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winstonkim

Are you worried about pain in your hip?

You don’t have to put up with the pain.

Call us on 0161 4476753

And Book your Appointment

Mr. Winston Kim

Orthopaedic Surgeon and Hip Specialist

Are you worried about pain in your hip?

Over the years have you noticed that you can’t walk as far as before? That you’re getting less mobile, with increasing stiffness and discomfort?

The discomfort might not even just be in your hip. You might even have pain in your groin, side of hip, buttock or the front of your thigh as well.

Maybe it’s been going on a long time, and gradually you find you cannot do as much as you once used to. Perhaps you find it difficult to walk, climb the stairs or lean forward when you’re sitting down. You may even have developed a limp from the discomfort you’ve been getting, or even fallen as you’ve become more unsteady and found it harder to “catch” yourself.

All these symptoms can be caused by problems affecting the hip, and if this sounds like you perhaps the time has come to get some specialist advice.

THE GOOD NEWS IS THAT YOU ARE IN THE RIGHT PLACE

Before any medical problem can be treated, the consultant needs to understand exactly what is causing the symptoms – to make a proper diagnosis. And here at the Manchester Hip and Knee Clinic we are particularly well equipped to do this, because our team of specialist physiotherapists and occupational therapists is led by Mr. Winston Kim, FRCS (Orth), an orthopaedic surgeon with many years of experience and expertise in diagnosing and treating all problems affecting the hip and knee.

 

WHAT CAUSES HIP PAIN?

diagram

But what could be causing the pain?

The commonest causes of pain in the hip and groin are:

  • Arthritis (or early arthritis)
  • Muscle/ligament strain (often due to overuse or sports injuries)
  • Labral (soft tissue cartilage) tears

It may be that you already have a good idea what the problem is: you may have already been told that you need something doing, either an injection, key hole surgery to the hip or a hip replacement, or perhaps you have had a hip replacement in the past and wonder if there’s a problem with it now. It may be that you can look back and recall your symptoms gradually worsening from an injury or fall some months or even years back.

The hip joint

The hip joint is a “ball and socket” joint and is one of the strongest – if not the strongest – joint in the entire body. It is the ball-and-socket shape that makes the hip so mobile.

The structure of the hip joint

On the left of the diagram above you can see that the hip joint is totally surrounded by large, powerful muscles. These muscles add strength and stability to the joint, but it is easy to see how pain from these muscles can mimic pain coming from the hip joint which lies underneath it.

On the right side of the image you can see a cut-away drawing of the hip joint itself, clearly showing the “ball-and-socket” nature of the joint.

The head (“ball”) of the femur, the long bone of the thigh, is securely held in the “socket” of the pelvic bone by strong ligaments. The surfaces of the ball and socket joint are covered in very smooth, slippery “articular cartilage” and there is very slippery, lubricating fluid (“synovial fluid”) in the gap between the two bones. This is why in a normal, healthy joint the bones can move easily over each other without rubbing against each other and without pain. The cup is deepened by very strong rings or cartilage called “labrum”. Just like the muscles, these cartilages can become damaged causing pain.

HIP ARTHRITIS

What happens in arthritis of the hip?

One of the commonest causes of hip pain is arthritis. In arthritis the cartilage covering the ball and socket gets damaged so instead of gliding freely over each other the bones now grate and rub against each other. This causes further damage to the articular cartilage and later to the bones resulting in pain, stiffness and a “creaking” feeling from the joint when you move. Over time this can be very disabling.

Is Arthritis the only cause of hip pain?

No. There are small pockets of fluid around the hip called “bursae” and these can become inflamed and cause pain too. This is very common but it is not always clear what has caused it in the first place. It can sometimes be difficult for a doctor who is not an expert in conditions of the hip to distinguish “bursitis” from problems in the hip joint.
Hernias, muscle and ligament strains (“Gilmore’s groin”) and enlarged glands can also cause pain in the groin, which can be mistaken for pain coming from the hip by the inexperienced.

The “labra” – the rings of cartilage holding the “ball” of the femur in the “socket” of the pelvic bone can also become worn or torn and this too can cause pain and other problems. This is an increasingly recognised condition and the good news is that in the hands of an expert it can often be treated with a “keyhole” type operation (Hip arthroscopy) rather than more major surgery. There is increasing evidence that treating labral tears early may prevent progression of hip arthritis.  I have a particular interest in treating such conditions.

Finally, another common problem is “referred pain”. Because of the way the nerves of the body send information to the brain, the brain sometimes misinterprets where the pain is actually coming from. For this reason a patient may complain of pain in the hip when the problem causing the pain is actually in the back or the knee!

This is why it is so important to see an expert in diagnosing and treating problems of the hip and knee, who can accurately diagnose what the underlying problem is and the true source of your symptoms – because unless the cause of the problem is accurately identified it cannot be successfully treated.

What causes osteoarthritis of the hip?

We don’t yet fully understand why some people develop osteoarthritis (“wear and tear” arthritis) and others do not. It is certainly linked to previous injuries and childhood hip problems, and worsened by being overweight, although many people develop the condition and often no cause is found. Increasingly, clinical research suggests that Hip Impingement and Hip Labral Tears may predispose some patients to the development of early arthritis.

Why is arthritis of the hip important?

Simply put, because of the pain and stiffness it causes. With time, stiffness increases and mobility decreases and this can have a significant impact upon your ability to get around and to live an independent and active life. It can also be really quite painful. Paradoxically some people with very bad osteoarthritis do not have much pain, yet others with only mild osteoarthritis can have very significant pain.

The whole point of treating hip arthritis is to firstly relieve the pain and secondly to increase your mobility, allowing you to live as full and active a life as possible. The good news is that modern surgery – especially joint replacement surgery – is very effective at treating both the pain and stiffness that goes with hip arthritis, and this is one of the real success stories of modern medicine. Keyhole surgery of the hip may also have a role in the treatment of early hip arthritis and cartilage tears of the hip.

How are hip problems diagnosed?

First and foremost the most important thing is that you are seen and assessed by a doctor who is a recognised expert in hip problems. This is because the hip is complex and reaching the correct diagnosis is so important to planning the correct treatment and in achieving the best results for you. There are a number of causes of hip and groin pain, and not all of these are due to a problem in the hip as we have seen. And because it can be difficult to determine where the exact problem lies for a non-specialist a general practitioner will almost always refer a patient with symptoms from the hip to a hospital specialist for proper assessment and treatment.

What happens when I see the consultant?

Unlike in the NHS where you may be seen by any one of a number of doctors working under the supervision of a consultant, privately I always see my patients personally. The first thing I always do is to sit down and listen to you describe exactly what has been troubling you – to take a detailed “history” of your symptoms. I also always ask about any background of injury as well as any other health problems you may have.

After this we will move on to an examination, where I will examine your hip, knees and also your back to get to the root cause of your problem.
At this stage I will have a very good idea about the cause of your symptoms but will need to organise further tests to confirm the diagnosis and to make sure there are no other problems which might be missed. The commonest tests I consider are:

An X-Ray

An X-ray of the hip is a simple test that gives much information about the bones of the hip joint and is often all that is needed to make a diagnosis.
At this stage I will have a very good idea about the cause of your symptoms but will need to organise further tests to confirm the diagnosis and to make sure there are no other problems which might be missed. The commonest tests I consider are:

xrays

An MRI Scan

An MRI (“Magnetic Resonance Imaging”) scan. This is a special scan that does not use X-rays but is especially useful at showing soft tissues and fluid. It is good for looking at the muscles and ligaments around the hip. It is also very useful in picking up a condition called avascular necrosis of the hip, which is commoner in younger people as a cause of their hip pain.

A CT (“Computed Tomography”) Scan

This is an advanced series of X-rays of the hip which are turned into three- dimensional images by computer. The CT scan is very good at showing “hard” structures such as bone, and is sometimes necessary when planning treatment, such as if the “socket” part of your hip joint is shallow.

Arthroscopy

An arthroscopy of the hip joint is a relatively new procedure in which a small camera is passed through a small cut in the upper leg and into the hip joint. Often small procedures can be done through the arthroscopy, which saves you from the discomfort and longer recovery time of a bigger operation.

The scans above are all quite painless and done as an outpatient. An arthroscopy however involves you being put to sleep with a anaesthetic so that the surgeon can pass a tiny camera into the hip through a small nick in the skin. This allows him to look directly into the hip and to see what the problem is directly. You might ask why this is necessary with all the other scans at our disposal, but the fact is that firstly no scan is 100% accurate and perfect (neither is arthroscopy, for that matter) but also we can sometimes treat certain problems within the hip using the camera (the “Arthroscope”) and so avoid a bigger operation.

Blood tests

The commonest problem with the hip joint is osteoarthritis otherwise known as “wear-and-tear” arthritis, but there are other potential problems such as rheumatoid arthritis that can affect the hip too. A blood test is often useful to distinguish between the two problems.

How is osteoarthritis of the hip treated?

There are two main ways of treating osteoarthritis of the hip:

  1. “Conservative management” – in other words painkillers, physiotherapy treatment and exercise
  2. Surgery

Once I have assessed you and taken any X-rays or scans that might be necessary, I will discuss with you the best way forward. A great deal will depend upon how bad your symptoms are and how much impact they are having on your quality of life, and there is no need to rush into having anything done. My aim is to explain the cause of your symptoms, present the treatment options to you and then to answer your questions thoroughly so between us we can decide on the best treatment for you.

Hip replacement surgery

Broadly speaking, there are two types of operation for hip osteoarthritis:

1. Total hip replacement

As you might expect, in total hip replacement both the head of the femur (the “ball”) and the “socket” of the pelvis is replaced.

beforeafter

2. Hip Arthroscopy for early arthritis / Hip Impingement- see my section on Hip Arthroscopy and Hip Impingement

What can I expect on the day of surgery?

Unlike the NHS, where again I will supervise but may not perform every operation on every patient, privately I not only see all my patients personally but if any of my patients needs an operation I also perform the procedure personally.

On the day of your operation you will be met at the reception by hospital staff and taken to your own room. Here the nurse looking will greet you and you will be seen shortly afterwards by the anaesthetist and myself where we can run through what to expect and give you the opportunity to ask any last – minute questions you might have.

After your operation you will feel drowsy but will feel little or no pain. I will see that you are well in the recovery suite of the operating theatre and in your room later. If required I will telephone your partner or other relative to let them know that all went well.

Are there any complications of surgery?

On the day of your operation you will be met at the reception by hospital staff and taken to your own room. Here the nurse looking will greet you and you will be seen shortly afterwards by the anaesthetist and myself where we can run through what to expect and give you the opportunity to ask any last – minute questions you might have.

After your operation you will feel drowsy but will feel little or no pain. I will see that you are well in the recovery suite of the operating theatre and in your room later. If required I will telephone your partner or other relative to let them know that all went well.

It is important to realise that all surgical procedures have the potential for complications and although hip replacement surgery is a very common – and safe – operation it should still not be taken lightly. Risks associated with Hip arthroscopy found sections within my website on Hip Impingement and Hip Arthroscopy.

Possible complications following hip replacement surgery include:

  • Blood clots in the leg (deep vein thrombosis or DVT)
  • Bleeding at the site of surgery
  • Infection
  • Dislocation of the new joint
  • Ongoing Pain in spite of surgery
  • A difference in leg length
  • Nerve damage.

You should also be aware that if you have an on-going medical problem such as problems with your heart then surgery can make that problem worse. I want to re-assure you though that when I see you I will cover all the pros and cons of the surgery as well as specific risks relevant to you. I will also be able to answer any questions you may have and work closely with senior anaesthetists to make sure everything goes smoothly and comfortably.

As you might imagine, training and experience are very important in ensuring a good outcome for patients so I am delighted to say that I have performed many hundreds of hip replacements over the years including many revision cases for failed surgery from other centres.  I am proud to say that that the expertise and teamwork we bring to the care of our patients is reflected in the results we get.

Follow-up

A vital part of hip replacement surgery is post-operative physiotherapy, and your commitment to this is vital in determining how well you are going to recover from surgery.

Physiotherapy after your hip replacement

Physiotherapy is the cornerstone to good recovery and I only work with specialist hip physiotherapists who will put together a tailor-made programme for you based upon your own health and level of activity prior to surgery as well as your goals after surgery.

Frequently Asked Questions

It is entirely understandable that you will have concerns regarding hip replacement surgery and here I answer some of the most common questions I have been asked over many years of treating patients.

What are the risks of surgery?

The risks of hip surgery include: deep vein thrombosis, infection, dislocation, ongoing symptoms in spite of surgery and bleeding. The likelihood of any problem after surgery is low and most people have no problems at all.

Will I need to be put to sleep for my hip replacement?

Hip replacement surgery can be performed under general anaesthetic or under spinal anaesthesia, similar to when a woman gives birth. You will be seen by one of our expert anaesthetists during your preparation for surgery and he or she will discuss the options with you and advise the best way forward.

How long does the operation take?

Typically 1 ½ to 2 hours.

Is the operation painful?

Some discomfort is of course to be expected after any operation and hip replacement is no different. However the discomfort is usually short-term and I always give my patients pain relief to take regularly whilst they are recovering from surgery.

How many nights will I need to stay in hospital?

This depends upon the type of procedure you have as well as your own general health. Generally patients stay in hospital for 3 nights and we always try and get people home as soon as they are ready to leave, are comfortable and able to cope at home. We work closely with our physiotherapists to make sure you only leave hospital when you are ready.

What patients who had Hip surgery / Hip conditions treated by Mr Winston Kim:

Are you worried about your Hip?

Call us on 0161 4476753

Written by a patient

I was diagnosed by Mr Kim in 2014, as having osteoarthritis in my right hip. I was told this was not uncommon as i had been playing football all my life,some of it professionally. Mr Kim was friendly, patient, very professional and explained every aspect of the condition, procedures, choices and possible results of any decisions made. I had suffered with my deteriorating hip for some time and it was now affecting walking freely,at times moving more like somebody a lot older than my 54 years of age. The pain i had at times was intense,mostly in my right groin made worse by the sitting position and especially driving the car,which at times was excruciating. I decided to procede with hip arthroscopy and microfracture, rather than the alternative, a full hip replacement, after considering all avenues, options, and outcomes with Mr Kim. The operation was performed in October 2014 at the Spire hospital Manchester by Mr Kim and i am extremely happy with the results. I am now back in work, moving freely and symptom free, attending the gym 4 to 5 times a week and following Mr Kim’s advice to avoid high impact exercise, like treadmills and to prolong the joint as long as possible. I would highly recommend Mr Kim and the alternative to a full hip replacement even if this means you are just delaying the full replacement to some time in the future. A big thank you again to Mr Kim and everyone at the Spire hospital Manchester who took great care of me.

Written by a carer

The “Go To” Hip & Knee Surgeon…… Winston Kim, to me, is the “go to” Hip and Knee Surgeon in Greater Manchester. I’m a health care professional and have seen him at work. This is a gifted surgeon- the full package- talented, well trained, generous with his time, humble (if that is possible in a surgeon) and above all, a caring Surgeon. I chose to ask Mr Kim to care for uncle Jim at the Alexandra Hospital. I have seen him look after some really tough cases, and many retired doctors and consultants have placed their trust in him, and had him operate on them. My 90 year old uncle had severe longstanding knee pain, but had refused surgery for ages putting up with pain. Mr. Kim picked up the fact that it was referred pain from the hip, even though my uncle had no hip pain. His confidence reassured us. He did a hip replacement, and gave Uncle Jim a new lease of life. “You put your life and your trust in your surgeon’s hands. Mr. Kim has given me back my life and rebuilt my trust….”, reads one of over 100 reviews online on him- check it out for yourself!. (www.iwantgreatcare.org). But, I knew that already….. P Ryder, Manchester, on behalf of Uncle Jim, April 2015

https://www.iwantgreatcare.org/doctors/mr-winston-kim

Written by a patient

I had a total hip replacement in December 2013 and a total knee replacement 7 days ago. My new hip has given me a new lease of life without pain. I was able to take part in exercise and walking without impingement. I was diagnosed with knee failure in September 2015 and was able to speak to Mr Kim about my knee. He is honest and frank about the exercise in preparation for the operation and rehab. Mr Kim is a caring and highly experienced surgeon. He is supportive to your needs and worries. I hope this is the last operation I will have for a while. I would highly recommend Mr Kim if you want 100% of your life active and pain free!

Written by a patient

I had right hip arthroscopy, carried out by Mr Kim. I was really impressed by the amount of information I received in both the consultation and pre op. The aftercare was superb. After 12 months of continuous pain and discomfort, I had forgotten what normality felt like. 1 week after op felt good, 6 weeks after feel marvellous. A massive Thank you. A.Lewis

https://www.iwantgreatcare.org/doctors/mr-winston-kim

Written by a patient

I had a left hip replacement 3 years ago. From the first consultation and throughout the treatment, I found Mr. Kim Most helpful in explaining what would be required for the operation. On the day of the operation he put me completely at ease as this was my first operation & I was very nervous. Post operation he helped me very much and the support staff and physio were excellent in aiding my recovery. I had several reviews to check on the healing & mobility progress all very helpful until I was discharged. I have made an excellent recovery without any disability. Thanks to Mr. Kim

https://www.iwantgreatcare.org/doctors/mr-winston-kim

Written by a patient

Male Aged 36 August 2014 – Right hip arthroplasty, labral debridement, microfracture chondroplasty Mr Kim performed a right hip arthoscopy to repair damage in my right hip in August 2014. I had been experiencing moderate discomfort in my right hip for several years, but this had worsened significantly in mid 2013 onwards. I am now 6 months post op and I am pleased to say that the symptoms I was experiencing are beginning to disappear. The rehabilitation process has been quite lengthy – 8 weeks on crutches TTWB post op with a very gradual return to light activity, building up to more progressive exercise from month 4/5 onwards. For the first time in a number of years I feel able to squat and deep flex without feeling a painful ‘clunking’ sensation in my right hip and I am slowly beginning to get back to hill walking and light mountain biking. I am hoping to return to 5 a-side football in summer 2015. For me the key part of the process has been Mr Kim taking time to diagnose my problems and then effectively managing my expectations in terms of the recovery process. He has always taken time to explain the diagnostic and the surgical process and I have always felt entirely comfortable and safe under his care. I would unreservedly recommend Mr Kim. Mike Doyle Cheshire

https://www.iwantgreatcare.org/doctors/mr-winston-kim

Written by a patient

I have recently had a replacement hip operation in November 2014 at the Alexandra hospital, the consultant who performed the operation was excellent in his standard of care, before the operation I attended a consultation with Mr Winston Kim, he made me feel very calm and Informed me on the procedure and everything what is involved, everything went really well, also the after care has been excellent, I have felt assured and at ease with the whole procedure , I am so grateful to Mr Winston Kim (consultant) for his care and understanding.

Listen to patients who had Hip Pain, Deciding on Hip Surgery and after Hip Surgery

Winston Kim

MBChB, MSc, FRCSGlasg (Tr & Orth)

Consultant Orthopaedic Surgeon

Specialist in Hip and Knee Surgery

CALL US ON  0161 4476753

email us at manchesterhipandknee@gmail.com