Hip replacement surgery is an operation to replace an arthritic, damaged hip joint. When there is significant cartilage loss in the hip joint causing pain, stiffness and mobility issues, a full replacement of the joint may be required. By the time hip replacement is necessary patients are often waking in pain at night and unable to put their shoes and socks on. Getting out of the bath or low chairs and car seats can be a struggle.

Understandably, you may have a lot of questions when you are told you need surgery. Here, we reveal the answers to some of the most common questions patients have about the procedure.

Before hip replacement surgery

Prior to undergoing hip replacement surgery there are things you should do to help limit the risks, and ensure the procedure runs smoothly. While the risks of hip surgery are minimal, it helps to ensure you are as fit and healthy as possible before the surgery.

Partaking in gentle exercise such as walking or swimming, will help to strengthen the hip muscles and aid in your recovery. If you smoke, you should also aim to quit a few weeks before the surgery. Nicotine has been proven to complicate healing, and it significantly increases the risks involved.

You will be given antibiotics to take before the surgery, and once again afterwards to reduce the chance of infection.

It is important that the skin around the hip and leg is in good condition at the time of surgery.

Other medical conditions, such as diabetes, should also be under control and there will be a pre assessment process to check general fitness for surgery. This will include routine blood tests.

Mr Punwar will advise you on the best ways to prepare for the surgery and his expert team are always on hand to answer any questions you may have.

During the procedure

Hip replacement surgery takes between 1 to 2 hours to complete. A consultant anaesthetist will see you prior to surgery and discuss the options available.

You will generally be given a spinal anaesthetic, ensuring you don’t feel anything during and shortly after the procedure.

A 10-15 cm curved incision will be made at the side of the hip, before Mr Punwar dislocates and removes the femoral head. An uncemented metal socket will be attached to the pelvis, before a metal stem with a ceramic or metal head is implanted in the femur. The femoral stem may be cemented or uncemented depending on bone quality and shape. Mr Punwar will plan the surgery beforehand and make sure you are aware of the intended procedure.

Any blood loss will be minimised and the procedure will be carried out in an ultra-clean air operating theatre to minimise infection.

The wound will then be closed up with clips or sutures and protected with a surgical dressing to minimise the risk of infection.

Recovery from hip replacement surgery

The few days after undergoing hip surgery, Mr Punwar and the physiotherapy team will keep a close eye on you to ensure you are regaining mobility. A postoperative x-ray will be taken, and you may experience some bruising and swelling around the site of the operation. There may be some lower leg swelling. You will be given compression stockings to reduce swelling and guard against deep vein thrombosis. You will also be given daily injections of a low dose blood thinner to prevent thrombosis for 4 weeks. This is recommended by the National Institute for Clinical Excellence (NICE).

Pain relief will be prescribed as necessary to help your recovery. At 2 weeks a wound check will be performed to make sure the skin incision has healed well.

For a period of six weeks, you may need to take precautions to protect the hip such as sleeping on your back, sitting in very low chairs and avoiding crossing your legs. You will be provided with specific aftercare instructions you should follow, after the procedure by Mr Punwar and the physiotherapy team.

Ideally, you should avoid driving for 4-6 weeks after the surgery. In most cases, patients recover and can resume daily activities within six weeks. A review will be arranged 6 weeks after surgery. This ensures you are recovering as expected. Further follow-up will be arranged as required.

To discuss whether a hip replacement surgery is a suitable option for you, contact Mr Punwar today. You can call on 0808 1631268, or email punwar.admin@lips.org.uk.

Knee pain affects millions of people every day, leading to a lower quality of life and issues with mobility. Treatments for knee pain largely depend upon the root cause of the problem. For those suffering with pain due to bone marrow lesions, one option that is proven to work is subchondroplasty.

So, what is subchondroplasty for the treatment of knee pain? Learn everything you need to know below…

What is subchondroplasty?

Subchondroplasty is a minimally invasive procedure that aims to fill in subchondral bone defects. It is a fluoroscopically assisted procedure that uses AccuFill®Bone substitute material (BSM) to fill in the gaps.

The procedure tends to be carried out alongside an arthroscopy. This helps to both visualise and treat the problems discovered in the joint. The Accufill BSM hardens and creates new bone as the body heals.

Those who undergo a subchondroplasty report a reduction in pain and an improvement in quality of life. Having the procedure also doesn’t impact your ability to have further surgery if it is needed.

What types of knee pain will subchondroplasty help?

Subchondroplasty can treat subchondral bone defects which may occur due to osteoarthritis for example. Over time, conditions such as osteoarthritis can wear down the cartilage and bone. Not only is this extremely painful, but it can also lead to a loss of mobility.

A previous study has shown that subchondroplasty can also be highly effective at treating bone marrow lesions. The study also showed that the procedure could reduce pain and prevent the need for a total arthroplasty at the follow up stage.

Whenever the pain is caused by the bones, and not the tissue of the joint, subchondroplasty can help. As it is an outpatient procedure, patients can usually leave on the same day. It is provided via an injection into the bone, making it a minimally invasive procedure.

Seeking a diagnosis for knee pain

If you are experiencing any type of knee pain, it’s important to get to the root cause of it. If left untreated, knee pain can worsen, and you may start to lose function in the joint. This can limit your quality of life, preventing you from moving around and putting you at greater risk of other health problems.

To find out what might be causing your knee pain, contact Mr Shah Punwar today. Mr Punwar is a specialist in knee pain and he can determine the cause of your discomfort and the right treatment for you.

Soon, Mr Shah Punwar will be offering subchondroplasty treatment (Zimmer Biomet method), but he can discuss all of your treatment options that would give you the best results. It may be that a knee replacement is the best way to treat your knee pain permanently.

New research funded by the National Institute for Health and Care Research has found that fewer knee replacement procedures are being carried out in England due to strict guidelines. Many surgeons are refusing to carry out the procedure until patients lose weight.

Those who do not lose weight are being refused a knee replacement in some cases, leaving them in pain and suffering with mobility issues.

So, why are patients advised to lose weight before knee surgery? And can patients get help with weight loss to progress with their knee surgery?

Achieving a healthy BMI before knee surgery

Most health professionals use the Body Mass Index (BMI) formula to work out whether your weight is within a healthy range. BMI is your weight divided by your height squared (multiplied by itself). Having a raised BMI increases the risk of having a complication from any surgery. Risks of surgery with a raised BMI include medical problems including DVT, wound infection, heart problems, respiratory problems, nerve injury and even death. The usual requirement is a BMI of 40 or less.

Patients over 40 BMI are given a target before they can proceed with their surgery. They can engage with weight loss services either through their GP or other sources. Occasionally, patients can be referred for bariatric surgery.

Losing 20lbs can help your recovery

A study carried out in 2019, revealed that patients who lose 20lbs are likely to have shorter stays in hospital, and be discharged home rather than to a rehab facility. Interestingly, these results occurred even if the patient was still classed as morbidly obese.

Recovering at home can improve your surgery results, as there is less likelihood of post-surgical infection. Additionally, there are advantages of home comforts such as a better night’s sleep in your own bed. However, weight loss can be extremely challenging, particularly for those who are morbidly obese.

The dangers of losing weight too quickly

While losing weight does reduce the risk of surgery, patients face new risks if they lose it too quickly. Some of the main issues that can arise from losing weight too quickly include:

  • You may lack important nutrients
  • Headaches and muscle pain
  • A reduced metabolism
  • A loss of muscle mass

When patients are told that they need to lose weight in order to have a procedure, it can cause them problems trying to lose weight too quickly. Unfortunately, they don’t often realise the dangers of doing so, and in some cases, it could delay the knee replacement even further.

Seek advice to prepare for knee surgery

According to research, losing just 20 pounds is a good goal before knee surgery. However, if you have a BMI over 40, your surgeon can refer you to weight loss services. This will help you to lose the weight required to progress with treatment. This greatly reduces the risks, even if you are classed as morbidly obese.

If you are in need of knee surgery, book a consultation with Mr Shah Punwar today. If you are concerned about your weight, he will be able to advise you on how to prepare for knee surgery, so that you benefit from the best results after the procedure.

Hip arthritis can be a very painful condition that makes life difficult for many people. Normally, following symptoms of prolonged pain or tenderness in the hip joint, it is formally diagnosed after a clinical assessment by a GP and an X-ray.

However, sometimes the pain of hip arthritis can be misleading. This is because the distribution of pain can be more widespread. It can even be felt in the knee, and mistaken for other conditions.

Here, we will look at why patients often experience knee pain when they have hip arthritis, and the best ways to manage it.

Why does hip arthritis cause knee pain?

The reason you may seek a diagnosis for hip arthritis is experiencing pain in and around the hip joint that lasts more than a few days. But, pain relating to hip arthritis can be felt in one or more parts of the body including in the groin, the front of the hip, lower back and even in the knee.

The main symptoms of hip arthritis include:

  • Pain and tenderness in the hip joint
  • Joint stiffness after sitting or lying down for a long period of time
  • Difficulty in performing daily activities
  • A feeling of bone rubbing against bone

When you have hip arthritis, inflammation of the tissues and nerves can occur. This causes pain initially in the hip, but can refer to the knee. This usually follows the distribution of the saphenous nerve, which branches from the femoral nerve. However, the obturator nerve which passes from the hip to the inside of the knee can also cause referred pain.

Get your knee pain checked

If you have knee pain without any symptoms of hip arthritis such as stiffness, then it is very unlikely that you have hip arthritis. But, you could have knee arthritis – another very painful condition that affects the knee joint, caused by inflammation that develops over time due to cartilage damage. It can also lead to other problems including swelling and muscle weakness in the legs, when left untreated and can cause mobility issues, usually later in life.

When you have knee pain, it is best to get a confirmed diagnosis of the cause so that you can look at the best treatment options. You can request X-Ray imaging from your GP, that should confirm a diagnosis of arthritis. Imaging can also help you understand the nature and extent of damage, and your doctor can check your joint movement and function.

Treating your knee or hip arthritis

When you have a diagnosis of arthritis, the next best step is to organise a consultation with experienced knee and hip surgeon, Mr Punwar. You can discuss treatment options, including lifestyle changes, medications, physiotherapy and whether joint replacement surgery would be the best option for you.

If you are experiencing knee pain, hip pain, or a combination of symptoms, consult Mr Shah Punwar today.


A new study has revealed that walking can help to prevent knee pain for those suffering with osteoarthritis. The research, carried out by the Baylor College of Medicine, highlights the long-term benefits of walking regularly for patients over 50. Additionally, it also suggests walking could be an effective way to slow down damage within the joint.

So, how can walking help to prevent knee pain caused by osteoarthritis, and what other treatment options do patients have? Find out everything you need to know below.

What did the study reveal?

The study, published within the Arthritis & Rheumatology journal, used the results of a multiyear observational study known as the Osteoarthritis Initiative. Participants aged 50 and over, self-reported the frequency and amount of time they spent walking. Those who reported that they exercised more than 10 times were categorised as ‘walkers’, while those who didn’t were categorised as ‘non-walkers’.

It was discovered that the walker group had a 40% reduced chance of developing new frequent knee pain. Additionally, the results showed that walking regularly can help to slow down degeneration of the joint.

How can walking help to prevent knee pain?

Walking is best known for its cardiovascular benefits. However, as the new study shows it can also be useful in pain reduction of the joints. So how does it help to prevent knee pain?
There are several reasons walking could help to reduce pain in the joints. These include:

  • It can help to rebuild the joint
  • Weight management
  • Strengthened muscles

In osteoarthritis, the cartilage of the knee can become damaged and worn. When you walk, it helps to rebuild the cartilage, reducing the pain experienced over time. This can also aid in mobility, further reducing the risk of further degeneration.

Walking also helps to keep your weight under control. Being overweight puts a lot of pressure onto the joint, leading to additional pain. By managing your weight, it will help to ease the pressure on the joint, effectively minimising the pain felt.

Finally, walking regularly helps to build up and strengthen the muscles. This in turn helps to take the pressure off the joint, reducing pain felt in the knee.

Treating knee osteoarthritis

While this new study highlights the benefits of walking to ease knee pain, it is worth noting that knee osteoarthritis won’t just go away by itself. You may delay suffering pain and mobility issues, but the condition may worsen as time goes on.

In order to treat knee osteoarthritis, patients should seek advice from a specialist. It could be that knee replacement surgery is required to reduce pain and improve mobility.

Book a consultation with Mr Shah Punwar now to determine whether a knee replacement could be the best way to treat your knee pain permanently.


The Princess Grace Hospital in London has published a new study into stener-like injuries in the American Journal of Sports Medicine. One of the rarest sports injuries, it is known to significantly impede healing.

Here, we will look at what the latest study found, and what a stener-like injury of the MCL is.

What is MCL?

The MCL (medial collateral ligament), is a stabilising ligament in the knee. It is one of four ligaments that starts at the end of the thigh bone (femur) and ends at the top of the shin (tibia). Its main function is to prevent the knee from opening, and like all ligaments it is at risk of being injured or torn.

When a tear occurs, it tends to affect the top of the MCL where it attaches to the femur. However, it is possible for patients to experience a tear at the bottom near the shin. If a tear does develop in the bottom, it will usually take longer to heal than a tear at the top of the MCL.

What causes an MCL injury?

MCL injuries can be caused by a range of factors including bending or twisting when playing sports. It can also occur due to a knock to the outside of the knee. Injuries are graded depending upon their severity, ranging from Grade 1-3. Normally, an ACL injury causes worse pain than an MCL injury – with more widespread swelling around the knee and sometimes an audible ‘pop’ sound.

Stener-like injuries of the MCL are rare, but they are frequently linked to ACL tears and require surgery as early as possible. They occur when superficial MCL fibres tear, while the deeper fibres stay intact. The superior fibres can become displaced, preventing the MCL from healing.

What did the latest study find?

The latest study followed 23 elite athletes aged 19-37, who underwent surgery by the same surgeon. Most participants were men, including 16 football players, and 7 rugby players. The minimum follow up was 24 months after the surgery date.

A total of 15 athletes underwent an anatomic suture anchor repair isolated to the distal tibial insertion site. Eight of the athletes needed an anatomic suture anchor repair at both the distal and proximal attachment sites.

All participants managed to get back to pre-injury sporting levels, with the mean time to return being 16.8 + 2.7 weeks.

The surgical approach to treat stener-like lesions of the MCL resulted in a high return rate to pre-injury sporting levels. Additionally, it showed a low risk of recurrence.

One thing that can’t be overlooked is the importance of rehab after surgical repair. Physiotherapy plays a crucial role in helping athletes to get back to their pre-injury fitness levels. Those who have been diagnosed with stener-like MCL injuries should also seek treatment as soon as possible. This will prevent the injury from worsening, increasing the chance of a faster recovery.

A new study carried out by researchers from the University of North Carolina, has revealed that women take longer than men to recover after ACL repair. This highlights the need for a different approach to be taken during recovery.

According to the research, men continue to see an improvement over time, whereas women’s results plateau. So, why could this be and what did the study reveal?

Understanding the latest study

Up until now, very little research has been carried out to determine the gender differences in ACL repair recovery. The new study analysed data from 218 young adults and adolescents, looking at patient-reported outcomes and quality of life.

Those who undergo ACL repair are known to be at an increased risk of developing osteoarthritis. It is also known that those with worse patient reported outcomes, also have worse biological indicators. These are both associated with an increased risk of developing osteoarthritis.

In total, 133 females and 85 males were included in the study. Data was assessed at 6, 12, 24, 36, 48, and 60 months after undergoing an ACL repair. In terms of quality of life related to knee osteoarthritis outcome scores, there were no significant differences recorded. However, males did show a steady improvement over time, whereas females experienced a plateau.

Why do females take longer to recover after ACL repair?

While the latest study did reveal differences in ACL repair between men and women, it didn’t reveal the cause. Previous research has suggested there may be differences in the psychology of recovery between male and female patients. It has also hinted that there may be biological factors at play too. However, further research needs to be carried out to identify the factors associated with a different outcome.

Within 5 years, women don’t experience the same level of improvement as men in terms of recovery. This suggests that time alone isn’t enough to aid in results, and that intervention may be needed for women who undergo an ACL repair.

The importance of an individualised rehab approach

One thing the latest study does highlight, is the need for an individualised rehab approach in patients. An ACL repair is one of the most effective ways to treat an ACL injury, but it does come with potential risks and complications that patients need to be aware of. To maximise results and improve patient outcomes, commitment to a full physiotherapy programme is key.

The role of physiotherapy in ACL injuries is to reduce pain, improve mobility, and help patients get back to their pre-injury fitness levels. It is tailored to each patient’s needs, ensuring the most effective recovery.

To receive the best treatment and improve your chances of a successful recovery after ACL repair, book a consultation with Mr Shah Punwar today.

Running is fast becoming one of the most popular ways to exercise, with over 2M people in the UK undertaking it as part of their regular exercise regime.

It appeals to many people as running can be enjoyed alone or as part of a group in almost any environment. There is no need to spend lots of money on equipment, all you need is the correct shoes and the motivation to go!

The Myth of Osteoarthritis and Running

Historically running has been given a bad reputation due to the misconception that running was a cause of osteoarthritis. However, the most common causes of knee arthritis are either your genetics or following severe trauma to the knee (post-traumatic arthritis).

Furthermore, there is evidence that, for those with osteoarthritis, running improves knee pain and does not contribute to worsening pain. There are many other causes of knee pain in runners that are not due to arthritis.

Running is a good, safe and healthy form of exercise that has huge benefits for the entire body and can actually bring many benefits to the knees in particular. It can also help with weight loss, which can significantly reduce the stress put on joints and improve symptoms of osteoarthritis.

Lower The Risk of Injury

The best thing when starting running, especially if you have a preexisting condition like osteoarthritis, is to speak to a health professional first.

Always start off slow, and if you experience any pain then ease off and take a couple of days rest. If you have daily pain from osteoarthritis already, keep a journal to track your running progress and different feelings of discomfort or pain. Some people find running on grass or a trail is easier on the knees than running on a hard road surface.

Whether you run on road or grass, it is vital to have the correct footwear. By speaking to a physiotherapist, they can check your running style by doing a ‘gait analysis’. They can also advise you on the correct running shoes. Additionally, they can give you exercises to help you avoid injury. Improving your core strength, leg and hip strength will usually significantly improve your chance of running pain-free.

Warming up and cooling down properly through dynamic stretching will help the muscles to prepare for exercise and also cool down following your workout. The muscles can then relax and return to their normal range of motion.

What If Your Knee Pain Is Severe?

If you are experiencing severe knee pain from arthritis, then there are treatment options available to you. When there is widespread cartilage damage, a total or partial knee arthroplasty surgery may be the best option.

If you would like more information about knee osteoarthritis and the treatment options available to you, get in touch to arrange a consultation with Mr Punwar.

Many people are starting to resume their favourite winter sports. These recreational sporting activities include both individual as well as team sports such as ice hockey, downhill skiing, snowboarding, and cross country skiing. Due to the nature of these sports, they have been linked with a higher incidence of injury. In particular, there is a high risk of damage to the meniscus and cruciate ligaments in the knee. Each year many people require medical attention following knee injuries whether that be from collisions or overexertion.

Types of Winter Sports Knee Injuries

Research has suggested that knee injuries are the most common soft tissue injury relating to winter sports. Although they are less prevalent compared to sports such as football, the severity of the injury in winter sports can be much higher.

The musculoskeletal system which is made up of bones, muscles, joints, tendons, ligaments and cartilage is the most common site to suffer from damage. This could include sprains, dislocations, fractures along with cuts and grazes.

One of the most common winter sports injuries is damage to the anterior cruciate or collateral ligaments. This often happens during a twisting motion.

Tips To Avoid Knee Injuries

Fortunately, most winter-related injuries can be prevented with appropriate planning, preparation and the correct equipment. Although there is no way that you can completely rule out the risk of injury, there are several things that may help to prevent an injury.

Improving your stamina can allow you to ensure that you have enough energy to perform sustained physical exertion required for these sports. It will help you to feel less tired and exhausted, preserving your energy to ensure that you are able to consistently perform a safe technique.

It is also vital that you spend time warming up before engaging in winter sports. Muscles, tendons and ligaments are all prone to damage when they are cold. It is advisable to increase your warm up time. Additionally, make sure that you cool down correctly following exercise by stretching. Certainly, this could help to prevent delayed-onset muscle soreness also known as DOMS.

Staying hydrated throughout the day by regularly drinking water is advised. Particularly as water plays a part in ensuring the optimum function of muscles, joints and blood vessels. When dehydration occurs, a loss of coordination and muscle fatigue can develop. Furthermore, it is best to abstain from alcohol so that you stay in control.

First Steps Following an Injury

In the unfortunate event of an injury, you must seek immediate medical attention. A trained medical professional can assess the severity of the injury. Many low-grade injuries affecting the soft tissue can be treated with the ‘RICE’ method. This abbreviation for Rest, Ice, Compression and Elevation is advised as first-line treatment. It will collectively help to support the injured joint and prevent additional swelling.

ACL Reconstruction Surgery

As previously mentioned, a common injury when skiing is damaging your anterior cruciate ligament (ACL). The ACL is an important stabiliser of the knee which fortunately can be reconstructed through surgery. The procedure involves using the hamstring tendons to fashion into a new ligament. This is positioned in the knee using minimally invasive telescopic surgical methods.

Following this procedure, a physiotherapy programme is followed in order to ensure the knee is able to gain strength and perform a full range of movements. Read Sarah’s story here – first-hand patient experience following a skiing accident and her journey to recovery through the help of Mr Shah Punwar and his dedicated team.

Although serious knee injuries can feel debilitating, with the right specialist help and interventions it is possible to make a complete recovery. If you have concerns about ACL injuries and would like to consult with Mr Punwar, please call us on 020 8194 8541 or email Punwar.admin@lips.org.uk

Our knees are some of the most hard-working joints in the body whether that is during everyday routine tasks, high impact sports or simply supporting body weight.

It’s no surprise that with the strenuous work that the knees perform throughout our lifetime they will likely wear out or sustain injury at some point. Here we look at some common knee injuries and some easy ways that you can take care of your knees.

Common Knee Injuries

The two most common soft tissue knee injuries are meniscus tears and anterior cruciate ligament (ACL) tears.

A meniscal tear happens when part of the knee called the meniscus, which helps to cushion the joint, ruptures usually due to a forceful twist of the knee. This leads to painful swelling and stiffness.

An ACL injury is more common in athletes, and similarly to meniscus tears, these occur during a twisting movement. The ACL is an important stabiliser in the knee. It joins the bottom of the thigh bone (femur) to the top of your shin bone (tibia). ACL tears can be either partial or complete tears, depending on whether the ligament stretches or completely ruptures. People who enjoy pivoting sports such as football, netball, rugby and basketball are particularly prone to these injuries. ACL injuries are often combined with meniscal injuries and other ligament sprains around the knee.

The most common painful knee ailment in the slightly older age group is as a result of arthritis. This gradual process can cause inflammation in the knee joints as a result of cartilage damage. Knee arthritis leads to pain, stiffness and swelling if left untreated. This is often accompanied by muscle weakness and deformities of the legs. For example, bowing, leading to a progressive loss of function and mobility.

Ways To Take Care Of Your Knees

Knee pain resulting from common strains and sprains can often be treated at home. You can follow simple, non-invasive methods such as rest, ice, compression and elevation which is also known as RICE. Anti-inflammatory over-the-counter medication, such as Ibuprofen can also help to decrease knee pain.

It is also important to address the cause of the pain – is it worse doing certain activities? Is it triggered by particular types of footwear? Or, has it worsened in line with weight gain? All of these questions are important to consider as it could help to highlight lifestyle causes that could be contributing.

Additionally, trained physiotherapists may be able to assist in helping to stretch and strengthen the knee joints and surrounding muscle in order to help take care of your knees. They can also address any muscular imbalances that may be contributing to the pain.

The Next Steps: Imaging

If you are still struggling with ongoing knee pain, after trying these conservative treatment options, then it is a good idea to organise some imaging of the knee. An MRI scan (Magnetic Resonance Imaging) is often used for soft-tissue injuries whereas simple weight-bearing X-rays usually suffice for arthritis. These images can help you to understand more information about damage to the cartilage, meniscus, ligaments and bone structures surrounding the knee.

If there is confirmed damage to either the cartilage surfaces or soft-tissue structures, and you are suffering from pain and limited movement, then knee surgery might be the best option for you.

For isolated meniscal tears this may include telescopic knee surgery and for ACL tears a reconstructive procedure. Widespread cartilage damage can be addressed with either a partial or total knee replacement.

Mr Punwar will make sure that you are fully informed of the risks and benefits of surgery and provide a comprehensive aftercare plan.

Treatment Plan

If you would like more information on knee injuries, knee surgery and the options available to you then get in touch today to book a consultation with Mr Punwar.

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