Hip replacement is one of the most successful operations in modern medicine, but it should not be the first step in management of your hip osteoarthritis. Understanding this helps you make better decisions about when and whether to act. Mr Kosuge sees many patients who are unsure whether their hip pain is “bad enough” to see a specialist. Here is how to think about it.

Recognising the early signs

Hip osteoarthritis is the gradual wearing of the smooth cartilage that lines the hip joint. The early signs are often subtle. Many people feel it first as pain in the groin rather than over the outer hip. It may spread towards the front of the thigh, or even the knee. Stiffness after sitting, difficulty putting on socks or shoes, a reduced range of movement and pain that worsens with activity are all common. In the early stages the discomfort tends to come and go, which is one reason people put off seeking advice.

What is happening in the joint

As the cartilage thins, the joint moves less smoothly and the surrounding tissues become irritated. This is a slow process and its pace varies enormously from person to person. Some people remain comfortable for years with simple measures, while others progress more quickly. An X-ray confirms the diagnosis, but the decision about treatment rests on your symptoms and how much they affect your life, not on the X-ray alone.

What to try before considering surgery

For most people the first steps are non-surgical and they are worth taking seriously. Keeping active with low-impact exercise such as swimming, cycling or walking helps maintain strength and movement. Losing excess weight reduces the load through the joint. Physiotherapy can improve the muscles that support the hip. Simple pain relief used sensibly can keep you moving. A steroid injection into the hip can also provide a period of relief for some patients. None of these measures reverses the arthritis, but they can control symptoms and, for many, delay surgery for a long time.

When it is time to see a specialist

The right time to seek an opinion is not a fixed point on an X-ray. It is when the pain is disturbing your sleep, limiting the things you want to do, or no longer responding to the measures above. Seeing a specialist does not commit you to an operation. It simply gives you an accurate picture and a clear set of options, so that if the time for a hip replacement does come, it is a decision you make on good information.

Arranging an assessment

Mr Kosuge will examine your hip, review any imaging and explain the full range of options, surgical and non-surgical. To arrange a consultation at The Rivers Hospital, High Wych Road, Sawbridgeworth CM21 0HH with Mr Kosuge:

• Online booking

• Telephone: 01279 602675

A torn meniscus is one of the most common knee injuries and one of the most misunderstood. Many patients arrive at consultation assuming a tear always needs an operation. Often it does not. Mr Kosuge sees this frequently, so it is worth setting out what a meniscal tear is, what it feels like and how the decision to operate is actually made.

What the meniscus is

Each knee has two menisci, which are wedges of tough cartilage that sit between the thigh bone and the shin bone. They act as shock absorbers and help the knee move smoothly and stay stable. A tear can happen suddenly, for example twisting on a planted foot during sport, or it can develop gradually as the cartilage wears with age. The two situations are quite different. That difference matters for treatment.

The symptoms to look out for

A meniscal tear typically causes pain along the joint line, swelling that comes and goes and a sense that the knee is not quite reliable. Some people notice clicking or catching. In more significant tears the knee can lock, which means it becomes stuck and will not fully straighten. Locking is one of the clearer signals that surgery may be needed.

Why many tears do not need an operation

Where a tear is degenerate, meaning it is part of gradual wear rather than a fresh sports injury, good evidence shows that surgery often adds little over a course of physiotherapy, activity adjustment and time. The body can settle a great many of these tears without an operation. Removing torn cartilage is not without consequence either, because the meniscus is there for a reason and taking it away can load the joint differently. For these reasons Mr Kosuge does not rush to operate on every tear that shows on a scan.

When surgery does make sense

Surgery, usually a keyhole (arthroscopic) procedure, becomes the sensible option when a tear is causing true mechanical symptoms such as a locked knee, when a specific type of tear in a younger patient is repairable, or when a reasonable period of non-surgical treatment has not settled the symptoms. The key is matching the treatment to the tear and to the person, rather than to the scan alone.

Getting the right assessment

If your knee is painful, swelling or catching, an accurate diagnosis is the first step. That usually means an examination and often an MRI scan. Mr Kosuge will explain exactly what has been found and set out the options honestly, including the option of not operating.

To book an appointment with Mr Kosuge at The Rivers Hospital:

• Online booking

• Telephone: 01279 602675