Phil Orrell

Good evening, everybody, and a warm welcome to our webinar this evening from Benenden Hospital. We'll just pause a few seconds to allow participants to join.

Okay. A very warm welcome, as I say, to our webinar this evening on hip and knee replacement surgery. We're live from our broadcasting HQ here at Benenden Hospital. My name's Phil. I'm your host for this session and I'm joined by our expert speaker this evening, Consultant Orthopaedic Surgeon, Mr. Raman Thakur.

Please feel free to ask any questions throughout this presentation. So, if you've never joined one of our webinars before, the format of this particular one will be a  minute session,  minute presentation, I should say, on hips, on knees, excuse me. And then there'll be an opportunity for a Q&A after that. And then there'll be a presentation on hips and an opportunity for questions and answers after that. So, we will answer your questions after each topic, and please submit your questions by using the Q&A icon which can be found at the bottom of your screen and you can submit your questions anonymously, or you can give your name, and

I should let you know that, if you do give your name, this session is being recorded.

If you would like to book your consultation, we'll provide contact details on how to do that at the end of this session and we'll be including an exclusive attendee offer.

So, without further delay, I will hand over to Mr. Thakur.

Mr Raman Thakur

Good evening, everyone.

I would like to introduce myself, Raman Thakur. I'm orthopedically trained from Hyderabad in India, and subsequently I trained in the southeast England region under Guys and St. Thomas's rotation.

So, following the completion of training, I did a fellowship in hip and knee reconstruction in New York, at Lennox Hill Hospital and a hospital for special surgery.

I became a consultant hip and knee surgeon practicing from East Kent and have worked at Benenden since 2012.

I have been a member of the American Academy of Orthopaedic Surgeons and the British Arthritic Association.

My specialities include hip and knee replacements, robotic knee replacement, and arthroscopy and ACL reconstruction of the knee system

In this session, we are doing the knee first. So, we look at knee osteoarthritis, the options for treatment, discuss a bit about knee replacement, surgery, and then open up the session to question and answers, and similarly, with the hips, we'll do the treatment options for arthritis of the hip, discuss a bit about hip replacements and then open up for a Q&A session.

So, in knee osteoarthritis, what is osteoarthritis? It is gradual wear and tear, degradation of the lining surface, lining of of the bones on the femur and tibia affecting the knee, and also the kneecap

In the early stages, it presents with people noticing early morning stiffness i.e. stiff first thing in the morning. As you get going, it gets easier, and you can do a more lot more mobility, and with time it eases off and becomes less painful and less stiff. Pain on excessive activity, sensation of clicking and grinding or/and swelling of the knee.

As the arthritis progresses, it becomes a lot more painful, not only with activity, but also with rest. It interferes with sleep at night, the knee may get deformed, either knock-kneed or bow-kneed deformity as the common ones, and the walking distances gradually start getting diminished and function in terms of day to day and activities also get restricted; stairs, slopes become much more difficult to negotiate.

So, in the early stages, non-operative treatment is what is advocated, which involves modifying what you can do, accepting some of the limitations on your activities and particularly avoiding impact stuff, help get your weight towards the ideal body weight doing exercises to help strengthen the knee muscles with physiotherapy, simple painkillers, such as paracetamol, ibuprofen, if it is appropriate for people, can be used.

Sometimes knee strapping, especially if people feel it's giving way or something, can just add a bit of proprioception and support, making it feel much more secure. 

And injections which can be either cortisone injection or, what is shown on the picture, Durolane which is a hyaluronic acid injection.

If the non-operative treatments are not effective and not working, then surgical treatment options may become more appropriate and the simplest of those being arthroscopy, which is keyhole surgery. Take this procedure, in and out, tidying things up, especially if they have just torn a meniscus, sometimes loose bodies and things like that which can be dealt with through the arthroscopy. If there is a very small focus of bone-on-bone lesion, micro fracture can also help heal that area and help relieve pain.

In the more advanced cases an osteotomy, particularly if there is a deformity to help correct alignment, may relieve pressure on the worst affected side, and therefore allow a better weight going through the better part of the knee and reduce pain, and can be effective for several years.

Eventually, if the knee has progressed to bone on bone and nothing else is working, then joint replacement surgery will be the one that will hopefully give long-term relief of symptoms.

Cartilage transplantation is something that is still experimental and not really proven at the moment to be working with arthritis.

Knee replacement surgery. Done over a hundred thousand in the past year in the UK. The majority of patients have a spinal anaesthetic, and then sedation, so that they have a better recovery immediately post-op and have good relief of pain.

A hospital stay can be one or two nights, depending on individual independent progress, and the criterion for getting people home depends on them being safe on their feet. If they have managed to do the stairs, and the wound is looking dry. Patients are mobilised, full weight bearing on the day of the surgery if it is done in the morning, or the following day if it is being done in late afternoon.

As mentioned, knee replacements can be different types. The most common ones are shown in the pictures there, which are total knee replacement. The partial knee replacement is the one on the X-ray picture on the right knee. It shows a medial sided unicompartmental knee replacement. Constrained are much more advanced implants, and not commonly used unless there is damage to the ligaments. 

More recently, an addition to our surgical armamentarium at Benenden Hospital has been the ROSA robot, which helps the surgeon place your knee replacements in an ideal position. It avoids having to put instrumentation into the femur and tibia, and therefore reduces the trauma of the surgery.

It also helps align the soft tissue ligaments a little a bit better, so that patients seem to feel much more secure and get a usually earlier recovery from the knee replacement.

And that has been our early experience with it.

Phil Orrell

I think we are on to question and answers. So yeah. Okay, we can take a few questions from our audience now. So, our first attendee asks can you have a knee replacement if you are on blood thinners?

Mr Raman Thakur

The answer is, yes, you do need something of an individualised management if patients are on blood thinners, especially if you're on warfarin, we need patients to come off that for few days, and we give bridging treatment with Clexane, which is injectable heparin. And similarly, people are on the modern blood thinners also, this is similar things.

There are only a couple of blood thinners which we really worry about, and one of them is clopidogryl, because that can cause a lot of thinning, a lot of bleeding from surgery, and therefore we usually need patients to stop that for at least a week prior to surgery. But in general, the answer is, yes.

Phil Orrell

Okay, thank you. Our next attendee asks, is there a lower age limit for knee replacement?

Mr Raman Thakur

The important, the way to answer that, I think, is yes, there is no lower age limit, but also the important thing is the lifespan of knee replacement. It doesn't last forever. So, knee replacements fail in the longer term, at the rate of one to one and a half percent a year. 

So, what we are saying is at 20 years, 20 to 25% of the knee replacements fail, and most people whose knees have failed will have to have them redone. And again, in another 10 to 15 years, because revision knee replacements don't tend to last as long as primaries, and they may need further surgery. And there is a limit as to how many times one can go in and keep doing the knee replacement.

It is not just the bone, but also the soft tissues which are affected. So, the general advice is to delay it as long as possible, and the average or the mean age for patients having knee replacements in the UK at the moment is around  to  years. So that's the reason why you might get the answer from your surgeon, saying, leave it whilst you are in your forties and fifties, and have that surgery as late as possible.

Phil Orrell

Okay, thank you. Moving on to a question from Julia who asks If both knees have had ACL reconstruction, will this prevent having a knee replacement?

Mr Raman Thakur

Not really. The only thing with previous knee surgery is the fact that it slightly increases the risk of infection with subsequent operations, and that is true even with knee replacement surgery. Having said that, the incidence is still pretty small.

The second thing about ACL reconstruction, the ACL is usually sacrificed during total knee replacement. So, it doesn't matter if that is functioning or not functioning, and in general the hardware from ACL reconstruction does not interfere with knee replacement. So, the answer is, no, it doesn't preclude you from having knee replacement surgery.

Phil Orrell

Okay, thank you. Our next question from Angela, who says my GP said I'm too young at 67 for a knee replacement, as they only last ten years. Is this the case?

Mr Raman Thakur

I think it really depends on how bad your knee is, and if it is quite bad, and you have been assessed, and the that is the only option - I would be happy to do it on someone who is 67. 

I wouldn't say they last only ten years. As I said, the failure rate is about one to one and a half percent, so 10 to 15 will fail at ten years and 20 to 30 will fail by twenty years. So, there is still a fair proportion of those still going after twenty years.

Phil Orrell

Okay, thank you. We've got quite a detailed question here from a gentleman called Chris, who says I had a scan at Benenden in May this year, which revealed osteoarthritis in both my right knee and left hip. So, this is kind of, I guess, crossing over the two topics. Very sensibly, I was advised waiting before the symptoms worsened.

Given I want to do a lot more travel and walking, I'm now debating whether to take action sooner rather than later. My question is, do I need another scan if one was taken in May this year, before having another consultation with yourselves?

Mr Raman Thakur

I think the more important question is what are the level of your symptoms, and how much it is affecting you on a daily basis, and how intrusive your hip or knee have become?

Usually, the scan in itself may show it is quite bad, but we are not in the process of treating the images, we are treating people, and if you don't have symptoms, then I would also suggest you wait until your symptoms do get more significant and they become more intrusive. Arthritis usually has a waxing and waning pattern, just like a cycle of the moon or sun. In that you will have good full moon, new moon, and all phases of the moon in between. Similarly, arthritis can have really bad days, really good days, and all variations in between.

And, over a period of time, the bad days become more frequent, the intrusion into day-to-day activities becomes more frequent. So, when it comes to a time where your symptoms have got steadily or progressively worse, and your function is declining to a level where you are not able - you know, you're not coping, or you're not prepared to accept that deterioration in function - then that would be an appropriate time to consider having something done.

I hope that answers that question.

Phil Orrell

Thanks. Thank you. Next question comes from Mohammed who asks does the ROSA knee replacement surgery take longer than a standard knee replacement. If so, how much longer?

Mr Raman Thakur

Yes, ROSA needs the robot to be adjusted and programmed, and things like that. So, it adds another twenty minutes or so to the actual procedure. It also involves putting in a couple of pins, which are a bit extra to a standard joint replacement. But once the ROSA programming is done and the robot knows about the knee, then the rest of the procedure is exactly the same, or slightly quicker. So, in general, it takes about twenty minutes to half an hour extra on a standard knee replacement.

And, as we do more of these, the setup gets easier, and therefore the extra time becomes less and less.

Phil Orrell

Okay. Thank you. The next question is how soon would I be able to run after a knee replacement?

Mr Raman Thakur

That's an extremely good question. The question is, are you running for fitness? Are you running to catch a bus?

If you ask me or any surgeon, the advice would be, please do not run after a knee replacement, though I've known of people who have done marathons after knee replacement, that is not what we would recommend. It is not something that the knee replacement is designed for.

The problem with doing impact stuff after joint replacement is you will wear out your plastic components much sooner and you end up having to have a revision knee replacement or hip replacement. So, if you're going need to run for a bus or something, usually three months.

Phil Orrell

Okay, thank you. It appears that Mohammed has a follow-up question to the ROSA question earlier. If the procedure takes longer, is there an increased chance of infection? 

Mr Raman Thakur

Not really. We have done about twenty or twenty-five of these. We haven't noticed any increased rate of infection. Other centres that have done lots more have also not shown any increased rates of infection.

Phil Orrell

Thank you. Another, I guess topic crossover from this attendee. Can a hip replacement positively help with arthritic knee pain?

Mr Raman Thakur

So, I think the important point is, is the pain in your knee coming from your hip or your knee?

And you do get a bit of crossover and referred pain into the knee from the hip. So, if people have hip and knee arthritis on both of them, the general recommendation, as well as my recommendation, would be to have the hip sorted first, because if there is an overlap of pain which is coming from your hip, the hip replacement will relieve that.

If your knee symptoms are still quite significant and affecting you, and the arthritis is bad, then you may still need a knee replacement. But doing a knee first will not relieve the hip problem. But there is a good chance, that if majority of your knee pain is coming from the hip that will get relieved after a hip replacement.

Phil Orrell

Okay, thank you. Quite a topical question here from Vanessa. What do you think of Arthrosamid as an alternative treatment?

Mr Raman Thakur

So Arthrosamid has been shown to have a coating effect on the lining of the joint, but it is not a cure for the problem, so I think it is similar to a steroid injection, to a hyaluronic acid injection in that it will help. But it is not a cure for the problem, so I think eventually the situation will come when it is more intrusive, and if it doesn't work then you will require a joint replacement.

Phil Orrell

Okay. John asks I have a lot of pain walking, severe arthritis to right hip. Sorry. That's a hip question. Apologies. I thought that was a knee question.

This I presume relates to knees as well. Will I have to have another X-ray with you, even if I had one with the NHS four weeks ago?

Mr Raman Thakur

So, the most important thing with that, is to make sure that when you book your appointment you let the booking team know that you've had a knee X-ray or a hip X-ray done, and also inform them at which hospital. And then, what will happen, is that Benenden will reach out to your provider and arrange for those images to be transferred across, so that they are available with us before the consultation. And if we have those pictures to hand, we probably will not need another X-ray.

Phil Orrell

Okay, thank you. This person asks, I am 54, and was told that I have complete loss of cartilage and a tear. I'm very active and an injection hasn't worked.

My knee is quite painful most days, although I do exercise most days. Could I continue without a knee replacement? Or am I doing more damage?

Mr Raman Thakur

I think, so long as you're not masking the pain, and you are managing to continue with exercise and activity, and your symptoms are manageable, I don't see any reason for you to restrict your activities.

However, if your pain is becoming more and more, or you are taking a lot more pain killers or injections to mask the pain and doing the same activity, then you probably are at risk of doing more damage. So, whilst you are able to have simple analgesics, one or two paracetamols, or a couple of ibuprofens then yeah, fine, I would say you need to remain active.

You need to do the exercises to keep your muscles and joints in good condition. If your muscles support your joints better, you'll put less pressure on your joints, and therefore you will be able to function better, and you do need the muscles in good condition if you are coming towards surgery. So it's important to remain active.

Phil Orrell

Thank you. I think we have time for one more knee question. This person asks My friend has had knee replacement surgery and had sciatic pain. After the first, due to compression of her femur area, the surgeon adjusted the process for her second knee replacement. Is this a common side effect? And what are the risks? How do you mitigate?

Mr Raman Thakur

So, I'm suspecting that when you said sciatic pain after compression in the femur area there, you're probably referring to the first knee replacement having been done under a tourniquet, a control, and we do know that a tourniquet can cause a lot of ischemic pain and nerve pain, post-surgery.

So, at least in my practice and in the practice of few other surgeons here at Benenden Hospital, we have stopped using a tourniquet during the operation, and that way we tend to reduce the risk of any pressure in the thigh and have less incidence of any sciatic pain.

However, having said that, there's no guarantee that people can't get sciatic pain or nerve root pain related to any pressure on their nerves, either in the back or around the hip. So that would be something that is coincidental, but not directly attributable to the surgery.

Phil Orrell

Okay, we are roughly at the halfway point now. So, thank you, Mr. Thakur, for your oh, we have one more question. Okay. We have a follow up question.

This person asks, I appreciate what you said about running. Can you resume playing doubles tennis?

Mr Raman Thakur

Yes, you can. Yes, you can. And usually three months, at least three months after surgery. Yeah.

Phil Orrell

Perfect. Okay, thank you. We've definitely exhausted the knee replacement questions so we can move on to hips. Okay, thank you.

Mr Raman Thakur

So hip arthritis again, is the same thing. Wear and tear at the hip joint and it leads to pain and stiffness in the joint, obviously injuries, age. It is slightly more prevalent in ladies and obesity also increases the risk of arthritis, both at the hip and knee. It also accelerates the progression of arthritis as well. 

Again, symptoms are pretty much similar. Increased pain and stiffness, pain in the groin, pain in the buttock, and pain on the side of the hip. Difficulty in stiffness can lead to difficulty in putting on shoes, socks, tying shoelaces and, as the pain and arthritis progress, the pain can start becoming more intrusive with rest, pain affecting sleep at night, and as people tend to use less and less, and functional decline will cause weakness and wasting of muscles, and the hip movements become more and more restricted.

In the early stages, if there is, as I mentioned earlier as well with the flare ups of arthritis, if it is not born on bone pain, relief medications and physical measures, such as TENS machines can help with the pain. Lifestyle changes, particularly using a cane or a walking stick on the opposite side can make it easier to cope with the hip. Pain steroid injections can help if other measures are not effective. We did talk about physiotherapy, ice and hot packs, depending on which one helps people, or sometimes either, or both.

And finally, you know, if there is a little bit of a high arch, dropped arches, insoles, and footwear can help relieve pressure and make things easier on the hips and knees.

Eventually, if the pain is becoming more and more intrusive, hip replacement surgery would become the option. Not in vogue now, and it is extremely uncommon in this era for anybody to have, fusion of the hip as a surgical option when hip replacement has been so successful.

So hip replacements again, are done through a spinal anaesthetic or a general anaesthetic, a one-to-two-night stay in hospital. The components are a pin which goes into the femur and a metal socket which goes into the pelvis.

The bearing surfaces are a plastic bearing which goes into the socket in the pelvis, and either a metal or a ceramic ball, which goes onto the pin on the femur, and the ball moves on the plastic. And that's what, therefore, relieves the pain, as the bone is not rubbing on bone, which is a problem in hip osteoarthritis.

Subsequently you will need physiotherapy. There are some do's and don'ts so long as you follow them. By six weeks there is over 90% recovery, and most patients are pain free, walking independently, and have discarded their walking aids. Driving usually starts after six weeks. And over 90% of people are pleased and happy with the outcome of hip replacement surgery. 

Phil Orrell

Right. There are some questions. Our first one comes from John, who says I have a lot of pain walking, severe arthritis to right hip. I've been told that, although I'll need a hip replacement. But first, special exercises are recommended. I've been very active and wonder what exercises you recommend, and is it likely to work? He's got a further question. Right. There's a follow-up question.

Could you scroll down to the follow up question?

I have pain in right knee and severe arthritis in my right hip. It can rotate my ball and socket. I'm 77, very active, but pain with walking is getting worse. Why don't you say the first one is answered, and then we can go down. Okay. So recent investigation says, I will need a replacement soon. But how long?

Mr Raman Thakur

Okay, this is a cost-based question. So, the first thing with hip arthritis is, as I mentioned a bit earlier. The possibility is that majority of your pain in the knee is possibly coming from your hip.

And if the hip arthritis is worse, and it is now intruding into your activities. It is restricting the distances you walk, you're walking with a limb you are in pain, with rest, and you're struggling when you stand up, after sitting for long periods and things, you're struggling to put on your shoes, cutting toenails, putting on socks, getting in and out of car.

Then I think you are almost there for a hip replacement. So, I would suggest, getting an opinion from an orthopaedic specialist and then take advantage of the 50% off consultation, maybe, and have your up-to-date X-rays. If you have had X-rays, please make sure that you tell them when you're booking so that they are available at the consultation.

And once we note that you are a candidate for hip replacement, then that might be the right thing to do, even at your stage, what you are describing, and with the level of limitations you are experiencing.

Phil Orrell

Okay. This person asks, I require a hip replacement at the relatively young age of 37. I'm looking to delay this for as long as possible. However, it will need doing. How long will the hip replacement last, and will it need to be done again? Will I be able to run post hip replacement within a non-contact sport and what can I do prior to surgery to improve my recovery?

Mr Raman Thakur

So, starting with the first question, how long will the hip replacement last? And, as I said, a bit earlier, modern processes and modern bearing surfaces have become a lot better than the older bearing surfaces. So, the modern plastics, the modern ceramics are a lot more hard, harder wearing, and they do provide longevity for joint replacements.

Even having said that, if you have your surgery before then as you're asking the questions relating to function, you can understand that if I did a hip replacement in somebody in the age of 70, 80, versus somebody in their forties, the person who is 40 years is going to put the hip through a lot more than a person who is 70, and also the level of usage, especially, you're asking about running and things means that you're doing a lot more impact stuff on the hip than somebody else who is in the latter part of their life.

So, the question about how long it will last relate to all these various things are mentioning, and if you are using the hip more, you are putting a lot more impact stuff on it, the likelihood of it lasting long as long as somebody who's not doing the same will certainly be much less.

Having said that, we still think the rate of about one to one and a half percent failure rate of joint replacements still applies unless you are doing a lot of impact activities so lasting about 10 to 15 years, possibly 20 years, is what you're looking at, and if you do wear it out, then having further surgeries in your late fifties and further surgeries down in seventies. So, you're looking at at least possibility of two to three further joint replacements, which we are not saying will happen. But given that age, given your activity levels, that is certainly possibility on the cards, and therefore it would be prudent to defer it for as long as you can.

Running post hip replacement again, as I mentioned, if you are doing something like double tennis and things like that, that's absolutely fine. If you are doing singles, tennis, and things like that, you're running a lot longer distances and things, then probably you are likely to cause yourself earlier chance of wear and earlier revision surgery.

What can you do prior to surgery to improve your recovery? Keeping your muscles in good condition so exercises as advice from Physio, maybe cycling, maybe swimming, which are probably less impact, and your hip will allow you to do more than just walking. But walking as well. All these certainly keep your hip muscles in good condition, and certainly would be advisable before surgery. 

Phil Orrell

Okay, thank you. I'm assuming that the next few questions are from the same attendee, who is asking anonymously.

They say that their wife has developed severe pain in her right hip and knee. An X-ray has been carried out. Right hip, knee, spine, and left knee reveal issues. Physiotherapy and tests are booked. Not at the surgery stage, yet.

Is there any evidence that supplements, for example, turmeric can reduce or delay symptoms associated with hip arthritis. So, as far as my knowledge goes, turmeric has an anti-inflammatory effect.

Mr Raman Thakur

So, it works in a similar fashion to anti-inflammatory medication, and certainly yes, it can help relieve the pain. But I would certainly recommend mentioning this to your doctor, because if they are also prescribing some anti inflammatories, then it may not be good for her body, so certainly have a chat with your GP who will be able to look at everything and then advise whether or not that is appropriate for her.

I certainly think you're doing the right things by having all the investigations, and while she's able to cope and manage with the level of pain, certainly continue with conservative management.

Phil Orrell

Okay thank you. I think we've run out of questions from the audience. I don't know whether it's worth moving on to a couple of frequently asked questions here on the right-hand side. I think you've answered two of these.

So, one of the frequently asked questions we get is, can I have a hip replacement if I've already had a knee replacement?

Mr Raman Thakur

The answer to that is, yes, we do that quite frequently, and there is certainly no restriction for having a hip replacement if a knee replacement has been done before.

Phil Orrell

Okay, we've had a couple more questions come in just now. This person asks, how is pain managed post hip replacement surgery? 

Mr Raman Thakur

So first and foremost, having the hip done under a spinal anaesthetic with blocks, and local anaesthetic injection itself gives a good relief of symptoms. In the immediate post-op period, we start prescribing simple analgesics like paracetamol, codeine, and if patients' pain does become more intrusive or more significant than that, then we have got stronger painkillers down in the opioid side to help control the pain by day.

Two a day, three at the most. Most patients will require simple paracetamol plus or minus codeine to help with their pain. So hip pain does seem to get under control fairly early and fairly easily compared to knee replacements.

Phil Orrell

Okay, thank you. The next question comes from Sarah, who says I had a total hip replacement five years ago and now I'm anticipating a second one on the other hip.

I was advised to sleep on my back post-op, which I did for six weeks. That was very challenging. Do I need to sleep on my back for so long?

Mr Raman Thakur

The concern always is, Sarah, that we are worried about the hip dislocating. And the only thing that is stopping that happening are the sutures we put in to hold the hip in position.

So if you were to cross your legs, which can happen if you're lying on your side, then the concern is that you put your hip into a position we don't want to. Then you can dislocate your hip, and that is the main reason why we advise sleeping on your back and not crossing your legs. So yeah, unfortunately, that is holds true. Even for your second hip.

Phil Orrell

Okay. This person asks, do you have an opinion on collagen supplements?

Mr Raman Thakur

So, part of the conservative treatment is trying various medication, and some people try supplements. If you are asking me as a doctor and scientist. Unfortunately, there is no scientific evidence that collagen or glucosamine in any of this work better than others, but some people find that they help them. So, it is worth trying them. But if you are noticing no significant improvement in a few weeks, then probably it's not worth continuing. 

Phil Orrell

Okay, thank you very much. We have exhausted all questions from the audience. Thank you. And I'm sorry if you had questions lined up, and we didn't get around to answering those. But if you have questions and you provided your name, we can answer them via email.

Please could you move to the next slide, Mr Thakur?

As listed on the screen, here we are. We are giving an exclusive offer for attendees of this webinar, so, as a thank you for joining we are offering a free knee consultation for a limited time only. And when you're booking online you can use the code FREEKNEE all in caps as listed there or you can take advantage of 50% off a hip consultation when booking online, and for that you can use the code HIP50 all in caps.

You will also get a call back from your dedicated Private Patient advisor, an email with the recording treatment information and the loyalty reward scheme points that you receive for attending this webinar. And you will receive updates on news and future events.

Following this webinar, you'll also receive a survey, and we'd be grateful if you could complete the survey at the end of the session, and your responses will help us shape future events.

If you'd like to discuss or book a consultation, our Private Patients team can take your call, and they're here until .pm this evening, or between am and pm Monday to Friday using the number on the right-hand side of your screen there.

Our next webinar is on cosmetic surgery, and you can sign up to that via our website. So, all that remains for me to say is, thank you for tuning in this evening. On behalf of Mr. Thakur and our expert team here at Benenden Hospital, I'd like to say thank you for joining us today and we hope to hear from you very soon. Thank you and goodbye.

Mr Raman Thakur

Thank you for having me.