How I work

I am a hip and knee surgeon who also studies, using national registry data, which operations and implants work best and why some go wrong. That research shapes the choices I make for each patient.

What I believe

• Your goals come first. We start with what you want to get back to, then decide whether surgery is the right way to get there. Sometimes it is not.
• Choose implants on evidence, not fashion. Most of the implants I use have long, published track records in the National Joint Registry and high independent ratings (ODEP). I will use a newer design when the evidence for it is convincing and its results so far are heading the right way.
• Look at all the problems, not just revisions. Hip replacements are usually judged by how often they need replacing. My research showed that this misses many patients who need further major surgery, such as fixing a break in the thigh bone around the implant. I choose implants to lower the risk of that further surgery.
• Match the implant to the bone. Bone quality varies a great deal. I assess it on your X-rays before surgery and plan the implant to suit it.
• Explain everything. You will see your X-rays, understand the plan and know what recovery looks like before you agree to anything.

Hip replacement

I choose each hip implant to try to lower the risk of any further surgery, not just replacement of the implant:

• Stronger bone: an implant the bone grows onto, making a strong bond that helps protect against fracture.
• Less strong bone: a cemented implant, held firmly in place by bone cement and chosen to reduce the risk of fracture.
• High risk of dislocation: a "double-jointed" (dual-mobility) implant.

I explain the options and my reasons at your consultation.

How I reach the hip

Wherever possible, I perform hip replacements through the Röttinger approach, a type of anterolateral approach. Rather than cutting through muscle, I reach the hip through a natural gap between two muscles on the side of the hip. Because these muscles are kept intact, I do not usually ask you to follow hip precautions afterwards, and you can move normally from the start. If I use a different approach, or your operation is a revision, I will tell you what to avoid. For revision (re-do) surgery I usually use the posterior approach, from the back of the hip, which gives the access these more complex operations need.

The Röttinger approach also works well for people with a larger build, where some other muscle-sparing approaches are more difficult.

Knee replacement

No two knees are quite the same, so I try to place the new knee where your own joint line was before arthritis changed it, rather than forcing every knee into the same straight line. I learnt this approach, often called kinematic alignment, during my fellowship in New Zealand, and I usually plan and perform knee replacement with a robotic system. It helps me place the parts to the plan I make for your knee.

The aim is to give the best chance of a knee that moves and feels natural, and to reduce the need to release the soft tissues around the knee. To be open with you: the research evidence for this approach is mixed, and it has not yet been shown to be better than traditional methods in every study. But I really like the way the knee feels after surgery with this technique, and I will talk you through what it can and cannot promise.

I always resurface the kneecap (patella), because this is likely to reduce the chance of needing further surgery later.

Industry links

Like many surgeons, I teach on courses run by implant companies, and my research has received industry funding. The knee robot I use is made by DePuy Synthes, a company that funds some of my research. I list every link openly on my disclosures page.