A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one. This can totally transform quality of life and offers relief from a very painful joint as well as improved mobility. Adults of any age can be considered for this surgery however it is most common for individuals between the ages of 60 and 80.

Mr Shah Punwar uses both cemented and uncemented stem systems usually with an uncemented metal socket. He only uses hip components with a 10A* rating which are proven to have excellent long-term results on the National Joint Registry (NJR). Mr Punwar will be happy to discuss the choice of implant and the NJR during consultations.

What To Expect Post Operatively

After hip replacement surgery, you will be cared for by Mr Punwar’s healthcare team who will monitor you and ensure that you are well hydrated and managing any pain. You can expect to be in hospital for at least a few days and Mr Punwar will check on you to ensure that you are regaining mobility and have a satisfactory post-operative X-ray.

Nausea, loss of appetite, and constipation are all common following surgery but will usually return to normal function after a few days. Medication can be prescribed to aid recovery from these.

It is very common to experience ankle swelling and some bruising around the operation site and this usually takes several months to resolve.

During the first four-6 weeks following surgery, some general hip precautions may be advised in order to protect the hip whilst the muscles are healing eg: sleeping on your back and avoiding leg crossing, however following this period your normal sleeping position and activities can be resumed.

It is generally recommended that you refrain from driving until 4-6 weeks post-surgery as you will need to ensure that you are able to perform an emergency stop and put your foot down on the brake and clutch safely.

Rehabilitation After Hip Replacement Surgery

Following hip replacement surgery, you should be able to put all of your weight through your new hip, however, you will be guided with a rehabilitation programme provided by a highly skilled physiotherapist. Initially, you may need the assistance of walking aids however you will quickly progress to becoming independent.

You will be advised to take analgesic medicine to help reduce any pain or discomfort and allow you to maximise the required physiotherapy in order to aid a rapid return to normal mobility. You will have regular check-ups with Mr Punwar to make sure that you are recovering well.

Complications After Hip Replacement Surgery

In order to prevent the risk of developing any blood clots post-surgery, you are likely to be prescribed anticoagulation medication in either injection or tablet formulations. You will also be provided with anti-embolism stockings to wear which are also designed to help reduce the risk of blood clots.

There is less than 1% chance that the ball joint can dislocate from the socket. But the highest chance of this happening is within the first 6 weeks as the tissues around the hip are not fully healed. This is why some general hip precautions are usually advised.

It is also important to monitor your surgical wound as this will need to be kept clean and dry with the dressing changed regularly in order to reduce the chances of any external infection occurring.

Get In Touch

If you would like to find out more information about hip replacement surgery, please get in touch to arrange a consultation with Mr Punwar.

As we are now learning to adapt to life alongside COVID, athletes across the globe are eager to return to the arena. However, questions are being raised by professionals as to whether the prolonged break in training regimes could be damaging. And this will result in an increase in the occurrence of immobilising injuries – particularly anterior cruciate ligament (ACL) injuries.

A primary concern raised by professionals is that the break-in practice could lead to a higher rate of injury and re-injury. This would be a result of delayed and potentially compressed workload and gameplay as events resume.

Anterior Cruciate Ligament Injury

An ACL injury is a tear or sprain of the anterior cruciate ligament. This is a strong band of tissue that helps to connect your thigh bone (femur) to your shinbone (tibia). Most ACL injuries occur during sports after a sudden stop or change in direction along with jumping and landing. These injuries are very common in sports such as football, basketball, rugby and netball.

After surgery, it is unlikely that an athlete would return to play for at least nine months – which is a significant chunk of an athlete’s career. Additionally, re-tear rates are as likely as 20%. Although strengthening muscles around the knee, as well as balance exercises, can go a long way to reduce the risk of this happening.

Prolonged Breaks In Athletic Performance

The break forced by COVID is likely to have resulted in the deconditioning of important physical qualities associated with performance. Additionally, there are expected reductions in competitive match fitness and sport-specific skills.

The physical and psychological impact of competitive environments can also add an extra level of pressure. Especially for athletes who have not been in these situations for a prolonged period of time.

Currently, there are increased risks of playing sport in a world adapting to COVID, such as meeting social distancing requirements.  But there are also concerns that this extra pressure could be detrimental to athletes’ ongoing mental health.

Returning To Play after ACL surgery

Surgery to repair an ACL tear can help you to return to your previous athletic form. Furthermore, when training or a rehabilitation programme has been compromised, a graded return to full training is recommended.

For more advice on ACL injuries or if you have any other questions about returning to sport after surgery, get in touch with Mr Punwar today to arrange a consultation or book online.

Researchers from Lund University in Sweden have discovered that out of all cruciate ligament injuries, 69% can be explained by genetics.

This discovery may have important implications when predicting those individuals who are at higher risk of developing this type of knee injury. It will also enable more individualised injury prevention plans.

Anterior Cruciate Ligament (ACL)

The anterior cruciate ligament (ACL) injury is one of the most commonly occurring knee injuries. It is especially common among those who undertake sports on both amateur and professional levels.

The anterior cruciate ligament is a ligament in the knee which joins the femur (upper leg bone) with the tibia (lower leg bone) and its primary purpose is to keep the knee stable. It is commonly injured through motions such as sudden stops, changes in direction, and after jumping and landing with impact.

Genetic Origin

The main risk factors in sports, that result in an ACL rupture include playing on surfaces with high friction. Also, sports like basketball and football where there are sudden stops or pivoting. However new research is suggesting that it is also associated with risk factors that have a genetic origin. This includes bone geometry of the knee, malalignment and generalised joint laxity. This type of injury has also been linked to hypermobility.

An anterior cruciate ligament rupture can lead to reduced quality of life and is associated with up to 10 fold increased risk for developing osteoarthritis of the knee.

Osteoarthritis Genes Discovered

Almost 9 million people in the UK suffer from osteoarthritis. This degenerative joint disease affects the joints, that become damaged, painful and often very restricted. There is no current treatment for osteoarthritis and it is often managed through pain relief and often eventual surgery.

New research investigating the genetics behind osteoarthritis has revealed nine novel genes for osteoarthritis. The research will help to identify genetic risk factors for the disease. This might be a stepping stone into the understanding of osteoarthritis and the development of treatments.

By revealing how these genes contribute to osteoarthritis, this research could open the door for new treatments to help millions of people.

Get In Touch

If you have concerns about your knees and have a family history of knee joint problems, Mr Punwar can carry out a thorough examination, as well as MRI scans if necessary.

Mr Shah Punwar is highly experienced in treating ACL tears, as well as treating those with osteoarthritis. He can help advise on how to manage your condition and give you a personalised treatment plan. Get in touch and book a consultation today.

Knee replacement surgery is an operation to replace the damaged parts of your knee and is also known as knee arthroplasty. If there is widespread cartilage damage within the knee accompanied by pain and limited movement, a knee replacement may be the best option.

Before Knee Replacement Surgery

Before the surgery takes place, you will be able to speak to Mr Punwar in a consultation. He will make sure that you understand and are comfortable with the treatment and he will be able to advise on what to do beforehand to help ensure that it is a success. You should let him know if you are taking any medication, as this needs to be considered before you undergo any invasive surgery.

It’s also important to keep yourself fit and healthy especially in the build-up to your operation. This includes maintaining a healthy weight, exercising regularly and also making sure that you stop smoking several weeks before the operation.

In terms of skin preparation, it is a good idea not to shave or wax the area where the incision is likely to be and try to have a bath or a shower either the day before or on the day of surgery to prepare your skin and reduce the chances of infection.

During the Procedure

Once you are safely anaesthetised, an incision will be made on the front of your knee. Any damaged joint surfaces are removed and then replaced with an artificial knee joint. Mr Punwar only uses modern implants that have a good track record, and he will try to minimise tissue damage.

The skin is then closed using either stitches or clips and secured with a surgical dressing to keep the wound clean and minimise the risk of infection. To aid this you will also be given antibiotics before your surgery and several doses following the procedure to give you the best coverage.

Recovery

After the surgery, you will be cared for by Mr Punwar’s healthcare team who will monitor you and ensure that you are hydrated and managing any pain.

Mr Punwar will keep a close eye on you whilst you recover in the hospital for a few days after the procedure, ensuring that the results meet your expectations. It can take up to 2 weeks for your wound to heal and you will be given plenty of after-care advice.

You will have regular check-ups with Mr Punwar to make sure that you are recovering well. Most individuals recover and return to their normal activities within 6 weeks.

If you would like to find out more information about knee replacement surgery, please get in touch to arrange a consultation with Mr Punwar.

The most common form of arthritis of the hip joint is osteoarthritis (OA). This is characterised by pain and stiffness in the hip, usually worsening over time.

There is, however, another form of arthritis that can affect the hip joint. It is called rheumatoid arthritis (RA) – a chronic, inflammatory, progressive autoimmune disease.

Here, we take a look at the differences between these two forms of arthritis, what causes them and how they can be treated.

Osteoarthritis causes

OA of the hip is often known as a ‘wear and tear’ condition. This means that it can really affect anyone, as it is caused by overuse of the hip joint. This can occur in sport, or as a result of occupations which involve repetitive squatting. A break of the hip joint can also lead to OA years later. Problems with the hip in childhood and subtle anatomical mismatches between the ball and socket joint can also lead to OA in later years.

It usually presents in older people, however there is an increasing prevalence of osteoarthritis in younger people. It commonly starts in the 50s and affects women more than men.

Mainly affecting those who have led extremely active lives, or who are seriously overweight, it leads to pain mainly felt in the groin and difficulty bending down to put shoes & socks on or to get out of a low chair.

Rheumatoid arthritis causes

Rheumatoid arthritis is an autoimmune condition. This is when the body’s immune system has decided to turn on itself and start attacking healthy cells. It is still unknown exactly why this happens, but it is believed to have a genetic link. This sets up an inflammatory reaction in the joint with synovitis (inflammation of the joint lining) and erosions into the bone. The bone often becomes softer than in OA and this can lead to deepening of the hip socket and thinning of its floor.

Rheumatoid arthritis is more common in people with a family history of the condition. And similarly to OA, it also tends to affect more women than men.

Symptoms – osteoarthritis versus rheumatoid arthritis

The main difference in the symptoms of osteo versus rheumatoid arthritis, is that the problem may affect just one hip joint, rather than both. In both conditions pain is felt in the groin area or buttocks and sometimes on the inside of the knee or thigh.

Sufferers of both conditions may also experience a grinding sensation when trying to use the affected hip. Furthermore, they may find that the joint seems to ‘lock’ into place.

Rheumatoid arthritis often affects both hips. But people who have rheumatoid arthritis often first experience symptoms in the smaller joints, such as in the hands or feet. Then it spreads to larger joints like the hips. Other specific symptoms of RA include:

  • Pain and stiffness that may feel worse in the morning or after periods of resting or sitting
  • Pain that may lessen with movement and increase with vigorous physical activity

Treatment – osteo versus rheumatoid arthritis

Because rheumatoid arthritis is a chronic, progressive condition, symptoms are often managed using medication to prevent ‘rheumatoid flares’. This can help to alleviate some of the pain and swelling and in recent years, with the introduction of novel drugs, has led to a large reduction in severe rheumatoid cases.

Osteoarthritis can also be treated with medication, but other ways of managing symptoms are also recommended. People often find relief by making lifestyle changes and minimising the activities that aggravate the condition. This might mean switching your sport of choice to something lower impact.

Surgery

With both osteo and rheumatoid arthritis, surgery is something of a last resort. If your symptoms cannot be relieved with medication or lifestyle adjustments, then hip replacement surgery may be the answer.

Generally, total hip replacement surgery presents the best option for arthritis sufferers. This removes the whole hip joint and replaces it with a new surface. Mr Punwar uses both cemented and uncemented stems with excellent long-term results together with an uncemented metal socket. Cemented sockets are sometimes used with very weak bones, particularly in rheumatoid sufferers. Hip replacement relieves the pain of arthritis and restores movement to the hip joint.

Hip replacement surgery can have a dramatic impact on the quality of life. But you should always be aware of the risks, and be able to make an informed decision about the best time to undergo surgery. For more information, please call us on 020 8194 8541 to arrange a consultation with Mr Punwar.

There has been a dramatic increase in recent years of female athletes suffering from knee injuries. In Australia, the AFLW (Australian rules Football League for Women) saw 12 ACL injuries last season.

It is tempting to assume that this rise in knee injuries is mostly due to the increased media coverage that women’s sport is seeing. And that certainly goes some way to explain why we’re hearing about them.

But new research has shown that AFLW players are nine times more likely to suffer a knee injury than men. So this suggests that there is a biological cause.

Anatomical differences

One major reason put forward by medical experts for this gender imbalance when it comes to knee injuries, is the anatomical difference between men and women.

And the anatomical differences that cause the problem are not in the knees themselves, but in the pelvis and hips.

The female pelvis is designed for childbirth. This means the cavity is shallower and wider than in the male pelvis, and it tilts forward. This forward tilt impacts on the angle of the hip joint, which in turn can cause the femur (thigh bone) to be angled inwards.

As a result, unless the muscles in the core, hips and thighs are extremely strong, there is a tendency for the knees to be angled slightly inwards, which increases the risk of anterior knee injuries.

Hormonal differences

The other reason cited – although in fact it does tie in with the first – is hormonal. When boys go through puberty, they experience a rush of the hormone testosterone. This allows them to build muscle quickly.

The skeletal structure also changes during puberty, both for boys and girls. The skeleton becomes taller and denser, and an influx of testosterone allows boys’ bodies to cope with that. This means that the muscular structure is able to support the skeleton.

Women do have a small amount of testosterone in their system, but not enough to have a significant impact on their muscles. So while their skeleton increases in density and height, they don’t have the same muscular structure to support it.

How can women avoid ACL injuries

The key to avoiding knee injuries is to increase the strength of the hip and thigh muscles. Any weakness in these muscles will correspond to problems in the knee. This includes anterior knee pain or patellofemoral syndrome as well as ACL tears.

In Australia, as a result of this recent research, the AFLW has instigated a ‘prep to play’ regime. This focuses on the implementation of specific strengthening exercises for the hip and thigh muscles.

Another way to help protect your knees from injury is to practise ‘balance training’ – this essentially means trying to balance on one leg on progressively less stable surfaces. This helps to build up the muscles around the hip, knee and ankle.

Mr Shah Punwar is highly experienced in treating ACL tears and has an excellent track record. He submits all his ACL cases to the National Ligament Register, allowing long term follow-up and monitoring of outcomes.

Surgery to repair an ACL tear can help you to return to your previous athletic form, but expect a structured rehabilitation programme to prevent re-injury. Also, if you are returning to contact sports, expect to be on the bench for at least nine months post-surgery.

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 .

 

Outer – or lateral – knee pain is common, particularly amongst runners and athletes. However, the actual cause of the pain can be difficult to pinpoint. This part of your knee forms a crossing point for lots of different anatomical structures.

The Iliotibial (IT) band is often blamed for outer knee pain, but there are actually several other possible causes. Read on to find out the most common causes of lateral knee pain.

Iliotibial band syndrome

The ‘IT band’ is a common cause of lateral knee pain in runners. The iliotibial band is a long strip of tissue running right down the outside of your thigh, from hip to knee. Iliotibial band inflammation is an overuse syndrome that often occurs in long-distance runners, cyclists, and other athletes. However, it can be further aggravated by poor flexibility, poor training habits and anatomical imbalances.

How to identify ITB syndrome

ITB pain usually gets worse when you are exercising, as the friction between the ITB and the knee joint is increased. The pain tends to be greatly reduced when you rest the knee.

You may hear snapping or popping noises coming from your knee that accompany the pain, and in severe cases there may be some swelling.

Treating ITB syndrome

The best and most effective treatment for ITB syndrome is to stop the activity that has caused the problem. At least for a few weeks.

You can speed up the healing process by applying ice to the knee and by stretching. A foam roller can be useful to help massage the area during these stretches.

More severe cases may need medical or even surgical intervention. If your knee does not heal after a few weeks of rest and stretching, you should visit your GP.

Lateral meniscus tear

The meniscus is a piece of cartilage that sits between your thigh and shin bones, forming an integral part of the knee joint. The outer section of the meniscus can tear – sometimes suddenly as a result of injury, or sometimes slowly with wear and tear over time.

How to identify a lateral meniscus tear

With this type of outer knee pain, you will probably find yourself unable to go on with your usual sporting activity, as the knee may well give way at the joint.

There may also be some swelling and stiffness, and difficulty extending or flexing the knee.

Treating a lateral meniscus tear

Again, rest is the most important thing, with some ice to alleviate the swelling. You may also be advised to elevate the knee. Physiotherapy may also be helpful once you are ready to start using the knee again.

If the injury is not responding to these treatments, surgical treatment may be necessary.

Lateral collateral ligament sprain

Another band of tissue, the lateral collateral ligament (LCL) is much thinner than the ITB and runs from the thigh down to the femur. This is the ligament that keeps your knee on the straight and narrow, preventing it from bowing out to the side.

Injuries to the LCL are most common after a sudden stop, or a twisting motion. However a strong blow to the inner knee can also do it.

How to identify LCL sprain

When you sprain your LCL you may well hear a ‘pop’ sound, and there will almost certainly be some swelling and pain. You may also feel that the joint is unstable. But one unique identifier of LCL sprain as opposed to other outer knee injuries, is numbness or tingling in the foot. This is because the LCL is located close to a nerve that runs down to your foot.

Treating LCL sprain

Surgery is not usually used to treat LCL sprain, unless it forms part of damage to another structure in the knee. Immediate treatment involves resting the knee, applying ice and elevating the joint to reduce swelling.

This may be followed with splinting the knee, or even using a brace to keep it in place. Physiotherapy can also be useful to get the knee back to its former state.

One more option

If none of these sounds like it could be the cause of your knee pain, and you can’t think of a specific precipitating event, then osteoarthritis can be another cause of outer knee pain. Your GP can refer you for specialist treatment if this is the case.

If you would like some expert advice about your knee pain, the best plan is to have a consultation with Mr Punwar. To book an appointment with Mr Punwar at either of his practice locations, please call his LIPS practice team on 0208 194 8541.

Traditionally, knee replacement surgery has been something of a one-size-fits-all procedure. Whilst the prostheses are of course available in different sizes, they are standard sizes. So the surgeon has to choose the one that is the closest fit to the patient’s actual knee.

We are staying active until much later in life now, and more young people are having knee replacement surgery. A knee replacement that allows for greater functionality has become necessary.

Custom knee replacements

Standard knee replacement surgery can still be very effective. But surgeons like Mr Punwar want to be able to offer their more active patients something that best suits their needs. Above all, the surgery should allow them to return to a level of activity that is similar to what they are used to.

To achieve this, the patient’s knee is scanned using a CT scanner. This information is then fed into special software that will turn the scan into a 3D model of the patient’s knee joint.

This means that the prosthetic knee replacement is an exact replica of the patient’s own knee. Therefore it should function almost as well as the original knee.

Who is a suitable candidate for custom knee replacement?

Anyone who is a candidate for knee replacement surgery could opt to have a custom knee replacement. However younger patients with an active lifestyle will get the most benefit from having a totally personalised procedure.

How long do custom knee replacements last?

As with standard knee replacement surgery, a custom knee replacement should last for at least twenty years. The concept is too new for any data to be available yet. However, many surgeons believe that a custom joint should last longer, as a better fit means less wear on the bones beneath.

Are there any advantages in terms of the surgery itself?

Because the replacement is an exact match of the patient’s own knee joint, there should be less bone cutting required during surgery. So, in theory, the operation may be quicker than a standard knee replacement procedure.

This also means less disruption to the tissue, so recovery may be slightly quicker too. However, it is important to follow your surgeon’s post-operative advice and not do too much too soon.

Are there any aesthetic benefits?

Yes – because the prosthesis is an exact model of your natural knee. Once the swelling has gone down, the look of your knee should be pretty well preserved. In addition, the improved mobility the procedure provides should make your knee replacement pretty much undetectable.

If you would like to find out more about customised knee replacement surgery and whether it would be a good fit for you, book a consultation with Mr Punwar. For an appointment at either of his practice locations, please call his LIPS practice team on 0208 194 8541.

We’ve talked a lot about anterior cruciate ligament (ACL) injuries, because they account for around 40 per cent of all knee injuries. Which means they are one of the most frequent problems seen by orthopaedic surgeons like Mr Punwar.

ACL injuries are particularly prevalent amongst athletes – particularly in sports like basketball and football, where pivoting occurs a lot. But anything that involves a sudden stop or change in direction can cause an ACL tear.

How do you know if your knee injury is a torn ACL?

Here are five major signals that your injury is a torn ACL:

A popping sound

This is probably the biggest giveaway of an ACL tear. At the time that the injury occurs, if you hear a popping sound coming from the affected knee, it is likely to be ligament damage.

Pain

The most common sign of an ACL tear is pain in the affected knee. Patients often report that the pain is immediate and worsens when they try to stand up. Athletes are unable to return to play. Of course, pain alone is not necessarily indicative of a specific injury. Most injuries will cause a certain level of pain – but in combination with the popping sound and other symptoms listed here it could suggest a torn ACL.

Swelling

Whilst with some injuries swelling occurs slowly in the hours after the event. With an ACL tear the swelling tends to be immediate and obvious. This is because the ACL has a good blood supply which is disrupted when the ligament tears.

Instability/difficulty walking

Many patients with ACL tears report that they are unable to stand or put weight on the affected knee after the injury. Some say that when they try to stand, the knee buckles or gives way beneath them. It would therefore be very difficult for people with this injury to walk unaided. Other parts of the knee, such as the shock absorbers, are often damaged at the same time as the ACL. This can lead to locking and clicking.

Is it possible to have a partially torn ACL?

It is not only possible, but in fact very common to have a partial tear. Research has shown that between 10 and 27 percent of ACL injuries are partial tears. ACL tears are graded into three categories:

  • Grade 1 is the mildest category, where the patient is usually still able to walk and has some knee stability. The ligament has been stretched, but not fully torn
  • Grade 2 tears are where the ligament has been further stretched and is partially but not completely torn
  • A complete tear is Grade 3

What should I do if I think I have an ACL tear?

Following immediate treatment in an emergency department, if you think your knee injury might be an ACL tear, the best thing is to have it assessed by a specialist. Patients are usually given crutches, painkillers and have an X-ray in the emergency department but it can be difficult to make a definitive diagnosis at that time.

Orthopaedic surgeon Mr Shah Punwar is highly experienced in knee injuries and will perform a thorough examination as well as organising an urgent MRI scan where necessary. The road to recovery can be quite long after an ACL injury. Mr Punwar offers both careful surgical reconstruction and a personalised rehabilitation plan to get you back to sport as soon as possible.

If you have concerns about your knee injury, and would like to book a consultation with Mr Punwar at either of his practice locations, please call his LIPS practice team on 0208 194 8541.

Knee osteoarthritis is a relatively common condition, affecting up to 45 per cent of people during their lifetime. 19 percent of people over 45 have some degree of osteoarthritis in the knee, and that figure increases to 37 per cent in the sixty plus age group.

However, despite its prevalence, people are often unsure why they developed the condition, and wonder if they need surgery for knee osteoarthritis. Mr Punwar sees a lot of patients that have suffered with knee pain for a long time before seeking treatment. In this article we will be clearing up some confusion around knee osteoarthritis.

Osteoarthritis is often termed non-inflammatory (‘wear and tear’) cartilage damage separating it from the inflammatory joint conditions such as rheumatoid arthritis which is increasingly treated with modern drugs. There is some overlap between the two types of joint arthritis.

What causes knee osteoarthritis?

The exact cause of knee osteoarthritis is not yet known, but we do know of some things that can increase your risk of developing the condition:

Obesity

The more weight there is to carry, the greater the stress placed through the knees. In a normally aligned leg 60% of weight is carried through the inner part of the knee explaining why the inner (medial) part of the knee often degenerates first. Your risk of developing joint pain and osteoarthritis increases with weight.

Age

There’s not a lot you can do about this one but knee cartilage, like most collagen based connective tissues in the body, articular cartilage tends to get weaker over time, which can lead to damage from minor injuries.

Joint trauma

This could be one big accident, like a broken bone, or a series of mini traumas (from a high impact sport such as football), which over time can lead to widespread osteoarthritis

Lack of exercise

In case you were thinking you’d better pack away your running shoes to save your knees, conversely too little exercise can also cause problems. Poor muscle tone puts extra stress on the knee, and lack of movement prevents joint (synovial) fluid from circulating. Lack of movement also leads to stiffness which can affect function.

Family history

If anyone in your family has had osteoarthritis in the knee, your chances of developing the condition are increased.

Gender

Women are 40 per cent more likely to develop osteoarthritis than their male counterparts. Female knees often start to bend outwards (knocked knees) leading to pain on the outer part of the knee joint, which is particularly painful. Men are more likely to develop the pattern of osteoarthritis where the knees bend inwards (bow legs) putting stress on the inner aspect of the knees.

Overall a combination of genetic and lifestyle factors affects your risk of developing knee osteoarthritis (OA).

What are the symptoms of knee osteoarthritis?

If you’re not sure whether you’ve got knee osteoarthritis, these are the symptoms to look out for:

  • knee pain that is worse when you are moving it
  • a warm feeling in the knee joint
  • swelling
  • stiffness
  • less movement in the knee
  • a creaking or cracking sound when you move the knee

How should knee osteoarthritis be treated?

How you treat the problem very much depends on the individual. If you are overweight, your doctor may suggest weight loss, which can provide a surprising amount of relief. Certain strengthening exercises can also be helpful in mild cases.

You might be prescribed painkillers or anti-inflammatories, or your doctor may suggest corticosteroid or hyaluronic acid injections into the knee joint. Physiotherapy and knee supports can also be useful.

If your knee osteoarthritis is very advanced, best shown by ‘bone on bone’ appearances on X-ray, and these other options aren’t working, it may be time to consider surgery.

In these end stage cases patients are often woken from sleep with knee pain and are unable to do their activities of daily living independently, such as driving and shopping.

Types of surgery for knee osteoarthritis

There are several types of surgery that can be used to treat knee osteoarthritis, and the right one for you will depend on many factors. Here is a brief rundown of the surgeries available:

Total knee replacement

This is for more severe cases where there is widespread cartilage damage, accompanied with pain and functional loss. It involves the removal and replacement of the entire knee joint. Mr Punwar only uses modern implants with a proven track record. He  ensures that every effort is taken to minimise tissue damage and promote rapid recovery. Emerging technologies such as custom made knee replacements are producing promising results. There is an added benefit of having implants tailored to individual anatomy. Please discuss with Mr Punwar if you are interested in finding out more about custom knee replacement surgery.

Partial knee replacement

This is increasing in popularity as the benefits of minimally invasive surgery are becoming clear. However, partial knee replacement needs to be performed in carefully selected patients for the best chance of success. Surgery involves replacing just one of the knee’s three compartments – the inner (medial), knee cap (patellofemoral) or outer (lateral) knee. By far the most common partial knee replacement involves the inner side of the knee only.

Benefits of the partial knee replacement approach include bone conservation, lower medical risks and faster recovery. Also, better function as all the natural knee ligaments are preserved. There are risks of other parts of the knee wearing out over time but generally partial knee replacement patients are very satisfied.

Knee arthroscopy

A form of keyhole surgery, this involves entering the knee through a tiny incision and using a telescope to view. The joint damage is assessed and minor procedures are performed to smooth the knee joint and remove inflamed tissue. This procedure is usually suitable for less severe cases and is no longer widely used in the treatment of knee osteoarthritis.

Knee osteotomy

As with partial knee replacement, this is suitable for (usually younger) patients whose knees are poorly aligned. The procedure involves the removal of a small wedge of bone from either the femur or tibia. This is then replaced with bone graft or a synthetic replacement. The realignment of the leg changes the load distribution on the knee, reducing pain in the affected compartment.

The only way to be certain which of these surgeries is best for you is to have a thorough consultation with Mr Punwar. To book an appointment with Mr Punwar at either of his practice locations, please call his LIPS practice team on 0208 194 8541.

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