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Skiing and hip surgery

• Make sure that you are fit enough before you go

• Choose a time when the slopes will be less crowded (out of the school holidays)

• Avoid difficult runs, moguls and ice

Glucosamine sulphate and chondroitin for osteoarthritis

Lots of my patients use glucosamine and chondroitin, and would like to know more about these supplements. Here is some useful information from the Arthritis Research Campaign:

Osteoarthritis is the commonest form of arthritis. It particularly affects the weight-bearing joints of the legs and back, becoming more common with age. Many people take glucosamine sulphate tablets with or without added chondroitin. Cartilage contains substances related to glucosamine and chondroitin and taking supplements of these natural ingredients may nourish damaged cartilage.

The research findings are conflicting, but more evidence is accumulating that some people, at least, will benefit from this therapy. Much of the research has been undertaken on people taking a combined daily dose of 1500 mg of glucosamine and 1200 mg of chondroitin and so this would be a good combination dose to use if you wish to try them. They can also be taken separately if you prefer. Glucosamine should not be taken by people who have an allergy to shellfish, although there is now a vegetarian version that can be substituted. In some people glucosamine can increase the level of sugar in the blood, so if you have diabetes be sure to check your blood sugar and discuss with your doctor if your blood sugars seem to be higher. Also if you are taking warfarin your blood-thinning control (international normalised ratio, or INR) may be affected, so make sure you have your regular blood checks and again discuss this with your doctor. Try glucosamine and chondroitin supplements for 3 months and if your joint pain is much improved you may wish to continue with them.

Hip replacement meets most patients’ expectations

A study has found that the vast majority of patients who undergo hip replacement surgery are happy with the results.

Researchers at the Hospital for Special Surgery in New York recruited 405 patients, all of whom were about to undergo total hip replacement, which is a common treatment option for people with severe osteoarthritis.

Patients – who had an average age of 66 years at the start of the study – were interviewed before their operation and asked to list their physical and psychological expectations.

They were then re-interviewed approximately four years after their operation and asked whether each of the expectations they had previously listed had been fulfilled.

Nearly half (43 per cent) of the patients said that all of their physical and psychological expectations had been completely fulfilled, while an extra 32 per cent revealed that all of their expectations had been somewhat fulfilled.

Overall, 87 per cent of expectations had been fulfilled and the researchers noticed that high levels of satisfaction tended to be reported by people who were young, employed, had a body mass index (BMI) of less than 35, had not developed a post-operative limp, and who had not experienced any complications.

Writing in the Journal of Bone & Joint Surgery, the study authors concluded: “Our findings may be useful for counselling patients and for providing a framework for using fulfilled expectations as another patient-centred outcome of total hip arthroplasty.”

Bilateral (both sides) hip surgery

I first started doing bilateral simultaneous hip procedures about three years ago, and the results have been very good. If both hips are as bad as each other, it makes a lot of sense to have them both sorted out at the same time. It sounds daunting, but it means having only one anaesthetic, one hospital admission and one period of rehabilitation. We have developed an efficient and safe pathway of care which means that most patients are in hospital for about a week, and are usually back to work/normal activities three months after surgery.

Careful patient selection is very important, and not everyone is suitable for the procedure. In this case we usually perform the two operations about 3-6 months apart. A recent meta-analysis looked at the results of 2063 bilateral simultaneous hip replacements and concluded  ‘This procedure was..found to be economically and functionally efficacious when performed by experienced surgeons in specialist centres’.

If you would like to discuss this in more detail, please contact us.

Problems after hip resurfacing

Hip resurfacing has been around for over 12 years, but in the early days, it was really only done by ‘enthusiasts’, specialist hip surgeons who saw its potential. We have seen a number of problems in recent years. In men there is a small risk of a fracture of the neck of the femur. This usually happens around 3-4 months after the operation at the time when the patient returns to work, or sports. It is a distressing complication, and requires another operation, but the outcome is usually excellent. Later failures (around 3-4 years after surgery) are more commonly seen in women. The femoral component (the ball part of the joint) can loosen, causing pain, clunking and a feeling of instability in the joint. This too requires surgery to sort out the problem. There are increasing reports of problems related to reactions to the metal constituents of the bearing. These usually present with increasing pain, and an ‘awareness’ of the joint. In some cases there is a large collection of fluid in the joint, and this can be associated with damage to the soft tissues around the hip. A recent study from Oxford, published in the Journal of Bone and Joint Surgery showed a significant difference in the incidence of this complication between men and women. In my own practice, I have had a similar experience, and stopped using resurfacings in women 3 years ago. If the situation is left untreated, the damage can be severe and this can make the subsequent operation very difficult. If you have a painful hip resurfacing, you must seek advice from your surgeon. You will need to have blood tests and a scan, and usually an aspiration of fluid from the hip. It’s likely that the resurfacing will have to be removed and a new hip replacement put in. In the last few years I have done this procedure many times and the outcome is usually very good. If you would like to find out more, please get in touch.

Which hip replacement is best for me?

This is one of the most difficult questions! The answer is of course, ‘it depends’. Many countries (including the UK) collect data on the outcome of hip replacement surgery. Surgeons complete a form after every operation detailing the indication for surgery, information about the patient and the implants used. Statistical analysis is performed on the data and this shows which implants last longest.

If we used this information in isolation when choosing the right implant for a particular patient, we would probably use something like a cemented Charnley stem and a cemented polyethylene cup. This hip replacement would almost certainly give excellent pain relief for most patients. However if you are under 65, have complex anatomy or want to do anything other than potter about, it might not fit the bill. The plastic socket will wear out in time, causing pain, instability and loosening of the implants. Joint replacement surgeons want to provide their patients with implants that will allow them to work, play some sports and return to as normal a life as possible. In order to this we use materials such as ceramics and chrome/cobalt/molybdenum which are durable and wear resistant. Hip replacements using thes materials haven’t been around for as long as the more traditional systems, and as a result they might at first glance might not appear to be as good as the older hips. However there is ample evidence in the literature to show that ‘conventional’ hip replacements in younger patients are more likely to fail in their lifetime than in older patients. Most of the joint replacement surgeons that I know spend a lot of time trying to work out which operations and implants are best for their patients. We use the information that is available to us to help inform our decisions, but ultimately rely on our training, experience and judgment to the do the best we can, as often as we can. If you want to find out which type of hip replacement might be best for you, speak to an experienced hip surgeon who will help you decide.

Hip replacement for women

Over half of my patients are women, and many of them are young and physically active. Lots of them enjoy playing tennis, going to the gym, and doing Pilates. They need a hip replacement that is durable and unlikely to dislocate doing their normal activities. Hip resurfacing hasn’t really fulfilled its early promise for female patients, but we are seeing excellent results with ceramic hip replacements. I use the DeltaMotion hip system which allows me to implant the biggest bearing currently available.

If you would like to discuss your hip problem with me, ask your GP for a referral.