of your problems going from the how things have come about how they affect you and generally building up a picture of how the how the worn out hip or knee is impacting on your life and whether it’s stopping you from doing anything that you that you enjoy doing or having an impact on your work or general mental health and well-being there’ll then be a physical examination this is designed to see exactly how worn or otherwise the Joint may be look at the strength and the patency of the muscles and ligaments and nerves that support and Supply the joint but also looking for other causes of your pain symptoms in and around the hip joint may not come from the hip they may be indicative of a of a back problem or of a soft tissue problem and it’s important to exclude or confirm these before proceeding with surgical intervention we then look at the Imaging available we look at x-rays or scans that you may or may not have already had often people will come along to the hospital having been investigated elsewhere and it’s a fairly simple procedure to have those scans transferred electronically onto the hospital system so that we’re able to look at them together and I can talk you through any particular findings if there are no scans or Imaging available then we do have a modern Imaging suite at the at Benenden where we can take X-rays and scans as appropriate and those special tests we can then look at and go through to reach a diagnosis once we’ve done all that then there will be a shared decision-making process really to tailor the treatment that is best for you at that particular time in life.

Treatment options they vary from simple things that you can do for yourself such as losing weight or doing exercise which is a generally a very good thing to try to strengthen the muscles and ligaments that can support a failing joint non-operative treatments including Physiotherapy and occupational therapy and Pain Relief activity modifications other options would include injections in or around the hip joint there are many soft tissue problems around the hip joint that can be dealt with rapidly and easily in the clinic environment with an injection if we’re looking at doing an injection into the hip joint itself then this is something that’s best performed in an operating theatre under x-ray guidance so that’s a more invasive procedure I’ve mentioned physio then we’d be looking at if all of those conserve down and invasive procedures fail then the only thing left when it comes to our arthritis of the hip would be a hip replacement there are no smaller operations that work to preserve a hip joint once your hip looks like this person’s right hip here then there really is no choice if you can’t live with it there really is no choice other than hip replacement surgery.

The surgical journey itself starts with pre-habilitation it best for people to be as strong and as healthy and as mobile as they possibly can be prior to their surgery it means that they will get through their surgery more quickly and they will be able to recover in a more rapid way you will then have a pre-assessment appointment that will be where you see the nurses and the physios and often you’ll see the anaesthetist at this stage as well to discuss the kind of anaesthetic that you will be having for your surgery the pre-assessment is very important it’s designed to make sure that you are fit and healthy enough to have your surgery and also to make sure that it’s appropriate to have your surgery here at Benenden once that pre-optimization and a pre-assessment process is done then you will come in for you for your operation the rapid recovery program that we use here at Benenden starts at that pre-assessment appointment your recovery is much quicker and much better if we start that process before the actual operation itself so you’ll get a good idea of what’s expected of you before during and after your hospital stay.

You will be admitted on the day of the surgery, operating we operate all day here at Benenden and on weekends as well our surgical sessions tend to be split into morning and afternoon sessions so you may well be asked to come here first thing in the morning or you may find that you get admitted to the ward at late morning or lunchtime if you’re not going to have the operation until the afternoon. Your hip replacement will generally be under what’s called a spinal anaesthetic where you have an injection into the lower part of your back this will put your legs to sleep on top of that you’ll be offered sedation that means that as well as your legs being asleep you won’t be aware of what’s going on around you some people don’t want to be sedated in any way and are quite happy to talk and chat throughout their surgery. Personally, I can’t think of anything worse, I’d much rather be asleep but those both options are available to you. Typically you’ll have a one or two-night stay in hospital really that depends on how quickly you get up and about and you’re finding your feet after the operation it’s becoming more common for people to be discharged home the day after a hip replacement but it’s by no means mandatory we if you have your surgery in the morning we will have you standing up on the day of the operation. It’s important that you’re fully weight-bearing from day one even if it’s just standing or walking across the room it means that the morning after the surgery you have the confidence you know that hip is already you know it’s sound you know it’s solid you know it will bear your weight and the focus of the hospital stay will be intensive Physiotherapy and nursing care to ensure that your pain is under control and your mobilization is progressing well you’re the medical team at Benenden you’ll be there’s a resident medical officer who is there to look after your immediate medical needs there is also an on-call team who are available 24/7 for more urgent matters and of course you’ll see your Consultants again after the surgery whilst you’re in hospital you when you are at the stage where you are safe to go home you will have had some x-rays you will have had blood tests you’ll be up and about and dressed and mobilizing and you’ll be happy and safe transferring in and out of cars going up and down stairs and you’ll be you’ll have passed your driver’s license with your crutches as well. So once all of those boxes are ticked and the physios and nurses and you’re happy with your progress then you’ll be discharged that could be day one post-op or it may well be day two one of the things that you that you will be given is you will be given a course of anticoagulants so these are medications that are designed to minimize but not exclude the risk of blood clots following surgery. For a hip replacement you’ll be given a prescription of these for four weeks, if we’re if we’re talking about knee replacement then you’ll have a two-week supply. These in the old days these used to be injections which people tend not to enjoy being given so now there are oral tablet versions that most people are a lot more comfortable with taking, you will have physiotherapy as an outpatient and you will be seen and reviewed again in the clinic by your surgeon at about six weeks down the line.

We’re very aware that many people travel quite significant distances to have their surgery here at Benenden, traveling home is generally not an not a problem I personally am more than happy to follow people up with a telephone or video consultation remotely at the six week stage rather than a long journey to come back to see us here at Benenden but either way whichever works for you we’re happy with  at that six-week appointment so I’ll just have a drink oh that’s a six-week appointment we’ll look at your wound typically, that’s a picture that someone’s taken from the internet there, that’s what a hip replacement will look like at about six weeks post-op so it’d still be a little red and lumpy and that’s completely normal it’s part of a normal healing process, generally at the six-week stage half the people I see are using some kind of walking aid whether it be a crutch or a stick but half of the people that I see are walking completely unaided at that stage.

It is generally safe to drive again most people the average time following a hip replacement that they that they’re they get back behind the wheel is around six weeks, that tends to be because that’s the time that people ask their surgeon whether they can drive, essentially what it boils down to is that you have to be able to get in and out of the car safely you have to be able to not be under the influence of any mind-altering drugs or strong painkillers and you have to be able to control the car. This is a right hip scar, if you’ve had a right hip replacement then you need to be able to stamp on the brakes without hesitation before you can drive safely and a lot of people will find that is around six weeks, that that can happen but like I say that is an average time and individuals will vary, there’s been talk of hip precautions on this even when I started surgery so not that long ago I like to think not that long ago surgeons were very strict on what they allowed patients to do in the immediate post-operative period, there was a big list of do’s and don’ts not bending too much, not performing certain activities following hip replacement and there’s been a trend over the years with modern implants with lessened risk of dislocation or potential problems, there’s been a relaxation of hip precautions but you will still find that if you read your pre-operative booklets, there will be general advice of things that are safer to try to avoid if at all possible in the early post-operative period but by the time you come back at six weeks then those precautions will be fully relaxed there are complications and problems that can arise with any major operation and a hip replacement is no exception. There’s a risk of infection is at the top not because it’s the commonest problem but because it can be one of the one of the worst surgeon orthopaedic surgeons in particular we are meticulous to avoid infection and everything that we do during and after the surgery is designed to minimize that risk but it still can happen the infection rate at Benenden is less than one percent which is better than the national average and certainly a lot better than most other local hospitals there’s a risk of blood clots I spoke about medicine to prevent you getting blood clots that those tablets are one of what we call a multimodal approach so one of very many measures that we used to try to minimize the risk of blood clots following this surgery but despite all those blood clots can still happen and you can get a blood clot in your leg which can be more of an inconvenience than anything else or you can rarely but unfortunately it is a possibility you can get a blood clot in the lung which can be a lot more serious there is a risk of nerve injury with any operation that involves cutting around nerves there can be swelling or bleeding or bruising or pressure on the nerves and that can result in numbness or loss of function again vanishingly rare when you’re talking about modern hip replacement surgery dislocation I’ve touched on before the artificial hips are vulnerable in the early stages to dislocation while the soft tissues and muscles are healing and strengthening around a hip replacement then there is a risk of dislocation if you are unlucky or the or the things work their way loose or you have an injury so that can happen leg length discrepancy your legs can feel longer or shorter before an operation and can go the other way after the surgery quite often people’s legs are as part of the process when your hip wears out there’s a combination of real and apparent shortening of your legs so your joint can wear and your hip can feel shorter because of that and also it can stiffen up and that can lead to feelings of a shorter hip. Once you’ve had a hip replacement then that the hip replacement will restore your previous anatomy so you go from a situation where you felt short to feeling to being balanced again but initially you can feel longer there is a we plan surgery beforehand using a computer program to so we’re very accurate in how we make the cuts and how we implant the these the these things so the chances of a significant bothersome leg length discrepancy that requires further intervention is again vanishingly small artificial joints can wear out that tends to happen over the course of many years decades modern implants are designed to last an incredibly long time and certainly if you’re talking about having a hip replacement of the average age so as a 69 year old if you have a modern hip replacement that is performed technically well and you don’t have any unfortunate medical complications then I would anticipate that that replacement would last you the rest of your life.

A lot of people that find the decision whether they want to go down the surgical route can be quite difficult there are many decision-making tools out there I’ve mentioned the national joint registry that’s a very useful online resource that will tell you a lot about surgeons and a lot about hospitals and also a lot about whether it’s the right thing for you to do to have a hip replacement and it’s a worthwhile looking at the national joint registry patient support tools that can take you through that process with a simple questionnaire you can look at the PHIN which is an online resource looking that rates private hospitals will give you an idea of the kind of activity levels and feedback there are also lots of review sites every you can review everything these days and I’m no exception I get reviewed on a regular basis by patients on these websites so there’s a website called Doctify which you’ll see signs for around Benenden and there’s also websites called Top Doctors as well so you can look at all of these and you’ll see when you click on them you’ll get these kind of things these profiles there’s a top doctor Phi on the left Top Doctors on the right sorry I’ve used the same photo for both but you can read all my five star reviews or look at look at everyone else around and look at the kind of reviews and feedback that people have been left over the over the weeks and months preceding so it’s quite a useful thing to get to know your surgeon before you meet them.

Here is this is a video; this is one of our previous patients talking about their hip replacement experience here at Benenden so I’m just going to let that play I’ll just stop my feed for a minute and so you can concentrate on them.

Andy Chandler

How I was feeling before was very nervous. I’ve never experienced anything like this before. I don’t know what I was worried about at all. I felt no pain there was no discomfort at all so I don’t know what I was worried about as far as I would suggest to anyone that’s been offered that sort of treatment go ahead 100%.

I was in the hospital only the one day and I was out walking two and a half hours after the operation. I felt as if I could run a marathon, it’ll fail foreign to be out there Sunday playing golf. I’m going back to work tomorrow.

Don’t put it off and as far as where you go, you cannot beat Benenden Hospital.

Alex Chipperfield

There you go completely unbiased video there from Andy talking about how he got on following his surgery. He did mention going back to work, that’s something that we often get asked how long I should take off work. I advise people to say that they’re not going to be at work for around two or three months following their operation now most people feel that they can get back to work sooner than this but what you don’t want to be is you don’t want to be under pressure getting back to work whether that is from yourself or from your work you this is a big operation and although you will be up and about and in hospital very for a brief period it’s still big surgery and you do need time to recover both physically and mentally from this and to recover best you don’t want to be under the extra pressure of worrying about having to get to work on Monday as well so that’s just my advice as far as that goes.

Moving on now to knee replacement. So, a knee replacement again the number one reason that we perform knee replacements here at Benenden Hospital and anywhere in the country the number one is that wear and tear that osteoarthritis the and again the same the same as the hit that is a that is a multifactorial problem that generally is related to life to injuries to weight and to family history so all of those things will contribute to the development of arthritis there are other conditions that can also lead to a knee being worn out there are so-called inflammatory arthritis so these are the ones they’re not the wear and tear ones they’re the diseases that where your own body attacks the joints inflammatory arthritis such as rheumatoid arthritis or gout or that kind of thing it’s been interesting the seeing the prevalence of rheumatoid arthritis in people needing knee replacements over the years again 20-25 years ago when I started about one in three knee replacements were performed for rheumatoid arthritis now it’s much rarer that people get to that stage there’s been a revolution in as far as drug treatments for rheumatoid arthritis have gone and it’s a much those medications have saved many people with rheumatoid arthritis from worn out knee joints it still does happen but yeah significantly less common than it used to be. There are certain injuries that can predispose you to needing a knee replacement the classic one is what’s called a tibial plateau injury that’s where you break the bone that makes up part of the knee joint and that can predispose you to rapid onset of post-traumatic arthritis even if it is treated surgically at the time ligament injuries can also lead you to develop arthritis more rapidly these both those ligaments and broken bone injuries they’ve it’s very rare for them to lead to immediate knee replacement what we’re talking about is the hastening of the onset of the arthritic change in the knee the aim of a knee replacement again is to relieve the pain to allow you to get up and about more to increase the mobility it’s quite common with knee arthritis for people to get deformities of the knee and people end can end up severely knock knead or bendy legged or have permanently bent knees and all of these things you will attempt to part of the knee replacement surgery will involve realigning that joint to correct those deformities that have come on as a result of the architect change again with knee replacements as with hip replacements the patient population the age we at which people are having this surgery is getting lower and lower there are again at the moment the average age is mid to late 60s but it’s I’m seeing more and more people in their 50s and younger with completely worn out knees and these are the these people are almost a different subset a younger higher demand patients who still want to undergo sporting activities to a higher level high expectations there you know there’s a lot of pressure on them and on the surgery and the implant to get people back to their previous level of functions and some people some people’s expectations do need to be managed when it comes to this artificial joints will not allow you to lead a completely normal life without restriction there will be some high demand on then high demand activities that will be difficult if not impossible following knee replacement and it’s important that you’re aware of that before the surgery.

This is a picture of the knee replacement that we use here at Benenden, it’s called the Vanguard knee replacement, knee replacements themselves like I say they’re common we do a thousand of them here and there are a hundred thousand of them performed every year here at Benenden again I’ve spoken about the average age and again hugely successful operation with the overwhelming majority of people are pleased with the results and again these are things that last for decades.

The Vanguard knee replacement there are many brands of knee replacement there are four or five big Orthopaedic implant manufacturers in this country and each of those manufacturers will have several models or versions of knee replacements it’s like cars really it’s like all the big manufacturers have lots of different models and the same thing is true with knee replacements and sometimes it people ask how you choose which implant which knee replacement which hip replacement should you have essentially what you want is one that is proven to work you want one that has a track record you want one that’s going to last you the rest of your life hip replacements knee replacements Orthopaedic implants they are all monitored they are monitored by joint registries both in the UK and globally and from that huge amount of data that is out there we can we can monitor the implants that perform well and the implants that don’t perform well the Vanguard knee replacement is one of the ones that performs incredibly well throughout the globe and lasts an incredibly long time. There are new innovations and new designs that are coming onto the market all the time and it’s a tricky situation with new things because you again knew you want you want modern implants but you also want ones that are proven to last and work so finding the balance between those two it can often be difficult and then we often find that there’s a pressure from marketing from these big companies that manufacture these as a marketing pressure and a demand to use their new implants but I mean that needs to be backed up with solid data that this is going to be the right thing that lasts a very long time generally a knee replacement is held in your body with what’s called cement, it’s not cement it’s actually an epoxy resin that that helps the metal implants bond with the bone and whether we replace the under surface of the kneecap as well that tends to vary from surgeon to surgeon and it generally depends on whether or not your kneecap is worn out or not if it isn’t we leave it alone if it is then we resurface it.

Symptoms of knee arthritis, again pretty similar to the hip arthritis really it’s pain that’s the number one thing generally early on in the disease when the when the knee is beginning to wear out you tend to find that it’s pain on doing certain things so demanding activities that have a high impact or that involve a lot of twisting, turning rapid acceleration deceleration change of direction that kind of thing you may experience some stiffness especially first thing in the morning there may be some clicking and grinding sensations or some swelling in the knee what then tends to happen over time is those symptoms will progress and the pain will become more dominant and you go from a situation where you only get pain with activity to getting pain with rest or at night time you’ll notice deformity that we talked about before and you’ll notice that you’re your world shrinks essentially your walking distance decreases your activities what you can do comfortably will diminish as well and there will come a point that that life living with that worn out knee no longer becomes acceptable and then we talk about surgical treatments there are again before we go down that surgical route there are non-surgical treatments that we’ve spoken about before with the hip so activity modification, weight loss, physiotherapy, strapping, analgesia, painkillers, footwear changes, exercise all of these things are incredibly important and can help you live with a failing knee for many years before you get to the stage where you end up needing surgery there are injections that can be performed into the knee as well there are injections of lubricants and there are also injections of steroids that can try to help calm down the inflammatory process inside the knee there are other injections that are being developed at the moment the holy grail of course is an injection that we can do that will reverse or halt the degenerative process that’s happening inside someone’s knee as I said previously there is currently no cure for arthritis and the injections the things like PRP or blood injections that are being developed and the idea behind them is to try to be that cure for arthritis unfortunately at the moment there is no scientific evidence that any of those newer injections make any significant difference to people in the long term especially people with established arthritis there may be there may be an indication for very early arthritic change but that’s you know the evidence really isn’t out there at the moment most of these injections the new injections aren’t funded by insurance companies either so it’s something that most people would have to fund from their own pocket and my general advice apart from in very special cases my advice would be that I wouldn’t waste my money on these new injections just yet because there simply isn’t the evidence to back it up anyway surgically there are a few things that we can do I’ve highlighted the things that are available at Benenden the realigning your joints so breaking your legs to realignment what’s called an osteotomy and cartilage transplant again these are these are specialist procedures that are only performed in a few centres certainly in around the southeast of England it’d be very rare and not performed here at Benenden the ones in bold we do perform here arthroscopic techniques so Keyhole surgery to try and minimize the symptoms the mechanical symptoms that can come from arthritis and try and help regenerate some form of soft cartilage cover inside your knee those things that we do here on a regular basis and of course joint replacement surgery itself before knee replacement again before hip replacement sorry if I’m repeating myself here but again it’s all about pre-habilitation it’s all about optimizing your health and keeping making sure that your muscles are as strong and as mobile as possible and again that the pre-assessment process the nurse the physio the anaesthetist is a similar process to what you what I’ve already described with hip replacement.

With hip replacement there tends to be only one option there, that’s the total joint replacement with knee replacements there are there are partial replacements as well as a total knee replacements if only one part of your knee is worn out whether that be the inner part the medial part of the lateral part or even the kneecap joint at the front if that’s the only part of your knee that’s worn and the rest of the knee is pristine and all the muscles and ligaments around that knee are normal then you may be suitable for a partial knee replacement. The advantage for a partial knee replacement is that it’s you know you it’s a less of an operation don’t get me wrong it’s still a big surgery, it still involves a hammer and a saw in your leg but it’s people tend to recover more quickly from partial knee Replacements and the end result people tend to feel it feels more natural following a partial than a total knee replacement so if you are suitable for a knee replacement a partial replacement we will have that discussion in the clinic and if you agree that is the right road that you want to go down then that’s again something that we offer here at Benenden.

Total knee replacement would be the other option and there’s x-rays this person has had a partial knee replacement on the right and a conventional knee replacement on the left there are other options when it comes to surgery bigger than primary knee replacement they tend to be either for redo operations or when there’s a severe deformity or significant amounts of muscle and ligament damage though I’ve put them in Brackets because they're their operations that I perform but I don’t perform them in Benenden it’s not that we don’t offer that service at Benenden hospital so that would have to be performed elsewhere. Again, after the operation the inpatient stay is focused on getting you up and about and getting you comfortable and mobile as quickly as possible again you’ll have intensive physiotherapy again you’ll be working on your movement and your Mobility you will have the routine x-rays you will have the blood test and again you’ll be in hospital one or two nights following the surgery I must say my experience is more common for people who’ve had hip replacements to go home the day after people with knee Replacements tend to go home at two days it can be a little tougher in the early stages following a knee replacement than a hip. Again, the risks of the risks involved in knee replacement surgery are fairly similar to hip replacement blood loss and damage to the bones or to the nerves again infections are mentioned at the top because it’s important but not because it’s common again blood clots and I’ve spoken about the mitigating factors that we put in place to avoid them down at the bottom it says stiffness and swelling that’s not a risk of a or a complication of a knee replacement that’s a fact you will your knee will be stiff and swollen to start with that’s part and parcel off of the early stages of a knee replacement operation but that swelling will settle and that stiffness will improve as well as everything heals the modules again later on down the line knee replacements can wear out like I’ve said modern implants last decades.

I’ve touched on a few innovations when we’re talking about injections, but there are new technologies out there as well with regard to both hip and knee replacement surgery. The first of which is a custom-made knee replacements these are when the implant is built tailored specifically to you the we there are customized knee and hip replacements these are a bit of a again these tend to be more of a sales gimmick than an actual treatment there are rarely there are people whose Anatomy is so extraordinary or deformed that they have to have something built for them but generally you know knee Replacements come in multiple different sizes each of the components of a knee replacement comes in many sizes so our operating theatres stock multiple sizes shapes Contours of knee and hip replacements and you know for 99.9 percent of patients your implant is built for you in the hospital by choosing the right size sized and sided components for you having to have an implant built for you is an incredibly rare thing navigation computer navigation and robotic surgery these are things that are again these are industry Innovations to try to improve the accuracy and therefore the longevity and satisfaction from hip and knee Replacements this is one system here this is Rosa is a knee robot who she can she can help me during an operation to try to perform the surgery more accurately it is not a robot performing your operation it is it is a mechanical arm that allows the placement of The Cutting blocks to for me to perform the surgery with more accuracy I have no doubt that over the next few years robotic assisted surgery will become more and more mainstream and I think it’s only a matter of time before this kind of surgery is performed in multiple private hospitals and in Benenden we currently don’t perform this the reason being that this is still in its experimental stages at the moment the only genuine guarantee that I could give you with a robotic operation is that it will take longer to perform and it will cost you more money there is no at the moment there is no evidence that it will result in you having a better joint replacement that will last longer or perform more well than the current conventional system these are first generation systems as the technology develops and matures over the years I think like I said this is going to be the future it’s not there yet so it’s something that as an orthopaedic surgeon as a group are keeping a very close eye on I was at a conference yesterday when the focus of discussion was this kind of surgery and at the moment it goes in the experimental in very specialist units area rather than being more of a mainstream thing but I’ve no doubt that will change as things progress over the over the years.

I’m not the only person here at Benenden there are many of us here who perform hip and knee Replacements here these are a Rogues gallery of myself and my colleagues all of whom are eminently qualified and happy and amenable and waiting to help you out with your hip or knee replacement most of us here specialize in both hips and knees there are a few a couple on this list who only perform knee replacement surgery but you know all of us are local people and local surgeons with a great deal of experience and I’d be happy having my surgery performed by any one of them if I wasn’t available so there we go that’s quite enough of me talking, for now, I think we’ll hand over for the Q a session from now.

Mirella Falcone

I’ll take some questions starting with Angela, so what is the Aftercare for when you return home?

Alex Chipperfield

Depends on what you mean really Angela the idea is that when you return home, you don’t really need very much Aftercare that’s the plan so, for example, for your wound we generally try to use stitches that melt away and dissolve underneath your skin what that means is that you don’t need someone coming along every day or every other day to rip your dressing off to look at your wound you don’t need someone to come along and take out your stitches so the aim is for everything to be very low maintenance sometimes you will have surgical Clips rather than the stitches if your skin is not suitable for that and they will need to be removed at about 10 days or two weeks after the surgery you’re very welcome to come here for that but generally most people tend to have that done by the practice nurse at their local GP surgery. There you will be that you’ll be given physiotherapy as an outpatient again that can either be local to you or you can come to Benenden Hospital to have that if you are local to us the other Aftercare the physiotherapy that is you’ll be given a booklet with advice and exercises and you will have the ability to be able to ring up the hospital ring up the ward if you have any problems or worries or concerns and that’s one of the advantages of being at Benenden hospital that I found certainly compared to the other hospitals I work in, especially in the NHS, Benenden although we are a big busy high volume unit it’s small enough that when you ring up you speak to someone you speak to a human being who can who can help and so there is aftercare from that point of view. Generally, most people go home equipped with all that they need to get them through the first few weeks while they’re recovering from the surgery.

Mirella Falcone

Thank you. Next question is my mother is 89 and struggles with hip pain is there an age limit or risks to having it done at this age and would she need it again?

Alex Chipperfield

The short answer is no, there is no age limit. Like I said, people have hip replacements at all ages ultimately it boils down to rather than age it’s fitness it’s general Health so the question would be you know if your mother is healthy enough to have a hip replacement operation, obviously having a hip replacement at Benenden Hospital is slightly different from having a hip replacement in say an NHS Hospital, there is no intensive care facility here so part of the pre-assessment process before the surgery is to make sure that you’re healthy enough to have the surgery here and to make sure that the risks are minimized but no 89 is just a number what’s much more important is your general health and whether it’s safe to perform the surgery here. Will it need to be done again, that well that depends on how long you plan on living really like I said these last decades and to be honest most 89-year-olds it will see them out.

Mirella Falcone

Thank you. Next question is I have heard of having a double hip replacement, would you operate on both at the same time? If so, would this affect my recovery?

Alex Chipperfield

It’s quite tricky to operate on both at the same time because you’re lying on one side, so you’d have to do one, then turn you over and do the other. It is a relatively rare thing for to do bilateral joint replacements in the same sitting, I do it in my practice I you know I do hundreds of these every year and the bilateral cases I do maybe one or two a year, it’s quite rare to be in a situation where both are equally affected and you are strong enough and healthy enough to be able to go through a double operation. Will it have an impact on your recovery, yes and no it is obviously it’s a much bigger operation it’s twice the size of the surgery so it is it takes you longer to get over having both hips done at the same time than it would having one hip done but it’s quicker to get over having both hips done at the same time than having one hip done recover from it and then have the other hip done and recover from that. So, your combined hospital stays, and recovery is shorter with a bilateral procedure like I say it is it’s a rare procedure to have done it may be that your particular set of circumstances does mean that you’re amenable to having that I certainly do perform that for people. Again, another thing is whether or not it is safe and appropriate to have that surgery here at Benenden, again that really depends on your pre-assessment so yes it’s possible it’s unusual but possible you will require a quicker than you would do if you had two done separately but it will take you longer than if you’d have just had one done.

Mirella Falcone

Thank you for that really comprehensive answer. Next question is does Benenden Hospital offer payment plans for hip and knee replacements?

Alex Chipperfield

The answer to that is yes, they do. There are all sorts of payment plans available and if you speak to the Private Patient Coordinators, they will take you through all that as far as it goes.

Mirella Falcone

Thank you. Next question is I’m 61 and still work full time, I have been recommended to have a knee replacement, I do quite a bit of heavy lifting at work would I still be able to do this after I have recovered?

Alex Chipperfield

If you are able to do that now and then it may well be that it’s not quite the right time to have your knee replaced if you are you know it depends on the level of function that you’re currently at, but the short answer is yes you should be able to. You’re not going to be able to do it immediately, it’s going to take you time like I mentioned I recommend that people take three months off work that’s on average that’s everyone and most people’s work can be fairly sedentary if you are someone whose work is high demand or you know you’re doing a lot of lifting or manual work then you may find that initially when you get back to work you’ll be on limited duties or restricted duties and it may take you longer to get back to the stage where you’re fully functional but on the whole if the only thing that’s holding you back is the worn out knee if you can once you’ve recovered from the surgery once you’ve built up the strength and confidence in your muscles again and your knee is as strong as It ever was, then I can’t see any reason why you can’t get back to things.

Mirella Falcone

Thank you. Our next question is from Anne, can you leave it too late for knee surgery?

Alex Chipperfield

The short answer is no, the long answer is that it’s something again that would have been something that we’d have seen decades ago that where things are left to such extremes that the joint is no longer reconstructable. It’s still something that you when often you know people will travel overseas as part of their training or fellowship and you know seeing you see that kind of problem in the developing world but in the modern world with the kind of technologies that we’ve got when it comes to joint reconstruction and replacement, I I’ve never been in a situation where I’ve told someone that I cannot reconstruct their joint. It’s advisable that you don’t leave it so long that everything else around that joint becomes useless so technically being able to reconstruct the joint is one thing but the more the really important thing is having useful and functional muscles and ligaments and tendons around that knee so if you leave it to the stage where those muscles have withered away to nothing then yes technically you could leave it too late but from a purely surgical mechanical point of view no.

Mirella Falcone

Thank you very much. Our next question is from Richard, is the route to treatment via a GP or direct to yourself?

Alex Chipperfield

Both is the answer. GPs tend to be the gatekeepers for referrals on to what we call secondary care or hospital care and it’s whether that be via Benenden membership via the NHS or even with a with a private referral that process will start with your GP for a number of reasons that no part you know talking about all the steps that you normally go through before you’re considering joint replacement surgery that would could be managed locally before you got to me if you see what I mean and another reason is that it’s a GP referral not only will give you will give us the information about your particular condition but also it provides us with all your previous medical history as well so all the medications you’re on every operation every hospital admission and consultation you’ve had will come through attached to that GP referral and that’s often quite useful and vital Information. When we’re looking at the rest of you we are you know we are contactable via you know directly you can ring up the private office and I see people all the time who’ve self-referred as well and there’s I don’t have an issue with that it may involve a few more tests before we get to the surgery that would have otherwise been performed at the pre-hospital level but no by all means we’re open to all-comers really.

Mirella Falcone

Thank you. Next question is from Catherine, can the pain in the hip flexor improve quickly after the hip replacement?

Alex Chipperfield

I’ve never had a hip replacement so I can’t answer from first-hand experience. What I can do is tell you about the thousands of patients that I have operated on and give you some generalizations as far as hip replacements go I am I continue to be surprised amazed delighted call it what you want at how rapidly people who’ve had hip replacements recover they often describe they as soon as they come around from the anaesthetic they say my pain has gone the pain from that worn out hip you know it’s really common that it will go and that surprises me considering you know the size of surgery that and you know what’s involved in a hip replacement you know it’s a big operation to go through and for people to be literally hours after their surgery say like Andy saying my pain is gone it’s consistently impressive it you will be saw from the operation there’s no getting away from that but most people describe that pain as a tightness or a stiffness rather than you know the pain that they came into hospital with and the thing about the pain post-operative pain is generally that tends to settle so any pain that you do have will settle as you heal but the that initial pain doesn’t always but the vast majority of people who have hip replacements they are really pleased about how quickly that pain goes away.

Mirella Falcone

Thank you very much. Next question is from Jenny, I live in Northern Ireland is it okay to fly after surgery?

Alex Chipperfield

There are a few things when it comes to flying, the first one is the logistics are flying sitting in a cramped economy class seat with high sides putting pressure on your legs and your wounds sitting in that position for an extended period will be uncomfortable and painful and difficult. The second thing but there are ways around that the second risk is a risk of developing blood clots like we’ve said before there’s you know there is a risk of blood clot and that risk is increased by having joint replacements three the other thing that increases your risk of surgery is air travel that combination of stasis of pressure changes of dehydration then it’s a perfect environment in an airplane to put you at a higher risk of a blood clot. Generally, the advice that that we give that comes from that national guidance when it comes to travel following joint replacement surgery is that you don’t fly for six weeks following a hip or a knee replacement for the next six weeks. So up to three months after the operation it’s okay to travel short or so four hours or less and then from three months onward unrestricted travel as with all of these things that is advice you can choose whether to follow that advice no one’s going to turn you away at the gate because you’ve had surgery sooner or later if I were you in Northern Ireland I would get the ferry across which is miserable but at least you are not putting yourself at a higher risk and you can walk around and stretch your legs your journey time may be longer but your risk of blood clot will be significantly less.

Mirella Falcone

Thank you very much and just our last question of the evening is from Linda, I live two and a half hours away from Benenden how will physiotherapists be arranged?

Alex Chipperfield

So, like I said Benenden do offer physiotherapy at the hospital a five hour round trip for that wouldn’t really be sensible as far as I would suggest. So, the there are two options really and it’s best that you ask this question now because it’s something that you really need to arrange in advance what you don’t want to be do doing is being discharged from hospital and then think oh crikey I need some physiotherapy so there are two ways that you can do it number one would be through arranging physiotherapy through Benenden have a network of approved physiotherapists spread around the country and there may well be one that is local to you that referral process will have to go through head office in York and that’s something that you would need to arrange through that it’s not something that can be arranged at this hospital then referring you to a Benenden physio locally the other way to do that would be outside of Benenden and that would be via your either by your local GP or if you have an if there’s a local private physiotherapist that you know or trust or that you have recommended to you then you could always make the make the arrangements yourself for that.

Mirella Falcone

Thank you very much thank you to everyone that’s asked questions this evening, if you would like to book your consultation, please do contact us on the number on screen before 8 o’clock this evening or alternatively between eight and six Monday to Friday. We are offering attendees 50% off an initial appointment with the terms that are shown on screen. You will receive a short survey after this presentation so I would be grateful if you could spare a few minutes just to let me have your feedback on today’s webinar. Our next webinar is on the 11th of October with our experts who will be discussing foot and ankle treatments. So, on behalf of Mr Alex Chipperfield, myself and the team at Benenden Hospital, I would like to say thank you very much for joining us this evening and we look forward to joining us at our next webinar thank you very much.