Hip & Knee Conditions & Treatments
Mr Kosuge offers specialist assessment and treatment for the full range of hip and knee conditions listed below. He sees patients privately at The Rivers Hospital, Sawbridgeworth, and on the NHS at The Princess Alexandra Hospital, Harlow. Patients travel from across West Essex and East Hertfordshire — including Bishop's Stortford, Epping, Hertford, Chelmsford, and Ware — to receive specialist orthopaedic care.
For each condition, Mr Kosuge begins with a thorough assessment and explores all appropriate non-surgical options before considering surgery. Where surgery is required, he uses evidence-based techniques and provides detailed pre- and post-operative support throughout your care.
Hip Conditions
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Avascular necrosis is loss of blood supply to the ball of the hip (the femoral head), which can weaken and collapse the bone. Early on it may be painless, but it typically progresses to deep groin or buttock pain that is worse on weight- bearing, and, if untreated, to hip arthritis. It is also known as osteonecrosis or AVN of the hip.
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A shallow or poorly formed hip socket, present from early life, which leaves the joint less stable and overloaded. In adults it often causes groin pain, a sense of the hip giving way, and early osteoarthritis. It is sometimes called hip dysplasia or an adult shallow hip socket.damage.
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An injury to the muscles or tendons of the inner thigh where they attach around the groin, common in football, running and other sports that involve twisting or kicking. It causes inner-thigh or groin pain that is worse when bringing the legs together or pushing off, and is often described as a pulled groin or adductor strain.
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Pain over the bony point on the outer side of the hip, coming from the gluteal tendons and the overlying bursa rather than the joint itself. It is typically worse lying on that side, climbing stairs or standing for long periods. It is also known as trochanteric bursitis or outer hip pain.
Patient Information Leaflet from Mr Kosuge →
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A strain or tear of the hamstring muscles at the back of the thigh, ranging from a minor pull to a complete tear off the bone near the hip. Symptoms include sudden sharp pain at the back of the thigh or buttock, bruising and pain on bending the knee or sitting. It is also searched as a pulled hamstring or hamstring tear.
Patient Information Leaflet from Mr Kosuge →
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A tear of the labrum, the rim of cartilage around the hip socket, and a common cause of groin pain and clicking in active adults. Read more on Mr Kosuge's webpage.
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A very common problem that can closely mimic hip pain, with aching or stiffness in the lower back that sometimes refers into the buttock and thigh. Telling back-related pain apart from true hip pain is an important part of the assessment, because the treatment is different. It is often searched as lower back pain or sciatica.
Patient Information Leaflet from Mr Kosuge →
British Association of Spine Surgeons →
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Burning pain, numbness or tingling over the outer thigh, caused by compression of the lateral femoral cutaneous nerve near the front of the hip. It is often linked to tight belts or waistbands, weight change or pregnancy, and the skin can feel sensitive to touch. It is sometimes spelt meralgia paresthetica or described as outer thigh numbness.
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Wear of the hip joint and the most common reason for hip replacement in the UK, typically causing groin pain and stiffness that worsen with activity. Read more on Mr Kosuge's webpage.
American Academy of Orthopaedic Surgeons →
American Academy of Orthopaedic Surgeons (Animation Video) →
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An audible or palpable snapping around the hip, usually from a tendon flicking over bone as the hip moves. It is often painless and harmless, but in active people and dancers it can become sore and feel as though the hip is catching. It is also known as snapping hip syndrome or dancer's hip.
Knee Conditions
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A common cause of pain on the outer side of the knee in runners and cyclists, caused by the iliotibial band rubbing against the thigh bone. The pain is typically sharp or burning, comes on at a predictable point during activity and eases with rest. It is also searched as ITB syndrome or runner's knee.
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A tear of the meniscus, the knee's shock-absorbing cartilage, causing joint-line pain, swelling and sometimes catching or locking. Read more on Mr Kosuge's webpage.
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The most common reason for knee replacement, causing activity-related pain, stiffness and reduced movement as the joint wears. Read more on Mr Kosuge's webpage.
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Damage to the smooth cartilage lining the knee — either the cartilage alone (a chondral injury) or the cartilage together with the bone directly beneath it (an osteochondral injury) — often following a twist, impact or sports injury. It causes localised pain, swelling and a sense of the knee catching or giving way, and a loose fragment can sometimes form within the joint; if left untreated it can lead on to osteoarthritis. It is also searched as chondral damage, knee cartilage damage or an osteochondral defect (OCD lesion).
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Pain and degeneration of the patellar tendon just below the kneecap, common in sports that involve jumping, sprinting or changing direction. It causes pain and tenderness at the front of the knee that is worse on jumping, squatting or going down stairs. It is widely known as jumper's knee.
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A common cause of aching pain at the front of the knee or around the kneecap, caused by the way the kneecap moves against the thigh bone. It is typically worse on stairs, squatting, kneeling or after sitting for a long time. It is also known as runner's knee or anterior knee pain.
Patient Information Leaflet from Mr Kosuge →
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Inflammation of the bursa on the inner side of the knee, just below the joint line, often occurring alongside knee osteoarthritis or in runners. It causes pain and tenderness on the inner knee that is worse climbing stairs or getting up from a chair. It is also searched as inner knee pain or pes anserinus bursitis.
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Inflammation of the bursa in front of the kneecap, usually from repeated or prolonged kneeling, which causes a tender, sometimes visibly swollen lump over the front of the knee. It is commonly known as housemaid's knee or kneecap bursitis.
Patient Information Leaflet from Mr Kosuge →
Hip Treatments
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Mr Kosuge explores non-surgical options first for most hip problems — pain- relieving medication, physiotherapy and targeted exercise, weight management and, where appropriate, injections. For many patients these control symptoms well and either delay or avoid surgery altogether.
Chartered Society of Physiotherapy →
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An image-guided injection of corticosteroid and local anaesthetic into the hip, used both to pinpoint whether the joint is the true source of pain and to relieve it. The diagnostic information it gives is often as useful as the pain relief when planning treatment.
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A joint-preserving procedure for early avascular necrosis of the hip, in which pressure within the femoral head is relieved to improve blood flow and slow or prevent collapse of the bone. It is sometimes combined with bone graft or stem cells, and is most effective when the condition is caught early.
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One of the most successful operations in medicine, replacing the worn hip with an implant to relieve pain and restore movement. Read more on Mr Kosuge's webpage.
Versus Arthritis patient information booklet →
American Academy of Orthopaedic Surgeons (Animation Video) →
International Cartilage Regeneration & Joint Preservation Society (Animation Video) →
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Surgery to replace a previous hip replacement that has worn, loosened or failed — an area of particular expertise for Mr Kosuge. Read more on Mr Kosuge's webpage.
American Academy of Orthopaedic Surgeons →
American Association of Hip and Knee Surgeons (Patient Guide) →
International Cartilage Regeneration & Joint Preservation Society (Animation Video) →
Knee Treatments
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Non-surgical treatment is the right first step for most knee problems — medication, structured physiotherapy and exercise, weight management and, where suitable, injections. These often control pain and keep patients active without, or before, surgery.
Chartered Society of Physiotherapy →
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Injections used to manage knee pain, including corticosteroid, hyaluronic acid, platelet-rich plasma (PRP) and Arthrosamid, each chosen to suit the problem and the stage of wear. Mr Kosuge will advise which, if any, is appropriate for you.
Steroid:
Hyaluronic acid:
American Academy of Orthopaedic Surgeons →
International Cartilage Regeneration & Joint Preservation Society →
Platelet-Rich Plasma:
American Academy of Orthopaedic Surgeons →
International Cartilage Regeneration & Joint Preservation Society →
Arthrosamid:
A newer, long-lasting injection for knee osteoarthritis that cushions the joint, offering an option for patients who want to delay or avoid knee replacement. Read more on Mr Kosuge's webpage.
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Keyhole knee surgery using a small camera and instruments through tiny incisions to diagnose and treat problems such as meniscal tears, cartilage damage and loose bodies. Recovery is usually quicker than open surgery. It is also known as a knee scope or keyhole knee surgery.
Patient Information Booklet from Mr Kosuge →
American Academy of Orthopaedic Surgeons →
Royal College of Anaesthetists →
International Cartilage Regeneration & Joint Preservation Society (Animation Video) →
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Arthroscopic trimming of the torn, unstable part of a meniscus (a partial meniscectomy) to settle pain, catching and locking — the most common surgical treatment for a symptomatic tear that is not suitable for repair.
Patient Information Booklet from Mr Kosuge →
International Cartilage Regeneration & Joint Preservation Society (Animation video) →
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An arthroscopic procedure that stitches a torn meniscus back together rather than removing it, preserving the cartilage and its long-term protective effect. It is suitable for certain tear patterns, particularly in younger and more active patients.
Patient Information Booklet from Mr Kosuge →
International Cartilage Regeneration & Joint Preservation Society (Animation video) →
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An arthroscopic technique that makes tiny openings in the bone beneath a small cartilage defect to stimulate the body to form new repair cartilage over it. It is used for focal cartilage damage rather than widespread wear.
Royal Orthopaedic Hospital NHS Foundation Trust →
International Cartilage Regeneration & Joint Preservation Society (Animation video) →
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Replacing only the worn compartment of the knee (a unicompartmental replacement), which for suitable patients means a smaller operation and quicker recovery. Read more on Mr Kosuge's webpage.
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A highly effective operation replacing the worn knee surfaces to relieve pain and restore function. Read more on Mr Kosuge's webpage.
Versus Arthritis Patient information booklet →
American Academy of Orthopaedic Surgeons (Animation Video) →
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Knee replacement performed with robotic assistance (VELYS) for precise implant positioning and alignment tailored to your knee. Read more on Mr Kosuge's webpage.
Not sure where your pain is coming from?
Mr Kosuge will assess your hip or knee, explain the diagnosis, and talk you through the options. Consultations at The Rivers Hospital, Sawbridgeworth.