Michael A Tuke FREng
Chairman and Owner, MatOrtho Ltd
Consultant Knee Surgeon, Fortius Clinic, South West London Elective Orthopaedic Clinic (SWLEOC)
If you are preparing for a joint replacement operation, you have the freedom to choose your surgeon — and your implant. So do some investigating and make your voice heard.
As we age, degenerative arthritis can take a devastating toll on our bodies, and particularly our hips and knees. That’s because articular cartilage, the low friction lining in our joints, wears away over time. Unfortunately, unlike other tissue, cartilage doesn’t have the ability to repair itself. “Once it’s gone, it’s gone,” says Michael Tuke, founder and chairman of Orthopaedic company, MatOrtho Ltd. “And as it wears out, the trouble — and pain — begins.”
Yet joint degeneration isn’t only an issue for people in their 60s, 70s or 80s. It can happen to those in their 30s, 40s and 50s, too. “We are all living longer and want to be more active, so this is a condition that will affect more and more of us,” says Tuke. “Joints can also be damaged by excessive physical activity or injury in earlier life. Whatever age you are, when joint cartilage wears away and bone begins rubbing on bone, it’s extremely painful.”
This is why joint replacement can be so life-enhancing for patients with degenerative arthritis. “It’s not simply a way out of pain,” says Tuke. “Joint replacement can help us live longer – especially by being active in later life.”
As the patient, you can choose your surgeon and your implant
“Yet there’s something that people with the condition may not realise,” says Tuke. “When it comes to a hip or knee operation, we don’t have to accept the first surgeon we are sent to and whatever implant they happen to use. Times have moved on over the last few decades; GPs and clinicians are more beholden to their patients these days.”
Indeed, Tuke believes that anyone who is prescribed for hip or knee replacement surgery should first choose the best implant. This requires a certain amount of research, but is easier than you might imagine, thanks to The National Joint Registry (NJR).
Patients should do their research for joint replacements
“This is a government database, open to everyone, which records information on joint replacement surgery in the UK,” says Tuke. “If anyone needs a follow-up procedure, information about that is also registered. It records why the surgery was necessary and which hospital carried out the operations.
“It then shows how long each implant brand is likely to be effective, because some under-perform against national averages and some consistently have lower re-operation (revision) rates year-on-year. The NJR also records information about individual surgeons so anyone can see the results of their operations.” Another source of information is available via the Orthopaedic Data Evaluation Panel — or ODEP — which provides a scoring system for devices and their success rates.
Giles Heilpern is the Consultant Knee Surgeon who performed knee replacement surgery on actress, Miriam Margolyes, at South West London Elective Orthopaedic Centre (SWLEOC). “Interestingly, Miriam is the only person I’ve treated, to date, who had actually studied the National Joint Registry Database,” he remembers. “I’ll never forget our pre-op conversation. She said: ‘I should ask you about your revision rates — but, of course, I know all about them because I’ve looked at the NJR.’”
Miriam’s positive post-op mindset
Miriam needed a new knee due to osteoarthritis damage, so Heilpern gave her an MRK™ (Medial Rotation Knee™) replacement, which took around an hour to implant and was a complete success. “The ultimate goal with a knee replacement is, of course, to have a happy patient,” he says. “I’m a firm believer that this is more likely to happen if the implant behaves like a normal knee, which this implant does. Around 10% to 15% of patients are unhappy with their knee replacement — so we are always looking for ways to minimise that group. And on the National Joint Registry, this implant does better than most of the rest in terms of patient-reported outcomes.”
Miriam’s motivated, no-nonsense approach was also useful in her post-op recovery period. “Knee replacement is a painful operation and recovery can be slow and difficult,” explains Heilpern. “Patients end up with a swollen knee joint, which they need to get moving in the first few weeks, otherwise it can scar and stiffen. They need the right mindset to push through the pain and do their exercises — and Miriam certainly had that mental fortitude. She just gets on with things.”
The MRK™ has been awarded a 13A ODEP rating. Latest ODEP ratings can be found at www.odep.org.uk