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Private hip replacementMay 15, 2013 at 10:30:21 PM New videos and detailed PDFs on hip replacement surgery and enhanced recovery.More

Goring Hall NewsFebruary 2, 2012 at 07:22:58 PM I have strived to provide our local population with an excellent level of orthopaedic service over the last eight years. I am privileged to have achieved many truly remarkable patient outcomes and some measurable successes for example rapid recovery in knee replacement with data in the top 1 percentile nationally........More

Knee Replacement Surgery

Knee Replacement has improved dramatically over the last 3 years with further advances in the last 3 months.

Traditional total knee replacement was asscoaited with satisfaction rates of 80% but now these are 95% with quicker and easier recoveries for most patients.  

Video Showing Rapid recovery using modern proven and inhouse developed approaches:

Custom Knee Replacement / Resurfacing 

Knee Replacement / Resurfacing, Attune (non-custom)

Practice

Ethos: To provide the very best in service, experience and outcome.

National Specialist in Custom Knee Replacement, including total knee and partial knee replacement.

Video showing walk in walk out Total Knee Replacement using the Attune Knee Replacement system.

Why choose James Lewis?
In short I am driven to continually improve every aspect of the knee replacement experience and outcome. The small details added together make a real difference, I am continually amazed at the improvements in early outcomes, this is great for patients - such as the lovely chap last week who cycled two miles to see me for his two week follow-up check and then cycled home again.
The details are in preoperative preperation risk reduction, surgical precision and judgement and a close knit, excellent, stable theatre team. Members include assistant anaestetist, scrub staff, anaesthetic assistant.
After care is also extrememly important with hand picked physiotherapist, hydrotherapy, pain prevention and sleep protocol and the amazing Gameready device 
The surgery itself is carried out without use of tourniquet where possible to reduce pain and swelling and therefore aid early recovery. 
Implant postionioning with developed techniques for reproducability. Technical areas at surgery including low impact cementing and fixation technique to reduce hammer induced bone trauma and accurately reproduce cement thickness to within 1mm of designers recommendations. 
I am obsessive regarding infection prevention approach including infection restistant stitches with increasing specialisation, critical assessment, team work. I have made and perhaps pioneered a number of advances which translate in to reprocucabiliity and predictability of outcome. I use specialist additional intstruments, some custom made for a particular stage of the operation, I am privaledged to train and share experiences with other consultant surgeons on a one to one basis and both present at and attend national knee replacement meetings.
Most Custom knee replacement patients go home the day following surgery, most Attune knee replacement patients go home after 2 nights.
My aim is provide a first class outcome for those with painful knee arthritis seeking:
  • a rapid recovery with as much comfort and minimal swelling as possible,
  • restoration of quality of life,
  • a new knee that feels like one's own,
  • trust and stability in thier knee
  • strength
  • return to an active and enjoyable lifestyle
  • focus on risk reduction including avoidance of transfusion and and an exceptionally low infection risk.

Which is the Best Knee Replacement?

The focus of knee replacement has been on how long they last rather than how they "drive" or perform.

In my view the Conformis iTotal is the best performing Knee Replacement. It has taken me over three years to be sure of this view and a number of technical operational refinements to deliver reproducability to reach this conclusion. I have formed this view from studies, presentations, and personal experience. The Custom iTotal is a little more expensive (£13900 plus CT scan) but does well in the following areas of: 

knee feeling like one's own natural knee, 

strength and power in the knee, 

straight leg alignment,  

trust in the knee,

flexion (bend in the knee), 

low incidince of clicking,

near natural movement, 

forgetting about one's new knee

return to activities

material quality and thus wear expections and predictions

overall satisfaction.

and finally documented side by side patient diaried recovery experiences are startling (standard knee of the 2000s on one side and a Conformis on the other)

Apart from cost and a manufacture time of 6 weeks I am not aware of any downsides when properly implanted. I think the tolerances of implantation with the Conformis are potentially narrower than some other implants. A possible limitation is that it has been available for 10 years, it is true that some older knees have been available for longer and thus have a longer follow op time period. Overall I would rate it as 9.8 / 10. I have fed back suggested refinements to Conformis the manufacturer on instruemtation and planning areas rather than the implant itself. 

I have 16 years of consulant knee replacement experience and have used different brands and different designs with varying philosophies of design. In the 1990s and 2000s the outcome of knee replacement across the continents was an 80% patient safisfaction rate with the dissatisfaction commonly being in areas of pain, tightness, poor bend and limitations of activities. Of the designs in this era the data or "expert review" that compares outcome of one knee prosthesis to another is remarkably lacking. In most products such as cars or cameras there are several sources of review. I suspect the reason is partly that surgeons tend to stick with one design of knee replacement and partly the barriers of carrying out a comparative study of two types or brands. The strongest data indicates that in the 2000s that the NexGen was the best knee replacement when comparing the four leading brands althought the differences were small between the NexGen and the others. Some comparative data indicates that a medial pivot design of knee is better than other designs. In the 2010s decade there have been new designs from many implant companies. One company DePuy Syntheses has launched the Attune Knee which has 4 year Data in the national Joint Registry. Other new designs are the Persona from ZimmerBiomet, XP Preserving knee from ZimmerBiomet, Journey 2 from Smith and Nephew and Saiph Knee from Mat Ortho. There will be other knee replacements of new design but none that I have been aware of significant clinical use in the UK to include in comparions. I have searched (10.06.17) the PubMed database for outcomes with these new knee implants and can find very little to demonstate the quite probable postive outcomes of the other new knee brands. The Persona data shows better outomes with the more congruent polyethylene insert than the less congruent insert. I have  examined and interviewed a small number of  selected XP preserving patients by lead surgeons at an international meeting and formed the view that they were less good than the Conformis in the areas of feeling like a normal knee and stability. 

Returning to new vs old knee designs. The Attune performs better in every domain of patient function, performance and satisfaction than the Depuy Knee of the 2000s namely the PFC, using this comparator if the PFC was similar to the other knees of the 2000s, which it was acording to patient reported outcomes, then logical follows that it is better than the other knees of this period. However the Attune does not have long term results (3 years of at least a hundred patients). Comparative data or experience of other knees versus the Attune are lacking. Movement based studies of the implant design favours Conformis over Attune. My experience of Conformis and Attune favours Conformis in the areas of power, stability, trust and reduction in clicking. Conformis wins on power through its trochlea referencing at the front of the knee and rotational matching which reduces clicking. It also comes with pre navigated positioning guides called PSI or patient specific instruments which help the surgeon place the implant in the right place. Finally it has a better fit on the top of the shin bone (tibia)

I would probably rate the  Attune as 9.5/10 for early outcome

Other modern knee designs / Brands are probly in region of 9.5/10. Some evidence would favour the medial pivot knee (Saiph) and from my own personal assessment of the XP in expert hands I don't think the upsides warrant the downsides.

I would rate Knee replacements of 1990s and 2000s  as a whole as 8/10 based on satisfaction rates of 80%, there may well be exeptions.

How much does it cost to have a knee replament? (all inclusive Package)

Attune Knee Replacement  £12 315

Custom Total Knee Replacement £13900 plus scan

I use the Attune Knee Replacement and the Custom iTotal Knee Replacement.

Experience: I have carried out 750 knee replacement or knee resurfacing proceedures over the last 3 years, which places me in the top 15 in England and Wales and the in the top 2 for Conformis custom knee replacement.

The Attune and Conformis give proven superior outcomes in a number of measurable areas including patient satifaction. One study shows an improvement of patient satisfaction from 74% to 94% with the Conformis knee compared to a traditional knee.

Please see the rationale for Custom Knee Replacement.

Custom Hip Replacement- again minimally invasive technique: the following video was filmed by the patient himself:

Recent developments include use of Physicool - an evaporation based cooling bandage that increases comfort and is proven to aid recovery.  Further developments include the use of a transcutaneous muscle stimulating device to aid muscle recovery following surgery (Compex). The focus is on Modern knee surgery including:

Below is a Video Showing an 8 month result after a Custom 2/3rds knee resurfacing (Conformis)

More Custom Knee information here

     

Custom knee replacement, this is individually manufactured metallic components to exactly fit your knee. Furthermore the custom knee replacement or partial knee replacement functions as a knee resurfacing implant, where the old damaged cartilage is removed and the new product fit on the original bone on the weight bearing bone.

Award winning Enhanced recovery program, routine walking 3 hours post surgery and sitting out for one's evening meal, if staying overnight. Patients frequently comment at the comfort levels and rapid recovery.

Video August 2013 Hip replacement patient showing free walking on the second day following Minimally Invasive  Hip Replacement, Sussex, Goring Hall.

       

Minimally invasive total hip replacement, normally with a 1-2 day hospital recovery. An ultaposterior approach is used to proctect the "walking muscles", 36mm pink delta highly polished ceramic articulations from ceramtec are used for stability and excellent long term wear reduction. Custom hip replacement equipment is used to allow the operation to be carried out in a reproducable fashion. Refined technique for reproduction of leg length. Custom hip replacement by Symbios offered.

Lovely Hip Replacement story and video, from Real Life tested. Quality of life restored, back walking along the beach in Worthing, Sussex after Hip Replacement.   

A national trainer for the Partial Knee Resurfacing system and Custom partial knee- an alternative to Total Knee Replacement in upto approximately half of traditional total knee patients.

Top 1 and 2 percentile length of stay outcomes compared to national peers for knee and hip replacement (Worthing and Chichester NHS data).

Exceptionally low infection rates (Data on file)

Partial knee resurfacing as a day case.

Custom knee resurafcing as a day case. First day case iDuo knee resurfacing in the UK, first lateral duo knee resurfacing in the UK..

Locations

Custom Total Knee Replacement at Wimbledon Parkside, Wimbledon, SW19 5NX. I have lived in Wimbledon for 4 years. 

Surgery at Goring Hall Hospital, BN12 5AT Sussex or Wimbledon Parkside, London, SW19 5NX

APPOINTMENTS:

Wimbledon and Goring Hall Hospital, ring 0845 912 1000 for an appointment. 

Education
Schooled at Portsmouth Grammar.

Trained at Guys Hospital Medical School, further training at The Royal National Orthopaedic Hospital, The Royal London, The Nuffield Orthopaedic Hospital (Oxford), and  Norwich. In an obsessive fashion I did 3 Fellowships and a further 6 month consultant period alongside Niel Thomas.

A higher degree in Orthopaedic Engineering, awarded distinction.

International training in USA, Australia and Germany.

Custom Knee Information here.

RECENT NEWS

Educational Talk at Warren House, Kingston, 25th April 2015. Very well attended by a wide range of GPs, talk focused of Non-operative management with emphasis on the 2014 OARSI update and Custom Total Knee Replacement including design principles, wear data, performance, opinion, and evidence based medicine......delivering a knee replacement that feels like your own and a leap in patient satisfaction.

Educational Talk at Mumbai, India, 2015. Delivering a knee replacement that feel like your own and gap balancing. Invited talk. 

Educational Talk, AAOS, USA 2014. Custom iDuo Knee resurfacing.

RECENT MEDIA

Saga magasine

Daily Mirror

ITV News

Hip Replacement Results from regular Feedback Audit

Results 6 month questionaire 2014,  replies:

Would you recomend Mr Lewis for Hip Replacement?

Recomendation rate:  Yes: 100% No: 0% (27 replies)

Overall Score 9.46/10 (26 replies)

Patient Feedback (consent given for publication)

  • Able to drive again without cramp pelasure walking bird watching and visiting historical houses and gardens plus future holidays continue with exercise - very important.

                            Consent given, Hip Replacement July 2014, review January 2015. Score: 9/10

  • I now walk with a normail gait; i can happily walk my dog and can tackle stiles uneven surfaces etc.  It is with great joy that I can play with my small grandchildren as getting up and down is so much easier.  It has removed the frustration that i used to feel at the restrictions that my painful hipplaced one my life.  I realise now that one of the main difficulties was the reduced mobility in the joint.  The new hip is remarkable and relaly does move smoothly and with ease.  I cannot praise Mr lewis and his team strongly enough.  Nothing was too much trouble and I was always treated with care, compassion and courtesy.

                            Mrs JJ, Hip Replacement July 2014, review January 2015. Score: 10/10

  • I have got my independence back I no longer have to rely on my daughters help.

                            Consent given, Hip Replacement July 2014, review January 2015. Score: 10/10

  • To be without pain relief is to be given back quality of life I had forgotten.  I feel I have come alive. I am completely unware of my new hip.  Post-operative discomfort was very short lived and is a distant memory.  Even my tiny scar has almost disappeared.  If there is anyone out there who is dithering about having a hip operation I can only say 'get on with it'. Get a life. I cannot thank Mr lewis and his team at Goring Hall enough for what they have been able to do for me. I would recommend them to anyone and everyone.

                           Consent given, Hip Replacement July 2014, review January 2015. Score: 10++/10

  • Pain in legs now gone but pain in lower back remains but improving gradually.  

                           Terence Parkes, Hip Replacement June 2014, review December 2014. Score: 10/10

  • I have no pain in my hip at all and if wasn't for my back pain caused by a stupid friend when I was was 10 who pushed be off my bike it would be perfect.

                            Priscilla Fullerton, Hip Replacement June 2014, review December 2014. Score: 10/10

  • I didn't realise how restricted my life had become until me new hip "set me free"

                             Mr  JC, Hip Replacement June 2014, review December 2014. Score: 10/10

  • My hip opeation has given me back the level of pain free movement that I used to take for granted.  From the operation to recovery has been marvellous.  I could not be more pleased.  Thank you dosen't seem enough.

                             J Edwards , Hip Replacement June 2014, review December 2014. Score: 10/10

  • Sometimes I have to remind myself how liberated I feel - no more pain or inhibiting walking.  I am amazed at how normal everything has become and how much better my persistent back pain is.  

                           Rosalie Murphy Hip Replacement April 2014, review October 2014. Score: 10++/10

  • My right hip is wonderful (replaced)- my left hip (arthritic) I have difficulty walking up stairs i have to hold on.  

                           Anonymous, Hip Replacement April 2014, review October 2014. Score /10: not stated.

  • Without a doubt it has made a huge differnece to every day living.  I can now enjoy going for walks and playing golf as before. 

                           Jean Roberts Hip Replacement April 2014, review October 2014. Score: 10/10

  • I didn't realise how much my hip stopped me doing things I wanted to do and how much it stopped me sleeping.  Im now back riding my horse, walking dogs. 

                            Anonymous, Hip Replacement March 2014, review September 2014. Score: 10/10

  • I can now work out three times a week without any pain.  I am planning a walking holiday in india.  My new hip gave me back my life thank you.

                            Mrs JB Hip Replacement March 2014, review September 2014. Score: 10/10

  • I can now walk around giolf courses and last week was able to walk 7 miles in a day without discomfort.  I have got my life bacl! Should have had the operation years ago.

                            Mr RC, Hip Replacement March 2014, review September 2014. Score: 10/9

  • I can go for long country walks with no discomfort and i have started to play tennis again.

                            Mrs JC, Hip Replacement March 2014, review September 2014. Score /10: 10

  • Before the op I was wheelchair bound.  Now I can walk normally 4 miles around a golf course 3/4 times a week inc pushing a trolley.  I exercise on the bike for 25 mins 4 days a week and swim 10/12 lengths of a 25 meter pool 4 days per week.  I also do other things its best not to tell you about. 

                            David Carter, Hip Replacement Febuary 2014, review August 2014. Score /10: 10

  • Every day has been transformed so that walking to the shops or for pleasure has become possible again.  My working life as a dance teacher is now pain free and has become enjoyable again.  I am still not yet at full dance fitness but my strength is improving week by week and my firends and colleagues are amazed at the progress I have made. Thank you. 

                              Mrs JT, Hip Replacement Febuary 2014, review August 2014. Score /10: 10

  • Fantastic results! Previously in constant pain now I have free movement in my hip which allows me to undetake many activities not possible before.  SO many thanks Mr lewis brilliant result!

                              Anonymously, Hip Replacement Febuary 2014, review August 2014. Score /10: 10 

 

  • Last week i returned to dance after a 3 year gap.  Unsurprisingly it was a bit scarey at first but I managed the Fox-trott and the Samba.  Please to say I did it even better than it used too!

                               Mrs SH, Hip Replacement Febuary 2014, review August 2014. Score /10: 10

  

  • My new hip has given me a new lease of life.  I have gone from dreading all social occasions to appreciating how wonderful; it is to be completely pain free.  I am now enjoying everything including holidays abrad, going to the gym and going for long walks.  Life is really worth living again.  Thank you Mr Lewis.

                               Alan Hillman, Hip Replacement Febuary 2014, review August 2014. Score /10: 10

 

  • Completely changed my life! No pain at all.  Can now walk, drive and fly to Australia to visit family.  Life was really miserable before the operaiton even work which i love was becoming something I dreaded mainly due to disturbed nights and lack of sleep.  I am grateful to Mr Lewis and his team.

                               Patricia Raggett, Hip Replacement Febuary 2014, review August 2014. Score /10: 10

 

  • Unfortunately after about 4 weeks I started getting pain in my other (right hip and knee).  This finally resuteld in limping and physio/chiropractic couldnt help.

                                Mrs LW, Hip Replacement Febuary 2014, review August 2014. Score /10: 10

 

  • Now very happy to be able to enjoy gardenning and to play golf without the pain.  Thank you.

                               Mrs GD, Hip Replacement January 2014, review July 2014. Score /10: 10  

 

  • I am amazed and delighted with my new hip which feels perfectly normal.  I now walk without a limp and am able to walk, swim, play short mat bowls and garden with ease.

                                Jane Everett, Hip Replacement January 2014, review July 2014. Score /10: 10 

  • The main difference is that I can now climb stairs or steps using the leg with the new hip first.  Of course the abscence of pain from this hip is a great boon.

                               Mr EF, Hip Replacement January 2014, review July 2014. Score: 10/10 

  • I can now walk and play golf as much as I like without pain and discomfort.  Putting on socks remains a chore but a relativly small inconmvenience.

                               Anonymously, Hip Replacement January 2014, review July 2014. Score: 9/10

  • Am now fully fit for sailing.  Just one problem - my new hip is so good that it makes me aware of other jionts which might need further attention.

                               Stuart Sanderson, Hip Replacement January 2014, review July 2014. Score 9/10

 

Hip Resurfacing: Patient feedback Febuary 2015:

After many years of high-end sporting activity - covering a mix of Judo, Olympic weight-lifting an Tae Kwon Do - my right hip began complaining that perhaps I'd written a few cheques in my youth that it now wished to cash in!! Initial thoughts were centred around back-problems, as post training, I would suffer severe back ache on my right side and pain in my groin leading to sleepless, or at best, disturbed nights. Eventually, after many visits to the chiropractor, I saw my GP who referred me to Mr. James Lewis at Goring Hall. Initial X-Rays indicated OA. Options were discussed including the possible use of BHR, which on-balance sounded like the best option moving forward. 

Being an engineer by background, and having a daughter with a background in sport science, I embarked upon researching this form of intervention from both perspectives. It very quickly became apparent that there were a number of athletes who had also elected for BHR and who had returned to their original activities; some even returning to competition. 

My research also indicated a number of key criteria that should be considered when embarking on a BHR: 

1. Select your surgeon carefully: Whilst experience is a factor, other aspect are equally important such as attention to detail, meticulous planning, ability to communicate and build a strong patient / consultant relationship with an empathetic stance towards sporting activities. 
2. Ask many questions: Including topics such as past patient experiences (both good and importantly not so good), prosthetics used and their characteristics in terms of manufacturer; how they rank in terms of performance; metallurgy and even (if you can bear it - there are some very good YouTube videos of the procedure out there!) info on installation procedure.
3. Recovery protocols: For active, sporty people I would countenance that this is fundamental. Mr Lewis and his team focus specifically on this area. This is apparent from the get-go with not just an array of good information pamphlets made available, but with a recovery regime targeted towards resumption of mobility as quickly as possible. This starts subtly with small aspects such as the use of carbohydrate loading as part of the pre-op regime to combat muscle atrophy, on to the option of anaesthetic used for the procedure with the advantages present with respect speed of recovery if a spinal and sedation option is selected. On this last point, I was initially sceptical, never having experienced this process before. But I can now vouch for its effectiveness and advantages. 

James Lewis, in partnership with all of the excellent staff at Goring Hall, has built a team around him that appreciates these aspects fully and do all they can to ensure a rapid return to mobility, and in time, sporting activities. 

Overall, for the younger active patient presenting with similar issues who wish to maintain their QoL, including sporting pursuits, the BHR solution under James Lewis' holistic approach  is a solid option well worthy of consideration. 

Best Regards / Tim Randall 

National Hip resurfacing outcomes with the Birmingham resurfacing product as per the NJR (National Joint Registry)

Data current as of Feb 2015 - the NJR 11th edition published in 2014.

9% of Birmingham resurfacings have been revised (redone) at 10 years. This data set is of patients aged at a median of 55.

This is at least as good as total hip replacements in those of similar age:

10.5% (in the under 55s) or 8.5% (in age 55 to 59) of total hip replacements have been revised at 10 years (NJR data).

Of the resurfacing Brands, the Birmingham is the most favourable (LINK) data on page 50.

Written 18th February 2015.

 

http://www.sussexhipreplacement.co.uk/