Hip & Knee Care

Osteoarthritis of the knee is a degenerative condition of the joint resulting in pain, stiffness, and loss of function.

The ends of our bones within the joint are lined by a smooth and slippery surface, known as cartilage. This allows the bones to move against each other without friction and allows for painless weight bearing and mobility. Your knee also has two other types of crescent shaped cartilage known as meniscus, which help to distribute weight evenly across your knee joint. There is also cartilage lining under surface of your kneecap.

Osteoarthritis causes the lining cartilage in your knee joint to become thin and rough. This leads to your symptoms. When symptoms affect activities of living and function, a total knee replacement can be offered.

This is a surgical procedure in which your surgeon will replace your damaged joint with metal, high quality polyethylene or ceramic joint. This is routine procedure performed for an advanced arthritic hip / Knee and is proved to be very successful in providing pain relief and improving function including mobility.

If you have advanced arthritis which does not respond to a non-operativetreatment, then your surgeon will discuss surgical options with you.

Most of the patients after hip and knee replacements are able to leave hospital after one night stay, whereas some may be able to go home on the day of the procedure. Your consultant will discuss these options with you.

Any surgical procedure will cause some pain and discomfort. Our surgeons have experience in enhanced recovery pathway where they will inject local anaesthetic in the soft tissue around the joint. This is effective in controlling pain and helps in early mobility.

Sometimes mild and moderate osteoarthritis of the joints can lead to severe symptoms. In these cases, regenerative option may be offered to you. The regenerative treatment utilises your own cells and growth factors to treat osteoarthritis and tendinitis. This can potentially delay the need for a total joint replacement procedure.

Regenerative treatment helps by reducing pain, inflammation by using your own body cells and growth factors leading to relief of symptoms and improvement in function.

Osteoarthritis - Although joint replacements provide a final solution to end-stage disease, these procedures cannot be recommended to younger patients with early- to mid-stage OA. Patients who would want to try alternative biological treatment based on their own cells can opt for regenerative treatment.

Patients who suffer from chronic tendon conditions (Gluteal tendinitis, Trochanteric bursitis, golfers and tennis elbow, planter Fasciitis) may be candidates for platelet rich plasma treatment.

Regenerative treatment options are -

1. Mesenchymal stem cells derived from adipose tissue or Bone marrow
2. Mesenchymal stem cells derived from human placenta
3. Platelet Rich Plasma (PRP) – Blood derived
4. Autologous Protein Solution – nStride – Blood derived

Your consultant will discuss with you which treatment would be most suitable for your condition.

Regenerative treatment for osteoarthritis and tendinitis is an evolving science. Many research papers are published every month increases our learning about the outcome.

nStride, APS - Intra-articular use of APS (nStride) for mild to moderate knee OA was safe, and significant pain improvement was documented 3 years after a single injection. (The American Journal of Sports Medicine 2020;48(11):2703–2710).

Microfragmented adipose tissue (MFAT), Mesenchymal stem cells - Several research articles have shown that MFAT, Mesenchymal stromal cells and Bone Marrow Derived Mesenchymal Stem Cells (BMAC) have good results in osteoarthritis of the knee and hip for improving VAS and Oxford hip/knee scores. This is a low-morbidity alternative biological treatment and can delay the need for total knee replacement in suitable patients (Hindawi Stem Cells International Volume 2021, Article ID 9921015).

This study shows that a single-dose MFAT injection leads to clinical, functional, and quality of life improvement at two years of knee osteoarthritis. These findings provide evidence that this treatment modality could be a safe and effective option to other commonly available treatments in carefully selected patients. International Orthopaedics volume 45, pages1179–1188 (2021)

PRP- Results of Platelet-Rich Plasma for the Management of Hip and Knee Osteoarthritis showed that PRP is a safe treatment with potential to provide symptomatic benefit for OA up to 12 months. Younger patients with less severe disease may be more responsive. (CurrRheumatol Rep. 2017 May;19(5):24.).

These procedures are low risk procedures. Many procedures can be done in the outpatient department, and some may require short GA as a day procedure.

The regenerative treatment is provided at the following two sites -

1. Healthshare Clinic Winchester
   Chilcomb Lane, Winchester, Hampshire, SO21 1HU
2. Fitzrovia Hospital
   13-14 Fitzroy Square, London W1T 6AH.

• Rest for the first 24–48 hours, but do not lie sedentary
• There may be some pain and discomfort around the injection site. We suggest simple pain killers such as paracetamol and codeine along with ice compression for pain relief.
• We advise you stop anti-inflammatory (such as ibuprofen) medication approximately two weeks before and not to recommence for six weeks after the procedure.
• Start graduated Physical Therapy after seven days, but avoid impact exercises such as running, jumping, squash and jogging.
• We will advise you further based on your individual situation and needs.
• If you had incision/wound on your abdomen, we advise to keep it dry until seen in two weeks for a wound check.