Rick Kelsey is a Times Radio, BBC Business and Spotify presenter who also hosts one of the fastest growing sports YouTube channels, The Running Channel, with well over 500,000 subscribers and bringing how-tos, features, top tips and more about running to runners of all abilities.

Yet, after two failed knee surgeries, Rick was worried he’d never be able to run again. After a third opinion from Mr David Houlihan-Burne and a high tibial osteotomy performed last year, Rick was able to don his running shoes once more.

“It’s been a long road but after three operations and eight months on crutches, we are – fingers crossed – at the beginning of my comeback to running. There have been many setbacks and quite frankly at times I didn’t know if I was ever going to get out of pain again, never mind run again.

“In February 2021, I was doing sprint intervals in the park and all of a sudden just something went in my knee. I didn’t know at the time how much it was going to test me physically and at times make me feel completely hopeless.

“I’d lost all the cartilage in my knee and in parts it was completely down to the bone and I had multiple tears. The decision was made to perform a chondroplasty which had a 50% chance of success but as I was only in my 30s it was still worth a go.

“However, it failed and it was time for something more drastic – an operation known as a high tibial osteotomy. Essentially, they cut your tibia in two and put in a wedge in order to shift your weight from one side of your leg to another. It’s only done in certain circumstances and the recovery was brutal.

“David Houlihan-Burne is a top surgeon who has worked with a lot of elite GB athletes, so I have absolutely no idea why he wanted to work with me, but he did and he worked his magic and I started to think well maybe there’s a chance I can get back to running.”

When patients tear their ACL, they often ask me the question: “Why them?”

I explain there are multiple factors associated with the risk of tearing your ACL, the most common being landing sports and in particular landing or twisting in a specific way. However, why one person may tear their ACL ahead of another is also multifactorial and we know there are risk factors including having poor neuromuscular control of the knee.

In my years as an orthopaedic surgeon specialising in knee injuries, I have seen a number of families where several members of the same family have torn their anterior cruciate ligaments and indeed in one family I had the mother and both daughters all tear their ligament within six months of each other!

There is more and more evidence to point to a genetic predisposition to tearing your ACL, although identifying this in advance of the injury is almost impossible. This recent research in the British Journal of Sports Medicine outlines the high genetic contribution to anterior cruciate ligament and is another area that we should look at in families where one individual has sustained a cruciate rupture.

Perhaps the whole family should undergo an ACL rupture preventive exercise programme?

Once again, another study has been produced confirming the importance of exercise in the treatment of knee osteoarthritis. Not only does a strength and conditioning programme improve the muscle strength around your knee and will benefit you in terms of pain relief in the medium to long term, should you come to need a knee replacement in the future, then having strong thigh muscles will allow you to recover very much quicker.

This study, published by Western University in Canada, includes a 12 week programme of a neuromuscular exercise programme which demonstrates the old adage “no pain no gain”. Exercising through your discomfort is safe and, with the right exercise, working through this initial pain will improve your function and reduce your overall discomfort from your arthritis.

For more advice on the treatment of knee osteoarthritis, call us on 020 3693 2127 or email us on Knee@fortiusclinic.com to arrange a consultation with Mr David Houlihan-Burne.

Deciding when enough is enough when it comes to the knee pain, stiffness and lack of mobility you’re experiencing can vary from patient to patient. As discussed in our previous post [internal link], timing is everything when it comes to knee replacements as leaving it too late can have a significant impact on your quality of life. Yet, many knee osteoarthritis sufferers, particularly those in their 50s and even 40s, may worry that their knee replacement may wear out too soon.

A recent wide-scale study, however, has found that majority of knee replacements last more than 25 years – much longer than was previously believed. Carried out by researchers from the University of Bristol and published in The Lancet last year, the study reviewed 25 years’ worth of operations, involving more than 500,000 patients.

Dr Jonathan Evans, lead study author and research fellow at Bristol Medical School, said: “At best, the NHS has only been able to say how long replacements are designed to last, rather than referring to actual evidence from multiple patients’ experiences of joint replacement surgery.

“Given the improvement in technology and techniques in the last 25 years, we expect that hip or knee replacements put in today may last even longer.”

How long will my knee replacement last?

The study looked at data relating to both hip and knee replacements, of which there are approximately 160,000 procedures performed each year in England and Wales. They found:

  • Total knee replacements: 93% lasted 15 years, 90% lasted 20 years, 82% lasted 25 years
  • Partial knee replacements: 77% lasted 15 years, 72% lasted 20 years, 70% lasted 25 years
  • Hip replacements: 89% lasted 15 years, 70% lasted 20 years, 58% lasted 25 years

The research was based on statistics gathered from the joint replacement registries in six countries which held at least 15 years of data; Australia, Finland, Denmark, New Zealand, Norway and Sweden. In the UK, our national joint registry data does not extend that far back, but the researchers noted that the results reflected the results from smaller scale studies of UK patients.

So, rather than waiting until pain, stiffness and lack of mobility becomes unbearable, these findings can give confidence to younger, more active patients that a knee replacement could be a viable option. During your consultation with Mr David Houlihan-Burne he will always discuss the benefits and risks of having surgery now or at a later date, as well as consider the non-operative treatments that could delay the need for surgery at this point.

At the moment we are all trying to get to grips with Boris’s latest rules on what you can or can’t do, so understanding the long-term, collateral damage of COVID is almost too much to take on board. However, we are already seeing a very real impact on waiting lists for elective surgeries on the NHS, particularly for joint replacements.

COVID has been described as a ‘wrecking ball’ through NHS waiting times and it seems that the consequences for those that were waiting for knee replacement procedure will be significant.

This delay is more concerning in light of a recent study that found that most patients wait too long to undergo knee replacement in terms of improvement to quality of life.

What happens if I delay my knee replacement?

Researchers at Northwestern University’s School of Medicine discovered that when people waited too long, they lost more function, resulting in weight gain, depression and other associated health issues. The outcome of the procedure that they eventually undergo may also be less successful.

The study, published in the Journal of Bone and Joint Surgery, followed more than 8,000 people with symptoms of knee osteoarthritis over eight years.

“People are waiting and waiting to have the procedure and losing the most benefit,” said lead researcher Hassan Ghomrawi, associate professor of surgery at Northwestern University Feinberg School of Medicine.

“When people wait too long, two things happen,” Ghomrawi said. “The osteoarthritis causes deterioration of their function. Some of them wouldn’t be able to straighten out their legs, affecting their walking and mobility. When you can’t get exercise, you can start to develop other health problems such as cardiovascular problems. You may also become depressed. The overall impact can be huge.”

Yet, timing is everything, as knee replacements have a certain longevity. To discuss whether a knee replacement is the appropriate option for you at this moment, call us on 020 3693 2127 to arrange your consultation with Mr David Houlihan-Burne.

Mr David Houlihan-Burne writes an articles for the BUPA Cromwell Hospital magazine on the enigma of anterior knee pain:

“GPs and physiotherapists are often faced with patients of all ages complaining of pain at the front of the knee. This is an extremely common problem, accounting for 25-40% of all knee related issues seen in a sports knee clinic. It can be very debilitating and is traditionally poorly treated.”

Mr Houlihan-Burne talks to the Guardian Newspaper about new materials and technologies being utilised in knee reconstructive surgery:

“Mr David Houlihan-Burne, consultant orthopaedic surgeon at BMI Bishops Wood Hospital, says that, after many years of trial and error, new materials are becoming available to repair damaged knee cartilage and torn knee ligaments.”

Every year thousands of Britons tear a knee ligament, increasing their risk of developing arthritis. Carlo Barbieri, 51, a civil servant from Bexley Heath in Kent, was given a new artificial knee ligament.

Watford Observer quotes Mr Houlihan-Burne in 2009 regarding the design and opening of the Mount Vernon Treatment Centre

Consultant orthopaedic surgeon, David Houlihan-Burne, who has overseen the project, pointed to infection control being the most important aspect of the new building.

He said: “I suppose the most important thing for me was starting off here in a brand new building with a zero per cent infection rate. And that, from the public’s perspective is where we want to stay.

Article in Orthopaedics Today quoting Mr Houlihan-Burne as co-chairman at recent European Rapid Recovery meeting:

“The whole thing is underpinned by process optimisation. Do not start looking at surgical procedures without these processes in place or it will not work,” said David Houlihan-Burne, FRCS (Orth), specialist lower limb arthroplasty and soft tissue knee surgeon at The Hillingdon Mount Vernon NHS Hospitals Trust. Houlihan-Burne discussed the stages of process optimisation
and said various support services are available to those who want to implement fast-track arthroplasty.