Louise King

Good evening, everyone. Welcome to our webinar on treatments for hip osteoarthrosis. My name is Louise and I'm hosting today's session. I'm joined by our presenter Associate Specialist Surgeon, Mr Kumar Reddy.

This presentation will be followed by a question-and-answer session. If you'd like to ask a question during or after the presentation, please do so by using the Q&A icon at the bottom of your screen. This can be done with or without providing your name. Please note this session is being recorded. If you do provide your name. If you'd like to book a consultation, we'll provide contact details at the end of this session.

I'll now hand over to Mr Kumar Reddy and you'll hear from me again shortly. Thank you.

Mr Kumar Reddy

Hello, there. Good evening to everyone. Many thanks for the introduction, Louise. Very kind of you.

So I just would like to give you a brief talk about what is osteoarthrosis, how it affects the hip joint and what about hip replacement and the types of hip replacement. I'll make it brief, so that it would allow you to ask questions, so that I'd be able to answer at the end of the session.

So briefly to talk about osteoarthrosis. It is a common condition affecting the joints in the body. Most commonly the hip and knee and also shoulder and elbows to an extent. The joints are usually covered with smooth cartilage, they become damaged and gradually get thinned out and roughened, producing pain in the joints. Eventually there may be no cartilage left in some areas of the joint, which, again resulting in a lot of pain, stiffness and it affects the ability to mobilize.

This is about me. I'm an Associate Specialist Orthopaedic Surgeon. I've been doing the hips and knees for the last 25 years and I also attend the American Academy of Orthopaedic Surgeons once in two years and my special interest is mainly total hips, total knee replacements, partial knee replacements, revision, hip and knee replacements and I'm also one of the members of the Revision Knee Forum, which we have established in Canterbury. So it covers the whole Kent area and is the revision hub and I also got interest in doing orthoscopic surgeries, ancillary constrictions, and meniscus.

So these are the things I would like to cover you with regard to surgery at Benenden Hospital with hip arthritis, its treatment, options, hip replacement surgery, process, and recovery and at the end of it you can have question and answer session.

I'm pleased to say that we are one of the leading providers of private hip treatments in Kent. This hip replacement surgery is done in a clean and calm environment. We've got a team of experienced Orthopaedic Consultants and physiotherapists at Benenden Hospital and I'm also very proud to say that we got very good, high, patient satisfaction rates and we also follow the rapid recovery program.

These are the team of the Consultants who does hip replacements in Benenden Hospital. We've got Alex Chipperfield, who is the clinical lead and also is the Medical Director for the Benenden Hospital. We got Mr William Dunnett who is also a lower limb arthroplasty Surgeon who does hips and knees and Mr Oliver, he also does total hips, total knee replacements and Mr Thakur, who is also specialized in doing total hips and total knees and partial knees.

Right with regard to hip arthritis, I've explained to you what are the causes. Joints to become mainly painful and stiff, the smooth articular surfaces becomes damaged, and they eventually gets roughened, thereby producing a lot of pain. The cartilage gets damaged and that's how you develop arthritis in the joint, and also there are other conditions that can cause arthritis which can be inflammatory, rheumatoid arthritis, gout and a vascular necrosis of the hip leading to arthritis, where certain conditions can cause loss of blood supply to the hip joint, thereby resulting in a vascular necrosis and also injury. Any traumatic injury to the joint, like a dislocation or a fractures. They can also, in the long term, produce a premature osteoarthrosis affecting the joints right mainly, the symptoms when we ask the patients what is the main problem, they say that the hip is quite painful and they also express having immense difficulty in cutting the toenails, putting the socks, tying the shoelaces and also getting in and out of the car and in and out of the bath and their daily activities are severely disrupted because of the pain they usually rely on their partner, or go to the chiropodist to have their toenails cut and the other thing is their sleep disturbance. Sleep is constantly getting affected because of the pain and because of the pain they tend not to use the muscles or the lower limb much thereby you get weakness and wasting of the muscles and you also have got marked limitation of movements in the hip.

Right, with regard to treatment options you got in the initial phases. You can try some painkillers in the form of Paracetamol, or some anti-inflammatories like Naproxen, along with Omeprazole or Lansoprazole with the view to line the stomach and you can't keep on taking anti-inflammatories because they would have side effects on the kidneys as well as your stomach and the other things you can consider is steroid injections which can be administered under fluoroscopic control. You also can also inject hyaluronic acid which may well be helpful and also using a walking stick sometimes would be significantly helpful and of course physiotherapy is there, and the next one is, if all these conservative methods of treatment fail to significantly improve your symptoms and quality of life. The next step is one need to consider surgical intervention in the form of the replacement surgery and people used to do joint fusions in the past. It is not ideal in the current setting as it was, caused tremendous amount of stiffness and it may cause loading of the knee and the back, causing problems with regard to demographics. With regard hip replacement surgery, nearly about 47% of hip procedures are done within independent hospitals in the UK and over a hundred 1,000 hip replacements are performed in Uk itself and overall worldwide about a million hip replacements are done. Hip replacement. Surgery is the second-best operation in the world behind cataract, surgery and 96% of patients are very happy with the outcomes.

Next is what is hip replacement surgery. Unfortunately, I could not get the models today to show you what it is about. It is made of two parts. One is basically a ball and socket joint. The ball is the femoral head, and the socket is the acetabulum so these are inserted into the healthy portions of the pelvis, which will be in the socket, the established shell and in the thigh bone the femoral stem. This relieves the pain, reduces stiffness, and improves the ability to walk, thereby improving overall your quality of life.

Next, you may ask, do I need a hip replacement surgery? You may benefit from a hip replacement surgery. If you have got severe pain that limits your everyday activity, and your sleep is constantly getting disturbed because of the pain, and you find it hard to walk in a distance and also stiffness and inability to do all the mentioned activities earlier. The types of hip replacements that we do at Benenden have been time tested and majority of them. They have got a good track record and the implants that we use in Benenden, or uncemented or hybrid toe lip replacements. They've been tested for about 30 years and 95% of them they survive minimum period of 20 years or more. You also have got cemented hip implants and also uncemented. My practice, over and above large, has been in the last 20 years have been majority of them, uncemented. Total hip replacements, where you rely on the natural bone to bind it like a glue instead of using the cement and also with regard to bearing surfaces, my preferred choice is, use a ceramic head on plastic. So the long-term survivorship of the ceramic heads are much longer when compared to the metal heads.

What is involved during a hip replacement surgery. It is an hour and 45 min to an hour-long surgery. Majority of the patients do have spinal anaesthetic with a view to numb the legs and that is the safest and best way ever and it's preferred this way and you also have sedation so that you don't hear the noises during surgery with regard to the hammer and using the saw majority of the patients do stay for about a day or two in the hospital and you'll be discharged the following day. The very day on the surgery, the physios we got an excellent team of physios who would enable you to mobilize with the help of either Zimmer or sticks and once you are safe, mobilizing will be discharged home.

So these are the typical X-rays of hip replacement surgery, which is on the left, you can see a hybrid total hip replacements. On the right side. You can see a completely uncemented core pinnacle, total hip replacement and recovery from hip replacement surgery.

Your hospital stay. You can get up and walk as quickly as possible after surgery, with the help of the Physiotherapist. Of course, initially you may be able to walk on the same day as your operation. Usually, if you have surgery in the morning, they will try their best to get you up in the afternoon, but you have in the afternoon, the very next day they would try to get you up and mobilize. Initially you will have, or you will experience a different type of pain in the in the hip and you may notice some swelling in the feet. As I said to you, average hospital stay is about one to two nights and usually you're seen within six weeks following hip replacement surgery. When I do the hip replacements. It's like patients learn to walk again. So once you regain confidence, nothing stops you and you can get back to your normal activities and I normally allow them to drive after six weeks following surgery and as soon as you get off the crutches and regain confidence and recovery from a hip replacement you can usually prescribed painkillers for a few weeks and if you got some staples or we do dissolvable stitches. My preferred choice is using dissolvable stitches in the form of Monocryl or Stratafix and some of colleagues use staples as well and there's no harm in using staples and we normally tend to see you after six weeks, show you the X-rays and then discuss about the exercises and give you advice that you can sleep on either side with a pillow in between and also get back to driving. Usually we lie on the side, and we tend to do muscle, sparing approach and also tendon sparing approach. So we don't tend to cut the tendons anymore. So it's minimally invasive surgery. So that recovery and the outcomes are much better with regard to this hip replacement. High impact activities may speed up the wear and tear process and one will be able to advise you with regard to getting back to high impact activities. As these are artificial joints, they're subjected to wear and tear and certain positions you need to avoid like bending more than 90 degrees crossing your operated leg where there is a potential risk of posterior dislocation.

These are the potential risks with any hip replacement surgery. One is mainly infection. So this is one thing we as surgeons, we all read about it and the infection rates. I'm proud to say that in Benenden Hospital it is much less than the national average and the other complications include deep vein thrombosis and also developing pulmonary embolism. That's why you are given blood thinning tablets for a period of 35 days for hips and 14 days for the knees. There is also risk of dislocation where the ball can come out of the socket and cause a dislocation. Again. It's a very rare entity in my book and my view, if a dislocation occurs immediately post op, either it could be malalignment of the socket and it's most likely our fault. We tend to rectify as soon as we can by taking you back to theatre. If it is potentially unstable and revising the cup into a better anteversion, or the revision that requires to stabilize your hip. The next one is loosening. Sometimes these implants can become loose where we might have to redo it again and the other complication is leg length discrepancy where one leg can be slightly longer or shorter than the other. Usually we do check during surgery time to ensure that that is the case. But sometimes you cannot compromise on the stability where we might have to slightly lengthen the hip and again, fracture is one of the complications where, during surgery, there can be a fracture, periprosthetic fracture. Again, it's a very, very rare entity. It's not a common occurrence. It's about one in a thousand and if this happens, then you may need revision, surgery. It can also be damage to the nerves or the vessels where one can experience a foot drop due to the damage to the sciatic nerve.

Right and also I'm going to talk about the National Joint Registry and this joint registry collects information on total hip operations from hospitals in England and Wales. The registry will help to find out which are the best performing implants and most effective type of surgery and recording your details enables the NJR. To link people to the implants 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 received it, and your details enable you to participate in a feedback survey and all the personal data is treated as very confidential at all times. This would also enable the surgeons to identify the implants that are not performing well so that they can choose the implants better and it's also in the public domain where you can look up a surgeon's profile to see how many hips or knees a person has done and what are his complications. What are his revision rates all these, they're available in the public domain where you got access.

Thank you so much for listening to me for having patience in the last 20 min.

Louise King

Thank you. That was really interesting. So we have some questions that have come through and I'll just go through them.

The 1st person says, what percentage of patients are successful?

Mr Kumar Reddy

Over 80.

Louise King

What if a patient has varicose veins or varicose eczema?

Mr Kumar Reddy

Patients who got varicose eczema the important thing is, you need to have a consultation with your with your Orthopaedic doctor and to see and  examine you and to ensure that the symptoms are mostly arising from the hip and it also should be backed with evidence of X-rays to make sure that there is evidence of arthritis in the hip, just to not confuse that the pain is coming from varicose veins rather than the hip. If it is, then you would certainly benefit from a hip replacement surgery.

Louise King

Thank you. This person says, joining on behalf of their mother-in-law, who has severe hip pain. She is less mobile now and she's in her late eighties and would rather avoid surgery. Would you suggest? What would you suggest for someone who has pain but isn't interested in being very active again? Is there an alternative?

Mr Kumar Reddy

Yes, surgery is not the only answer for hip pain, but age is not the criteria we do in 90–95-year-olds have done them. It's mainly to get rid of the pain and to get back on their feet and to improve the quality of life.

If one is not willing to have surgery. There are other modalities of treatment, as I suggested to you, either physiotherapy taking regular painkillers, anti-inflammatories, paracetamol and occasionally naproxen and also you can have fluoroscopic guided steroid or hyaluronic acid injections which may be beneficial if you do not go via the surgical route of hip replacement surgery.

Louise King

Great. Thank you. This person says, aside from waiting lists, is the process quicker at Bendon and they miss what you said about rapid recovery, so could you just give an overview of that as well? Please.

Mr Kumar Reddy

I have to say, the hip replacements in the NHS. The waiting list, soared though, it was about more than two, three years after Covid. They seem to have come down. It is still we are working to reach 52 weeks. We're trying our best to get to 52 weeks. But currently, my waiting list is about 62 weeks and yeah, it is definitely within 18 weeks you can have the surgery done at Benenden Hospital. If you come by the I referral route where we can see you and by the time we see you they need to be done within 18 weeks.

Louise King

Thank you. This person says, why would they opt for an uncemented hip? Wouldn't this come loose or be less secure?

Mr Kumar Reddy

My preferred choice is the uncemented hip because I don't like using cement. But my colleagues do cemented hips, and they've got the same results. If you look at the evidence, there is no difference between the two. But recently the uncemented. They've got good evidence to say that the outcomes are much better, and the survivorship is also much better relating to uncemented hip replacements.

Traditionally, when Sir John Chanley invented the hip replacement it was a cemented hip replacement. So there is no difference whatsoever. It's purely the surgeon's choice this uncemented hip, it works extremely well in my hands. So that's why I choose to use uncemented for the last 20 years or more.

Louise King

Thank you. I think, related to that, someone said, best type of implant, hybrid cement, uncemented or uncemented.

Mr Kumar Reddy

That's what I said. I mean, there's no I mean, all the all of them have got good track record hybrids cemented, uncemented. They're all performing well in the NJR. Provided they're done well and provided the hip centre is maintained.

Louise King

Yeah. Great, thank you. Is it possible to ski after hip replacement? If so, how long after surgery should they wait before skiing?

Mr Kumar Reddy

Yeah, I have to say, people have gone back to skiing after hip replacement surgery and normally I would not allow them to ski for at least a period of eight weeks to three months before they go back to skiing again.

Louise King

Thank you. John asks if a hip replacement lasts about 20 years. How difficult is it to do a second replacement?

Mr Kumar Reddy

Well, John, I mean, we've got the technology nowadays to do the revision hips and it is a complex surgery, no doubt, but it can be done. I do these type of surgeries in my NHS practice and though I do not do, and we don't do it in Benenden because it is more complex surgery, and you also need to stay in the hospital with a good backup so it can be done. So if anybody needs one, it can be done. It's not a problem nowadays.

Louise King

Thank you. Terry is a keen runner and he's on hold pending a hip replacement. What is the best type of joint? What is the best joint type for a runner? Is it ceramic?

Mr Kumar Reddy

Because of survivorship, because you're impacting because these are artificial joints, they're subjected to wear and tear. So if you're looking at the long-term survivorship in your best interest. It would be a ceramic.

Louise King

Okay and he adding to his question, he's diagnosed with mild prostate cancer and he's subject to advanced surveillance, including two yearly pelvis MRIs. Does this limit his choice for hip joint material type?

Mr Kumar Reddy

No, it should not limit. I mean, usually with this prostate cancer. People do look into long term whether you've got some metastatic lesions or so, in which case a cemented or a hybrid implant would be the best choice. But I have done for uncemented as well and they've been performing well with prostate cancer.

Louise King

Thank you. I mean, this person says, where do they go for physio after the operation. Benenden, or somewhere local to them? It depends where they're located, I imagine.

Mr Kumar Reddy

Basically, if you're local, our Physiotherapist will be taking care of you. But if you're not local, it can be arranged which is closer to your home the physiotherapy and nowadays our guys are also doing zoom sessions through or Microsoft link to give you physiotherapy sessions.

Louise King

Thank you relating to that. Do we routinely organize our patient physiotherapy on discharge?

Mr Kumar Reddy

We do organize routinely physiotherapy after hip replacement surgery, either NHS patients, Benenden patients or self-paid private patients.

Louise King

Chris asks, what factors determine whether steroid injections represent an intermediate treatment before surgery is required and how long are the benefits of steroid injections? Or are there any risk factors.

Mr Kumar Reddy

It's a very good question. So the steroid injections are mainly given. One is to determine the diagnosis. If one is not sure whether it's coming from the back or the hip. If the injection or even if it leaves for two weeks of relief, you definitely know that it is coming from the hip itself. Then you can have the definite treatment in the form of hip replacement surgery, usually by and large. The steroid injections are temporary. They may last between two to six weeks maximum, and you'll be back to square one.

Louise King

Really? Okay and we have another question related to that from Susan. So could you clarify the procedure for the steroid injections in the hip?

Mr Kumar Reddy

Steroid injections in the hips are usually done under X-ray control with fluoroscopy, which means we normally put the needle in inject a little bit of dye to ensure that the needle is definitely in the joint and then we inject the steroid. If it were done blindly, I would not have it, the reason being 50%, you may be outside the joint and this would not serve the purpose.

Louise King

John says, after initial consultation, how long is the wait before surgery is usually performed? Now imagine from a from a self-paid primary perspective. It's only a number of weeks, isn't it? Often.

Mr Kumar Reddy

About yeah. Less than six weeks. Yeah it is less than six weeks. John.

Louise King

Thank you. Kieran had a fracture of the greater trochanter as a complication. Is this likely to happen when he has the second hip operation?

Mr Kumar Reddy

Right, Kieran. There is no guarantee, and nobody can give you a hundred percent guarantee and say that it would never happen again. It's a bit unfortunate that you had a fracture of the greater trochanter. Usually people do take care of it and make sure that this doesn't get repeated again. So yeah.

Louise King

Thank you. Sally says, how usual is it to have severe pain moving around the leg as a result of the hip arthritis and do you have any thoughts on reducing this pain whilst waiting for the operation.

Mr Kumar Reddy

Yeah, you do experience some amount of pain coming around the hip that radiates along the thigh. Sometimes it can be back related as well. So in the meantime you can rub some anti-inflammatory gels like, I believe, or water gel that are available and you can also take some medications discussing with your GP. Whatever is appropriate for you. You can take those, and you can also try pain patches that may well be beneficial while you're awaiting for a hip replacement surgery.

Louise King

Anonymous person says, are all hip replacements the same size? Are they strong enough for a large frame? My husband is six foot five.

Mr Kumar Reddy

The hip replacements. They are not the same size. You got to choose the type of the size that fits into the bone. So we got sizes varying from eight till about 14 to 16 in core hip replacements. Likewise you've got different sizes. It all depends on the diameter of the bone in the thigh bone and again, the same socket. You've got different sizes of sockets ranging from 44 to nearly 64, or even 66. So it all depends on what the size it comes up to and we do have it on the shelf so that we don't run out of sizes and use a mismatch implant.

Louise King

Great. Thank you and Angela says, is hydrotherapy available. At Benenden and is it recommended after surgery or is swimming recommended.

Mr Kumar Reddy

Hydrotherapy as far as I know, I don't think it's available, but you can have a hydrotherapy where the centres in the NHS hydrotherapy pool and you also can go to other centres locally. To have hydrotherapy or swimming is also a good exercise.

Louise King

Angela needs a hip replacement on her right hip. However, she already had a knee replacement on the same leg. Will this be an issue and can it alter the leg length more.

Mr Kumar Reddy

It's not a problem. I do hip replacements after they had the knee replacements. So we just need to perform the surgery carefully and everybody should be aware that you had a knee replacement so that everybody is aware of the knee replacement so that we can perform a hip replacement without any major issues whatsoever and the leg length. Discrepancy will not be a problem, because it's mainly coming from the hip. As your knees are already in alignment, so we can ensure that that is not the case.

Louise King

And our final question is from Leo, and he says, What can one expect from tens machines in terms of pain relief?

Mr Kumar Reddy

It is a nerve stimulator. It can give you some pain relief. Mostly it is used in lower back pains and hip pains. We hardly use any tens machine for a hip, but it's one of the modalities of pain-relieving methods. So people do use tense machines mostly in the lower back.

Louise King

Great. I did say final question, but two poor people have come in. So our final two questions now. Is there a weight limit to a person having a hip replacement?

Mr Kumar Reddy

Well, we have. We certainly have got a limit at Benenden Hospital. The BMI is about 41, I think, at Benenden Hospital, so that would be the maximum where you can be allowed to have a hip replacement at Benenden. But if you're a high BMI patient, it's in a catch 22 situation where you have got pain, and you cannot exercise because of the pain. I'm very sympathetic to those patients and in NHS. My cutoff is about 48 BMI.

Louise King

Okay and Susan said, are specific exercises to develop glutes, such as leg lifts, bridges, etc. a good or bad idea? Whilst waiting for treatment. She has found them painful but understands that long term. They may be helpful.

Mr Kumar Reddy

I think, within the pain limits, doing exercise is quite important to get the strength in the glutes and so that it would enable you to recover better following surgery. I won't push too hard, because you are in a lot of pain just within the pain limits. Do the exercises which would enable to strengthen your glutes so that it will help you to enhance the recovery better following surge.

Louise King

Alright, thank you. So I think we got through all the questions there, which is brilliant, please, could you move on to the last slide.

So as a thank you for joining this session, we are offering 50% off the value of your hip pain consultation available. If you book within the next seven days. A call back from our dedicated private patients team, your specific advisor an email with recording treatment, information and loyalty reward points and updates on news and our future events. We have many different webinars throughout 2025.

We'd be grateful if you could complete a survey at the end of this session and it really helps us shape future events and if you'd like to discuss or book your consultation, our private patients team can take your call until 8.30pm this evening. Or if you want to speak in the daytime, they're available between 8am and 6pm Monday to Friday. That's using the number on the screen to the right-hand side and that number will be in your email as well.

We have more events and webinars coming up on urology, varicose veins, knee surgery and hernia repair and you can sign up to any of these via our website.

So on behalf of Mr Kumar Reddy and the expert teams at Bendon Hospital. I'd like to say, thank you so much for joining us today and we hope to hear from you very soon. So thank you very much and goodbye.

Mr Kumar Reddy

Thank you.