During this difficult period, we have been recommending remote consultations (phone or video) when possible to limit the risk to patients and staff. However, if an orthopaedic problem can not be solved remotely, we can now offer face to face consultations. If you do attend clinic in person, please be aware that you and others will be required to follow increasingly familiar infection control measures including wearing of masks and social distancing.
Please contact 02079083709 if you would like to arrange a consultation to discuss a hip or knee problem with Mr Bartlett.
The Covid-19 pandemic has had a very significant impact throughout all surgical services. Indeed, for a period, many of us orthopaedic surgeons temporarily moved from our operating theatres to look after the sickest of patients in intensive care units. Thankfully the extreme pressures that hospitals were under due to the Covid-19 pandemic have now passed and we are able to start planning the surgical treatment of our long-suffering orthopaedic patients.
During the early phase of the UK Covid-19 outbreak all non-emergency surgery was cancelled as were non-urgent consultations. This applied to both NHS and private sector hospitals where resources were fully directed towards looking after those most in need. After the incidence of the viral infection started to fall, urgent planned surgery (for instance for the treatment of cancer) restarted. The experience gained through looking after such urgent conditions taught us how the risk of developing Coronavirus can be minimised in patients coming to hospital. Beyond following strict infection control precautions (masks, social distancing, cleaning protocols etc) additional measures include performing surgery only in "Covid free" hospitals, isolating patients before their surgery and testing both staff and patients for Covid.
At the time of writing (June 2020), we have been able to restart some planned orthopaedic surgery but we are progressing cautiously taking into account the urgency of the surgery, the surgical complexity and the patients personal Covid risk profile. Certainly we firstly try to treat problems such as hip or knee arthritis without surgery but in difficult cases a procedure such as joint replacement can now be considered. If you are struggling it would be worth arranging a telephone consultation in the first instance.
With the severe restrictions that we all currently experience, it is easy to adopt an inactive lifestyle. Whilst in the short-term, behaving like a "coach-potato" may lessen the aggravation associated with an arthritic joint, before long this approach will tend to lead towards muscular weakening and stiffening-up of the joints. A further concern is that prolonged inactivity due to both the lock-down and the presence of untreated arthritic pain will lead to the loss of fitness and increased physical fragility.
Sensible measures to adopt during the Covid crisis include taking daily gentle aerobic exercise (such as riding a bike or taking a walk) in combination with a regular routine of stretching and strengthening work. Exercises should be made less intense if tending to worsen the pain/ swelling and sessions need not be long. Whilst attending a gym or working directly with a physiotherapist may not be possible at this time, there is no shortage of motivational fitness videos on social media.
Beyond maintaining some physical activity, other lifestyle measures that are especially important at this time include maintaining a healthy diet, sleeping adequately, effectively managing stress and avoidance of unhealthy levels of alcohol.
Medications such as Paracetamol are generally safe and effective for low-grade joint pain although unfortunately panic-buying has resulted in limited supplies in the shops. NSAID like ibuprofen can be helpful but because of potential side effects, these medications should only be used following medical advise.
Dietary supplements for arthritis are big business. However, by the time arthritic symptoms are bad enough to cause someone to see a doctor, symptoms tend not to be helped much by using dietary supplements. Although NICE recommendations for the treatment of arthritis do not include supplements, substances such as glucosamine and/ or chondroitin are unlikely to cause significant harm. At a time when many conventional treatments are not available, it is reasonable for patients to try these. Some patients have also reported benefit from using turmeric tablets.
Although there has been plenty of discussion in social medial, currently there is no research to show that ibuprofen use is linked to the likelihood of contracting the virus or the risk of worsening of coronavirus symptoms.
Patients who have confirmed COVID-19, or believe they have COVID-19, should take paracetamol in preference to ibuprofen but those currently advised to use ibuprofen by their healthcare professional should not stop using it..
Many patients with inflammatory arthritis (such as rheumatoid disease) will be using so called "disease modifying drugs" to control their symptoms. As these drugs can suppress the immune system, some will wonder if they should stop using them during the Corona virus pandemic. In almost all circumstances, it remains important for these patients to keep their arthritis as well controlled as possible. Stopping such medication(s) could trigger a "flare-up" at a time when it would be difficult to arrange to see a GP or rheumatologist for any sort of quick intervention. Any patient with inflammatory arthritis who develops symptoms suggestive of COVID19 should seek proper medical advice from speaking to 111 and ideally also their rheumatology team.
Steroid injections can often significant relieve the pain caused by an arthritic joint. As this treatment is quick and not highly invasive, it may seem like an attractive option for some patients who can not be treated surgically at this time.
Whilst there is very little scientific data on the matter, there is concern that a steroid injection could cause immunological suppression in a patient incubating COVID. Furthermore, Steroid use has been associated with an increased risk for mortality in patients with influenza and delayed viral clearance in patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection. As with every intervention, the risk needs to be balanced against the anticipated benefits but whlist Covid-19 is widespread, most patients are advised to not undergo a steroid injection.
Restoring joint structure and pain-free movement is the principal goal when treating people with joint arthritis. Understandably, the concept of being able to regenerate normal tissue and joint function with an injection is an attractive concept to many people. Unfortunately, this has led to stem cell injections being heavily marketed by a number of private clinics for a multitude of orthopaedic and other conditions despite a paucity of scientific evidence to show benefit. Despite extensive research, there remains little or no credible evidence to support use of stem cells in patients with established hip or knee arthritis. What is clear about stem cell injections into joints (and indeed other injections) is that such treatments are expensive and certainly not without risks. Some reported complications have been very serious and necessitated in-patient hospital treatment. Consequently, my advice is to avoid this treatment altogether for hip or knee arthritis especially during the Covid pandemic.