Many people suffer from arthritis of their knees to varying degrees. Treatments that many be considered range from physical exercise programmes to surgery.
Mr. Edwards may consider steroid or viscosuppliment injections, focal chondral arthroscopic treatments, realignment osteotomies or partial or total knee replacements.
If you suffer from early arthritis of the hip there are a number of options you may be offered. These include exercise therapies, gait improvement with the podiatrist, intra-articular injections and in patients under the age of 45 years, hip preservation arthroscopic surgery.
For those people with more advanced arthritic change a total hip replacement may be the treatment of choice. Hip replacement has been around for over 100 years, but modern techniques and materials mean that the success and longevity of hip replacement is excellent.
Many people suffer from lateral thigh pain over the prominence of the hip. This is usually due to mechanical irritation of the tensor fascia lata resulting in inflammation of the trochanteric bursa and a tight, poorly functioning tensor facia lata and ileotibial band. Treatments are most commonly undertaken by a physiotherapist. When these interventions fail, injections or surgery may be required.
Viscosupplement injection can supplement the fluid in your knee to help lubricate and cushion the joint and relieve pain often lasting for 6 months. There are a number of very positive meta-analyses and research studies that show the efficacy of HA injections. In a recently (2015) published European (ESCEO) consensus statement on the management of osteoarthritis, on discussing Hyaluronic acid injection they say “Viscosupplementation with intra-articular (IA) hyaluronic acid (HA) is an effective treatment for knee OA with beneficial effects on pain, function, and patient global assessment. There is good evidence for the effectiveness of HA from RCTs, with a high effect size of 0.63 when compared with oral placebo, found in a recent network meta-analysis. IA HA was the most efficacious treatment for pain among all OA interventions.” In addition the American Medical Society for Sport Medicine recommends the use of HA for the appropriate patients with knee OA. However, NICE guidance(CG177) recommends against the routine use of these agents since there is no compelling evidence of their efficacy. Mr Edwards, after reviewing the evidence, considers it reasonable to offer this injection on an individual basis after discussion of the chances of improvement and based on the available evidence both published and in his own experience.
Corticosteroids have marked anti-inflammatory effects, and it is assumed that their analgesic action in osteoarthritis is in some way related to their anti-inflammatory properties. Evidence of their effectiveness is not consistent. However it remains a reasonable consideration in patients with arthritis when surgery is not indicated.
Having a mechanical cause for your knee pain may be amenable to key hole or arthroscopic treatment. Mr. Edwards undertakes 100s of knee arthroscopies each year. A number of conditions can be improved by arthroscopic surgery. These include torn cartilage (meniscus) which may require repair or trimming, treatments to areas of isolated lining (articular) cartilage damage including abrasion, ablation, microfracture and if necessary semi-synthetic grafting, pinching (impingement) of thickened lining tissue (plica conditions and fat pad impingement), and ligament injury.
People with painful knees and significant arthritis can have their lifestyles dramatically curtailed. In these cases total or partial knee replacements can restore function, reduce or even abolish pain and allow the person to enjoy the activities they have been unable to undertake possibly for years due to their knees.
Mr. Edwards was the first surgeon in Europe to use computer navigation technology for the Attune knee system from DePuySynthes. The Attune® Primary Total Knee System is designed with the goal of addressing the clinical needs of patients, surgeons and hospital providers. Extensive research and science is included in the design to help improve functional outcomes for patients, performance for surgeons and efficiency for providers. The ATTUNE® Knee is an innovative, comprehensive, integrated knee system. Click here for Mr Edwards’ TKR brochure. The Attune® knee replacement is available at Spire Hull. Mr Edwards uses the De Puy Synthes PFC Sigma® knee system at NL&G Trust based in Goole Hospital.
Where only one compartment is affected the SIGMA® High Performance Partial Knee is a unique system comprised of unicondylar medial and lateral implants and a full range of state-of-the-art instruments to perform these procedures. This surgery is usually carried out using less invasive techniques and a relatively small scar. Partial knee replacement is ideal for patients who only have arthritis in one side of their knee. It can give excellent function including ability to return to manual labour or even sport. However, it has less longevity than a total knee replacement. If it fails, it can be revised to a standard knee replacement usually with little difficulty.
A high tibial osteotomy results in a shift of the weight bearing axis away from the medial side of the knee. This can result in less pressure on a degenerative medial compartment and some relief of pain. Mr Edwards uses the Puddu system (Arthrex® Inc.) to achieve the necessary realignment in appropriate cases.
When physiotherapy has not achieved sufficient resolution of symptoms it may be necessary to be treated with injection therapies. Initially this would be a course of steroid injections to accompany physiotherapy. If this fails to achieve resolution of pain then PRP (Platelet Rich Plasma) injection may be used, although there is little evidence of its efficacy in trochanteric pain syndrome. If these modalities fail, surgery may be indicated to decompress the trochanteric area by excising the bursa, removing a small portion of the lateral prominence of the trochanter, lengthening the fascia lata and repairing as necessary the gluteus medius muscle attachment.
For moderate arthritis of the hip where hip replacement is not yet required, steroid injection into the hip may be a useful temporary pain relieving measure. This injection is given under image guidance since the hip joint is a deep and not easily accessed joint.
Having a painful, stiff and arthritic hip can be very debilitating. In suitable clients a hip replacement can be undertaken. This procedure removes the arthritic head of the femur and corresponding surface of the acetabulum (the ball and socket). These are then replaced by a stemmed femoral implant with a ball head and a cupped acetabular implant. The types of fixation vary between uncemented to cemented fixation techniques. Mr. Edwards utilizes the proven technology behind the uncemented Corail® femoral stem and the Pinnacle® acetabular cup with suitable bearing surfaces including ceramic bearing, ceramic on polyethylene and metal on polyethylene.