Conditions we treat

Cartilage is a firm and flexible tissue that protects the ends of the bones in our joints. It helps to ensure smooth movement and absorbs impact shock. Over time, or due to heavy use or injury, cartilage can wear away, leading to pain, weakness, and stiffness in the affected joint.

This is what’s known as osteoarthritis (OA). While it can occur in any joint, it tends to occur most commonly in our knees and hips. This degenerative condition, mostly affects people over 50, but can also affect younger age groups and people who have active lifestyles that carry a greater risk of injury.

As mentioned, age is a major factor in the development of osteoarthritis. Other causes include:

• Injury: Damage from an impact injury can lead to osteoarthritis, particularly if you use it before it’s had time to properly heal.
• Previous condition: If your joint has become damaged from surgery or a condition such as gout or rheumatoid arthritis, this is known as secondary arthritis.
• Genetics: There is some evidence that osteoarthritis may run in families.
• Gender: Women are more likely to develop osteoarthritis than men.

Symptoms of the osteoarthritis  include:

• Swelling: Sufferers will often experience swelling around the affected joint.
• Pain: Typically when you move the joint, or bear weight on it, or after being active for extended periods of time.
• Stiffness: You may notice stiffness in your joints. This can be particularly acute in the morning or after following a period of rest.
• Reduced mobility: A combination of the above factors often results in limited mobility for the sufferer.

Among the treatment options are painkillers, physiotherapy, exercises, injections and surgery. So many options can seem daunting, and the decision-making process for treating knee arthritis is complex, but Mr Miles will discuss everything with you to find which approach will give you the best outcome.

For example, if your knee is worn out and rubbing 'bone on bone', it may be best to go straight for a joint replacement. However, if the wear is more modest, it’s often wise to begin with more conservative treatment.

When it comes to joint replacement surgery, Mr Miles uses the latest robotic techniques for partial and total knee replacements. Patients typically enjoy more reliable results, less pain and a quicker recovery, particularly important considerations for knee replacements as they have traditionally been an operation associated with high pain levels and noticeable ongoing dissatisfaction.

The pain can travel down 30cm or so towards the knee, causing confusion for doctors and patients alike. As hip arthritis progresses, it often causes stiffness and, in many cases, deteriorates quickly.

With available treatment options including painkillers, injections and surgery, the choice is critical for patients to improve their quality of life. Mr Miles will examine you, and discuss your symptoms and their impact on your quality of life  to find which treatment will guarantee you the best outcome.

When the time comes to consider surgery, Mr Miles uses the latest robotic techniques to reduce the risk of dislocation and leg length inequality – both significant risks in traditional hip replacement surgery.

Find out more about the treatment options Mr Miles can offer you, using state-of-the-art robotically-assisted surgical techniques.

The meniscus a fibrous structure made from cartilage and located in the knee. There are two menisci in each knee, one either side and their job is to provide cushioning and shock absorption.

A torn meniscus is one of the most common knee injuries. It can be caused by:

• Knee twist injuries: The meniscus is commonly torn in sporting settings, particularly sports that involve a degree of twisting. This includes most ball sports, skiing and athletic and gymnastics sports.
• Wear and tear: In some cases, the meniscus is torn in one significant injury. In others, it can be damaged by a repetitive strain over time, leading to what’s called a degenerative meniscal tear.

Symptoms of a meniscus tear include:

• A popping sensation within the knee
• Swelling and stiffness over time
• Tenderness in the surrounding muscle tissue
• Pain when twisting or rotating your knee – (the pain could vary from mild to severe and may not be continuous).
• A clicking sensation in your knee when you bend it – you may not be able to bend or extend your knee fully.

The chances are that, if you have torn your meniscus, you’ll need some form of treatment to help it heal. The meniscus doesn’t have an excellent blood supply, and without the nutrients and cells that the blood brings, it is unlikely to heal on its own.

Precisely what that treatment is will depend on a number of factors, including the location and severity of the tear, and your age. Mr Miles will carry out some diagnostic investigations to assess the extent of the damage and discuss a personalised treatment plan with you.

As the meniscus doesn’t appear on X-rays, your diagnosis will typically involve an MRI scan. If the rest of the knee is in a good condition, then it’s likely your meniscus tear can be treated with a knee arthroscopy (keyhole surgery).

You may be prescribed painkillers and anti-inflammatory medicines in the short-term to help manage your symptoms, and physiotherapy to strengthen your knee and leg muscles can help to recover mobility and movement.

Find out more about the treatment options Mr Miles can offer you.

The anterior cruciate ligament, or ACL as it’s more commonly known, is one of the four main ligaments in your knee and joins the femur to the tibia in the middle of your knee joint. It helps to:

• Give your knee stability when twisting, when playing sports for example.
• Protect other parts of the knee (including the meniscus) from damage.
• Prevent the possible onset of arthritis.

ACL injuries or tears typically happen when pivoting or turning suddenly, for instance during sport. Football, rugby, basketball, netball, skiing and racquet sports are all common causes. Once it has been injured, it is pretty hard to rehabilitate and return to demanding sports with many direction changes.

Having said that, any high-impact accidents, for instance in the workplace or while driving, can result in damage to your ACL. While not everyone who injures their ACL has pain, many do, and sometimes they can even feel or hear the ligaments snap at the time of injury. Symptoms can include:

• A popping sensation in your knee
• Immediate swelling of your knee
• An inability to bear weight on the affected leg
• A feeling of instability in your knee

As the anterior cruciate ligament doesn’t show up on an X-ray, the diagnostic test of choice is an MRI scan.

Once Mr Miles has confirmed an ACL injury diagnosis, he will discuss the potential benefits of rehabilitation versus surgery with you.

For some patients, the desire to return to sports outweighs the inconvenience of surgery and the often difficult and prolonged recovery period. For others the balance might be different.

If your injury has left you with a knee that’s unstable and unable to bear weight, you may want to consider reconstructive surgery. For some patients, it’s a crucial step towards regaining their mobility and function.

ACL reconstruction surgery can help to stabilise your knee, reduce your risk of further injury, and also relieve painful symptoms.

For those who are keen to resume a sporting lifestyle, ACL reconstruction can help get you back you to full mobility, or something very close to it, and has a very high success rate over the longer term.

If you haven’t found the answer you’re looking for, please feel free to get in touch, we’re more than happy to help. In the meantime, you can find out more about the treatments Mr Miles offers, including ACL reconstruction on our Treatments page.

Chronic hip pain can have a serious impact on your quality of life. From difficulty in performing everyday activities such as walking, standing, or climbing stairs, to stopping them from taking part in exercise or sporting activities, it can limit mobility and stifle independence. This can lead to a marked reduction in your quality of life, including increased feelings of social isolation.

Hip pain can be the result of a number of causes. Among the most common are:

• Arthritis
• Muscle and tendon injuries
• Hernias
• Overuse
• Strain injuries, including bursitis

Given the wide range of factors, accurate diagnosis can be a complex process. That’s why, at your consultation, Mr Miles will give you a full hip examination and talk to you at length about your medical history and individual circumstances before deciding which investigations are most appropriate for you.

The site and nature of the pain can give a good indication as to the underlying cause. Typically pain felt in the groin which worsens with walking and is eased by rest, is associated with hip osteoarthritis. If this is the case, then X-ray is likely to be the most efficient diagnostic tool.

Pain on the outside of the hip bone, accompanied by tenderness when lying on that side is more indicative of trochanteric bursitis. Whilst your medical history can help provide supporting evidence, imaging tests such as MRI scans, which will give greater soft tissue and bone detail, are used to confirm the diagnosis

The treatment options for hip pain vary depending on the underlying cause and severity of the pain. However, some common treatments include:

• Rest: Resting your hip and easing up on activities that aggravate it can help to alleviate pain.
• Physiotherapy: Many causes of hip pain can be treated with physiotherapy. Mr Miles works very closely with physiotherapists in the area, and will be able to recommend the right therapist for you, with advanced techniques to help relieve your hip pain.
• Medications: Over-the-counter pain relief can help relieve pain and reduce inflammation. Prescription medications may be necessary in more severe cases.
• Injections: Sometimes rest, physiotherapy and medication isn’t enough. Local anaesthetic and corticosteroid (steroid) injections into the hip can help to reduce pain and inflammation for several months at a time.
• Surgery: In cases where other treatments have failed, such as advanced arthritis, surgery provides another, more permanent, route. Total hip replacements, for example, are a very successful method to relieve chronic hip pain. At your consultation, Mr Miles will work with you to come up with a tailor-made treatment plan to suit your specific needs.

• Arthritis: The knee is the most common joint in the body to suffer from wear and tear and arthritis.
• Injury: Whether from overuse during exercise, a fracture or damage to a ligament, tendon  or cartilage.
• Gout: An accumulation of urate crystals in your knee can cause inflammation and intense pain. This can come on very suddenly and is often characterised by a swollen knee that is red and warm to the touch.
• Tendinitis: Again, as with hip pain, inflammation of the tendons in your knee can cause mobility-limiting pain. Knee tendonitis commonly affects athletes and those with a very active lifestyle and, left untreated, can deteriorate over time.

Identifying the exact cause of a patient’s knee pain can be a complex procedure, and requires the expertise of a  specialist knee surgeon.

At your consultation with Mr Miles, he’ll talk to you in detail about your medical history and specific circumstances, perform an examination, and arrange for you to have the appropriate investigations. Typically, these will include X-rays and MRI scans of your knee.

As with hip pain, your treatment options for knee pain will vary depending on a number of factors including your age, health and the severity of your symptoms. Among the more common treatments are: 

The main treatments for knee pain may vary depending on the underlying cause and severity of the pain. However, some of the most common treatments include:

• RICE: Often the first line of treatment for knee pain, this helps to reduce swelling and support the knee through resting the knee, applying ice, using compression bandages, and elevating the knee above heart level.
• Physical therapy: Stretches and exercises can help improve strength and flexibility in the knee, as well as reducing pain and preventing future injury.
• Medications: Over-the-counter pain relief and anti-inflammatory drugs can help relieve pain and reduce swelling. If the pain is severe, stronger prescription medications may be necessary.
• Injections: Steroid injections are often used to reduce inflammation and pain in the knee. As with steroid injections for hip pain, the results vary from patient to patient, but can prove very successful.
• Surgery: In severe cases, or when other treatments have failed to address the symptoms, surgery may be necessary. At your consultation, Mr Miles will talk to you about your symptoms and work alongside you to come up with a personlised plan that you’re happy with.

While knee and hip replacement surgeries are incredibly safe and effective solutions to arthritis and injury-related conditions, there are potential complications that can arise, including infection, stiffness of the joint, and instability. This can lead to many patients needing revision surgery to either replace or correct a failed implant.

Mr Miles is one of the leading revision joint surgeons in the country by volume, and has helped hundreds of patients with complex surgery cases in need of a second opinion.

In the majority of cases, total knee replacements are remarkably successful procedures. However, around 15 per cent of patients report being dissatisfied with the outcome of their operation. This is due to technical problems with the procedure, ongoing pain or other complications from surgery.

Recent changes in how painful knee replacements are investigated and managed, require these cases to be discussed with surgeons working in major revision centres. Mr Miles heads the revision knee team at the Royal National Orthopaedic Hospital, London's biggest major revision centre.

If you are unhappy with the results of a procedure, Mr Miles will carry out the appropriate investigations to establish whether the issue is one of infection, a mechanical problem or pain associated with your implants.

His methodical approach is a critical step in calculating the best treatment options - any attempt to carry out knee revision surgery without first understanding the cause is likely to be unsuccessful.

Similarly, revisions carried out by surgeons who do not routinely perform revision surgeries also tend to be unsuccessful.

Infection of a total knee replacement occurs in one to two per cent of all cases. It’s a severe complication and requires careful treatment by an experienced team.

Using a combination of imaging and tests on tissue samples taken from the knee, Mr Miles will be able to determine whether infection is present and what’s causing it. This information will help to build the treatment plan for your knee.

In some cases, we’ll treat the infections with long-term antibiotics. This is called suppression therapy. However, in many cases, a better option is to have surgery to remove the infected implant.

At The Wellington Hospital, we have a dedicated, multidisciplinary team of expert surgeons, radiologists and microbiologists who can help diagnose and manage your knee revision surgery.

We’ll work with you and advise you on which is the most appropriate course of treatment for your individual circumstances.

In a one-stage procedure, we will remove all of the infected material and perform the revision surgery at the same time.

A two-stage procedure is more common in complex cases or instances where the infectious organisms are proving resistant. The first operation is to remove all of the implants and put in an antibiotic spacer. Following a few months of antibiotic treatment to cure the infection, patients will have a second procedure (the second stage) to carry out the revision knee implant.

If you’re suffering from any of these conditions, you can find out more about the treatments Mr Miles offers, or get in touch to book a consultation for face-to-face advice.