Total Hip Replacement
This operation is arguably the greatest success of 20th century orthopaedic surgery. It is used in disabling hip arthritis. The operation can be done under general or spinal anaesthesia, and takes around an hour. The operation involves replacing the ball and socket hip joint by dislocating the hip, removing the head of the femur, and then cementing a plastic socket (made from high density polyethylene) into the pelvis and a metal component into the femur. Possible complications include dislocation of the prosthetic joint and infection, amongst others. The operation is generally very successful and the average length of stay in hospital is about a week.
As of March 2013 I've done over 200 total hip replacements. These have been generally satisfactory with a low complication rate. Since using the Exeter system there has been only 1 dislocation out of over 140 hips put in.
Total Knee Replacement
The concept of this operation is similar to hip replacement described above. The surgery takes about 90 minutes and involves removing the ends of the femur and tibia and replacing them with metal components separated by a polyethylene spacer. Technically it is more demanding than a hip replacement but again is generally successful. The main potentially serious complication is infection, which is commoner in knee replacement surgery than in hip replacement. Length of stay is about a week.
I've now done over 100 total knee replacements with good early results, no infections and no early revisions.
Keyhole surgery of the knee has become commonplace with advances in optics and video technology over the past 20 years or so. Arthroscopy enables the surgeon to look around the inside of the knee and deal with any loose or torn pieces of cartilage. It is generally done under general anaesthetic, and takes about 20 minutes, but can be longer depending on what is found. It is usually done as a daycase, and complications are few and far between.
Cruciate ligament reconstruction
Torn anterior cruciate ligament (ACL) is a common sports injury that can leave the knee relatively unstable. It is possible to live a perfectly normal life with a deficient ACL, but some sporting activities may be difficult – ACL reconstruction can potentially allow a return to even high level sports. It is carried out under general anaesthesia and is mainly done arthroscopically. A ligament graft is taken from elsewhere in the body – either the middle third of the patellar tendon or some hamstring tendons – and fixed inside the knee in place of the torn ACL. Hospital stay is 2 or 3 days, but the rehabilitation period is 6 months before a return to full sporting activities is allowed.
I no longer carry out this surgery as like all operations it is best carried out by someone who does it regularly. I refer patients under my care who could benefit from this procedure to one of my colleagues at Noble's.
Carpal tunnel decompression
This is one of the simplest and most effective orthopaedic procedures. It is done in 10 minutes under local anaesthetic, and involves releasing the tight ligament in the palm of the hand which is compressing the underlying nerve. If the diagnosis has been made correctly the operation works virtually straight away and the potential risks of nerve damage are very rare.
Dupuytren’s contracture release
This operation involves excision of the contracted palmar fascia that is the key feature of Dupuytren’s disease. It is done under general anaesthetic with a tourniquet around the arm to prevent any bleeding, and magnification to enable me to identify the small digital nerves and prevent damage to them. The incision is closed in a series of zig-zags. Main risk of the procedure is damage to the digital nerves, which can leave you with a numb finger. Patients generally go home either on the day of surgery or the next.