Why do you do what you do?

Orthopaedic surgery was a very attractive specialty to me because you could make definite changes in patients' quality of life. It allowed you to provide an intervention and, almost overnight, the patient was significantly better, whether it was trauma when someone broke a bone and you could fix it, or a hip surgery when someone had debilitating hip arthritis which almost puts them in a wheelchair and you can give them a hip replacement and then they can walk. It's being able to see that almost immediate improvement for patients. That was the start of why that seemed to be something that I wanted to do. It's quite diverse. The hip surgery ranges from elderly frail patients who have hip fractures through to patients who have very high demand and want to be able to do lots and lots with their hip through to more sedentary patients. It's a broad group. That's what brought me into hip surgery. I have a particular interest in patients who have a lot of comorbidities, who are considered high risk patients. I've always felt that a patient, through no fault of their own, may have a lot wrong with them which they need care for. I've always wanted to be able to provide care to those ones who are in a really difficult place. They may have heart disease or diabetes or they may have kidney transplants or liver transplants. My practice is trying to deal with those patients who have a difficult problem, but still need help with their bones and joints. The other thing that I have an interest in is patients who have metastatic cancer. You really get limited option opportunities to do things for patients who have a cancer that's spread to their bones, but to give them the better quality of life for the time they have remaining, and that's quite important to me. That's the biggest driver for me to manage patients with metastatic cancer.

What are the common symptoms that your patients tend to present with?

Patients with hip problems commonly present with pain, but that pain can be really variable. They can get pain in their groin, which they don't think is hip pain if they think it's in the groin, but actually can be coming from their hip. They often have pain over the side of their hips or pain in their buttock. A lot present with low back pain because the combination of hip and low back problems often go together. Another really common symptom that they present with is stiffness. The kind of stiffness that goes throughout the day or they notice that they find it difficult to put on shoes and socks and they just feel like that their leg is seizing up. Or it may be that it's a function problem that they can't walk as far as they used to or they've had to stop playing football or tennis because they just feel too uncomfortable at the end of the day after doing it, and are becoming more sedentary and missing out on doing the activity that they used to enjoy doing.

What are the treatments that you're able to offer your patients?

The first thing is just being able to give patients an honest assessment of actually what's going on because sometimes people just want to know what the problem is. They may not actually want to have anything done yet, but they'd like to know why something is bothering them. If it is, the things that we can do include getting them seen by physiotherapy teams, orthotics teams and other specialties that can help with them. We arrange injections into muscles, tendons and into the joints. We can arrange for them to have a therapy called shockwave therapy, which is very good for a condition called gluteal tendinopathy. Then we have the more invasive treatments such as hip replacement surgery and different types of hip replacements that we use. I choose the implant that best suits the patient. It's not a one-size-fits-all scenario. If there's something that's better for you, then we use that. Then there are patients who've had hip replacements in the past, and we know that they don't last forever or there may be problems with them that need assessing and sorting, and then it's a case of figuring out if we need to change their implants or if we need to do different operations to make their implants work better. As for trauma surgery, it's fixing bones, and that's often done with plates and screws, rods and nails. In general terms, that's what I do.

What are your areas of sub-specialist interest?

I did fellowship training in orthopaedic oncology and in hip and knee, but predominate hip reconstruction and joint replacements. I have a practice that has a lot of arthroplasties or hip replacement through all ages of adults. So, starting at 18 and all the way into the 90s or beyond. I have an interest in complex reconstructions, either complex patient groups who have multiple capabilities or orthopedically technical problems such as patients who have congenital dysplasia or sickle cell disease. I'm also a revision hip surgeon. My NHS practice is in a specialist centre where I do revision surgery. That's for implants wearing out, failing, treatment of infection, et cetera. I also manage bone infection around the hip, pelvis and femur in patients who've got infected joints or infected bones and manage them. In my NHS practice, I treat a lot of patients who have metastatic cancer around the hip, pelvis and femur and look at either reconstructing their hips with arthroplasty interventions or stabilizing their bones to minimize their risk of fracture and improve their pain. These are the main bits of what I do.