Osteoarthritis of the hip & kneeSupport and guidance for patients and carers to help determine the level (from 1-4) of osteoarthritis.

What is Osteoarthritis?Osteoarthritis (OA) is a common condition which can affect any joint, but it most commonly affects the large weight bearing joints such as the knee and hip.

The cartilage which protects the surface of your joints get worn/ damaged which causes friction and prevents the joint from moving smoothly.

The joint can become swollen, the joint can change shape and the muscles can feel weaker.

What are the risk factors? Age – the onset of OA is usually in the late 40’s and is more common in the

older population Genetics – there is some evidence to suggest OA can have a tendency to run

in the family Obesity – being overweight puts a higher demand on the joints and is certainly

a risk factor to predispose you to early onset OA Joint injury – a significant injury may increase the likelihood of developing OA in

that joint later Joint disease – diseases like Rheumatoid arthritis may cause damage leading

to OA

What are the symptoms?The symptoms of this condition will depend upon the severity of the condition but they may include:

Pain Stiffness Swelling of the joint Crepitus (crunchy grinding sounds from the joint)

Level 1 – Early arthritis

At this stage you have a good cartilage cover on your knee/hip(i.e. a good tread on your tyre)

Level 1

Symptoms: Intermittent aches and pains, often on the inside of the knee in its case. You may experience short lived sharp pains. You may have occasional swelling and notice some weakness of muscles at the front of the leg.

Level 2 – Moderate arthritis

At this stage your cartilage is worn and there are some bald patches (i.e. the tyre thread is wearing low)

Level 2

Symptoms: More constant aches and occasional severe pains often affecting the whole knee or hip. The area may remain swollen and sometimes be warm to touch. It may be ‘thickened’ and change in shape and the muscles may look smaller.

Level 3 – Advanced arthritis

At this stage there is very little cartilage left and thereare very large bald patches (i.e. the tyre is bald)

Level 3

Symptoms: Constant ache/pain often severe affecting the whole knee or hip. The area may be swollen, thickened, stiff and there is often pain on weight bearing. The muscles may look smaller and feel weak.

Level 1 – Early arthritisSymptoms of 'Level 1' include: intermittent aches and pains often on the inside of the knee – sometimes short lived sharp pains with occasional swelling. You may also notice some weakness of muscles at the front of the leg.

     

The main symptoms of early osteoarthritis are:

Pain – The pain tends to be worse when you move your joint or at the end of the day. As shown on the graph, you are able to tolerate the symptoms for the majority of the time with only brief episodes where the joint is disabling

Stiffness – Your joints may feel slightly stiff after rest, but this usually wears off quickly as you get moving

A grating or grinding sensation (crepitus) – Your joint may creak or crunch as you move – this is normal for osteoarthritic joints – do not be afraid to move them.

Swelling – The swelling is soft caused by extra fluid, and an sometimes be warm/ hot to the touch

Muscle weakness – the muscles around your joint may look thin or wasted and you might experience difficulty with some activities eg: going up and down stairs

Not being able to use your joint normally – Your joint may not move as freely or as far as normal. Sometimes it may give way because your muscles have weakened or your joint has become less stable. Exercises to strengthen your muscles can help to prevent this

Your symptoms will often vary for no clear reason – you’ll probably have good and bad spells. Some people find that changes in the weather make the pain worse, especially damp weather along with falling atmospheric pressure. Others find the pain varies depending on how active they’ve been.

Treatment options

Medication/PharmacyMedications  and creams can help with the arthritis pain and inflammation.  Some medications can conveniently be bought  “over the counter” . In order to make sure this is the right thing to do – access your local Pharmacist for advice about safe medication and creams which may help you to manage your pain/ inflammation. They will take into consideration any other medications that you may be taking and other medical conditions that you may have.

The following are Medications which are commonly recommended by the GP or Pharmacist:

Pain killers e.g. paracetamol/ codeine Anti-inflammatory medications to help reduce inflammation and pain: Non -

steroidal Anti-inflammatory drugs (NSAIDS) come in 2 types . the traditional medications such as Ibuprofen, Naproxen, diclofenac and the COX-2 inhibitors such as Celecoxib and Eterocoxib

You can also get NSAID’s in creams – these are described as “topical”. They are less likely to cause upset stomachs

All qualified Pharmacists in Great Britain must be registered with the General Pharmaceutical Council (GPhC). 

General Practitioner – GPIf your symptoms are concerning you then you may chose to visit the GP. The GP may request an X ray of your joint to confirm the diagnosis of Osteoarthritis. They will also advise you on appropriate medication, provide exercise information and discuss the benefits of maintaining a healthy weight

Weight lossObesity is the single most preventable contributor to Osteoarthritis for weight bearing joints. For every pound of extra body weight you may be carrying the increased

loading on the knees/hips going up stairs equals 4 pounds – so for every 10 pounds overweight you are your knees will have to take 40 pounds extra load.

If you are overweight it is best to address it with a combination of healthy eating and exercise. Help with this plan can be accessed from groups such as Weight watchers, Slimming World or the local council “Fit 4 Life” program.

Fit for Life programIf you are over 18yrs and have a Body Mass Index (BMI) of 25 or above Harrogate Borough Council offers a free 12 week service called “Fit 4 Life” (funded by NYCC Public health team) which combines Nutrition and lifestyle advice with exercise sessions. These programs are offered at venues across the Harrogate district during the day and some evenings.

The “Fit 4 Life” programme is made up of group sessions consisting of individual weigh-ins, physical activity and weight management advice, covering different topics each week including:

Goal setting Behaviour change

The “eat well plate” Salt

Portion sizes Benefits of physical activity

Eating awareness Eating out

Fats Food labelling Drinks

Before taking part in the group session you will be required to attend an induction with the instructor. This will include a basic health check, a health questionnaire and general chat about your lifestyle.

For more information about the Fit 4 Life programme call 01423 500600 (ext. 58382)

ExercisePhysical activity is the best non-drug treatment for improving pain and function in OA.  While you may worry that exercising with osteoarthritis could harm your joints and cause more pain, the research has shown that people can and should exercise when they have osteoarthritis. In fact, exercise is considered the most effective non-drug treatment for reducing pain and improving movement in patients with osteoarthritis.

What exercises work best for osteoarthritis?

Range of motion exercises can help maintain and improve the flexibility in the joints

Aerobic/endurance exercise strengthens the heart and make the lungs more efficient. This conditioning also reduces fatigue, controls weight and builds stamina. Aerobic exercises include walking, cycling, swimming or using the elliptical machine

Strengthening exercises help maintain and improve muscle strength. Strong muscles can support and protect joints that are affected by arthritis.

.How do I become active?

You will benefit from most exercises although we would recommend that you do not do high impact activity i.e. running long distances on a road surface. Locally Harrogate Borough Council run exercise programs and you can find the information by emailing sportsdevelopment@harrogate.gov.uk or visiting the sports development section of Harrogate Borough Council Website.

Walking aidsIf you are getting pain from your joint when walking/ weight bearing you could benefit from a walking stick. The walking stick will take some of your body weight through the hands reducing the load on the lower limb joints – there can be a 10-25% decreased load on your knees when you are using a walking stick in the hand opposite to the affected knee/hip.

There are several walking aids but in the early stages of OA a walking stick is the most appropriate. They are suitable for most people and easy to walk with.

Measuring a stickWhen on the floor the handle of the stick should reach your wrist when your elbow is very slightly bent.

Using a stickWhen walking with a stick use one stick in the opposite hand to the affected leg. Put the stick and the affected leg forward together.

InstructionThere are many web sites which give instructions on how to measure for a walking stick. Here’s one example:

How to measure a walking stick SupplyWalking sticks can be purchased from Yorkshire Care (Forest Lane Head, Harrogate: 01423 799960) / walking shops/ garden centres/ some pharmacists/ Sports Direct etc.

Your GP could also request one to be issued from the Physiotherapy department if you need help with balance or learning to use one.

Corticosteroid InjectionIf your joint is inflamed it may be that a corticosteroid injection could help with the pain and inflammation. These injections can be done by your GP/ Physiotherapist or in the Radiology department when guidance/imaging is used.

Corticosteroid is injected to reduce the inflammation and a local anaesthetic to help with the pain. It can take up to 3 weeks to have full effect and the benefit can last over a year.

If you are offered an injection make sure that you plan to have a “quiet time” over the following 2 days to give it maximum chance to be effective.

Level 2 – Moderate arthritisSymptoms of 'Level 2' include more constant aches and occasional severe pains often affecting the whole knee or hip.

At this stage your cartilage is worn and there are some bald patches (i.e. the tyre thread is wearing low).

Symptoms: More constant aches and occasional severe pains often affecting the whole knee or hip. The area may remain swollen and sometimes be warm to touch. It may be ‘thickened’ and change in shape and the muscles may look smaller.

Treatment options

Medication/PharmacyMedications  and creams can help with the arthritis pain and inflammation.  Some medications can conveniently be bought  “over the counter” . In order to make sure this is the right thing to do – access your local Pharmacist for advice about safe medication and creams which may help you to manage your pain/ inflammation. They will take into consideration any other medications that you may be taking and other medical conditions that you may have.

All qualified Pharmacists in Great Britain must be registered with the General Pharmaceutical Council (GPhC). For more information, see the GPhC website for details about regulations and registration.

The following are Medications which are commonly recommended by the GP or Pharmacist:

Pain killers eg: paracetamol/ codeine Anti-inflammatory medications to help reduce inflammation and pain: Non -

steroidal Anti-inflammatory drugs (NSAIDS) come in 2 types . the traditional medications such as Ibuprofen, Naproxen, diclofenac and the COX-2 inhibitors such as Celecoxib and Eterocoxib

You can also get NSAID’s in creams – these are described as “topical”. They are less likely to cause upset stomachs

General Practitioner – GPThe GP may be able to help you by:

Providing you with some exercises to do to protect your knee/hip Prescribing medications –

o Pain killers eg: paracetamol/ codeineo Anti-inflammatory medications to help reduce inflammation and pain:

Non -steroidal Anti-inflammatory drugs (NSAIDS) come in 2 types. the traditional medications such as Ibuprofen, Naproxen, diclofenac and the COX-2 inhibitors such as Celecoxib and Eterocoxib

o You can also get NSAID’s in creams – these are described as “topical”. They are less likely to cause upset stomachs

Recommending a corticosteroid joint injection if your joint is very swollen. Referring for Physiotherapy Requesting an X-ray

They may also discuss with you what stage you joint is in the Osteoarthritis journey and make other recommendation e.g. weight loss.

Weight lossObesity is the single most preventable contributor to Osteoarthritis for weight bearing joints. For every pound of extra body weight you may be carrying the increased loading on the knees/hips going up stairs equals 4 pounds – so for every 10 pounds overweight you are your knees will have to take 40 pounds extra load.

If you are overweight it is best to address it with a combination of healthy eating and exercise. Help with this plan can be accessed from groups such as Weight watchers, Slimming World or the local council “Fit 4 Life” program.

Fit for Life programIf you are over 18yrs and have a Body Mass Index (BMI) of 25 or above Harrogate Borough Council offers a free 12 week service called “Fit 4 Life” (funded by NYCC Public health team) which combines Nutrition and lifestyle advice with exercise sessions. These programs are offered at venues across the Harrogate district during the day and some evenings. You can find an up to date timetable   here.

The “Fit 4 Life” programme is made up of group sessions consisting of individual weigh-ins, physical activity and weight management advice, covering different topics each week including:

Goal setting Behaviour change

The “eat well plate” Salt

Portion sizes Benefits of physical activity

Eating awareness Eating out

Fats Food labelling Drinks

Before taking part in the group session you will be required to attend an induction with the instructor. This will include a basic health check, a health questionnaire and general chat about your lifestyle.

For more information about the Fit 4 Life programme call 01423 500600 (ext. 58382)

ExerciseAt Level 2 stage you may find that exercising is more uncomfortable however it is still very important and physical activity is the best non-drug treatment for improving pain and function in OA. While you may worry that exercising with osteoarthritis could harm your joints and cause more pain, the research has shown that people can and should exercise when they have osteoarthritis. In fact, exercise is considered the most effective non-drug treatment for reducing pain and improving movement in patients with osteoarthritis.

What Exercises Work Best for Osteoarthritis?

Range of motion exercises can help maintain and improve the flexibility in the joints.

Aerobic/endurance exercise strengthens the heart and make the lungs more efficient. This conditioning also reduces fatigue, controls weight and builds stamina.. Aerobic exercises include walking, cycling, swimming or using the elliptical machine.

Strengthening exercises help maintain and improve muscle strength. Strong muscles can support and protect joints that are affected by arthritis. You can find a list of suitable home-based exercises recommended by Arthritis Research UK on their web site www.arthritisresearchuk.org

How do I become active?You will benefit from most exercises although we would recommend that you do not do high impact activity i.e. running long distances on a road surface. Locally Harrogate Borough Council run exercise programs and you can find the information by emailing sportsdevelopment@harrogate.gov.uk or visiting the sports development section of Harrogate Borough Council Website or calling them on 01423 500600

Physiotherapy

Physiotherapy can help to reduce pain and functional disability for people who suffer from osteoarthritis.  The Physiotherapist can help with you by assessing your affected joint and other areas which could be contributing to your problem i.e. knee/spine/hip/foot – then agreeing a management plan with you which could include:

Providing advice about how to manage the problem Walking aids/gait re-education Manual therapy/mobilisation of the joints and soft tissues Exercises Corticosteroid joint injections TENS machines/Acupuncture

Access to physiotherapy

You can access the NHS Physiotherapy services in the following ways:

NHS Services:

The GP can refer you to direct access Physiotherapy provided from Harrogate District Hospital, Ripon Community Hospital and some local surgeries. If you have a more complex presentation, then the MSK service offers more interventions i.e. investigation/ joint injection etc

Education class: these are run on a monthly basis and provide education about the condition and how to best manage it

Hydrotherapy: use of the Hydrotherapy pool is available with the “Aquasize” Program at Harrogate District Hospital. It is recommended that you have been a patient there before accessing these facilities so that you know what you should be doing in the water. Call 01423 553472

Self- referral: This service is only available for patients registered with Leeds Road practice Harrogate/Church Lane Practice Boroughbridge and Dr Ingrams practice Ripon. This telephone access to advice/ treatment is available – Call 01423 554554 weekdays apart from Wednesday 9.30am -12pm

Privately:  There are many private providers in the Harrogate and Ripon district. You can find them in the Yellow pages or the Physio2U website. Harrogate District Hospital also has private services which you can access by telephoning 01423 553472.

All physiotherapists should be registered with the Health Professions Council and you can check this on their website. This registration ensures that the physiotherapist is qualified and an acceptable standard of care is provided.

Swimming/HydrotherapyExercising in water can give relief to pain in osteoarthritic joints. The buoyancy of water reduces the weight bearing load on the joint and provides assistance to range of movement exercises.

The benefits of exercise are similar to those for land based exercise  ie:

Increased circulation to the part improving tissue health

Reducing swelling Increasing muscle function and strength Increasing/ maintaining range of joint movement

The exercise can also help you remain “healthy” – exercising your heart and lungs at the same time and keeping your weight down.

Where to access a pool locally:

You can exercise in water at local swimming pools. Find out opening times and further details on the  Harrogate Borough Council website tel: 01423 500600

Hydrotherapy pool at Harrogate District Hospital. This program is called “Aquasize” and for a small fee (£5) you can use the hospital pool  which is easier to access if you are disabled. You can telephone for further information or to book your slot on 01423 553472 (Monday–Friday 9am-5pm).

Lister house in Ripon also has pool access for the disabled – 01765694740. Southgate, Ripon, North Yorkshire, HG4 1PG

AcupunctureThe British Acupuncture Association state that acupuncture treatment may help to relieve pain and improve function in patients with osteoarthritis by stimulating the body to release chemicals which help reduce pain and inflammation. This is done by inserting several small fine sterile needles at points around the body.

There are some people who find that acupuncture is beneficial in the management of the pain and disability created by osteoarthritis.

Should you wish to explore this as an option the following information may help you make a decision:

NHS Choices – Acupuncture The British Acupuncture Council  – website can locate your nearest

Acupuncturist using your post code The Cochrane Collaboration  – they have found there is some evidence

acupuncture may have a beneficial effect on osteoarthirtis The National Institute of Clinical Excellence (NICE)  – stated that the evidence

supporting the benefits of using acupuncture in the management of osteoarthritis is inconclusive

Tens MachinesA TENS machine is a small battery operated device that sends pulses of mild electrical current to your nerve endings via pads (electrodes) placed on the skin. It produces a tingling sensation and is thought to alter pain messages sent to your brain.  It is thought to relieve pain/relax muscles by stimulating the production of endorphins, which are the bodies natural pain killers.

The National Institute for Clinical Excellence (NICE) have stated that TENS machines should be considered for the relief of pain in Osteoarthritis.

Where do I get a TENS machine?

TENS machines are available from pharmacies, other major stores and on line.

Some advice regarding the use of TENS is available from the manufacturers, or from your physiotherapist or GP.

Corticosteroid InjectionIf your joint is inflamed it may be that a corticosteroid injection could help with the pain and inflammation. These injections can be done by your GP/ Physiotherapist or in the Radiology department when guidance/imaging is used.

Corticosteroid is injected to reduce the inflammation and a local anaesthetic to help with the pain. It can take up to 3 weeks to have full effect and the benefit can last over a year.

If you are offered an injection make sure that you plan to have a “quiet time” over the following 2 days to give it maximum chance to be effective.

Level 3 – Advanced arthritis

At this stage there is very little cartilage left and there are very large bald patches (i.e. the tyre is bald).

Symptoms: Constant ache/pain often severe affecting the whole knee or hip. The area may be swollen, thickened, stiff and there is often pain on weight bearing. The muscles may look smaller and feel weak.

Key points:

Take medication regularly as prescribed Use a walking aid Keep to an ideal weight Try to keep active and do the recommended exercises

Treatment options

General Practitioner – GPYour GP may repeat the X-ray of your joint and reassess your symptoms to establish if you have reached the stage where a surgical opinion could be beneficial.  If not already, they may offer a steroid injection into your joint.  Before considering surgery they will need to assess how severe your symptoms are using a questionnaire, whether you are using all your pain relief medication regularly, have already accessed physiotherapy, that you have a healthy weight or are working towards it, and, if you are a smoker, that you are offered help and support to stop smoking to increase your chances of a healthy recovery following surgery.

Weight lossObesity is the single most preventable contributor to Osteoarthritis for weight bearing joints. For every pound of extra body weight you may be carrying the increased loading on the knees/hips going up stairs equals 4 pounds – so for every 10 pounds overweight you are your knees will have to take 40 pounds extra load.

If you are overweight it is best to address it with a combination of healthy eating and exercise. Help with this plan can be accessed from groups such as Weight Watchers, Slimming World or the local council “Fit 4 Life” program.

Fit for Life programIf you are over 18yrs and have a Body Mass Index (BMI) of 25 or above Harrogate Borough Council offers a free 12 week service called “Fit 4 Life” (funded by NYCC Public health team) which combines Nutrition and lifestyle advice with exercise sessions. These programs are offered at venues across the Harrogate district during the day and some evenings. The “Fit 4 Life” programme is made up of group sessions consisting of individual weigh-ins, physical activity and weight management advice, covering different topics each week including:

Goal setting Behaviour change

The “eat well plate” Salt

Portion sizes Benefits of physical activity

Eating awareness Eating out

Fats Food labelling Drinks

Before taking part in the group session you will be required to attend an induction with the instructor. This will include a basic health check, a health questionnaire and general chat about your lifestyle.

For more information about the Fit 4 Life programme call 01423 500600 (ext. 58382)

ExerciseAt Level 3 stage you may find that exercising is very uncomfortable, however it is still very important and physical activity is the best non-drug treatment for improving pain and function in OA.  Try to do gentle exercises every day and this will help to reduce the swelling and pain. You will also be keeping your muscles strong to protect your knees/hips.

What Exercises Work Best for Osteoarthritis?

Range of motion exercises can help maintain and improve the flexibility in the joints.

Aerobic/endurance exercise strengthens the heart and make the lungs more efficient. This conditioning also reduces fatigue, controls weight and builds stamina.. Aerobic exercises include walking, cycling, swimming or using the elliptical machine.

Strengthening exercises help maintain and improve muscle strength. Strong muscles can support and protect joints that are affected by arthritis. You can find a list of suitable home-based exercises recommended by Arthritis Research UK on line or from your GP.

How do I become active?

You will benefit from most exercises although we would recommend that you do not do high impact activity i.e. running long distances on a road surface. Locally Harrogate Borough Council run exercise programs and you can find the information by tel: 01423 500600 or emailing sportsdevelopment@harrogate.gov.uk or visiting the sports development section of Harrogate Borough Council Website.

Walking aidsIf you are getting pain from your joint when walking/ weight bearing you could benefit from a walking stick. The walking stick will take some of your body weight through the hands reducing the load on the lower limb joints

There are several walking aids but in the early stages of OA a walking stick is the most appropriate. They are suitable for most people and easy to walk with.

Measuring a stickWhen on the floor the handle of the stick should reach your wrist when your elbow is very slightly bent.

Using a stickWhen walking with a stick use one stick in the opposite hand to the affected leg. Put the stick and the affected leg forward together.

SupplyWalking sticks can be purchased from Yorkshire Care (Forest Lane Head, Harrogate: 01423 799960) / walking shops/ garden centres/ some pharmacists/ Sports Direct etc. Your GP could also request one to be issued from the Physiotherapy department if you need help with balance or learning to use one.

If you have reached level 3 on the pathway, your osteoarthritis is now affecting you significantly. You may need to progress from a walking stick to a walking aid which provides more support.

Crutches: Crutches can be used if you need more support for walking and taking body weight. These are generally only required in the later stages of arthritis and not all people need this level of support. Crutches are issued by the Physiotherapy department at Ripon and Harrogate District hospitals.

Frames:- Walking frames are rarely required for osteoarthritic people unless they have more than one complaint.  They give a lot of support and help with balance. You should be given advice on how to use a walking frame before using one.

These are available from

Yorkshire Care, Forest Lane Head, Harrogate (01423 799960) and the Physiotherapy department (with a doctors referral) as above.

Psychological supportIt is normal to feel down about your arthritis. Negative feelings when dealing with pain and loss of function are normal but these can lead to depression and anxiety. Twice as many people with arthritis experience anxiety, compared to the general older adult population.

If you have negative feelings such as these do not struggle on your own. You can seek help and discuss the problems with your GP, Practice Nurse or even family and friends. All these conversations will help you deal with your emotions and they may lead to a more positive way of managing the problem.

Heat and iceFor moderate to severe pain from osteoarthritis, try applying heat and cold to the affected joints. Experiment with these heat and cold techniques until you find what helps you most.

Heat

Apply heat 2 or 3 times a day for up to 20 minutes, using a heating pad, hot shower, or hot pack. Heat seems to be effective for pain and stiffness related to inactivity of a joint

If you are using an electric heating pad, avoid falling asleep while the pad is on. If you think you might fall asleep, set an alarm clock to go off in 20 minutes. Use heating pads set on low or medium, never on high

If you are using a microwaved wheat bag make sure that you shake it before putting it on your skin to prevent any hot spots

Try alternating between heat and cold After a heat or cold treatment, try some gentle massage/ rubbing for relaxation

and pain reliefIceIce and cold packs can relieve pain, swelling, and inflammation from injuries and other conditions, such as arthritis.

Types of ice and cold packs

Ice towel

Wet a towel with cold water and squeeze it until it is just damp. Fold the towel, place it in a plastic bag, and freeze it for 15

minutes. Remove the towel from the bag and place it on the injured or sore area.

Ice pack

Put about 1 lb (0.5 kg) of ice in a plastic bag. Add enough water to barely cover the ice. Squeeze the air out of the bag and seal it. Wrap the bag in a wet towel and apply to the affected area.

Cold packs

Bags of frozen peas or corn are inexpensive, last 10 to 20 minutes, and mold well to your body. You can also buy cold packs that can be reused. Store them in your freezer. Some of are designed to wrap around an area, such as a knee.

Using an ice or cold pack

Apply an ice or cold pack to the sore area up to twice a day for as long as you have pain, swelling, and inflammation. Use ice for 15 to 20 minutes, 2 times a day

Always keep a cloth between your skin and the ice pack, and press firmly against all the curves of the affected area. Do not apply ice for longer than 15 to 20 minutes at a time, and do not fall asleep with the ice on your skin. It is best to check your skin every 5 mins to make sure that you are not getting an ice burn.

Level 4 – The surgical stageAt this stage you are no longer able to tolerate or manage your osteoarthritis symptoms and may be a suitable candidate for surgery.

At this stage you are no longer able to tolerate or manage your symptoms.

Seek advice from your GP.

Your GP will establish if your health is good enough to contemplate surgery and if you meet the established criteria, i.e. you are not too overweight, you are a non-smoker, you have taken medication appropriately and are using a walking aid.

Appointment with the Orthopaedic Surgeon:

The Orthopaedic Surgeon will discuss the risks and benefits of surgery with you. The decision to undergo a joint replacement is made between you and the surgeon based on your quality of life, management of symptoms, your own personal preference and your surgeons choice of best option for you as an individual.

Remember there is no going back once you have had the surgery, the onus of responsibility lies solely upon you to take charge of your rehabilitation by participating in physiotherapy treatments and continuing exercises and advice given by the physiotherapist to achieve the best possible outcome for your joint.

Once you have had the surgery you will need to take charge of your rehabilitation by participating in physiotherapy treatments and continuing exercises, following the advice given by the physiotherapist in order to achieve the best possible outcome for your joint.

Hip: http://www.orthopaedicscore.com/scorepages/oxford_hip_score.html

Knee: http://www.orthopaedicscore.com/sc orepages/oxford_knee_score.html