From Surgery to Recovery: Everything You Need to Know About Hip and Knee Replacements

Recovery and Pain Management After Hip Replacement

[00:00] Now just explain the recovery in the first 24 hours. So I'm on my hospital bed, had my surgery. When do I expect to say the pain? How long would the pain be? Yeah, well that lovely

[00:20] thing about hip replacement is patients describe pain going off like a light. Okay, it's really that good. We have not got that same situation in the knees yet. Okay, so just having that implant in actually takes away quite a lot of pain. And as a result, you still need quite a lot of hydromethalomorphin and algesia

[00:40] to actually figure out the cut that we've made, it almost goes very quickly. Your pain load goes quite quick. And it's quite often the case within three days, some of these high dose or high strength morphine can be minimized to just paracetamol and anti-inflammatories. But how long do you expect me to stay in the hospital?

[01:00] hospital. So if you're young and fit, guy like you, now we're saying 24 hours. Okay, we are in the US there innovating on same day discharge. Okay, we haven't got that in Dubai yet. If I had a nurse at home, I could probably do a same day discharge. And this was even when I was training 14 years ago. And when can I walk? You can walk within three to

Immediate Complications and Infection Risks

[01:20] four hours of that operation if not less depending on the that's really the anesthetist. I mean it's clean surgery and when that spinal wears off let's say within two to three hours you're up you go on a frame yeah you're then in a crutches within the afternoon you know within that within a few hours but a good muscly chap like you could probably even go from frame straight straight off without crutches. What are the immediate

[01:40] complications that we can face. I know it might be clean operation without any but yeah what are they possible? I suppose the first thing is like the most important one is how you put the implants in okay and the technical issue with that and as a result if you don't put them in right the hip can pop out okay and that can be a disaster okay that now that may happen

[02:00] Once it may be the case the patient hasn't helped because there are maybe a few restrictions You may tell the patient you tell the patient beforehand not to do certain movements. Okay, particularly when you bring the hip up and internally rotate the hip in Okay, particularly on a posterior approach. You might tell them not to go down too low squat Okay, squat down too low for the first six weeks

[02:20] There are studies now where they invented hip replacement saying that we do not need to restrict. At the moment, most surgeons are restricting their patients for six weeks, restricting various movements like internally rotating for six weeks. After that, everything

[02:40] Everything is good. There is a feeling as a surgeon that when you put this thing in apse right, even though you tell the patients you have to restrict, I am not that unhappy if they tell me that I did this movement or I slept in this way and it's their problem because I know that this hip is never going to come out.

[03:00] I just know that the patient is relaxed, I put it in and I just know that there are other times I might be a little bit more sensitive about it. Maybe the patient hasn't got so much good muscle, maybe they aren't as reliable. So I would just be a little bit more cautious with those. On the whole, I'm pretty cautious with most. I would tell them to follow the rules for six weeks and then you can do what you want.

[03:20] What about other complications? Not the fact that it might pop out, but anything else? Okay, so any joint replacement surgery you're obsessed about infection? Infection. Okay, and this happens in less than 1%, okay, but it is a disaster and it can happen. Okay, we can think of trying to, if the wound is still, that will give us an indication of usually pain, redness around the wound if it's still leaking.

Full Recovery Timeline and Physiotherapy

[03:40] You'd expect that wound to be dried up within the first 48 hours, 72 hours of an operation. If it's still leaking at seven or eight days, then it's sort of flagging something up. Okay. Now, a young fit individual like you will heal very well. An elderly chronic asthmatic on steroids, smoker, you know,

[04:00] These are sort of people that are much higher risk. Okay, and you have to watch them a lot more. When can I reach my full recovery? What I mean by full recovery is exactly doing what I was doing before the surgery. Yeah, well, I mean, I could say conservatively it's six weeks. So patients probably, and I would say six weeks. Okay, six weeks is a good mark of anything at all.

[04:20] really know why six weeks. We say six weeks just randomly for any fracture healing. If I was doing say five kilometer run every day and I had this hip pain, still I was doing it. I can go back and do five kilometer run. Yeah you probably could at six weeks. Yeah that's okay. But I'd say six weeks, not a day before. Okay I've had patients trying to do stuff like that at four weeks and you know what's interesting is I tend to get

[04:40] call at about three and a half weeks. I didn't get a call at two and a half weeks. Why? Because they've gone and done exactly that. They've upped their activity levels. They've forgotten almost. They had a hip replacement. Hip replacement can be so good you can forget you even had it done within three or four weeks. They go off, but still the soft tissues are still trying to heal. So I tell patients, no, wait the full six.

[05:00] Definitely no going swimming. I don't want any bugs from the swimming pool until that wound is completed for three weeks. So the wound is usually sealed up completely and the clips are out within 10 to 14 days, but another week after that everything about infection is about being obsessive about it and trying to minimize that risk. So even if it

[05:20] looks dry, the wound, you still say another week. Post-surgery, physiotherapy. Not really. Most of the time, no. Unless they're elderly, they need just general physio for mobility and stuff like that. It's that good. And sometimes if the patient has been leaving this hip for many, many years, the most weight is important. But pre-surgery is important to build. Not even then. No. No, I think the thing is just get the

[05:40] out of the pain of my advice is just get it done and then they can start walking and loading onto it normally. Any kind of physio to get your general mobility up is good but it's not a prerequisite. Why is it that many times in literature also they mentioned that you have full recovery which is getting back to your normal self is six months to one year. Is that old literature? Yeah that must be old literature definitely yeah.

Longevity and Future Revisions of Hip Replacements

[06:00] What about contact sport? If I'm a rugby player and I still play rugby as a leisure activity?

[06:20] sorts of things and that was in the rink in Dubai actually. So yeah, I'm assuming he's going in and bashing people after that. I had one patient who actually came in in about three months and he was able to put his foot behind his ear in some kind of yoga move and all this sort of stuff. So people do all sorts of funny things.

[06:40] But as long as they stick to the rules for the first six weeks is fine. I want to ask you a very very first and important question here So if I'm 55 and I have the surgery, yeah, and I if I'm lucky enough to live till 85 now I'm 30 years down the line. I have a hip replacement. I have a prosthesis inside how long I expect it to last yeah, this is so we would expect

[07:00] 90% chances still be there at 30 years. 90% chance? Yes. Now that's controversial and it's debated, but I would say I would give you 90%. What happens after 30 years? I mean, what are the possibilities? Well, the whole, particularly on the cup, it might have worn down completely and it may just need a line of change. It may just be the thing. A line of change? Yes.

[07:20] The inner pink liner, yeah. It may just be a simple case like that. That's fairly straightforward. You just go in and replace the liner. Maybe the whole cup is loose, particularly in cemented hips. This was a problem in the past. Or it may be that the whole thing needs replacing. But you tell a patient that you have 90% chances it's going to last for 30 years. Yeah, it's within that. I mean, that

Hip Replacement for Elderly Patients and Risk Factors

[07:40] is hotly debated and certain things. So when I was a medical student and then doing my emergency shifts and all that, they used to say a hip fracture in an elderly is a is a death sentence and that's obviously because of the pulmonary complications, the embolism and all that. In your population that comes to you, I know in Dubai, the geriatric population is less, but in the UK for example.

[08:00] When you had a lot of elderlies coming to you, did you have complications like an embolism happening after the manipulations that you do on the hip? No, the thing is, that's an interesting question because we've known now that maybe for the more active elderly that you want to do a hip replacement because people are living in a lot longer.

[08:20] So we used to probably think even growing up 70 years old, okay? Yeah, is it given that maybe these guys if they haven't smothed and they've done all the right things They're gonna be there till they're 90. Okay, so or maybe even longer than that, you know So you want something that lasts the trouble is if you'd put in a half a hit replacement that will wear eventually through the pelvis Okay, the whole point of having

[08:40] having this acetabulum is that it stops the wear of this hard hip replacement going in. So it's a bit of a judgment call. If you've got an 85 year old and you've got a rough idea that she's probably got five years left, you might want to do that if she's broken a hip. But we've turned it to fine and there has been studies now that the hip replacement is giving better

[09:00] for patients who are a bit older as well. But the good old, the good elderly. We know that an 85-year-old can be biologically 65 and a 65-year-old can be biologically 85. So it's a judgment call really. I need to ask you about this. The most recent or the most famous news has been what Andy Murray has done.

[09:20] done with his hip replacement or partial hip replacement. And then he went back into ATP tour and he was playing matches. Just tell us a little bit about that. Why did he have to undergo hip replacement? Yeah, but he's obviously like a lot of these sportsmen, particularly sometimes footballers as well, famously, they've just done so much loading and jumping up and down that they've just worn

[09:40] hip out. I've had my fair share of sportsmen who needed hip replacements even younger than that, like a 36-year-old professional rugby player. He was captain of a national side and stuff. And he was saying that he was bench pressing at a very young age. He's feeling pain as a teenager.

Sports, Activity, and Joint Damage

[10:00] So putting these abnormal stresses and loads on the hip like some of these sportsmen do is going to probably leave you prone to that. If you're a normal individual who's not doing these very extreme things, you're probably not going to run into trouble until you're in your 60s or 70s. But these guys are on a, you know, they're working on a different plane really, but the body hasn't caught up with that. But that's still an exception.

[10:20] What Andy Murray had? Very much so. But there are so many sports people who don't undergo this. This is a rarity. There may be a certain amount of genetics on it. I had a very young girl who came to see me. She was a high jumper. She was in a national team, she was landing on one side. And sure enough, because she's landing on one side,

[10:40] she got a hip arthritis on that side. The other side was completely normal. She was probably only 25 when I did it. Let's move to knee. Yeah. Okay. I think this one will be quicker because we've done a lot of the generic discussions already. So I understand that knee is a more complex joint than the hip. It certainly is and we certainly haven't solved it quite as well. If we're surgeons we've got to be on

[11:00] If I was going to choose to give you one, I'd give you a hip more than a knee. It's not to say the knees aren't great and I can get you out of pain, but there will be a grumble factor and there will be a slightly slower post-op recovery. But is it fair to say a knee patient is more troublesome for you as a doctor than a hip patient?

[11:20] No, but I'm going to say you never get you get that situation where occasionally where patients say within two days, it just went away. Okay. But usually there's a bit more. There's just a little bit more to it. But by the time they get there, okay, they get there, but they're not getting you that kind of instant feedback. So I told you why I went here in the first place.

[11:40] Like you do with a hip. And what are the causes for knee as compared to hip? I mean we talked about hip why people come to you. What about knee? What causes arthritis? Mainly arthritis. So again if they're coming a bit earlier have they done something abnormal? Some professions like builders for example they might do. Bodybuilders. No just even standard builders. Lifting heavy loads.

[12:00] People are being a bit overweight. The thing about the knee is that if it gets a bit arthritic, you can actually stop an awful lot coming to see me by just doing good physio. Building the muscles around it are really key to it. So for example, if I've seen a patient and they have, I've seen a patient, one of the most extreme patients was an Ironman.

[12:20] who had a very arthritic knee and virtually no symptoms. I always tell my patients this. The reason why is because he was training every day and he was light and strong. So the key with knee, and this will not be like that in a hip. The hip will suffer with that even if you are light and strong. With a knee, because you've got this quadriceps, basically this suspension that you can

[12:40] can build up, you can avoid a lot of trouble with the knee before you come to see me. But is it fair to say that people who have a more active lifestyle, like excessively active, sports people who exercise on a daily basis multiple hours a day, have a higher risk of knee arthritis? I don't think it is. You know there's some studies now, particularly where I worked in

[13:00] stamina stamina and I think he might have been a runner though but this was there was one professor who actually MRIed a bunch of middle-aged people okay before marathon and after marathon and they checked the width the thickness of their cartilage okay he found it was actually slightly thicker after the marathon and these are sort of people are a little bit overwhelmed

[13:20] weight during their first marathon in their sort of late 40s and 50s. They MRI'd about 50 patients, found that they may even have a protective effect. Everyone thinks doing a marathon was run the knee out and you wear it out quicker. Maybe the other way around. So no, it's not the case. But I would suggest that you wouldn't have any trauma to your knee. The contact sports, the sort of

[13:40] what I call the sudden impact where you can't measure your load, unlike cycling and running, which is what a lot of middle-aged people do, but this kind of sudden impact which can injure the knee, that may wear your knee out a lot quicker. But is it fair to say people who have a most sedentary lifestyle who sit a lot and not walk around so much, lack of exercise

Knee Arthritis: Causes, Prevention, and Non-Surgical Treatments

[14:00] That kind of pushes you to have arthritis early for the knee. It doesn't necessarily push you for that But it probably predisposes you to do more symptoms because your muscles around that got it, you know And so and also you're not so willing maybe to go for physio and do some work on it Okay, so if I said to you I can guarantee if you see this physio

[14:20] For six weeks, even the pain you're in now, you may stem having a knee replacement for a few years. I've heard that even from other doctors where they say if you have knee pain, people used to think I should exercise more, but they shouldn't, isn't it? You should restrict movement at least for some days. No, absolutely not. Okay, restrict it when you've got pain, definitely.

[14:40] If I listed someone for a knee replacement, I tell them use the stairs. Do your exercise. Walk every day. I want a conditioned well to build the muscles around it. It's very important. In fact, in the UK where you got to this concept where you were prehabitating, you were doing stuff before your operation.

[15:00] Generally, you are not deciding to operate on this patient. And the patient says, I have this chronic knee pain for a long time. Would you still recommend exercising to build those muscles? If it hurts, definitely you do not go into the pain barrier. And your body is telling you something. Otherwise, you go ahead. Because I never restrict any exercise. Plus, all the other benefits of exercise, your heart, lungs, your mental

[15:20] being. I can never restrict anyone. So for me, anybody who's say 55, 60 years of age, what's that alarm bell where I'd say, okay, I might have to think about a knee replacement? Pain, pain, pain. And pain particularly at night and at rest and walking around the mall and all that sort of stuff. I mean, if you see

[15:40] someone walking around comfortably two laps into buy more and you're barely getting from you know cost of coffee to the fountain or something then something really needs to be done because you can measure yourself against your peer. By the time you're 55 you know you do have some creaking and you know when you score. Come on we're both that same way it's not acceptable and this is the point we're all doing

[16:00] loads more stuff that our parents did at 55. We're all playing paddle now. We're all probably still playing cricket. We're definitely doing goal. We're definitely doing lycra and alcudra and all this sort of stuff. And we're swimming. So we're a lot more active now. We're playing like people in the 30s. You know, 50 is the new 30 in that way. So you have

[16:20] If you are in pain, you need to sort it out. And as I said, most of the time, if you're a good surgeon, you're trying to avoid surgery. You'll send you up to your physio colleagues and they can sort it out. And then occasionally your physio will say, no, I think this is the one we need. I hope I can say that for every surgeon. But yes, I take your word for it. No, it really is the key to that. Because within the

[16:40] As a surgeon, you want happy patients. You're doing something very invasive even now. We haven't got this thing with stem cells. All magic goes away and all that. So Paul, tell me about regular, what an anatomy looks like, what a knee looks like. There's a kneecap. Okay, a knee. This is a fibula. This is the outer part. This is the tibia, the shin bone, and then you have the thigh bone and you have the kneecap underneath.

[17:00] The kneecap has the thickest amount of cartilage in the body and it needs to because you need to usually go down the stairs with a bent knee and it needs to take a load at the front of the knee. So this is very important. So the knee is really made up of three compartments. The kneecap, the inner compartment, the medial compartment, the outer compartment, the lateral compartment. And you can see it's got this shock

[17:20] The blue bit, yeah? The blue stuff, yeah. It's called a meniscus. Meniscus, yeah. This is the stuff that when you jump down, it protects your knee. Like a cushion. Like a cushion, yeah. And then around the bones, you've got the white stuff, the cartilage. You know the stuff you see on the lamb bone when you're eating your meal. This is usually white and shiny and, you know,

[17:40] smooth. And again in the arthritic process what will happen if you get arthritis this will wear down sometimes to nothing and this cartilage will be destroyed as well and that's when it becomes intensively painful when your bone is in touching onto your bone. So two rough surfaces rubbing against each other. Exactly yeah and so normally this will happen

Knee Replacement Surgery: Procedure and Recovery

[18:00] on the inside of the knee. If you're, you know, they're very rarely, sometimes it happens on the outside and very occasionally it might just happen in the isolated kneecap. Okay. But on the whole, it will probably start in the inside, then go progesterone, and then into the kneecap. It'd be intensively painful, bone on bone. Okay.

[18:20] That's the anatomy. I'll be coming on to the next one. So you've told us what the knee anatomy looks like and we know that with arthritis the cartilage breaks down and the meniscus becomes thinner. Now if I'm coming to you at 40 or 50s and I have knee pain, you said that the first thing you would do is ask me to build my muscles around it to avoid the surgery.

[18:40] surgery. Now are there any other options before you offer me surgery like PRPs, stem cells? Just tell me about that. This is again controversial but I'm not a great believer in it. I don't think it works, I think the evidence is very sketchy. Steroids we used to put in a lot, we used to put corticosteroids in, you probably still hear sportsmen who need to get back on the pitch, create

[19:00] because of footballers, they get the odd shot. It does have the disadvantage that it can eventually, if you have repeated, it can destroy the cartilage. It also, if you're coming up for knee and hip replacement, it may actually make it worse. And there's a risk that may make infection risk higher. The one thing that does seem to work is a thing called hyaluronic acid.

[19:20] Yeah, it's kind of a gel. Yeah, it's a thick glupiviscus liquid that basically mimics the oil of the knee. Okay, the synovial fluid. It's a lubricant. It's a lubricant. Yeah, we know that about 60, 70% of the time it works. Okay, and it but it only really works in the early stages. Okay, in the early stage like your knee or

[19:40] knee. Okay, if it came in pain and it's not my first line and often I see patients who have offered this on their first consult. The first consult if it's a moderate early arthritis should always be a physio. Physio, right. Because you're still having to put it neatly. Yeah. Okay, this is the second line treatment. Second line treatment. Okay, unfortunately there is obviously a quite a sizable fee when you put in high

[20:00] ionic acid. So people have this and no physio, which I find incredible. Okay, and I see that a lot. Okay, and they've never been offered a physio. They've only been offered repeated injections of various things and worse stem cells, which is in my book, complete waste of time and money. Right. I think they'll be coming for me after this. There's a lot of adverts on Facebook, but honestly, it's not

[20:20] In my book it's not evidence based. That's the first line. Now, a big no-no, if you have a severe arthritis and you know that you may be coming up for a knee replacement within the next three to six months, no one should ever, ever put a needle into the knee. It will see an infection.

[20:40] If you look anywhere on Google or all these things, it will never allow you to do that. Now, I see this quite a few times where people have had an injection and the next day they've been listed for a knee replacement. This is really quite risky. From the infection point of view. From the infection point of view. As I said, as surgeons, we really try to do our best

[21:00] avoid any risk. Even if it was a minor risk, we're not going to compromise with that. And anyway, you're going to be fixing the problem with a brand new shiny knee. Why would you need to do an injection? So we've gone through the initial conservative treatments or the first and second line. Now you decide to do a knee replacement for me. I come to you, what is the prehabitation? What I need to do before I get to

[21:20] on the operation table. So building up the muscles. So I love the idea, I know you can look it up on YouTube, you can go to a physio, quadriceps strengthening. The inner quad particularly. This one. Show us the quadriceps or big muscles. Suspension muscles in the knee. You might even find you can stem not having a knee replacement for quite some time if you have strong

[21:40] Maybe you lose a pound here. A pound here is four pounds in the knee. Some patients come back and say, you know, I don't have any pain anymore. They've lost weight. Some patients who've lost weight, ironically, come with knee pain because they've been doing so much in the gym. So it's one or the other. Anesthesia. Anesthesia.

[22:00] Yeah, okay for a knee replacement. Yeah. Okay. What would you choose again? Spinal every time spinal again every time okay, because you even though you can be sedated you can be out You don't hear it. You will get up and move much much quicker. Okay, okay, you will not be knocked out for three days Yeah, okay, you will not feel dizzy and drowd or too dizzy into drowsy got it Paul. So now we

[22:20] So we've done this, so your table as this has given now you are going to show us the procedure itself with the knee model that we have. So is it a misnomer that this is not a knee replacement but rather a knee surface replacement? Yeah that's right yeah because people get very caught up by the fact that you have to cut so much bone. Okay well you don't actually. You cut the surfaces where it's diseased, where

Robotics, AI, and Advancements in Orthopedic Surgery

[22:40] where it's actually arthritic. So it's just really a shaving. So you shave off. Yeah, you shave off. Now, you have various jigs to shave it off with. You have blocks to make the shaves very neat and clean. So again, like you said with the carpentry, you have these various blocks. But you take basically five cuts, one, two, three, and then you do what's called chamfer cuts here.

[23:00] 4 and 5. That's on the femur and then you do one on the tibia. It's just the edges. You have this series of very fine cuts on the edge. So just to say prior to that, your incision is usually from here to here to give you access to the knee. You go into the access and then you flip the patella around

[23:20] to give you this access to get you the view of this. Gone through the cuts. It's clean now. Yeah, so it's clean now. And then essentially what we do is we just put this prosthesis in. Okay. Now this prosthesis just happens to be roughly the same size as this knee. You get the idea that this will basically want to slot onto that. Okay. In that way when the cuts are made. Yeah.

[23:40] Okay, now how do we hold that onto that? Now that is quite controversial. In the US, you might just use this special hydroxyapatite that I was talking about in the heat, which is where it sticks to the bone. We don't like that in the UK. We like to cement it in. So these in UK mostly get cemented. You can see everything. This is a used one, right? This is a used one. This has been inside someone. This is the cement. Cement. Okay.

[24:00] This is the stuff that basically glues it onto the bone. You can actually see the digitations of the honeycomb of the bone that it's been into and it sits in there and it takes about 13 minutes to 14 minutes to set and then you do the same on the tibia as well. So this goes into the tibia? Into the tibia. And this forms the meniscus, the white one?

[24:20] White one is effective in the meniscus. This is high dense polyethylene, a special polyethylene. It's been injected and irradiated with various things. And just to say, the cement has also got an antibiotic in it. And you give it for infection. You've also been given antibiotics in your induction and you usually get two afterwards as well. So again, coming back to that obsession against infection.

[24:40] can you just show how that knee surface fits into the synthetic meniscus? Yeah so this one fits into the top like that. Got it. Okay so we've removed all the meniscus and everything and so you're just a surface, you remove the disease area and it fits down into that and then these two just basically articulate like this. Now what's beautiful about this knee it's not

[25:00] notice they're not connected. And there's a reason for that. It's not a hinge because it's allowing for the various subtle movements of the knee. The knee is much more complex. Not only does it twist when you extend and flex the knee, it also rolls back. So it's what we call a semi-constrained implant. It's not fully

[25:20] What is the recovery period in this? Is it the same as hip?

[25:40] Well from the point of view you're in the hospital for 24-48 hours. Again, you can do same day surgery. People are pioneering that in the various factors and that will be probably a given in the next 10 years. I mean it's already like that in the US. Have you ever done bilateral procedures at the same time? That's a very good question. I have and I don't think it's worth it. Why? Because it bleeds,

[26:00] patients bleed more, there is a higher risk of infection, the rehabilitation is really quite tricky because you've got two operated legs. So one is painful, the other one is painful. At least you know what you've got on the other one even if it's arthritic. Just the risks, blood clot and all that sort of stuff. But what time frame would you leave between doing both? Yeah, that's a good question. So you Google that and I did look it up because

[26:20] because the patient was pushing it. He was a young, fit patient. I left it for six weeks. But ideally, I think three months would be the thing. But again, it's quite controversial. Same with patients believing you can have them both at the same time as well. Where I worked, I worked in the busiest joint replacement center in the UK with some excellent, excellent surgeons. You can tell me the name, yes.

[26:40] Robert Jones and those guys never did a very rarely did they do a bilateral. So if you've got the best surgeons and they are not offering bilateral that's telling you something. Now unfortunately we do see a lot of bilateral even being done. And we can debate that a lot in conferences and get very worked up about all that stuff. But again it kind

[27:00] comes back to minimizing risks. If you're a surgeon, you want to do the most you can to minimize the risk. And if we know the evidence is there and that will be debated, there's risk of infection, risk of bleeding, risk of complications, blood clot, why even risk it? I always ask this question to any surgeon that comes to our podcast and that is,

[27:20] When if not now, when do you think robotics coming into your surgery? Yeah, I mean we've already into robotics now. Okay, and yeah, there will be definitely the future. Okay, people got to understand right? This is Tesla we were dealing with and Tesla is still not driving itself. Okay, we're not gonna all leave tonight.

[27:40] When we leave and go home and that car is going to drive us. And this is where people have really been sold a little bit wrongly, I think. They can claim that they can put the implants in a better position and more consistently. There may be some evidence that I'm not so sure. They can claim also that

[28:00] time that it takes to put them in is the same as a normal surgery. There is a learning curve, so you're relying on maybe 30, 40 patients before you may be getting up to speed. And why would you risk those 30 or 40 in your experiment anyway? Because time is of an essence. In arthroplasty surgery, particularly knee surgery, you don't want to rush it, but you want

[28:20] to be doing it quite efficiently. If it's taking more than two hours you want to know why. Is it very very complex or is the surgeon probably not? But are you using robotics to assist at the moment? At least some surgeons do. You are and yeah we will definitely have that. In fact I've got a robot coming on in January but I tell you this at the moment it's just a marketing tool. Yes. Okay it's only because. Oh that's a big

Cost, Insurance, and Practicing Orthopedic Surgery in Dubai

[28:40] statement. Yeah, no, it is. I mean, I believe in Australia, they're not allowed to advertise that it's better. Okay. And there's a good reason for that. Okay, because people are being sold a little bit wrongly on this. It will come and it will happen. Okay, but nothing at the moment beats the surgeon. What about AI? Yeah, that will definitely happen. Yeah, I'm not completely like, oh, this is it's going

[29:00] It will be us in a few years. It will be able to do some effects. It will be a surgeon with the AI skills installed within him or her to do this procedure. Yeah, but would you want to be the guy that, you know, the patient who's being experimented on? That's what I'm saying. Okay. So for example, if I had friends and family, would I go to the latest thing? No.

[29:20] Try it and test it. Try and test it evidence for 30 years because we have known now that we've got caught with this stuff. And even really clever surgeons, really great surgeons have been caught out with the various problems. And there's been all sorts of two incision probes, metal on metal, all sorts of things have been done. And sometimes with the cleverest surgeons in the room.

[29:40] because they're the ones who usually offered it first. So you have to be two steps back and think, okay, is this going to be beneficial to my patients in the longer term? It looks great, but not everything looks great. I think I'm going to ask you the most important question about this podcast now. So if I have a number of elderlies that live with me, the question is, when you say

[30:00] sell hip replacement to them, they think, okay, I've been living 30 years with this pain, my quality is fine and I'm not bothered. What is that fine line that now today a 50 year old or 60 year old should cross to make that decision to go ahead and transplant his hip? Yeah, well that's a great question and I think that is, you can live with it.

[30:20] This is not cancer. You don't have to have it. But if you've got expectations in life to be nicer and better, perhaps you want to go hiking, perhaps you even want to ski, perhaps you want to just play with your kids or your grandkids and all that sort of stuff, it is revolutionary. That's defining the quality of life. That's individual. Mine might be different to yours.

[30:40] my kind of expectations for my next 30 years might be different to yours. So I might choose not to go ahead and operate myself. But movement is life in my world. Yes. OK, that's why I see it because if you don't move, you don't get out and you don't meet your friends, you know, all these things that even socializing, you need sort of be pain free and you may have to walk to their house and all that sort of stuff.

[31:00] So I would say that from that point of view, it's really, really key. So your quality of life will be much diminished. The second most important question, which is, and you can't run away from this question, the cost of replacement. So tell me if I want to replace one hip, give me an average cost in UAE and an average in E. So this is my dream to bring it.

[31:20] At the moment you are looking at around 80,000 dorams for cash. I have got it down to 75,000 if I could bring it down for me and a hip. It is pretty much the same? Now it is the case that we in Dubai get offered all the great shiny toys and they come at a price. Now if you ask the reps in the same companies do you have the toy that

[31:40] that I was using 15 years ago that seemed to be working very well in Mrs. Doris down the road and she was functioning on it. Could I have that one? Because presumably that goes cheaper now. This is the iPhone 6 and not the iPhone 16. You want to make a call. You can make a call with an iPhone 6. Exactly. Can I have the iPhone 6 please and not the 16 because we know that

[32:00] insurance is covered for everybody?

[32:20] That's the problem. Yeah, but once the cost comes down, maybe they will okay, and there are various ways around that and again It's just about maybe first of all the robot is going to put the price north Yeah, but but Paul, let me stop you there. Sorry about this. But I if it's trauma or it's a vascular necrosis Yeah, there is a medical reason to do the transplant. Yeah, the the autoplastic and they should cover it, right?

[32:40] You'd hope so, wouldn't you? Yeah, but obviously we know it. Come on. You know, I want the audience to know this. Yeah. I understand that quality of life is a relative. You can decide. So insurance don't cover it. But when it comes to medical reasons, surgical reasons where you can't walk because your hip is broken, I can't figure out insurance no more than any medical person here. I've seen people

[33:00] Most amazing medical insurances paying the highest of premiums and getting not back. Yeah, okay And then there are ones with much lower Okay, and suddenly they get their approvals in two days and I cannot fathom how and why I think do you know I have a theory that maybe if you ask for it on a Friday afternoon You haven't got the big boss there. Okay signing off. Okay, so

[33:20] Ever come to me on a Friday afternoon, they're always going to get a no. If you come to me on Monday when the big boss is in there and he can sign off on that 80,000 to around 90,000 procedure, then you'll get it ready. So I think there is an element of that. I just can't figure it out. Tell me two good reasons. Let's change the segment completely now. Two positives about working in Dubai as an orthopedic surgeon as opposed to you.

[33:40] king. Right. So I can see my patients as individuals. I don't think there's a patient I don't know the name of. Okay. I get referrals from other patients. Okay. They come to me and say so and so, so and so. I say, of course. I remember everything about them. I kind of know what their interests were, you know, when they were going to skiing again. You know, this

[34:00] This is really nice. They watch up me pictures, they tell me their life, and just to know my patients. And you can see them when the symptom happens when they need you, not a year later when NHS decides to send that patient to you. Exactly. They're not a number. They're not a sausage in a factory. They are really an individual that you see, that you talk to, that you might not even talk medicine about or

[34:20] tips about, sometimes the books they're reading, it's a really nice thing to have time with a patient and really, as you can see, I like talking myself. So it's kind of a two-way street. They probably don't come out with much other than me talking. But occasionally, I get a clue. When I was working in one place, I was working in

[34:40] Indian Company initially and I'd have every patient who was Indian tell me their top five restaurants in Dubai. Okay right so I know most of the good Indian restaurants in Karama around here okay because there was always one of the two names were coming up yeah so and then I would give them a top tip or something. What about if there's one thing that from an orthopedic surgery point of view Dubai

[35:00] can improve on? Yeah, the cost. I think the cost. You know, that's the thing, isn't it? And particularly for elderly people, there's a lot of people from UK wanting to retire here. Okay, the big, big rate limiting step is the enormous amount of insurance that they would have to pay if they're, and even if they're fit, you

[35:20] Even if they're a fit, they're paying a lot. So they really have to kind of figure out how a fit six-year-old can live here and not pay way above the premiums. And obviously, the people who have chronic diseases and whatever are an elderly, that would be a real game changer. And it would be a game changer in my world because I really, most of my patients would know

[35:40] are in their 60s plus. Are you planning to retire in Dubai? Yeah, probably to a certain extent. I definitely wouldn't be here in July. But come on, in December, what's a better place to be, isn't it? I mean, it's really nice. December till March, April is just a perfect place. So what's the retirement age for you?

[36:00] I mean, I was just surgeons that decide when they want to. But that's a great question as well. You know, I yeah, maybe you should I don't know because I feel my every surgeon feels their powers the strongest they can be. But, you know, I heard about an 81 year old surgeon in the US. The US seems they seem to go until they drop. The more adventurous. That's ridiculous. Yeah. But come on, be realistic.

[36:20] Let's say 65 like it is in the UK. 65 is in retirement age. Even if you think you're King Kong and you're just doing such great work. There's got to be other things in life for a start as fun as surgery is. There's all this admin and paperwork and approvals for insurance and all that. You don't necessarily want to be sitting there with a

[36:40] Pina Colada on a beach, but you do actually want to see what else is around it But I'm sure you've you know working so many years in the UK and Dubai You would have thought about financial freedom at some point. Yeah, and then becoming financial fee. Yeah. Yeah You think at 65 you will be able to reach that point where you decide? I've been here 12 years. I mean we're already like that. Okay, yeah compared to what we're back in the UK. Yes, absolutely. I mean it's ridiculous

[37:00] Yeah, my you know compared to my friends and my colleagues back in UK, you know in terms of that course. Yeah, of course Okay, and this is really what the gift of what Dubai does, you know It does give you that kind of freedom and options. Yeah doing and and to enjoy your life really absolutely them. Dr Paul. Thank you. That was my last question I think we covered everything about hip and hip

[37:20] And there's enough for audience to chew on and look up on Google if they need to what we've discussed. Yeah, but this was just fascinating Thank you so much for your time. Thank you very much

[37:40] You