First of all doctor, thanks for taking the time to talk to us. Could you begin by telling us a little about your background in orthopaedic surgery?
My interest in orthopaedics stems right back to my medical school years. My orthopaedic training was completed in the midlands and I pursued my specialist interest in hip and knee joint replacement surgery and knee joint reconstruction surgery by completing fellowships in Oxford, Toronto and Wrightington. Currently I practise as a lower limb arthroplasty and knee reconstruction surgeon in the North West.
Could you tell us about what orthopaedic procedures you have to undertake on a day-to-day basis?
I routinely perform patient specific knee replacements and knee resurfacing procedures, partial knee replacements, knee arthroscopies, cartilage and knee ligament reconstruction procedures for sports injuries, osteotomies around the knee to correct alignment and hip replacements.
What conditions could cause someone to need total or partial knee replacement surgery?
If someone has arthritis or cartilage damage in the knee and has problems with pain, stiffness, reduced movement and poor mobility, they will invariably proceed to have a knee replacement to improve their function and quality of life. Now if the arthritis is confined to just one area of the knee then they may be suitable for partial knee replacements or localised knee resurfacing procedures.
Are there ways to combat some of these conditions?
Regular non-impact exercise and activities will help keep the joints mobile help with the pain and if not then pain medications and physiotherapy is often used as first line treatment in these conditions.
How did you develop patient-specific knee replacement service?
One in five people who have a knee replacement are not fully satisfied following their surgery and are unhappy due to some on-going pain, discomfort or lack of expected function and movement in the knee. There is no specific reason for this but some contributing factors are caused by compromised sizing due to restricted sizing availability of ‘off the shelf implants’ and also subtle inaccurate positioning of implants causing:
- Some soft tissue irritation from implants;
- Exposed bone causing some bleeding and secondary stiffness;
- Kneecap tracking problems giving rise to anterior knee pain.
Hence using patient-specific implants for knee replacements, partial knee replacements and knee resurfacing procedures tries to reduce this dissatisfaction rate by designing the implants and positioning blocks based on patient anatomy so improving accuracy and sizing.
For these reasons, and also having the advantages of reduced hospital stay and quicker recovery, we are developing and promoting the patient-specific knee replacement service.
If surgery becomes a viable option, what considerations does the patient need to make?
Following the consultation and investigations, if the patient requires a knee replacement and is suitable for a patient-specific implant, they are sent for a CT scan of their knee which is used as a template to create the knee implants and the cutting blocks using 3D printing technology. This usually takes 4-6 weeks.
If the patient has an isolated localised cartilage defect and is suitable for a patient specific knee resurfacing procedure, then they are sent for a MRI scan and this is then used as a template to create the implants.
The procedure is fully discussed with the patient and a full consent process is undertaken and the patient is given additional information about the procedure in the form of booklets, video links and relevant website information.
What is a microfracture and how is it treatable?
A microfracture is a treatment modality for an isolated cartilage defect usually following an injury. It is usually performed through a keyhole procedure and is suitable for smaller cartilage lesions. It is a very common procedure performed for a small, localised cartilage defect. If cartilage lesions are large, or if the microfracture fails, then patients are considered for either cartilage reconstruction procedures or patient specific knee resurfacing implants to address the localised defect.
What advancements in orthopaedic surgery have you observed and contributed to in the last decade?
Advancements have been in cartilage reconstruction and regeneration procedures and in patient specific implants. The big drive in orthopaedic knee surgery currently is trying to regenerate and reconstruct cartilage to delay the onset of arthritis as a means of joint preservation surgery.
In people already suffering with arthritis, the drive is to improve function and satisfaction following surgery with patient specific implants.
The One Stop Knee Clinic is a comprehensive knee service designed to improve and enhance patient care by streamlining and completing the patient pathway in one visit.
This includes:
- Initial consultation;
- Investigations such as x rays, MRI scans and ultrasound scans;
- Follow up appointment with the results straight after the investigations;
- Physiotherapy review if required and braces etc.;
- Some treatment modalities such as injections, shock wave therapy etc.;
- All this is achieved within 2-3 hours in a single visit under one roof; saving patients time and inconvenience of multiple visits.
