The Bristol Knee Clinic
David Johnson in theatre and with a patient

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The Bristol Orthopaedic
& Sports Injury Clinic
St Mary's Hospital
Upper Byron Place
Bristol BS8 1JU

Tel: 0117 970 6655


Mrs Vivien Ablett - Total Knee Arthroplasty Case Study

In October 2002, after waiting for surgery for two years in the NHS, Vivien was sent by the Royal United Hospital in Bath to Mr Johnson. An initial arthroscopy was undertaken which demonstrated osteoarthritis in both knees. Unfortunately because of the extent of the arthritis Vivien had continuing pain, stiffness and restriction in her activities and ability to work. She therefore underwent a right total knee replacement in November 2002. At this time Vivien was aged fifty four which was very young for a knee replacement. Mr Johnson therefore used one of the new Oxinium total knee replacements. This was inserted using cement. Vivien recovered well and started walking on the second post operative day and was discharged after a week.

Vivien made such good progress that she requested to undergo a further knee replacement on the left side in July 2003 eight months after the right side. Again an Oxinium knee replacement was performed. Once again following this she made an excellent recovery and was discharged after seven days. When reviewed six weeks later she had a range of motion of 0 to 125 on both sides, no pain, swelling and was walking comfortably without any support or sticks. She was advised that she can return to gentle activities including gentle sports. Since then she has returned to full activity and is essentially unrestricted.

Vivien said "After waiting for two years to be seen by an NHS Consultant I was delighted to be referred by the Royal United Hospital in Bath to Mr Johnson. My experience was excellent, I would definitely recommend Mr Johnson and the Nuffield Hospital to other patients." When asked about undergoing knee replacement at such a young age Vivien responded by describing the difficulties she had with the pain and stiffness in the knee. "To be relieved of the pain has enormously improved my life."

Vivien was able to receive one of the new cemented oxidised Zirconia total knee replacements. This knee has been used for five years in the USA but is new to the UK. It uses a new technology to reduce the wear in the knee by up to 85%. Because of Vivien's very young age Mr Johnson was able to recommend this type of knee replacement for the potential increase in the life of the knee replacement.

Mr Johnson comments:

"Vivien is an excellent example of what can be achieved with knee replacement where patients should be able to return to daily activities and work without restriction. I believe that the new technological advances will potentially allow replaced knees to last for a longer period of time."

Mrs Una Carlow - Total Knee Arthroplasty Case study

Mrs Carlow's comments:

"Following an arthroscopy I was advised that the plan to have the uni-compartmental knee was not feasible and I would need a total knee replacement. My general practitioner referred me to Mr Johnson because the Oxinium knee seemed the preferred product for someone my age (58). However because of the nature of the arthritis present Mr Johnson believed there was only a slim chance that the mini knee was still an option. After my surgery I was surprised to learn that I did have the mini knee yet on reflection I was impressed that Mr Johnson had been able to make that judgment and switch to the more conservative approach during the operation.

And the result? To be able to put pressure on the joint and walk pain free from the day after surgery is like a miracle. And to walk silently without all the crunching and grinding sounds in my knee makes me feel like I'm gliding on castors! That is not to say there was no pain but it is the "bettering" pain that has to be gone through and is the short term temporary consequence of the surgery. However the bruising, swelling and muscle damage settles quickly. The first few days pass in a round of physiotherapy exercises, walking, pain control, rest and in my case ice to reduce the swelling. Concentration goes for a time - forget about all the things that would be done in this time off work...this time is truly for recovery. And the pay off comes soon afterwards in being able after 2 weeks to discard sticks, getting a high degree of flexibility and walking greater distances. I had wanted to be able to go for decent country walks and at 8 weeks I could see my goal is attainable. At 11 weeks from the date of surgery not only can I comfortably exceed 4 km but can go at a speed that I had completely forgotten is the norm for most people."

Mr John Kitchener - Total Knee Arthroplasty Case Study

Mr John Kitchener is a retired seventy-two year old. He was referred to Mr Johnson by his general practitioner in October 2002. John had suffered with increasing problems of osteoarthritis affecting the left knee over the previous two years. His walking was limited to a hundred yards with every step being painful. His left knee regularly gave way and kept him awake with pain at night. He had taken analgesia and anti-inflammatory medication without any great success.

When John first attended Mr Johnson in October 2002, clinical examination demonstrated a 7 degree deformity of the knee, a significant amount of swelling and instability. He was particularly tender along the inner aspect of the joint. Radiographs demonstrated severe osteoarthritis.

John accepted Mr Johnson's advice that a knee replacement was necessary. This was undertaken at the Nuffield Hospital in Bristol on 25 November 2002 using the new Oxinium total knee replacement. He was discharged home to the care of his wife ten days later and returned to see Mr Johnson in January 2003.

Only six weeks after the operation, John was noted to have made excellent progress, indeed, much faster than usual. His range of motion then was from 0 degree to 115 degrees, greater than the usual range of knee bend at this stage. He did not require further pain relief tablets and was walking at least half a mile a day and was very happy with his progress.

Mr Kitchener described the success of the operation:

"The Oxinium implant made it possible for me to have knee surgery that could last longer than traditional implants. I was in such dreadful pain before the operation, only managing to walk a few hundred yards, but each step was very painful. It's been a few months since the operation and after only six weeks I was able to walk again relatively pain free. I'm now doing really well and can walk at least 5 miles a day and do my gardening - I have been able to just get on with my life again."

Mr Johnson says "John's progress was remarkable. His very rapid recovery required only minimal assistance from the physiotherapist and his return to walking after many years of difficulty only six weeks following surgery was very gratifying. I very much hope John can now enjoy life again to the full benefit of his new knee."

Mrs Ann Taylor - Total Knee Arthroplasty Case Study

Mrs Ann Taylor is a District Nurse aged fifty-nine. She presented to Mr Johnson through her chiropractor. Ann had suffered with both knees causing increasing pain over the previous four years. The initial problem followed a fall 10 years earlier. Her knee's were stiff and she could not kneel, they were painful towards the end of the day and particularly when twisting or walking on stairs. She was not able to undertake a round of golf without significant pain.

Initially, arthroscopic surgery was undertaken in November 2002 when Ann was admitted to the Bristol Nuffield Hospital as a one night stay. Unfortunately, at that time, the arthroscopy demonstrated significant arthritis in the left knee. As a result of this, Ann underwent a left total knee replacement using the new Oxinium Profix knee in mid-January 2003.

Following surgery, Ann made excellent progress and was discharged from hospital only a week following the procedure. She had regained 100 degrees of knee movement after three weeks. At that stage, she had already reduced her requirement for analgesia to two Paracetamol tablets a day. Ann was delighted with her progress, and with regular exercise, physiotherapy and hydrotherapy sessions was unrestricted in undertaking most daily activities nine weeks following surgery and was able to play golf again after 12 weeks.

Mrs Taylor commented on the success of the operation:

"The Oxinium implant made it possible for me to have knee surgery at a young age. With a traditional implant, I would probably need a replacement implant later in life. It's only been a few months since the operation so it is still early days, but it is important to have good occupational health support such as physiotherapy, regular exercise and hydrotherapy to make sure the joint works properly. I'm now doing really well and have been able to get on with my life again as I'm out playing golf 12 weeks after the operation, walking around and I don't have the same degree of pain I had before surgery."

Mr Johnson suggested that "Ann's progress was excellent. She had no problems following the procedure, other than normal post-operative pain and swelling which resolved ove rthe first few days. Her rapid return to daily activities by three weeks and to golf by twelve weeks shows the excellent progress she has made. I now hope that she will experience up to twenty years of unrestricted benefit from this knee. Once again, the speed and extent of her recovery supports the view that use of the Oxinium Profix knee may be a significant advance.

How to arrange an appointment with Mr. Johnson

Your first appointment is usually arranged with Mr Johnson at the Bristol Nuffield Hospital at St Mary's. It is a modern well-equipped hospital with 36 private bedrooms and two operating theatres, and offers a full range of services.

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