Frequently Asked Questions

Pain from the hip joint is often felt in the groin and can go down the thigh into the knee. Pain is sometimes also felt around the buttock.

The pain can be coming from the joint, and is sometimes referred from other areas, in particular the back. Pain from the joint can occur as a result of an injury at sport. Pain can also be the result of wear and tear in the joint (osteoarthritis).

The specialist will examine you and will often arrange X rays or MRI scans to work out what the problem is.

Pain in the knee is usually the result of damage to the joint, but sometimes patients with pain in the knee have a problem with the hip and the pain is referred.

It is important that the specialist check your hip when assessing your knee. Knee pain can occur as a result of an injury at sport – for example damage to the meniscus (cartilage tear) or one of the ligaments.

Pain can also occur as a result of osteoarthritis, where the lining of the joint is worn away. The specialist will examine you and will often arrange X rays or MRI scans to work out what the problem is.

Pain that goes all the way down the back of the leg is known as sciatica. This will often be a burning sort of pain, sometimes with a numb feeling and pins and needles. This usually results from a pinched nerve in the back as a result of a slipped disc. Back problems can also cause a pain that radiates into the buttock, hip area and thigh.

Pain from the hip joint is usually felt around the groin and deep in the joint and can often radiate down the front of the thigh, into the knee, and sometimes the shin.

The specialist will examine the back and the hip and arranges X rays and often an MRI to work out the problem and most appropriate treatment.

Pain from the hip joint is often felt in the groin and can go down the thigh into the knee. It is very common for patients with a hip problem to feel pain going into the knee. This is known as referred pain. Some patients with a hip problem will only have pain in the knee. The specialist will always examine both joints to work out where the pain is coming from.

Pin with walking is very common in patients with hip and knee problems. Normal joints have a lining cartilage, which is a spongey material and works as a shock absorber. When the joint is damaged, or the cartilage is worn away in osteoarthritis, it becomes painful to walk.

Any pain which doesn’t go away over a couple of weeks is potentially serious. Where there has been an injury and there is significant bruising or swelling around the joint, this is a sign of potentially serious damage. If pain is stopping you walking, or doing things you want to do, this is also a sign of a serious problem. If you are feeling unwell in yourself, have lost your appetite, or are losing weight this can be a sign of something serious. Pain at night can also occur if there is a serious problem.

If you are experiencing any of these symptoms, then you should be seen and investigated by a specialist urgently.

We would advise an initial consultation with one of our consultants, where we will discuss what has been happening and how the pain you are experiencing is affecting your life. We will examine you and arrange further investigations to help identify what the problem is and advise a plan for treatment.

Joint replacement is the only surgical treatment once the lining is worn away. The main indication for a hip or knee replacement is pain and how this is affecting your life. People often notice that the joint is very stiff, which makes it difficult to put your shoes and socks on, particularly on one foot, it could be an indicator you need a replacement.

Patients often have a grinding feeling from the joint, as the worn surfaces rub together. When the arthritis gets very bad it can start to disturb sleep, despite taking pain killers.

The specialist will discuss joint replacement and other treatment options.

The ends of our bones, where they form the joints, is covered in a substance called articular cartilage. This is a spongy material, which acts as a shock absorber. It is very smooth and lubricated by joint fluid, which means our bones slide smoothly against each other. Over time it degenerates and dries out, becoming less effective, eventually becoming worn down.

Osteoarthritis is a condition where cartilage thins, bone becomes exposed and bone spurs called osteophytes form around the joint. This combination causes pain, stiffness and swelling of the joint. When weight-bearing joints are involved this is often very painful with walking and activity and becomes very disabling.

Nobody really knows the answer to this question! The articular cartilage which lines the joint has a unique structure means that has an extremely low friction rate, ideal for its purpose. It has no blood supply and relies on nutrients from the joint. Once it is damaged it does not repair and at the moment we have no way of repairing cartilage once it is damaged.

Osteoarthritis can occur due to a number of reasons. There can be a family predisposition. In younger patients, there are a number of factors which can cause the joint has been damaged, deformed or mal-aligned. This can occur as a result of problems in childhood, the shape of the joint, infection or injury. Most often there is no obvious cause, but results from primary osteoarthritis, which is essentially wear and tear over time.

Maintaining mobility and exercise is important in the early stages of osteoarthritis, as it has a number of benefits, including nourishing the joint, keeping weight down and strengthening the supporting muscles. We will often recommend physiotherapy when you begin to experience discomfort and stiffness in the joint.

Low impact exercise such as cycling, swimming and Pilates is very important in remaining active and managing the pain before patients are ready for joint replacement. Pain-relieving medications, anti-inflammatories and injections can all help control pain to keep you fit and active.

As osteoarthritis progresses patients find their ability to perform even normal activities becomes more and more impaired. As well as pain limiting activity, the joint becomes stiff and pain starts to be felt at night or at rest, which can greatly impact on sleeping patterns.

At this point, surgery may need to be considered. Our surgeons will order the necessary investigative scans and tests to assess the degree of deterioration. He will then help you decide whether you are ready for joint replacement surgery and explain the options available. The likely benefits and potential risks and complications will also be dealt with to guide your decision.

Hip replacement procedures take a couple of hours and are usually performed under a spinal anaesthetic along with sedation. There is very good evidence that this is the best and safest way to do the operation. This will be discussed with you at the pre-assessment and with your anaesthetist.

In a hip replacement the worn femoral head is removed. The socket is relined with a metal shell in the pelvis, lined with polyethylene. A metal stem is fixed into the femur, with a ceramic head on top, which articulates against the plastic in the socket. We are now sometimes using robotic technology, to make sure we put the parts in as accurately as possible.

Knee replacement procedures take a couple of hours and are usually performed under a spinal anaesthetic along with sedation. There is very good evidence that this is the best and safest way to do the operation. This will be discussed with you at the pre-assessment and with your anaesthetist.

During a total knee replacement procedure, both sides of the knee joint are replaced; the kneecap is moved to the side and the damaged ends of the femur and tibia are cut away, using specialist precision instruments to ensure good alignment and an accurate fit of the components. The anterior and in some types of the replacement the posterior cruciate ligaments are removed, but the main ligament of the knee are kept intact. The femur, or thigh bone, is then replaced with a curved replacement and the shin bone or tibia is replaced with a flat plate. The components are cemented in. A shaped polyethylene bearing is fixed to the tibial component and this articulates with the curved femoral component. The back of the kneecap is relined with polyethylene in most cases.

We are now sometimes using robotic technology, to make sure we put the parts in as accurately as possible and there is good evidence that this is associated with a quicker recovery and a better functional result.

Knee replacements are painful operations. We do our best to minimise this. The spinal help with this in the early post-operative period. We also put local anaesthetic into you knee during the operation and this can provide sustained pain control after the operation.

Modern hip and knee replacements have a very good chance of lasting at least 20 years. Patients will often feel the odd niggle from the artificial joint from time to time and this is normal. If a joint starts to become painful after it has been performing well, this can be a sign that something is going wrong.

The moving part will always wear over time and this can lead to the parts loosening in the bone and this is painful. Patients will usually start to notice pain with activity in a joint which was previously functioning well.

Infections can get into the joint fairly early on, or can occur much later, for example secondary to an infection elsewhere. This will cause pain, sometimes the wound will become red, painful and inflamed and occasionally the scar will even burst open. An infected joint will almost always require surgical treatment. This is highly specialised surgery, which our team have a huge amount of experience in managing.

This is almost never recommended. Surgeons will usually replace the hip first, when there is arthritis in both joints and do the knee later if necessary. Often doing the hip will relieve pressure on the knee, even though it is arthritic.

Knee replacements are painful operations. Modern techniques have made great advances in helping control this. The spinal anaesthetic, which is almost always used, help with this in the early post-operative period. We also put local anaesthetic around your joint during the operation and this can provide sustained pain control after the operation. All this helps minimise the use of strong opioid pain killers, which tend to make people feel sick and drowsy. We use regular paracetamol and an anti-inflammatory, with stronger pain killers as necessary. This approach means that patients usually get out of bed on the first day and are home within 2 or 3 days.

There is no best age. The decision to operate will be taken following careful assessment by the specialist, taking into account pain levels, functional restrictions, patient expectations and age. We try to avoid replacement in younger patients, as we know that artificial joints wear out with time and need to be done again, which can represent very major surgery.

The best thing for your recovery is to get you out of hospital a soon as it is safe after your operation. You will usually be able to get out of bed on the day of surgery. You will be seen at least twice a day by the physiotherapist to get you mobile and they will send you home with a set of exercises to do. Most patients will stay in hospital for 2 or 3 nights. We encourage people to take regular light exercises when they get home and this is actually the best way to control pain and stop you stiffening up.

We encourage patients to gradually return to normal activities after their surgery. It is usually beneficial to see a physiotherapist after the first week or so at home to supervise progression of your exercise programme. Patients are normally off walking supports and getting back to fairly normal day to day activities, including driving, by 4 to 6 weeks.

The surgeon will discuss your individual exercise profile and expectations before the operation. There are no absolute ‘must nots’ after hip and knee replacement. We discourage long distance running and other high impact exercise. Patients need to exercise caution with contact sports like football and ‘dangerous’ sports like skiing, where there is always a risk of something happening which is outside their control.

Although everyone is different, most patients are getting back to day to day activities, including driving, by 4 to 6 weeks. Full recovery, when people can fully utilise their replacement joint can take at least 6 months following surgery. Patients will need to reach certain milestones in the shorter and longer term, and this will gradually build over time to result in significantly improved mobility once the joint is fully healed.

After the surgery, you will be out of bed on the day of surgery, and encouraged to start taking light exercise as soon as possible. Patients feel very tired for the first couple of weeks, so it is question of mixing light exercise with rest.

Gentle, light exercise is very good for your recovery. The new joint will feel less sore and stiff if you take frequent light exercise; healthy blood flow to the surgical site is important for healing. Light exercise will also help to build up strength in the body.

Gentle forms of exercise are particularly good for those suffering from osteoarthritis. Although strenuous walks, hiking and walks involving steep gradients may not be ideal, short walks on a relatively flat plain that ensure that you are getting out and about and allowing your joints to flex are essential for making sure that the joint does not deteriorate faster than it is already doing.

Exercise to strengthen your core and gluteal muscles are very good for patients with hip and knee arthritis, as keeping the pelvis strong helps your joints to function better. Low impact exercise like static biking, cross training and swimming are also very helpful.

Surprisingly there is very little evidence that running is bad for artificial hips and knees. We are happy for patients to run short distances on a good surface with good shoes, but discourage long distance running.

Orthopaedic surgeons specialise in surgery on the bones and joints. We work closely with rheumatologists, who deal with non-surgical treatment of painful joints and in particular the drug treatment of rheumatoid and other inflammatory arthritis.

This will depend to an extent on the hospital where the surgery is done and the complexity of the surgery. A routine, straightforward case will usually cost about £15000.00. Most hospitals have a ‘package price’; our team will be able to help you with a cost estimate if you are considering funding your own surgery. If you have private insurance our consultants all charge the fees recognised by the various insurance companies.

Your GP can offer advice; recommendations from friends, who have had successful surgery, can be helpful. Many surgeons now specialise in hip and knee replacement, so are highly experienced in doing these operations. Generally number of cases performed is a good guide. Surgeon’s outcomes are now recorded in the National Joint Registry, so he should know the number of procedures he is performing and the number of hips which have needed to be revised in a 10 year period. Surgeons use different types of implants, so it is important to understand the type if implant the surgeon is planning to use and why. Different surgical approaches to the hip can be used and the surgeon will explain which approach he is going to use.

When you have met your surgeon he should have been able to answer your questions and give you confidence in his approach. We try to be transparent in the information we offer patients. The specialists in our group work together and have regular meetings to review results and discuss our plan for investigating and treating more complex cases; we operate together on the most challenging cases. We strongly believe that our approach helps to ensure the best outcomes for our patients.