Racehorses training

More than a quarter of British workers suffer from painful knees, according to recent figures.  For those under 55, a knee replacement is not possible because they can wear out and need to be redone.

Brian Douglas, 53, a racecourse facilities manager from Harrogate, had a new alternative procedure.


The Patient

Living in the Yorkshire Dales, I’ve always been very active, going on long walks with the dog and to the gym twice a week.

But around three years ago I started feeling pain in my left knee after I’d been for a long walk. It wasn’t totally unexpected — I’d had surgery on it after a rugby injury in the mid-nineties, where surgeons had to cut away some torn cartilage.

They warned at the time that this made it more likely that I’d get osteoarthritis, because cartilage cushions the joint, and when it’s worn away the bones start to rub together.

The pain in my knee went on for a year before I saw my GP. He told me to see how things progressed and to take painkillers when I needed them.

I started taking glucosamine supplements, and rubbing glucosamine gel into the knee which helped, and changed my routines — cycling in the Dales instead of walking.

But by the end of 2010, the pain was getting worse. I was referred to a knee specialist, who did X-rays and an MRI scan and confirmed I was starting to develop osteoarthritis.

He explained that I could have a knee replacement, which would mean cutting off the ends of the thigh and shin bones to replace them with an artificial joint. But since I was so young, and these replacement knees can fail after ten to 15 years, it could mean more surgery a decade down the line.

It would take part of my weight as I walked, reducing the load on the damaged part of the knee joint so it wouldn’t hurt so much. The knee joint would be left intact so that I could have a knee replacement later if I needed one. It sounded good, but I wanted to put it off as long as possible so I could stay active for the racing season.

I saw the surgeon Nick London at Harrogate District Hospital in September 2011, and had the operation on the NHS last January, with an epidural and light sedation. The procedure took just under an hour. I could see my knee on the monitors with the spring firmly fixed in place — it was amazing.

I used crutches at first, leaving hospital on the third day and taking paracetamol when I needed it — by the end of the first week I needed only a stick, and two weeks later I was back at work. I had some swelling around my knee, and for the first few months I couldn’t bend my leg to climb steps.

But now I’m as active as ever — the ache in my knee has completely gone.


The Surgeon

Nick London is consultant knee surgeon at the Yorkshire Knee Clinic and Harrogate and District NHS Foundation Trust. He says:

“Around 8.5 million Britons have osteoarthritis, which is basically wear and tear on the joint and can affect any joint including the hands, knees, hips, feet and spine. As the cushioning cartilage which lines the joint is worn away by use, the joint becomes inflamed as bone starts to rub on bone and causes pain.

We offer knee replacements to patients aged 55 plus, but these artificial joints can wear out over ten to 15 years and may need to be redone, which means repeat surgery in the same area. This ‘revision’ surgery is often less successful than the first replacement, with the patient experiencing poorer function, so we try to avoid offering knee replacements to younger people.

But over the past few years we have seen a huge increase in the number of younger people (aged 35 to 60) with moderately severe osteoarthritis. While being more active is good for health, it can take its toll on the joints. Not surprisingly, these patients become increasingly frustrated by the nagging pain and the effect it has on their family, social and working life. Patients can lose weight if they are overweight to take pressure off the joint, and can take painkillers and anti-inflammatories to reduce discomfort.

Physiotherapy can help build strength round the joint, and patients can reduce the impact by changing routines, for instance, avoiding running and taking up less weight-bearing sports such as cycling, walking, golf and swimming. The majority of patients first develop wear on the inner side of their knees, because this side bears more load when walking and running.

Some surgeons offer younger patients an osteotomy, which means realigning the joint to take pressure off the inner side of the knee where most of this wear and tear occurs. But this permanently changes the bone, takes a long time to recover and can reduce the effectiveness of any future knee replacement.

KineSpring, which was designed in the U.S. about five years ago, has been evaluated in clinical trials in Australia over four years and in a multi-centre European trial over the past two-and-a-half years. It’s basically a shock absorber which we fix between the thigh and shin bones to take some of the weight off the inner side of the knee.

KineSpring is made of titanium and cobalt chrome and looks like a strong spring, about 2 in long and the diameter of a pen, which we fix to two base plates attached onto the inner side of the patient’s thigh and shin bones. While it doesn’t take all the patient’s weight, it does reduce the load on the cartilage (where most of the wear and tear develops) by about 13 kg when patients are standing, and so reduces pain for these patients while preserving their own knee.

Studies have shown that KineSpring significantly reduces pain and improves knee function by more than 80 per cent in carefully selected patients who have this one-sided wear. The operation lasts about 45 minutes to an hour.

First, we make two 3 in incisions just above and below the knee on the inside of the leg, and expose the bone. Then we fix two base plates, about two inches wide, to the inside of the bone, screwing them firmly into place. Then we tunnel through the tissue between the thigh and shin, feeding the spring through soft tissue and attaching it securely to each base plate.

We then test the knee thoroughly, checking that the spring is relieving weight on the damaged section, and close the incisions with stitches.

Most patients leave hospital the next day, and will be able to put some weight on the joint immediately using crutches.

As with all surgery, there are small risks of infection, swelling and blood clots. We hope this procedure will go on reducing pain and damage in these patients for up to ten years or even more.

Since the patient’s natural knee is untouched, they can still have a knee replacement if the osteoarthritis goes on progressing, but in the meantime should have years of improved activity with greatly reduced pain.”

The operation costs £8,000 to £9,000 privately and a similar cost to the NHS — it is available at limited centres across the UK and Europe.

Article Source: The Daily Mail

Prof. Nick London

Prof. Nick London

Private appointments weekly at The Duchy Hospital Harrogate & Nuffield Hospital Leeds

Private Secretary

Lou Nellies
01423 369 119

Email Nick



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