Mr Ian Holloway

Mr Ian Holloway
Orthopaedic surgery
Central London


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Mr Ian Holloway

Orthopaedic surgeon in
London

MB BS FRCS(Tr and Orth)

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Mr Ian Holloway areas of expertise:

Professional statement

Mr Ian Holloway is a leading consultant orthopaedic surgeon in London, who specialises in hip and knee replacement surgery. He trained in London and was a senior trainee at the Royal National Orthopaedic Hospital.

Mr Holloway completed two specialist hip and knee fellowships in Sydney and Melbourne, Australia. He undertakes revision hip replacement for cases with significant bone loss and for periprosthetic fractures. He built his experience on the Bone Tumour Unit at Stanmore and treats patients with metastatic bone disease with an emphasis on early symptom control and aggressive rehabilitation.

Mr Holloway is a national and international speaker on enhanced recovery after hip and knee replacement. He has publications in the medical literature on hip and knee surgery and is also on the teaching faculty of a number of orthopaedic training courses. 

He is Deputy Training Programme Director for higher surgical trainees in the North West Thames region and is Clinical Lead for orthopaedics at the London North West Healthcare NHS Trust. He is a reviewer for the Bone and Joint Journal.

 Doctor's articles

Enhanced recovery pathway
Enhanced recovery pathways – getting ...

Read all articles by Mr Ian Holloway

 Credentials

GMC: ‍4072225

 Professional experience

• More than 25 years of experience
• Consultant Orthopaedic Surgeon, Cromwell Hospital (present)
• Consultant Orthopaedic Surgeon, Chelsea Outpatient Centre, Lister Hospital (present)
• Consultant Orthopaedic Surgeon, Fortius Clinic (present)

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 Sub-specialties

• Hip replacement
• Revision hip replacement
• Metastatic bone disease
• Periprosthetic fractures
• Knee prosthesis
• Hip osteoarthritis
• Arthritis
• Arthroplasty
• Bone metastases
• Hip
• Hip pain
• Hip prosthesis
• Hip replacement surgery
• Injuries diagnosis
• Joint injections
• Knee
• Knee arthroscopy
• Knee fracture
• Knee Osteoarthritis
• Knee replacement
• Medial collateral ligament
• Meniscus
• Metastasis
• Orthopaedic surgery
• Osteoarthritis
• Osteoarthritis of the hip
• Osteoporosis
• Osteosynthesis
• Patellar tendonitis (jumper's knee)
• Revision hip replacement
• Robotic surgery
• Second medical opinion

 ...

 Teaching posts

• Deputy training programme director North West Thames Orthopaedic higher surgical training programme.

 Education

• Entry to specialist register in Trauma and Orthopaedics (2007)
• Intercollegiate Examination in Trauma and Orthopaedics Intercollegiate Examination Board (2005)
• Fellowship of the Royal College of Surgeons of England (2000)
• University of London (MBBS) (1994)

 ...

 Publications and conferences

• Research published in the Medical Literature on the subject of hip and knee surgery.
• Publications in peer-reviewed journals.
• Presented at national and international meetings on enhanced recovery after hip and knee replacement.

 ...

 Professional membership

• Member of British Orthopaedic Association (BOA)
• Fellow of the Royal College of Surgeons of England (RCS)

Languages spoken

  • English

Patient reviews for Dr. Ian Holloway

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All reviews are from verified patients booked through Top Doctors.

Patient reviews

Verified Patient
09/04/2018

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Patients comments

Excellent, professional, everything works like clockwork, feel very confident

Verified Patient
17/02/2018

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Patients comments

Overall i experienced competence, courtesy and efficiency. i can recommend mr. holloway and the chelsea outpatient centre with confidence.

Verified Patient
09/02/2018

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Verified Patient
05/07/2017

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Diseases, Medical Tests and Treatments

Arthroplasty

What is arthroplasty? The term “arthroplasty” refers to any surgical procedure to restore the function of a damaged joint, often by replacing ...

Bone metastases

What is bone metastases? Metastasis is a process wherein cancer spreads from one part of the body to the other, affecting one or more organs. In bo ...

Hip replacement

What is it? A hip replacement is a type of surgery in which a degenerated hip is replaced with an artificial joint. There are different kinds of ...

Knee arthroscopy

What is knee arthroscopy? Knee arthroscopy is a minimally invasive procedure that allows access to and treatment of injuries affecting the various ...

Knee osteoarthritis

What is osteoarthritis of the knee? Osteoarthritis of the knee is a disease which mainly consists of a tearing of the articular cartilage, and it can be progressive. The disease is not exclusive to old age, however, the frequency of affliction increases with age. It is also more common in women than in men, and in people who are genetically predisposed to it. Although many of these factors are not preventable, it is possible to slow down its progression or to reduce the chances of it developing. There are two types of knee osteoarthritis: primary knee osteoarthritis, which is related to age, and secondary knee osteoarthritis, which occurs after a previous injury, such as a fracture and affects people with high levels of strenuous physical activity or those who are obese. Prognosis of knee osteoarthritis Although osteoarthritis is generally not a serious disease, it can gradually undermine the quality of life of those affected. Prognosis of the disease depends greatly on the pathology and its evolution. Early diagnosis and joint protection measures are key in helping to slow the progression and development of the disease. Pain and a lack of mobility are the main factors that have an impact on the person’s quality of life, causing it to decrease. The disease mainly affects people over the age of 50. It can make them more sedentary, which can result in obesity and the appearance of risk factors for conditions such as cholesterol, hypertension and diabetes, among others. Symptoms of knee osteoarthritis: The symptoms and manifestations of osteoarthritis are diverse, progressive and appear gradually over time. The most common symptom is joint pain with limited joint movement, accompanied by cracking sounds and sometimes knee joint effusion (also known as ‘water on the knee’). Some people may experience stiffness or joint deformity. The worst symptom is pain. In the early stage of the disease, pain occurs when you move or try to force the affected joint, and it subsides when you rest. As the disease progresses, pain can occur not only when you move the joint but also when it is being rested. However, joint pain is not constant, so you can go for long periods of time without any pain, although the disease continues to progress. How is knee osteoarthritis diagnosed? Osteoarthritis can be difficult to diagnose. Firstly, it should be noted that it cannot be diagnosed by X-ray, so a thorough medical history must be taken and a physical examination performed. If there is swelling in the knee, the specialist may decide to remove fluid from the joint to test it and to confirm the diagnosis. In addition to X-rays, a CT or MRI scan may also be used to diagnose knee osteoarthritis. What causes knee osteoarthritis? The cause of osteoarthritis is still unknown. However, there are a number of risk factors associated with its occurrence: Gender: osteoarthritis affects women between the ages of 50 and 55 in particular. Age: the risk of osteoarthritis increases after the age of 50 Genetics: it may be an inherited disease Strenuous physical activity: constant repetition of joint movements can lead to joint overload Menopause: decreased oestrogen levels are a risk factor for the development of the disease Obesity: this can aggravate osteoarthritis in joints such as the knees Trauma: fractures and injuries can trigger osteoarthritis. Can knee osteoarthritis be prevented? The main measures for preventing the onset of osteoarthritis are simple: eat a healthy, balanced diet and take regular, moderate physical exercise according to your age and physical condition. You should limit strenuous physical exertion, such as lifting or carrying heavy objects. Contact sports such as football and rugby are not recommended for people with osteoarthritis, as they can exacerbate the disease. Footballers are one of the groups most affected by this disease due to frequent meniscus injuries. Treatment for knee osteoarthritis The main objective of treatment for osteoarthritis is to improve pain and functional disability. The first step is awareness, as avoiding risk factors is essential for preventing or minimising the disabling effects of the disease. You will also have a personalised and adapted exercise regimen which you need to follow with the physiotherapist to help improve your condition. Anti-inflammatories: sometimes pain is severe due to inflammation of the area. In this case, anti-inflammatory drugs may be prescribed to reduce inflammation and relieve pain. Chondroprotective drugs: these are specifically indicated for the long-term treatment of osteoarthritis, as they act directly on the joint. They relieve pain and improve mobility, as well as attack the disease at the root by slowing its progression. Chondroprotectors include glucosamine and hyaluronic acid. Surgery: implant surgery will be recommended if the disease is very advanced; in this case, a partial or total knee implant. Which specialist treats knee osteoarthritis? There are several specialists that can treat knee osteoarthritis, including orthopaedic surgeons, rheumatologists and physiotherapists. ...

Osteoarthritis

What is osteoarthritis? Osteoarthritis is a degenerative conditions that affects the joints, causing them to become stiff and causing pain. Any of the joints in the body can be affected, but it more commonly affects the hips, knees, and small joints in the hands. It affects women more commonly than it does men, and is the commonest form of arthritis in the UK.   What are the symptoms of osteoarthritis? The most common symptoms of osteoarthritis are joint pain, difficulty in mobility, and stiffness or deformity in the joints. These symptoms vary depending on the patient and intensify in a progressive manner. Joint pain, the most common symptom, appears first with movement and ceases with rest, but as osteoarthritis progresses, the pain may also be present while resting. What are the causes of osteoarthritis? The causes of the onset of osteoarthritis are not currently known but there are a number of risk factors associated with it: Genetics: In more than 60% of cases, genetic inheritance influences the appearance of osteoarthritis. Physical activity: athletes and people who maintain high physical activity have a higher risk of suffering from osteoarthritis. Working day: those who perform repetitive joint movements in their working day can wear down the joints and overload them, which can trigger osteoarthritis. Menopause: osteoarthritis more commonly affects women who have reached menopause due to the decrease in oestrogen that occurs during this stage of life. Injuries: fractures and traumas in the joints can influence osteoarthritis. Obesity: although it does not directly cause the onset of osteoarthritis, obesity influences wear and tear of the joints and therefore the progression of the condition. Prevention of osteoarthritis To avoid risk factors and therefore prevent osteoarthritis, it is very important to eat a balanced diet, such as the Mediterranean diet, and perform regular moderate exercise, thus avoiding wear and tear of the joints. Avoiding obesity is important as carrying too much weight can be detrimental. Treatment of osteoarthritis The objective of the treatment is to avoid or reduce pain and improve mobility. To treat osteoarthritis, the medical specialist will recommend the patient a series of exercises to be performed which are adapted to their situation and abilities, often with the help of a physiotherapist. Pharmacological treatment: In most cases anti-inflammatories or analgesics are prescribed to reduce swelling and therefore pain. Chondroprotective medications may also be prescribed which may slow the progression of the disease. Surgical treatment: osteoarthritis in very advanced stages may require prosthetic surgery. ...

Arthritis

What is arthritis? Arthritis is a disease that causes inflammation of the membrane that covers the joints. There are more than 100 different types of arthritis, but the most common are: Osteoarthritis: the most common type of arthritis. It usually starts with age and affects the fingers, knees and hips. In some cases, it develops in areas where there was a previous hit or injury. Inflammatory arthritis: There are many types of inflammatory arthritis, the most common of which is rheumatoid arthritis, which occurs when the body's defenses do not work properly. It affects both joints and bones, often in the hands and feet.   What are the symptoms of arthritis? The symptoms of arthritis can be: Joint pain Joint inflammation Redness and heat of the skin around the joint Decreased ability to move the joint Joint stiffness, especially in the morning   What are the causes of arthritis? This pathology can be a consequence of: Bone fracture Autoimmune disease Infection by bacteria or viruses Joint wear Crystals (such as uric acid or calcium pyrophosphate dihydrate)   Can arthritis be prevented? Joint damage can be prevented with timely and adequate diagnosis and treatment. Also, if someone has a family history it is important to talk with the doctor, even if s/he does not have any symptoms. It is also recommended to avoid repetitive and excessive movements to prevent osteoarthritis.   What is the treatment for arthritis? The treatment aims to alleviate the symptoms and prevent the disease from getting worse. The treatment can be covered by several aspects: Lifestyle changes: this is the preferred treatment, since exercises help to reduce pain and fatigue, relieve stiffness and improve muscle and bone strength. The doctor can also recommend physiotherapy. Other measures may include sleeping 8-10 hours a day, not staying in the same position for a long time, eating a healthy diet, avoiding alcohol and tobacco, among others. Medicine: can be added to the changes in lifestyle. Surgery: is performed if the other treatment methods have not worked. The main intervention is arthroplasty, which consists of replacing the affected joint with an artificial one. ...

Hip

What is the hip? The hip is the joint where the thigh bone (femur) and the pelvis meet. It has two main parts: The “ball” at the end of the femur. The “socket” cavity in the pelvis. The hip is a spheroidal or “ball-and-socket” joint in which the ball of the femur fits inside the socket of the pelvis. As a result, the hips are very stable and permit a wide range of movement. The hip has a complex structure, owing to the weight it must bear and the essential function it performs. It is composed of: An extensive set of bones Ligaments Vessels Muscles What is the function of the hip? The hip is the joint that unites the upper body with the lower body. Therefore, its correct functioning is fundamental in allowing our body to move correctly. The hip is designed for mobility as well as stability. It enables the lower limbs to move in three planes, and also provides an important shock-absorbing function for the lower limbs and the upper body. What diseases affect the hip? Some of the diseases and conditions that can affect the hips are: Osteoarthritis of the hip Arthritis of the hip Hip fracture Congenital hip dysplasia Epiphysiolysis of the femoral head Snapping hip syndrome Hip dislocation Trochanteric bursitis Hip joint distension Treatment of hip problems can include rest, medications, physiotherapy or surgery, including hip replacement surgery. ...

Hip pain

What is hip pain? Hip pain is the discomfort that occurs in the hip or around it, including in the groin, thigh or knee. Pain in the hip can be accompanied by heat in the painful area, fever, swelling, or stiffness in the hip joint. You might find it difficult to walk or stand, bend over, or sit down without discomfort. What are the causes of hip pain? There are a wide range of things that can cause hip pain. Acute injuries or conditions affecting the hip in the short term include: hip fractures hip labral tears muscle strain infection in the bones or joints of the area Chronic conditions which can cause hip pain include: arthritis osteonecrosis bursitis snapping hip syndrome Finally, some conditions can affect the hip indirectly. One of the most common in older age is spinal stenosis, which can affect the nerves in the lower part of your spine and cause sharp pain down the hips and legs. Can hip pain be prevented? You can help protect your hip joint by: always warming up before exercise ensuring you have the correct walking equipment if you are unsteady on your feet to avoid falls avoiding exercises that elevate one hip over the other (running on uneven surfaces) warming up before each exercise using protective pads on the hip when playing contact sports maintaining a healthy weight strengthening your back and legs to support your hips with careful strength training Some conditions, such as spinal stenosis, cannot be fully prevented, and you may require medical treatment. What is the treatment for hip pain? The treatment will depend on the pathology that causes it. In most cases the first line of treatment is non-surgical and includes exercises, weight control, physical therapy, orthopaedic legwear, heat and cold therapy, and acupuncture, All of these aim to reduce the pain in your hip and improve your range of motion. In some cases, a pharmacological treatment is also required, which can include: over-the-counter painkillers non-steroidal anti-inflammatory drugs steroid injections In some cases, if the pain cannot be managed with conservative methods, surgery may be required, such as: hip resurfacing partial hip replacement full hip replacement These procedures are carried out by an orthopaedic surgeon. ...

Hip prosthesis

Hip prosthesis is a major surgery technique that involves replacing the damaged hip with an artificial joint. The characteristics of the materials used in this type of prosthesis allow mobility similar to that of the human joint. The materials used in these implants include: various metals such as stainless steel, cobalt, chromium and titanium alloys; plastic, usually polyethylene, a very durable and friction wear-resistant material. Hip replacement is recommended in cases of osteoarthritis of the joint or rheumatoid arthritis.  ...

Injuries diagnosis

How are sports injuries diagnosed? Some sports injuries are more easily diagnosed than others. More simple cases such as dislocations, cuts and grazes are diagnosed through seeing or feeling the injury. Cases that are more difficult, such as soft tissue damage, fractures and overuse injuries require an examination. The specialist will examine these the complex ones using X-rays, CT or MRI scans. The doctor will also ask questions about the patient’s medical history to identify any underlying issues. The patient may be referred to a specialist for a correct diagnosis.   What are the most common sports injuries? The most common sports injuries are: Ankle sprain Groin pull  Hamstring strain Shin splints Knee injuries such as ACL tear and Patellofemoral syndrome Tennis elbow   How are sports injuries tested? There are many different methods and tools used by sports medicine specialists to test for injuries. Shoulder (rotator cuff) injuries are best identified by observing and feeling the shoulder joint by using different movements. Injuries usually leave movement limited, therefore pain as a result of a range of movements can diagnose a specific type of injury. Strength tests can also identify any weakness in the joint. With cartilage tears in the knee, the doctor will apply pressure to see if there is any tenderness above or surrounding the cartilage. The knee may also be flexed and the doctor will listen out for a clicking or popping noise as the knee bends. This is known as the McMurray’s test and is performed when the patient is lying down. Ege’s test involves the patient squatting so that the specialist can check for a popping or clicking noise as the knee bends. There are several tests that are used to detect a ligament tear or strain in the knee. These include the Lachman test, the anterior draw test and the dial test. Most of these tests involve applying pressure to the knee joint and moving and bending the knee. The extent of the injury is usually determined by the movement or positioning of other parts of the legs and the location of the pain.   What are the different types of diagnostic testing? Diagnostic testing helps doctors to understand specific sports injuries. These tests include X-rays, CT scans, ultrasound and MRI scans.       ...

Joint injections

Joint injections are a treatment against joint pain that involves the injection of anti-inflammatory drugs and analgesics to improve joint mobility. It is a quick and simple technique, is minimally invasive, and produces longer-lasting effects compared to those obtained through a drug administered orally or intramuscularly.  ...

Knee

The knee joins the thigh to the lower part of the leg, connected by two joints. One is the tibiofemoral joint, between the femur and tibia, while the other is the paletellofemoral joint, between the femur and patella. The knee is the largest of the joints in the human body, but it is also one of the most easily injured. What is the knee made up of? The knee is made up of bone, ligaments, tendons, and ligaments. They work together to allow the knee to move smoothly and support the body. The knee joint is complex, and therefore it can be injured in a manner of different ways. Common knee injuries Some of the more common knee injuries include: Fractures Ligament injuries (such as anterior or posterior cruciate ligament injuries) Tears in tendons or meniscus Dislocation Symptoms of a knee injury The knee can be injured in many ways, but some of the most common symptoms include pain, especially while walking or moving, a feeling of instability, and swelling in the knee or around it. If you are in severe pain, cannot move your knee, have significant swelling, or cannot walk without limping, you should seek immediate medical attention. Treatment of knee injuries Treatment of knee injuries depends on the type of injury and the part of the knee affected. Some knee injuries can be treated through methods like physiotherapy or medication. Some can be treated simply by immobilisation – meaning you cannot move your knee. Usually in these cases a cast or brace will be fitted to ensure protection and help it to heal. In some cases, surgery may be the best course of treatment. Most surgical procedures these days are minimally invasive, using very small instruments and making minimal incisions, which usually allows for a faster healing process. In some cases, some injuries may need to be treated with open surgery which requires a larger incision.  ...

Knee fracture

What is a knee fracture? A knee fracture is a break or rupture in a bone in the knee joint. These bones are usually injured by falls, traffic accidents, contact sports and physical exercise. Prognosis: Depending on the severity of the fracture, some knee fractures can heal without the need for surgery, and conservative measures will suffice. However, bigger fractures will need surgery and a more lengthy recovery period with attention needed to physical therapy. Symptoms of a knee fracture: Symptoms of a knee fracture include: Joint pain and tenderness Swelling and inflammation, with the possibility of bruising Limited range of motion An inability to walk and move properly or place pressure on the affected knee Medical tests for knee fractures: Firstly, a detailed physical examination will take place. Next, the following will be carried out to determine the severity and location of the fracture: X-ray CT scan MRI scan What causes a knee fracture? The causes of knee fractures can be very varied. As mentioned above, many result from sports and physical activities. They can also occur following a fall or accident. Osteoporosis can also increase the risk of knee fractures. Can knee fractures be prevented? A knee fracture is difficult to prevent, unless certain sports or physical activities are avoided entirely. However, this is not realistic, but it is important to play physical sports with care, avoid poorly lit areas to not trip over, organize your house to avoid accidents, and wear a seat belt to minimise the possibility of knee fractures resulting from car accidents. Treatments for knee fracture Treatment of a knee fracture depends on the fractured bone and the type of fracture. If the parts of the bones are well aligned, a brace or cast on the knee may be enough. If the kneecap is affected, surgery may be necessary. Therefore, recovery from the injury depends on the fractured bone, the type of fracture, the treatment, and its progression. Which specialist treats you? Orthopaedic surgeons treat knee fractures. ...

Knee replacement

What is knee replacement surgery? Knee replacement surgery is a procedure that involves removing and replacing a damaged or worn knee joint with an artificial implant. An implant is placed in the damaged structure and replaces its function, allowing you to move the joint again, eliminating any pain you might have had before. During the operation, the damaged bone and cartilage are removed. For this purpose, either a general or regional anaesthetic will be administered. The anaesthetist and orthopaedic surgeon will decide which to use in order to minimise discomfort as much as possible. Why is knee replacement surgery performed? The main reason for knee replacement surgery is because of osteoarthritis of the knee, which damages the joint. A knee prosthesis or implant may also be required in the case of fractures that have caused significant damage to the subchondral bone, or in the case of specific bone tumours. What does knee replacement surgery involve? Knee replacement surgery takes around two hours and involves removing the damaged cartilage and bone from the joint and replacing them with artificial implants. These implants can be placed in different parts of the knee: the lower end of the femur (metal piece), the upper end of the tibia (piece made of strong plastic and metal), or at the back of the kneecap (made of strong plastic). Once the anaesthetic has been administered, the orthopaedic surgeon will make an incision of around 20 cm long in the joint to open it. The procedure is as follows: The patella is removed and a cut is made in the end of the femur and tibia to accommodate the prosthesis in the joint space The lower part of the kneecap is also cut so that the new piece fits well The two parts of the prosthesis are fixed to the different bones, one to the femur and the other to the tibia, using cement or screws The tendons and muscles of the joint are repaired and the incision is closed. Depending on the injury and the amount of bone removed, the knee replacement may be: Total or tricompartmental: the joint and kneecap are completely replaced. This is carried out with rigid axis prostheses (rarely used because they only allow a single movement, flexion-extension), joint surface replacement prostheses (isolated resection of the damaged joint), prostheses with linked components (these provide good stability due to the link between the tibia and the femur, as well as flexion-extension and rotation movements, but they are no longer used) and self-supporting prostheses (these replace the damaged surface and their design provides stability and functionality. The most common type is the medial pivot prosthesis). Unicompartmental : used for limited joint injuries. The prostheses usually have a metal femoral component that is placed in the damaged femoral condyle, and a polyethylene component that is placed in the tibial part. Preparing for a knee replacement: The orthopaedic surgeon and anaesthetist will advise you on what you need to do before the procedure. You must tell them about any medication you are taking, so that it does not interfere with the outcome of the surgery. The specialist will perform a series of preoperative tests, such as an electrocardiogram, MRI scan, x-rays and other procedures that will make the surgery easier and allow them to access the joint with full knowledge of the injury. Post-operative care: After knee replacement surgery, you must strictly follow the advice of the surgeon and physiotherapist for a complete and successful recovery. The physiotherapist will design a series of personalised exercises for you, adapted to the type of injury. These exercises will increase in intensity as the mobility of the joint increases. The objective is to regain and increase muscle strength, correct any instability or deformity, relieve any pain you may have, eliminate any scar adhesions and improve your physical function. The rehabilitation process also includes a number of other recommendations: to alternate flexion and extension movements when sitting, wear comfortable and well-fitting footwear, avoid sudden changes in weight to avoid overloading the joint, remove any furniture that may cause you to stumble or fall, do exercises at home (as recommended by the specialist), apply ice to the area after rehabilitation exercises, follow the instructions of the specialist for sitting, walking and going down stairs and, above all, keep the wound clean and disinfected. Alternative treatments: There is no alternative to knee replacement surgery. It is only performed in extreme cases, when the joint is severely damaged and the injury cannot be resolved with other procedures or treatments. The specialist will study the injury and decide on the best treatment or alternative. ...

Medial collateral ligament

What is the medial collateral ligament? The medial collateral ligament, also called the tibial collateral ligament, is one of the four most important ligaments of the knee. It extends from the inside of the lower thigh bone to the inside of the upper shin bone. Function of the medial collateral ligament: The medial collateral ligament provides stability to the knee and limits its movement from side to side. Injury to the ligament often results in a partial or complete tear or excessive stretching of the ligament. Pathologies of the medial collateral ligament: You may have damaged the medial collateral ligament if you have pain in the inner part of the knee, if the knee feels unstable and you think it might give way or become locked, or if you feel pain when bending or stretching the knee or when walking. Most injuries to the medial collateral ligament can occur if the lower leg is moved outward at the knee; if a blow is received to the lower outer thigh; or if you put one foot ahead of the other to increase momentum (in skiing, for example). This causes total or partial ligament distension due to the excessive stretching of the ligament by forcing the joint beyond its range of motion. This injury, which is very common in athletes, is known as a sprain or tear of the medial collateral ligament of the knee. It is common in football players but also in sports such as skiing, handball and rugby. There are different grades of injury: Grade I: There is moderate pain, little swelling, and you can move the joint. Grade II: You feel pain, accompanied by instability, inflammation and a loss of function. Grade III: Joint function is severely affected, with high instability, swelling, and pain. Treatments for pathologies of the medial collateral ligament: Treatment for a medial collateral ligament injury will depend on its stage. Thus, for grade I injuries, treatment will normally be conservative. This involves immobilising the joint and rehabilitation. For grade II and III injuries, the orthopaedic spealist should study the injury on an individual basis and decide whether definitive conservative treatment or a surgical procedure is most appropriate. Physiotherapy is essential for a complete recovery. The main objective is to reduce pain and inflammation so that you can walk correctly, and also do exercises with contrast hydrotherapy and electrotherapy without feeling pain. Hydrotherapy is also extremely helpful since it reduces stress during therapy and allows for painless movements against water resistance, which also strengthens the muscles. The physiotherapy exercise programme should aim at increasing knee flexion, recovering stability and gaining muscle. To this end, the exercises will be gradually increased. Also recommended is deep transverse friction massage of the muscle fibres, to promote the reorganisation of the ligament fibres and greater tissue regeneration, enabling nutrients to pass through more easily. Some specialists also recommend platelet-rich plasma therapy. These are proteins that are naturally made by your body and help repair and regenerate tissues after injury. Thus, after extracting a small amount of blood from your body, it is treated and platelet-rich plasma is obtained, which is then injected directly into the injury. Which specialist treats pathologies of the medial collateral ligament? Various specialists treat injuries to the medial collateral ligament. Thus, it is mainly orthopaedic surgeons specialising in knee problems who will assess the severity of the injury. However, depending on the injury grade, the physiotherapist may also be involved in treating pathologies of the medial collateral ligament. ...

Meniscus

What are the menisci (meniscus)? The menisci are two fibrocartilage structures located inside the knee. They improve joint function, acting like shock-absorbing cushions that help disperse the weight of the body and absorb forces exerted on the knee. They give the knee stability and play a key role in the proper functioning of the joint. The knee joints are among the most vulnerable joints of the body and can suffer serious injuries. They need to be able to withstand great pressure and to absorb and dissipate forces, which makes their role fundamental. Function of the menisci: The menisci have various functions: To absorb the shock waves generated when you walk or run. The menisci can absorb almost 20% of these shock waves. Force transmission: the fibres that make up the meniscus enable the transmission of compressive force by up to 50% when the knee is extended, and by up to 90% when the knee is bent. Joint stability: if the knee buckles, this may be due to laxity or tearing of the anterior cruciate ligament. Knee stability is influenced by the meniscus, the quadriceps and hamstring muscles. Proprioception: the menisci help to increase proprioception. Joint slippage: they contribute to the lubrication of the joint due to their shape and high water content. Pathologies of the menisci: Certain movements of the knee can cause injuries to the menisci, when they do not follow the movements of the femoral condyles over the tibial plateau. This happens if, for example, the knee is suddenly extended, which is very common in football players. In this case, there is no time for the meniscus to move forward, so it is trapped between the femoral condyle and the tibial plateau. Another type of injury is distortion of the knee joint, with external rotation and lateralisation, causing the meniscus to slide under the convexity of the internal condyle, resulting in a longitudinal tear of the meniscus. Moreover, a torn internal ligament can also lead to a torn meniscus. Meniscus tears are one of the most common injuries. Although common in athletes, anyone can suffer this injury. There can be different types of tears, but the most common tears are longitudinal, parrot beak, flap, bucket handle and mixed/complex. In the case of sports injuries, these are usually accompanied by ligament injuries. Treatments for meniscus pathologies: Conservative treatment is recommended for this type of injury, which is sometimes sufficient for meniscus tears, giving the knee time to heal itself. This process is known as RICE, which stands for rest, ice, compression and elevation. It may be supplemented with anti-inflammatory medication to reduce pain and inflammation. However, surgery may sometimes be necessary if symptoms do not abate. In this case, the orthopaedic surgeon will usually recommend knee arthroscopy. During arthroscopy, a mini camera is inserted into the knee through a small incision, allowing visualisation of the inside of the joint. The specialist will make two or three other small incisions to access the knee and repair the injury. After surgery, the specialist will immobilise the knee. When the wounds have healed somewhat, you should start rehabilitation exercises to restore joint mobility and strength. Which specialist treats meniscus pathologies? Orthopaedic surgeons treat problems relating to the knee and the menisci. ...

Metastasis

What is metastatis? Metastasis is a process wherein cancer spreads from one part of the body to the other, affecting one or more organs. This may also be known as ‘secondary’ cancer, and is a late stage, meaning metastatic cancer has a lower possibility of being cured. How does metastatis happen? Cancer can spread from the primary cancer site to other areas of the body through the lymphatic system or through the bloodstream. Cancer cells spread from one organ to another in this way, and tumours then form in other parts of the body. This does not create a new cancer, but rather is a metastised form of the orginal cancer, e.g breast cancer which spreads to the lung does not become lung cancer, but is metastatic breast cancer. What are the symptoms of metastatic cancer? Metastatic cancer does not always show symptoms. If they are present, the symptoms of metastatic cancer depend on where the cancer has spread to and how large the tumours are. Symptoms may include bone fractures and pain (when the cancer has spread to the bone), headaches, seizures, and dizziness (when the cancer has spread to the brain), being short of breath (spread to the lungs), and jaundice or swelling in the abdomen (spread to the liver). What is the treatment for metastasis? Once cancer has started spreading, it is difficult to then control it and treat it. Some metastatic cancers can be treated, but most cannot. The mainstay of treatment in cases where the cancer cannot be cured is to slow the growth of the cancer or to reduce or relieve the symptoms caused by it. Treatment for metastatic cancer depends on the primary cancer form and where the cancer has spread. Is metastasis preventable? The risk of secondary cancer developing depends on many factors, such as the type of cancer and the age the patient develops the cancer. While secondary cancer can develop, it is important to note that the risk is relatively small. It is not yet possible to entirely prevent metastasis.   Which specialist treats metastatic cancer? Cancer is often dealt with by various specialists as different specialties are involved in different areas of the treatment – for example, if surgery is necessary, a surgeon will be involved in treatment. However, the doctor who assesses, diagnoses and treats cancer is an oncologist. ...

Orthopaedic surgery

What is orthopaedic surgery? Orthopaedic surgery is the field of surgery responsible for diagnosing and treating a wide range of conditions of the musculoskeletal system, as well as for reducing the symptoms of any conditions affecting it. These conditions can affect the bones, cartilaginous structures or the joints. What conditions does orthopaedic surgery treat? Some of the conditions treated by orthopaedic surgery include: Foot injuries: metatarsalgia, bunions, cavus foot, flat foot, hammer toe; Hand injuries: scaphoid bone fracture, carpal tunnel syndrome, De Quervain syndrome, thumb arthrosis (trapeziometacarpal osteoarthritis), stenosing tenosynovitis (trigger finger); Knee, kneecap and ligaments injuries, as well as knee osteoarthritis; Shoulder injuries (shoulder impingement syndrome or swimmer's shoulder); Hip injuries (hip osteoarthritis). What are the sub-specialisations of orthopaedic surgery? Emergency or trauma surgery can be regarded as a sub-specialisation of orthopaedic surgery. This type of surgery treats people who’ve suffered a traumatic injury (thus, an acute trauma). A few examples of traumatic injuries include: Incision or laceration wounds; Gunshot wounds; Car accidents; Several types of domestic accidents; Work-related accidents. When do I need to see an orthopaedic surgeon? If you have one of the above-mentioned conditions, you should see an orthopaedic specialist, who will determine whether or not you need surgery. Should the orthopaedic specialist also be a surgeon, he or she will be the one performing the surgery (if needed). ...

Osteoarthritis of the hip

What is hip osteoarthritis? Hip osteoarthritis is a degenerative disease of the cartilage that covers the joint of the pelvic and femoral bones. This tissue facilitates movement between the bones and prevents them from rubbing against each other directly. When the cartilage decreases in thickness and texture, or is lost completely, the mechanism between the femur and the pelvis no longer functions correctly, resulting in hip osteoarthritis. Hip osteoarthritis can vary in severity, from mild to severe. Prognosis: Hip osteoarthritis is a chronic disease and usually progresses slowly over many years. It is one of the most common types of osteoarthritis. Symptoms of hip osteoarthritis: The main indicator of this condition is pain, which is primarily located in the groin area. Symptoms such as stiffness and impaired functionality (mobility) may also be present. The pain may sometimes radiate down the front of the thigh and also affect the knees, which might lead you to think that the problem is with the knee. Medical tests for hip osteoarthritis: In order to diagnose hip osteoarthritis, the specialist will: Ask questions about your symptoms and ask you to describe them. Examine the hip joint and its movements. This enables the specialist to assess the degree of osteoarthritis. X-ray the hip, to confirm the diagnosis. MRI scans may also be used. What causes hip osteoarthritis? The causes of hip osteoarthritis are numerous and results from a combination of genetic and environmental factors. Some of the secondary factors that cause hip osteoarthritis, either combined or in isolation, are: Obesity Older age Professional activity Excessive strain on the joint due to high-intensity sport Malformations Can hip osteoarthritis be prevented? One of the causes for the onset of hip osteoarthritis is ageing, making it impossible to avoid the disease. However, onset of the disease can be significantly delayed. The main actions you can take to try to prevent hip osteoarthritis are to: Lose weight Do physical exercise. This includes exercising the hip joints. Avoid movements that cause pain Use canes or crutches Follow a good diet. Treatments for hip osteoarthritis: There is currently no treatment that can cure osteoarthritis, but it can relieve symptoms, slow the progression of the disease and improve quality of life. There are several alternatives available: Weight control Correction of anatomical malformations or alterations Physical exercise Medication Surgery: replacement of the joint with an implant. This is usually performed for severe cases of the disease. Physical measures and medication can be considered conservative treatments, the aim of which is to minimise pain and immobilisation and to slow down the progression of the disease as much as possible. Which specialist treats hip osteoarthritis? Rheumatologists and orthopaedic surgeons would diagnose and treat hip osteoarthritis. ...

Osteoporosis

What is osteoporosis? Osteoporosis, meaning “porous bone”, is a disease in which the bones become weak and brittle due to the body either losing too much bone or making too little. On a microscopic level, the structure of healthy bone resembles a honeycomb, with hollows and spaces. In bones affected by osteoporosis, these hollows and spaces are much wider, meaning the bones are less dense, and therefore weaker than they should be. This makes them susceptible to breaks and fractures.   Symptoms of osteoporosis Most of the time, a person will not realise they have osteoporosis until they break or fracture a bone. The hip and wrist are the most common places that fractures occur, while spinal fractures are also relatively common. Stooped posture (in older people) and particularly significant loss of height (>2 inches) should always prompt investigation for osteoporosis.   Medical tests to diagnose osteoporosis The DEXA or DXA scan is a reliable method to measure bone mineral density using a low-intensity X-ray. It is painless, straight-forward, and involves minimal radiation – in fact, the operator sits in the same room as the patient. After the scan is done, the results are compared to that of a young, healthy individual, and based on accepted criteria a diagnosis of osteoporosis may be made.   What are the causes of osteoporosis? Losing bone is a natural part of getting older, but some people will lose bone density faster than others. In general, women have a higher risk of getting osteoporosis than men, especially in the years following the onset of the menopause, when bone density is lost more rapidly. Things that can increase the risk of osteoporosis include: A family history of osteoporosis Certain other medical conditions, e.g. inflammatory conditions, malabsorption problems, some hormone-related conditions, etc. Certain medications  (corticosteroids in particular). Heavy drinking and/or smoking Low BMI (body mass index)   Can osteoporosis be prevented? While it is impossible to prevent a condition like osteoporosis with 100% certainty, you can lower the risk of getting the disease by taking steps in your lifestyle to keep your bones healthy: Regular exercise Diet - a healthy, calcium-rich diet, and vitamin D supplementation Give up smoking and reduce alcohol intake.   Treatments for osteoporosis Treating osteoporosis revolves around treating fractures caused by the condition and trying to improve bone strength, which may involve medication. Your doctor will advise you on treatment depending on the results of your DXA scan and the cause of your osteoporosis. Most of the therapies available slow down the rate of bone loss and decrease fracture risk except for parathyroid hormone analogues which effectively stimulate bone formation. Possible treatments include: Biphosphonates to slow the rate of bone loss HRT  – in menopausal women Testosterone treatment – if osteoporosis is a result of hypogonadism in men. Selective oestrogen receptor modulators (SERMs) Denosumab (Prolia) – subcutaneous injections at six monthly intervals Parathyroid hormone analogues – delivered via subcutaneous injection, this hormone can actually increase bone density   Which type of specialist treats osteoporosis? Endocrinologists and rheumatologists treat osteoporosis. ...

Osteosynthesis

What is osteosynthesis? Osteosynthesis is a type of reconstructive surgery aimed at stabilising and joining the ends of a broken bone after a fracture, an osteotomy, or a non-union from a previous fracture. Bone fragments are stabilised by using mechanical devices. This allows for a complete or partial healing of the muscles and joint function. Once the bone fragments are stable, the mechanical device can either be removed or left in (if the procedure consisted of an internal fixation).   What is osteosynthesis for? Osteosynthesis is mainly done after a bone fracture. One of the fractures most commonly treated by osteosynthesis is the femoral fracture, although osteosynthesis can be used for many others as well. In the case of lateral fractures (a type of ankle fracture), this procedure can heal quickly the affected bone. It is particularly suitable for young people. Osteosynthesis can also be used to treat bone non-union. This is when a broken bone fails to heal following a fracture. Several factors can increase the risk of this happening, such as increasing age, a diet lacking in calcium, vitamins and proteins, smoking, diabetes, anaemia, an ongoing infection and taking painkillers or corticosteroids.   What does it involve? There are two types of osteosynthesis: External osteosynthesis – that is, by using an external fixator. This method can be used if you have a compound fracture, which has a high risk of infection. Internal osteosynthesis – there are two kinds of internal osteosynthesis: open reduction internal fixation (ORIF) and closed reduction internal fixation (CRIF). ORIF consists of open surgery to set the bones, while CRIF involves reduction without open surgery to achieve the same ends. Next, mechanical devices like pins, plates, or screws are used to fix the bones together. Another procedure consists of intramedullary osteosynthesis, which allows for better adherence and faster healing, since the mechanical device (usually a nail) passes through the medullary cavity.   Post-operative progress It is fundamental that you undergo physical therapy after the surgery. This is also true for every type of bone fracture. Physical therapy can include muscle strengthening exercises, stretching and functional recovery exercises. ...

Patellar tendonitis (jumper's knee)

What is patellar tendonitis? The patellar tendon, which connects the kneecap to the tibia, works with the muscles in the front of the thigh to extend the knee and allow running, jumping, walking, etc. Patellar tendonitis (also known as jumper's knee) is when this tendon is injured or overloaded. This condition is more common in athletes whose sport involves frequent jumping, such as basketball and volleyball. However, non-athletes can also develop patellar tendonitis. Prognosis: Patellar tendonitis is not usually a serious injury, but it must be treated correctly so that it does not lead to anything else or long-term problems. Symptoms of patellar tendonitis: The main symptom of patellar tendonitis is pain, and may occur during physical activity or after intense training; it may worsen to the point of making it difficult to practice sports; or may make daily movements (such as climbing stairs) difficult. There may also be stiffness in the knee, pain when bending, or weakness in the leg. Medical tests for patellar tendonitis: The following tests are usually used to diagnose patellar tendonitis: MRI scan : a test that uses magnetic waves to make detailed pictures of the area which may show changes in the tendon Ultrasound: this uses sound waves to create a picture of the knee and show possible tears of the tendon. X-ray : to help exclude other bone problems related to the knee pain. What causes patellar tendonitis? Patellar tendonitis is usually caused by repeated stress on the patellar tendon. This causes tears in it that increase over time causing pain, inflammation and weakening of the tendon. Can patellar tendonitis be prevented? Different steps can be taken to try to prevent patellar tendonitis, such as: Strengthen muscles with exercise Improve your technique when playing sports Not exercising when suffering from pain Treatments for patellar tendonitis: Treatment usually begins with physical therapy to stretch and strengthen the muscles around the knee. A strap may also be applied to the patellar tendon that puts pressure on it and helps to distribute strength, relieving pain. Medications are also prescribed, corticosteroids and surgery is the last option. Which specialist treats you? An orthopaedic surgeon would treat cases of patellar tendonitis. ...

Revision hip replacement

What is revision hip replacement? Hip replacement surgery is a very successful procedure and many patients undergoing a total hip replacement do not experience any problems. Over time, however, it may become necessary for hip replacements to be revised and for further surgery to be performed.   Why is it done? Most hip revision surgeries are done because the hip has become loose, due to the ball wearing the socket down. This leads to inflammation and the loosening of the socket. Often patients who have had a hip replacement at a young age and those who partake in a lot of physical activity will need a revision hip replacement sooner. Other reasons that a hip replacement needs to be carried out are: The hip has become dislocated due to an infection A fracture has caused the hip replacement to require a revision Malalignment; the original implant was positioned incorrectly What does it involve? Revision hip surgery is a major surgery that can take 3 or more hours. It involves the removal of the old hip and replacing it or restoring the damaged bone. Most patients will be catheterised during the operation, and the catheter will be removed 2 to 3 days after the operation. Revision hip surgery is more complex, which means that complications can occur more frequently. How do I prepare for it? One to two weeks before the surgery, you will be brought into the hospital for an assessment. Routine tests, such as blood tests, urine tests and MRSA screening will be carried out at the hospital. On the day of the surgery, your surgeon will answer any questions that you have and you will meet with the anaesthetist. Post-operative care After the operation, your surgeon and physiotherapist will decide how quickly you can bear weight on the hip. Your physiotherapist will teach you how to safely get in and out of bed, the bathtub and car. You will be asked to wear compression stockings for the next six weeks to reduce the risk of developing a blood clot. It will be advisable to sleep on your back and to avoid bending at the hip, twisting your waist and crossing your legs. When you can safely walk and your wounds are clean and have healed, you will be discharged. Most patients go home 5 to 6 days after the surgery. It generally takes about 6 weeks for patients to walk with one stick and most patients return to work after about eight weeks, depending on how much revision surgery was required. ...

Robotic surgery

Robotic head and neck surgery is one of the latest technological advances in surgery. This novel technology helps overcome restrictions present with conventional surgical techniques. Surgery is not performed by a robot but by the surgeon using robotic technology. Robotic surgery permits access to small spaces and removes all natural hand tremor. It permits precision surgery in real time using a 3D visual field. ...

Second medical opinion

What is a second medical opinion? A second medical opinion is when you consult with a doctor that is not your regular doctor about a potential diagnosis and/or treatment plan. There is no legal right to a second opinion, however, it is rare for a doctor to refuse. Why would you get a second medical opinion? Patients may consider a second medical opinion if they are facing a new diagnosis or recommended treatment because sometimes this can feel confusing and a second opinion can put their mind at ease. In addition, there are certain situations where a second medical opinion is sought after: Potential treatment is risky and could be life-changing or the diagnosis is possibly life-threatening The diagnosis is not clear-cut If you are considering a new treatment approach that is experimental The aims of obtaining a second medical opinion are: To confirm whether a diagnosis is correct and/or appropriate. To confirm whether a suggested treatment is correct and/or appropriate. To compare information received from each doctor so that you can make an informed decision – sometimes a second medical opinion can rule out the need for a potentially unnecessary invasive procedure. Possible disadvantages of seeking a second medical opinion include: The process can delay the start of treatment. Logistically, seeing another specialist might be difficult and possibly time-consuming. It might be stressful to hear the same diagnosis again. How would you seek a second medical opinion? You can request a second medical opinion from your GP or consultant, but before doing so it is recommended that you ask for as much clarification and explanation about the initial diagnosis and treatment, before seeking a second opinion. Obtaining a second medical opinion does not mean that the second doctor will then take over – if that is what the patient decides, then this needs to be agreed formally between doctors and hospitals.  ...

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Source: All information contained on this page as well as office hours available, are provided directly by the doctor who has the ability to update them at all times in order to keep the information as accurate as possible.
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