Category: News

This article by Andy McDonnell was published in the Irish Independent on the 21st of June, 2024.

Unable to train collectively at the time, amid the Covid-19 pandemic, the Louth senior football panel, under new manager Mickey Harte, were instructed to do lone training sessions. They were tough and I remember coming to the end of the gruelling session in March 2021 in Newtown Blues’ pitch and feeling a pain in my right knee.

I didn’t hurt it by twisting or turning and it wasn’t an impact injury. I knew something was up and when I went home the pain intensified.

Initially, it was thought by the medical team that there was nothing wrong with my knee, but I knew something wasn’t right. I played through the pain barrier weeks later against Antrim in the first round of the National League. I didn’t perform great but played the whole game. I remember getting home afterwards and I was unable to move my leg. It took me 10 minutes to get from my car to the couch in the sitting room.

I suppose breaking my femur in 2009 and having a minor operation in 2017 for a meniscus tear on the same knee didn’t help my cause.

Numerous physio sessions, anti-inflammatory tablets, consultant appointments and steroid injections failed to work as the pain remained.

I was diagnosed with knee osteoarthritis, otherwise known as wear and tear. I had planned to finish up playing for good as it was affecting my day-to-day life.

I then met a Meath man in January 2022 who I owe a great deal to. Liam Hogan, a physiotherapist, looked at my knee and to me I’d be back playing within six or seven months. I laughed at his optimism but told him I’d do everything I could.

A few weeks in and I wasn’t completing the rehab as planned. Liam was quick to call me out and told me not to be wasting his time. As the saying goes, “you only get out of it what you put into it”.

After consistently doing my rehab, my mindset changed as I started to feel the benefits of it. Eventually, I could walk pain free. My progress continued steadily and I made my comeback in a league match against Mattock Rangers in June 2022. Liam was in attendance and it was great to be back after a torturous 14 months.

We’ve become great friends since and recently caught up to speak about work, life, injury prevention, strength and conditioning and more.

Andy: Tell us a bit about yourself – what got you into physiotherapy?

Liam: I attended Cushinstown primary school in Kilmoon, Ashbourne Community School, and then studied physiotherapy at Ulster University, Jordanstown, and completed a Masters Degree in Sport and Exercise Medicine.

The common theme for me throughout those years was Gaelic football and a love for sport and that’s why I felt physiotherapy would be a great career for me. In terms of my friends’ group and social aspects, I think it’s something that’s been very good to me, both professionally and personally as well.

Andy: Can you explain how we met?

Liam: Before I worked in Santry, I was working in Our Lady of Lourdes in Drogheda and also with the Meath football team and one of my best patients that came through was your mother, who was a far better patient than you…

We got talking and she said that you were struggling with your knee injury. I spoke about you with Colm Nally and he felt you were in a rut. I didn’t know if I could help but told him I would meet you for a chat. We met up at the Blues and you seemed very apprehensive. I thought you were very down at the time and I’d often find that with players who were injured who hadn’t previously experienced a serious injury. I felt you had lost a sense of identity, a purpose, and I remember we had a chat about just trying to pull everything back and not make any plans about returning to football.

You were struggling running, struggling day-to-day and we made a plan. As much as we’ve slagged each other, we’ve become good friends over the last few years and your attitude was brilliant.

Andy: Can you explain the injury I had?

Liam: I know you came with the MRI that you had and I think you may have had an injection. The way I describe an MRI – it’s fantastic to have such detailed imaging but we sometimes hang our hat on what the MRI shows.

An MRI is a still shot that doesn’t show how an athlete is moving, their strengths, their deficits, their weaknesses. We often find MRIs that may show damage on a scan but the patient can be pain-free and vice versa, patients can be in a lot of pain even though their scan looks fine.

We’d look at the clinical picture and looking back, you had a lot of physical deficits from right to left knee. We looked at your hip control, your lower limb strength, reactive strength and just your overall conditioning. We just had time together and again having worked with Meath,

I know what it’s like working in an inter-county set-up. You might only get a couple of minutes here and there with people so that’s why I really enjoy UPMC Sports Surgery Clinic.

You tend to get substantial time with athletes and can make a very individualised plan and sometimes it’s just time that players and athletes need and want. They want numbers and objective markers and a clear plan is of paramount importance.

Andy: You are working in the Sports Surgery Clinic in Santry. What do you do there?

Liam: When I finished as physiotherapist with Meath, thankfully, I obtained a PhD role through the University of Roehampton working as a physiotherapist in UPMC Sports Surgery Clinic. It is a brilliant environment to work in and is a world-renowned sports medicine centre.

I have some fantastic mentors in Colm Fuller, previous Irish rugby physio, he’s our lead physiotherapist. Dr Neil Welch is our head of research and lab services and adopted Newtown Blues man Thilina Vitharana, he’s one of the best physiotherapists I’ve ever met and just a genuinely great guy. He’s probably not the first transfer for the Newtown Blues and probably won’t be the last.

The sports surgery clinic would operate on approximately 2000 ACLs per year and the majority of those would be tested in the Sports Medicine Clinic. You have the main hospital and then there is sports medicine and that’s where I’m based.

I am currently leading the hip and groin service and I’m aiming to develop a hamstring service based off the back of my PhD. My PhD is looking at hamstring muscle strength and return to play. It’s an interesting injury at the minute because it’s the number one injury in sport that’s increasing.

If we look at Premier League injuries from last season to this season, they’ve spiked by 96pc. There’s a lot of questions as to why that’s happening and why hamstring injuries are becoming more prevalent.

Is it the way the likes of (Mauricio) Pochettino and Ange Postecoglou play with the high press, the high numbers? I’m not saying I have all the answers but I am hoping my research can assess and potentially improve how we manage hamstring injuries.

Andy: You were Meath physio and played with Curraha, how did you manage the workload?

Liam: As manic as those few years were, I really did enjoy them and learned so much. A lot of physiotherapists sacrifice their own playing careers to work with a team but I had very accommodating managers who allowed me to do both. I think both set-ups complemented each other.

Being a player with Curraha, I would have often ended up playing with and against some of the players I was treating. I learned a lot from Meath then and tried to bring back as much as I could to our own club in terms of standards, strength and conditioning, tactics and a culture overall.

To be fair, only for Bernie Hogan’s ready-made meals, I would have struggled to balance it all but my family were so helpful to me during that time and through my entire life supported me.

I grew up as a Meath and Curraha fan and to be able to combine both during two successful periods was something I will always cherish.

Andy: There is a lot of conversation currently around gym work and its role in the GAA. Is there too much strength work and not enough football? Could this be a cause of the ACL and hamstring injuries that we have seen occurring?

Liam: I recently had a conversation with a friend of mine, Tommy Mooney, our lead S&C coach in the SSC. You often hear the usual narrative ‘there were none of these hamstring injuries in my day’ but the fact of the matter is that the demands of modern football far exceed the game from years gone by. Players are stronger, faster and, in my opinion, this only adds to our game as a spectacle.

Strength and conditioning is a tool to enhance the physical qualities of our game and if it’s done well, should complement injury prevention. It should not supersede the game but should be done in conjunction with skill development.

Tommy had research published that looked at elite vs sub-elite U20 footballers and not surprisingly, the inter-county footballers were better in relation to body composition, speed, fitness and strength.

But when they examined the elite players only, there was no difference in those who started and those who didn’t. Basically, when these players reached a certain level of fitness, it came down to skill level.

Andy: What advice would you give to any GAA player for injury prevention?

Liam: It comes down to brilliant basics. A good, evidenced-based warm-up is of paramount importance for injury prevention. Preparing your body for what it will have to do in a game. Fifteen minutes of prep work before you get into a warm-up, looking at hip mobility, glute activation, eccentric hamstring work and some plyometrics.

I think if you cover these areas, you are on to a good thing. I had a small role in the ‘Activate’ warm-up run by Ulster GAA and the Sports Institute of Northern Ireland 10 years ago. If performed correctly, it can reduce non-contact ACL and hamstring injuries by 50pc.

Then, having a good S&C programme, whereby you have at least one weekly consistent lift that you can monitor and quantify by the weight you are lifting. Everyone wants a quick fix and to find this magic solution that no one else is doing. Mark Brady is Dublin’s lead S&C coach and you always hear people chatting and asking him the question, “What are you lads doing in there? Tell us your secrets?”

But they are doing the simple tasks to an extraordinary high level and they appear to have really good structures in place to facilitate this.

Andy: You work with the best of the best athletes, what sets them apart from the rest?

Liam: I suppose I’ve worked in a couple of sports, Gaelic football, athletics, AFL and rugby. A lot of these top elite athletes have a lot of the same characteristics. I think the openness and willingness to learn, looking for consistent feedback, and again it comes back to the brilliant basics.

What’s their attitude like? Again, you’ll know very quickly when you meet an athlete if he’s listening to what you’re saying but I think it works both ways. Any athlete I’ve met, I try to learn from them too and you can always learn from somebody else, and they’ll teach me about myself and I’ll often seek feedback on my end as well.

At the end of sessions I’ll ask, ‘why are they here?’ Really, what do they want to get out of it because if our train of thought is totally separate, we’re not going to go in the right direction.

If I’m seeing an ACL athlete, we need to build a level of trust and support. It means that I can call him out if I feel he’s not rehabilitating to a sufficient level and vice versa, if he feels that I’m not giving him the support that he needs. What sets those guys apart are the one percenters.

How can they communicate to the best of their ability, how can they improve their strength to the best of their ability, how can they seek feedback and if you’re consistently seeking feedback but also working on those pointers, I think you’re only going in the right direction. These athletes are extremely punctual, have great attention to detail and a real drive for continuous self-improvement.

Andy: You spent some time in Australia recently in different sporting settings. Can you explain what you do regarding Irish AFL players?

Liam: Initially, it started with Cian McBride, who was playing with Essendon at the time. He came home during Covid to play for Meath. We had an Irish guy, Conor Daly from Leitrim, who was head S&C coach with Essendon and we liaised closely with Cian’s rehab. Leading on from that, I had the opportunity to go and visit Carlton, Sydney Swans, Greater Western Sydney and St Kilda.

It’s phenomenal and makes you very proud as an Irish guy to see the level that some of our male and female athletes are reaching over there. I had a conversation with Patrick Cripps, who was the 2022 Brownlow Winner, and he spoke about the high level our Irish athletes are at. He described his own old housemate, (Ciarán) ‘Casey’ Byrne as a “gun” who had all the capabilities of being one of the club’s best players.

I have huge admiration for ‘Casey’ and I was travelling in 2017 with Robbie Brodigan, the Oliver Plunkett’s midfielder. We met him in Melbourne after he trained, 30 degrees, out sipping on a coffee, work done for the day and all I could think was how envious I was that this guy has it all.

But he was secretly homesick and he returned, won an intermediate championship, a senior league, fought back from an ACL injury and is back playing for Louth.

I would encourage anyone who wants to go to go but always say you’ll only realise how special your own club and home is when you are away.

I would screen a lot of the Irish guys who would go over in terms of their medicals and when they’re home, I would work on some of their rehabilitation with some players.

It’s interesting for my own development and learning because you’re putting your own thoughts and ideas on rehabilitation out to someone in a professional sports environment in Australia.

I was very lucky to do online consultancy work with a few of the clubs as well and it’s very enjoyable on a Saturday morning, switching on the TV and seeing maybe a guy or two that you worked with. We have some phenomenal athletes who are over there at the minute flying in the flag.

If these guys go over and they don’t make their debut, the learning they get, the maturity they have, they’re working in a professional environment and that’s something, unfortunately, that Gaelic games can’t give at the minute. I wouldn’t ever put a guy off going over and I think it’s an unbelievable opportunity.

Andy: Do you think your trip to Australia benefitted you in your work field/life?

Liam: We have so many similarities in terms of training methods but what they do in the AFL, they obviously have time to recover but they just do all the same things at a high level. In terms of our communication from physio to S&C to management, those structures work really well and there’s always clear pathways for players to get back.

I suppose I’m trying to bring that into any time I meet a player. The question everyone wants to know is when they’re back. But instead of saying this ACL injury is going to take 9-12 months before getting back, I break it down that to be running, we need your lower limb strength and reactive strength to be within 20pc to earn the right to run and within 10pc before looking at a return to play.

If you can map out to a player what those markers should look like prior to playing and work backwards from there and where they should be hitting, it’s a much easier conversation in three or six months if they’re not back running, that you have had the initial discussion that these were the non-negotiable scores that have not yet been achieved.

We often find that with a lot of our ACL injuries, they’re coming into clinic and, yes, they’re running but their running mechanics may not be sufficient because they have too much of a strength gap.

It’s easy for me to say, of course, we have great access to these testing devices in the SSC but I think we can be, as a profession, more objective-based as opposed to time-based.

You should always have an open mind and it’s about trying to learn from everybody – athletes, coaches and physiotherapists into what we can bring back into our own game.

They do a lot of craft, which is basically 15-20 minutes of skill work, in AFL. They work on ball drills and a lot of work on the ground ball, which is a bit more of a common theme in the AFL.

Though, leading on from that, as a physiotherapist, nothing equates to playing and I think that’s something I can’t get across enough. We’re only facilitating you guys as players.

The best day of my life was winning an intermediate championship with Curraha and I don’t think anything will ever get close to that.

I was lucky to have met Liam when I did, and I can’t thank him enough for instilling faith in me when it would have been easy to write off my injury. I don’t want to give him too much credit but I probably wouldn’t be playing football today if he hadn’t put in the effort and time with me that he did. Liam is an extremely charismatic guy and has been very successful to date in his career.

It’s not every day you hear me giving a Meath man praise…

New UPMC Sports Medicine Clinic Opens in Ireland

In partnership with Mardyke Arena University College Cork (UCC), UPMC Sports Medicine Clinic, Mardyke Arena, UCC opened its doors to patients this week, expanding UPMC’s multinational sports medicine and orthopaedics network. Serving Ireland since 2006, UPMC is focused on improving access to advanced, specialized care for more people, where they need it. 

UPMC’s cutting-edge sports medicine services are delivered nationwide across six locations in Ireland including Dublin, Waterford, Limerick, Tipperary, Mayo and now Cork to serve people in the country’s southern region. 

“This partnership with Mardyke Arena UCC brings the advanced sports medicine and orthopaedic excellence of UPMC close to home for more people in Ireland,” said Joel Nelson, M.D., president of UPMC International. “The combination of research and medicine between two academic centers lends itself to developing new solutions and opportunities for people across Ireland, while working closely with the country’s public health system to meet the needs of those utilizing that avenue of care.”

The growth of UPMC’s signature specialty services across the country is in response to an increasing need and demand for UPMC’s high-quality specialty care. The new center provides physical therapy, postoperative and injury rehabilitation, concussion and hamstring services, performance analysis and will offer a range of UPMC Institute for Health classes.

UPMC Sports Medicine Clinic services are an essential part of UPMC Ireland’s nationwide network of hospitals and centers, also including UPMC Aut Even Hospital in Kilkenny, UPMC Whitfield Hospital in Waterford, UPMC Kildare Hospital in Clane, UPMC Sports Surgery Clinic in Dublin, UPMC Hillman Cancer Centre locations in Cork and Waterford and an outpatient center in Carlow. 

UPMC Sports Medicine Clinic locations across Ireland serve athletes of all ages, from youths to professionals. UPMC is the official health care partner to the Gaelic Athletic Association (GAA) and the Gaelic Players Association (GPA).

The center’s staff works with patients to prevent and treat sports-related injuries to maximize athletic performance. In addition, the new clinic cares for people of all ages with a variety of conditions, including an aging population in need of total joint replacement rehabilitation and support.

UPMC’s collaborative relationship with Ireland’s public health care system, the Health Service Executive (HSE), provides an avenue for individuals in need of surgery, rehabilitation or other advanced care to access UPMC’s high-quality services in cooperation with the public system.

“The opening of our new UPMC Sports Medicine Clinic is a testament to our commitment to delivering excellence in patient care in sports and exercise medicine,” said John Windle, general manager, Sports Medicine, UPMC Ireland. “Mardyke Arena UCC is known nationally and internationally as a center of excellence for sport and physical activity. We’re excited about adding world-class sports medicine services to this fantastic campus.”

UPMC Sports Medicine has an earned reputation for excellence for the range of world-class services and care they provide. Young or old, pro or amateur, UPMC Sports Medicine has the expertise, advanced technology and services to make a difference in people’s lives.

UPMC’s partnership with Mardyke Arena UCC strengthens the connection between academia and health care, fostering innovation and advancing the field of sports and exercise medicine in Ireland.

Mr. Gavin McHugh joins Arthritis Ireland’s Chief Executive Grainne O’Leary to speak about Surgery and Arthritis

When it comes to surgery in arthritis what are the factors that inform whether its necessary to have this sort of intervention in the first place?

I suppose I would stop you there in using the word necessary as quite often when it comes to a joint replacement strictly speaking it is not necessary it is whether somebody would benefit from it and I think it is important to make that little bit of distinction as ultimately it is up to the person and it is whether or not they decide to go ahead. It is not like a broken leg that absolutely needs to be fixed. In general, you can look at these things in terms of pain and disability. The overriding factor that drives someone to have a joint replacement is pain. The vast majority of people has pain. Disability can come into it but it is generally a secondary thing and I will talk about that again. In terms of the pain, again, we can go into as much detail as you want. For me one of the deal breakers is night pain especially with the hip you will find that people get to the point where they are wakening from sleep 1-6 times every night or most nights. Ultimately, that is when you would benefit from having something done. In terms of pain throughout the day or with activities if they are holding someone back from doing the activities that they want to do or indeed affecting their quality of life and it is not controlled then that is often a time to start thinking about having something done.

When we talk about some of the alternatives to surgery that people living with arthritis might explore before considering that option of surgery, what might they be?

We are often taught to see if the conservative measures have been exhausted and that is just a way of saying yeah, we have dealt with all that and it is now time to talk surgery. That is something that is really important to all of us as well. Ultimately, not only can you potentially gain months and even years without having to have surgery, you can potentially set yourself up much better off in the event that you do require surgery. Things like weight loss that we will speak about again can be very important and pure strengthening activities so anything that works again particularly from the hip and knee point of view like your quads and glutes in particular can benefit. Strictly around the hip I find a lot of stretching activities can actually precipitate more symptoms rather than improve things but within reason keeping active tends to do good and not bad. From an analgesia point of view simple analgise such as paracetamol which everyone turns their noses up at initially but I mean it comes with a very low side effect profile and it is often worth while trying to just take the age off of things and as you move up you can then mind that with anti-inflammatories. Opiate type of medications for the vast majority of people tend to avoid it. They tend to come with a lot of side effects and they don’t really work particularly well for musculoskeletal type pain. They work better for other types of pain like cancer pain and in that they have a hugely important role but for us for joint pain they are no great at relieving it and even if they do with time you tend to become tolerant to it so you don’t get the effects with time so for me just paracetamol and anti-inflammatories.

At what point would surgery be considered the better option for people?

Again, that is when you have to weigh up how it is affecting you day to day and you have more to gain than you do to lose anyway and when somebody’s quality of life is disrupted to an extent where they have more to gain than they do to lose then that is when it is worth while considering. I see people who get a little bit of groin pain for example on the 16^th or 17^th hole of a golf course and they play once a month and that’s it. I also see people who would wake 6 or 7 times every night and I’ve seen someone who has slept in an armchair for two years because they have not been able to lie down flat in bed and who could take 20 minutes to get to the bathroom. They are the two different ends of the spectrum; the vast majority of people are somewhere in between and again you have to see if you are leaning more towards the severe side of the spectrum or are you leaning more towards the conservative side of the spectrum where your paracetamol helps. This is something that I always try to say and it is that you don’t have to be as bad as people make it out to get a joint replacement and we know from loads of systems by scoring patients and if you divide them up in terms of severity the group that would benefit the most from a hip or knee replacement are the ones with moderate symptoms and it is very subjective as to what is classed as mild or moderate symptoms but the moderate group are the people who are still just about able to do their job and normal day to day activity and in many ways they are ready to hit the ground running after they get the joint done and they will rehab quite quickly. Whereas the really severe group the people I spoke about that have sept on an arm chair for 2 years well they have a huge amount of work to do following the surgery in terms of getting back to their morbid level. There is a happy medium, it is often not as bad as you think and with hips especially I find that people come in and they almost feel like a fraud and they think they are not bad enough. This is what a hip does to people, a hip slowly drags someone down along with everyone around them who is aware like their husbands, wives and children. Everyone around them will be saying “would you ever go and get that fixed, your always complaining” and the response usually is I’m not that bad as it is in our human nature to adapt and cope with things and we manage to get on with it and generally it is not that they are in denial, they don’t actually realise they are as bad and I often put it as a background noise that until you turn off that noise then you realise. It is only after people get their joints replaced that they then realise how bad they were prior to the surgery.

Surgery has all sorts of connotations but what type of risks should people be aware of before surgery takes place and what questions do you recommend someone asks their doctor or surgeon before undergoing surgery?

Joint replacement is still ultimately a joint replacement and it has moved on I think an awful lot in terms of how we go about it and the safety profile of it compared to 40 or 50 years ago and as I say it comes with significant risks although they are rare thankfully. The odds are very much in your favour so if you look at satisfaction rates after a hip replacement then you are talking 96/97% which is pretty hard to replicate in many other surgery’s that are performed. It comes with the standard risks like infection, infection is our nemesis and again if a surgeon has said that they have never had an infection in their practice then it is nonsense and everyone gets them it is just a fact of life and trust me we take the upmost precautions trying to avoid that but when you’re talking about a joint infection your talking 1 in every 300 which is not that common but it is still a risk you take when you are considering rolling that dice. Things like clots like a pulmonary embolism is a risk factor that you are talking maybe 1 in 500 to 1 in 1000 and that is the sort of rate now a days and how do we get around that we give you foot pumps we give you stockings to increase circulation but most importantly we get people up quickly and we get lots and lots of joints now immobilised in the same day. The quicker we get people up the lower that risk becomes and some people are usually given some form of blood thinner then after to help prevent it. Nothing can really reduce risk because some people are more prone than others but thankfully now a days it is uncommon. Then more specific things with regard to the joints with the knee stiffness would be one of our main issues and a knee replacement can end up stiffening the knee because the knee is hard work and as I say its not like you just get a hip for free but with a knee you most certainly earn it in terms of the recovery and it is not a 6 week job but it is a 6 month job in terms of that recovery and I think it is important that people know it is going to be sore. Then with regard to the hip, the hip popping out of the socket or dislocating again in comparison to say 20/30 years ago when dislocation rates were at 5% it is much less common now it is a 1 in 200 or 300 type of chance we use a bigger head in terms of the prosthesis so essentially it has to jump the radius in order to get out. Years ago, there was a 22-millimetre head that we used whereas nowadays most surgeons will use a 32- or 36-millimetre head and that comes with a lot more stability. We always quote things in terms of damage to the bone or the nerves around the area but again it tends to be very rare now and it is unlikely that something like that actually happens during surgery.

How do people maintain a healthy weight and build up the muscles and joints leading up to surgery? Does that help to improve outcomes?

Absolutely, the better shape you are in before surgery the better chance you have of doing better afterwards. Again, particularly with regards to the knee and if you look at the quad muscles on the front of your thigh which allow you to straighten your leg they are essentially an engine for the knee and they are often extremely weak and are often the cause of the arthritis process as people get a lot of inhibition, it is like your brain turns off the muscles in order to protect the joint which I think actually makes the joint worse. Unfortunately, when it comes to recovery and getting the knee to behave like it should then you need strong quads. There often has to be work put in before hand in order to strengthen up and that is the number one thing that will improve their outcome for them. When you think of getting up after a joint replacement and mobilising with crutches the more weight you are carrying then the harder it is going to be especially for the first couple of days.

Can you tell me a little bit about the different types of joint replacement surgery and why as a surgeon you might actually opt for those?

In terms of joint replacements there is actually not really a lot of difference as such. Lets focus on the hip first of all, broadly speaking you can offer a cement hip replacement as in one that is essentially glued in or grouted into the bone and that has a rough coating over the surface of it and it allows the bone to then grow onto the surface with it with time and that’s when it gets its fix as such but within that then because you have got the ball and socket you have then got two different sides so you can then have it cemented on one side like the cup or vice versa. In general, it varies hugely some surgeons will use one type or the other for certain cohorts of patients and I tend to use the cementing for most of my patients and again that is just my preference. Ultimately, a lot of it comes down to what you are most experienced using you are most likely to get the best outcome with the prosthesis that you are most familiar with. Knee replacements come with cemented and cement less options and increasingly now we are seeing a rise in cement less options but the vast majority of knee replacements are still cemented into place. There are subtle differences in the mechanisms of how two components in the knee fit and interact together, some have a dish but that’s getting into too much detail. Whatever works best for the surgeon is the way to look at it. Within knees then as well you can replace the whole joint or you can replace part of the joint which is a partial knee replacement and again I often say to people that the first thing I do when I look at someone for surgery is can I get away with a partial knee replacement and quite often you just end up replacing the knuckle on the inside and it is a much smaller operation. Smaller operations in general come with a lot less risk and come with a quicker recovery with a more natural feeling in the knee after. Ultimately, roughly 40% of the patients that I would see would be suitable for a partial knee replacement and it is something that I need to bear in mind and again the least you can put someone through is the best way to think about it.

How long does a joint replacement usually last?

This is the problem where it comes to expectations because I sometimes put people on the spot and say prosthesis can last a year which is possible because the bone can fracture around it, it could subside, you could get an infection and it could be out in a years’ time or less even but on average they are going to last very well we have the benefit now of joint registries across the world some of which have been going on for 30/40 years but the UK are coming up to their 20^th year this year and it tends to mirror our practice and we have an Irish joint registry but it is only in its infantry stage at the moment. If you look at the figures 10 years is often a nice length of time for a replacement to last and it is actually very similar in a hip and knee. The average hip and knee prosthesis have a 10-year survival and I say to people that does not mean you have to come and trade it in after 10 years if it is still going strong. Essentially you have a 1 in 25 chance of it not lasting 10 years or more. I replaced a lady’s hip their yesterday and she had her other hip replaced 29 years ago a cemented hip and it is going strong not a problem. One way of looking at it although getting figures for it may be hard is what are the chances in your lifetime that its going to be done again and ultimately that brings the whole age spectrum into it and if you are 80 years of age and you are getting a joint replacement then it is almost certainly going to be fine. If you are 40 years of age ad you are getting a joint replacement the implications are a lot more and not only need to be revised but it might need to be done again and the way to think of it is a mechanical set just getting bigger every time and you need to bring in bigger toys to allow you to fix the problems.

Where does age feature in joint replacement surgery?

It is an important factor to bear in mind and it is not as if we always push conservative measures but in young people but we are going to try our best. If an injection is giving some relief then you are going to try it again but you try your best to just push people out that other couple of years and they may not think that it is a huge thing but it actually if it gets them a couple of years further down the line it is a big deal potentially 20 years down that line and again if we go back to the same factors of quality of life. If your 40 years of age as far as I am concerned and your looking at a joint replacement, the diagnosis is correct well then so be it. As far as people are aware that yes there is a chance that it could be done again n their lifetime then I don’t see the sense in riding out 20 years of a poor quality of life just to get that joint replacement and that makes no sense to me.

Due to the higher life expectancy, do you still find people saying “they are too old to have a joint replacement”?

Absolutely, it is amazing to see the difference and I mean chronological ages and physiological age and it is absolutely amazing the difference. I suppose I have the benefit of getting to look in at peoples lives all the time and you see people who come in and they are 50 years of age and they look about 80. You see 80-year olds who would pass for 50 and that is the discrepancy that is there and it literally is plus or minus 30 years how they look, act and feel. I replaced a 93 year old gentleman’s knee a few months ago and essentially his knee was pointing the wrong direction and he couldn’t do anything and after that surgery he was back playing golf at 8 weeks and again am I going to say that everyone can get to that absolutely not but it shows that it is possible and at the opposite ends of the spectrum we can say your too young and I think that is wrong. The one thing that younger people need to realise is that there are to aspects to it. Firstly, they have a lot longer to go in terms of their life expectancy and for some people it could be 40-50 years maybe even more. The second thing is that younger people tend to be a lot more active so potentially they are going to use up a joint sooner so there are two ways to look at that why they may get through getting it done again.

You mentioned the different types of prosthesis that may be used during surgery. Does the patient have a role in making that decision with the surgeon or would it be completely down to the surgeon?

It is funny you say that because some patients are pretty well informed and I’ve had people come and see me and say I read about this and these are the exact symptoms I have but it is a little bit of a dangerous game to play someone coming in saying what they would like you to do. I will go back to what is on the menu is what the surgeon uses routinely. We are living in a different world years ago saying that’s what we needed and if it is a dictatorship for them then so be it. In that regard there is safety of little knowledge and by reading a lot you can actually end up confusing yourself more by going a little bit beyond that especially with internet because what you are relying on is not necessarily a fact and we can talk about things like stem cells and all these different things that come with a huge internet profile but there is very little evidence for it and the leading things in terms of joint replacement. What you need is something that has been tried and tested and has been around for a few years because then essentially you are not a part of an experiment it is only with time that we know how well something will work.

When someone is going for surgery, what happens in a pre-assessment?

From a hip and knee point of view all joints are pre-assessed and they have a pre-operative assessment and it is a normal medical check to make sure someone is optimising from surgery, that is probably the best way to look at it. They are seen by a doctor and a nurse and they get a little bit of history taken of their previous medical problems, their medication is looked into, their bloods get taken as well so we can examine things like your blood count and your kidney profile that type of thing. They will also get a trace of their heart or an ECG as it is called. If necessary some patients will get something called and echocardiogram which is an ultrasound scan of their heart but again the more information that we have then there is a lot less risk in many ways. If we know that something is there then it is rarely ever a problem and many patients sail through these things without any issue that can cause trouble afterwards or something that was diagnosed. Based on that pre-assessment, if more detail is needed well then, we can ask a cardiologist or a respiratory physio whoever is required, to give the go ahead. The vast majority of people will just sail through that there is no problem. Obviously, people that comer with more baggage, more problems as such then we need to pause for that little bit longer to make sure they can be done. The higher risk patients who can only be done in hospital with a backup its actually quite rare now it is a very small minority of patients who are not suitable for whatever hospital they are attending.

What might somebody expect post-operation in their ability to do small jobs like use the stairs or go to the toilet?

What I say to people when they are struggling the first day or two is that they are discharged the same day and truth be told people going home the same day I don’t prescribe it as such but partial knee is often two nights in hospital and a full knee replacement is 3 nights and a hip is 2/3 nights with us and I find that that is just the happy medium and people are going home because their pain is controlled and they are safe, mobile and confident to do things. Some people that day they are flying around but they are a lacking confidence a little bit and just would not trust it so I think a couple of days is absolutely fine. I think especially with hip some people are pleasantly surprised the first couple of days in how quickly they improve and the first day can be tricky but by the second day they are really starting to get going and then they are usually mobile and independent going up and down to the bathroom. Most people with a hip or knee replacement will be using crutches for the first 1 to 4 weeks depending on how they got on and how strong they are and how their pain is as such but they are better off anticipating in many ways.

Would most patients need occupational therapy and physiotherapy after surgery?

Not so much occupational therapy but occupational therapy is more changing things in their home and again you don’t really need modifications like that now. A lot of the old precautions and different things that used to be done have changed. We still get people to lie on their back for the first few weeks to help. A lot of these precautions were designed to help stop the hip from popping out of the socket as such and as I say that risk is much lower now a days and you can pull back a bit on that. In general, in relation to physiotherapy I would say yes and no because I am firmly of the belief that less is more with the hip and I frequently see people over doing it and irritating tendon muscles and other things around that area I believe just need a few weeks to heal and settle down. The knee as we spoke about needs to be moved and needs to get going and that would take a bit of work with  a physiotherapist afterwards and as much as anything the exercises are easy, they are very simple in terms of what to do but it is about having someone there going to give you a bit of encouragement saying “come on you can do two more” or knows when it is time to push you a little bit harder and some people like a personal trainer and some people don’t and for some people they absolutely love having someone there telling them what to do. I will often see the people who need the motivation after a joint replacement and then I will see other people who I need to pullback from overworking their joint replacement.

In relation to people who have been out of work with their surgery, how soon will somebody be able to return to work?

A lot of people who can work from home, particularly if they are self-employed they could be on their laptop doing a bit of work the following day from their discharge. If people can free up a week or two just for their own headspace I think that is very important. The opposite of that spectrum like manual work for example climbing up ladders and working on roofs then they could be out for ¾ months maybe even more, depending on what they do and when they will be signed off to be considered safe.

We have spoke a lot about hips and knees and they are the most common form of joint replacement but would you be able to tell us a little bit about other procedures that relate to someone with arthritis?

Replacements exist for most joints and my area is obviously hip and knee but there is an increase in shoulder replacements, elbow replacements would be a small enough number but again weight bearing joints re much more likely to cause problems and that is why the number of hip and knees outweighs everything by about 6 times and that is always going to be the case because different joints just function differently. Ankle replacements are becoming more common nowadays also and for other joints you have other options such as fusions. For example, it was very common to fuse the ankle to stiffen it instead of replacing it but I am now aware that people are starting to replace ankles more frequently. The hip joint in many ways is quite simple with the ball and screws and the mechanics of other joints do not work the same and it has been harder to replicate with replacements and that is part of the reason for that. In terms of going back to the knee you have to see if there is any other option than replacing the knee and there is a partial knee replacement as well as that knees will be suitable for something called an osteotomy which sounds barbaric but it is essentially cutting through the tibia bone usually but it can be the femur to realign their leg. If all their pain is on the inside of their leg and they are loading the inside of their leg and if you look around you may often see someone with a bow in their leg well that is loading one side of the leg much more and if you potentially unload that area as such by straightening their leg then you can take away the pain in their leg. For younger people in particular for example, if you are 20 years of age and you have well established arthritis on the inside of your knee well you are not really going to be able to say that a replacement is an option so that is when something like an osteotomy comes in.

What would be your top tip to somebody who is facing surgery?

I think there is a nice balance between being a little bit informed and knowing what your getting but not reading too far into it and sometimes people stress themselves out too much and whether they like it or not they have to place their trust in me or whoever the surgeon is for some people it is like getting on an airplane you have to trust the plot. You will not have a list of questions for the pilot so there is an inherent trust you have to give to the surgeon. You are reliant on the surgeon to do their part and then afterwards they can worry about doing their part and in that regard, you find out as the journey goes on because lots and lots of questions before hand are going to progress as you move on that journey and it is often a better way to do it knowing a bit but not worrying yourself either. If it is 8 weeks down the line just focusses on getting through today. A knee replacement is often really sore afterwards and you have got to be able to trust me. You have to think of it as though today is sore tomorrow will be better and then they know that they can trust you in that regard. My main tip then is really to just make sure you have yourself fit and strong but there is very much a happy medium there and if you can hardly walk because your hip is so worn then there is only so much prehabilitation you can do by doing your exercises before hand and there is no point in losing any momentum before you even start the journey. I spoke much earlier about the disability and forgot to go back to it and it is something particularly with the hip and knee that we see. You have your pain aspect but then when a joint is worn, from a hip point of view you have trouble getting your shoes and socks on, trouble getting out of the car, getting up and down the stairs. For the knee the trouble is behind you knee cap and you actually may have trouble even standing and this is something we spoke about as we get older in general the more baggage you carry in terms of that disability is then harder to manage. I often speak to people about the risk of a fall, if you have got pain every so often and the leg wants to go then you are at a risk of falling and breaking your hip as such so people looking to avoid an operation isn’t the answer and you are here saying what can I do to maximise the chances of getting someone back being fit again in that regard. The last thing you need if you are in your 80’s is something pulling you way down as far as I am concerned you need everything going for you.

This article by Oisin Doherty was published in the Irish Mirror on the 25th September 2023.

Paul McGrath has joked that he is ‘ready’ to earn his 84th cap for Ireland after undergoing knee surgery.

The legendary Ireland defender went under the knife to get a knee replacement at the Santry sports clinic in Dublin in recent days.

Taking to social media on Monday, the 63-year-old posted a snap of him leaving the hospital along with a caption that thanked the staff for their help.

McGrath was rather infamously plagued with knee issues throughout his illustrious career and was forced to change his training regiment in order to be ready for the weekend.

It did little to hamper his impact on the pitch however, and the Dubliner had a fabulous career at club level for Manchester United and Aston Villa.

At International level, McGrath was capped 83 times for the Boys in Green and famously starred at the 1994 World Cup, where his performance against Italy at Giants Stadium is still spoken about fondly to this day.

UPMC is excited to announce a new partnership with Agriland that focuses on farmers’ orthopaedic health.

The Mind Yourself Series provides insight into the physical challenges farmers face and offers advice on how best to manage and improve orthopaedic health — all so that farmers can improve their mobility, function, and overall well-being.

Across the series, we will introduce you to hardworking farmers from a range of farm enterprises who’ll share their orthopaedic concerns, and UPMC orthopaedic experts will offer guidance and advice on how best to minimise pain, maximise movement, and ensure that farmers are ready for the next farming challenge of the season.

The series will feature five videos and articles and will kick off on www.Agriland.ie in August.

Mind Yourself Series in association with UPMC.

As a farmer, orthopaedic health is essential for your well-being and your ability to stay working on your farm.

At busy times or when help is in short supply, it may seem easier to ignore your aches and pains or push through the agony of an old injury. But early intervention and timely treatment can have significant benefits in terms of pain relief, improved function, and prevention of further damage.

Progressive and persistent pain in your joints doesn’t mean that surgery is your only option. In fact, surgery is often a last resort and there are many other effective alternatives available.

Support network

A farm is a business, and as a farmer, you need to build a team and support network around you. That network may include a vet, a mechanic, contractors, or an accountant. But your own health is also critical to the success of the farm, never more so given the challenges of securing skilled labour.

Therefore, incorporating healthcare professionals into your network, or knowing where to go for help, will help sustain you and your farm.

“Farming is a physically demanding occupation,” Kalen O’Donahue, senior physiotherapist at UPMC Sports Surgery Clinic said.

“It involves a range of tasks, from heavy lifting and repetitive motions to prolonged periods of bending and standing.

“The farmers that I see in clinic are dealing with things like lower back pain, shoulder problems, knee injuries, joint inflammation, and repetitive strain. Often, they are putting up with these problems for far longer than they should.”

So, what is the advice for farmers dealing with recurring pain in their joints?

Dealing with recurring joint pain

Firstly, seek professional help. Persistent pain, limited mobility, swelling, joint instability, or joint stiffness is not normal. It shouldn’t be accepted as something to put up with.

Secondly, the advice is to stop putting off seeking help. Early intervention will save time in the long run.

A chartered physiotherapist can often be your first stop to help evaluate your orthopaedic symptoms. At a first appointment, a physical examination, and a functional assessment, which assesses how the condition impacts daily work-related activities, will be conducted.

If necessary, diagnostic imaging in the form of MRI or X-ray may be needed to provide a better understanding of the situation. A treatment plan is then developed by the physiotherapist.

But what if farmers don’t have time to follow a treatment plan?

Practical, tailored treatment

Treatment plans that are focused on exercises, manual therapy, or some moderate lifestyles changes shouldn’t be disregarded or dismissed as impractical.

“We work to build a treatment plan that works for them,” O’Donahue, who routinely works with farmers attending UPMC Sports Surgery Clinic in Dublin, said.

“We know what is manageable and we understand the time that can and cannot be given to regular exercise.

“Often these are simple exercises to improve movement in a joint or rebuild strength so that pain is reduced. We put the control back in the hands of the farmer and we work with them to ensure we get results, so they don’t have to grin and bear it for another season.”

O’Donahue added that sometimes allowing time for your body to rest and recover and getting enough sleep after physically demanding tasks such as dosing or following particularly busy times on the farm such as calving or lambing, is essential for tissue repair and overall well-being.

As a farmer, you will always prioritise your farm, the animals you care for, the crops you grow, and the machinery you use.

Prioritising your health

Prioritising your own health must also come into the mix. Neglecting personal health will ultimately impact the running of the farm.

Neglecting the aches and pains, or other issues, can cause minor issues to escalate into more severe conditions and perhaps have a more detrimental effect on the farm enterprise.

Early intervention and minding yourself today – taking care of your body now – will help ensure you continue with the work that you love on the land you love for years to come.

Read more about UPMC’s Orthopaedic Care for Farmers here.

Joining Pat Kenny was Dr Niall Hogan, Consultant Orthopedic Surgeon at UPMC Sports Surgery Clinic, to answer all your orthopaedic questions.

Listen to the interview here:

https://www.goloudnow.com/podcasts/the-pat-kenny-show-highlights-47/ask-the-expert-aches-pains-arteritis-and-joint-replacements-422213.

Read this Article with Mr Ray Moran, Consultant Orthopaedic Surgeon & Medical Director of  UPMC Sports Surgery Clinic.

https://www.thesun.ie/sport/gaa-football/10694989/female-athletes-knee-ligament-injuries-ray-moran/

This article was published in the Irish Sun by Andrew Ryan.

Mr Ray Moran – brother of former Ireland and Man Utd star Kevin Moran – explained to SunSport: “A lot of the early data came from American female soccer players because it is huge over there.

There is clear data that shows the number of incidents per hour played would be about four times as frequent as fellas. Moran has treated copious amounts of high-level athletes, studiously examining and theorising the rate of incidents and the reasons behind them. The most credible theory, from his perspective, boils down to biology.

BODY LOGIC

He explains: “If you look at the male shape and female shape standing together, men are pretty much up-and-down, whereas women, because their hips are set further apart at the pelvis for pregnancy and babies and things like that, that is what we call a valgus alignment.

If you jump and land on that when it is already bending inwards, the moment of bending further is even greater. It is a very fundamental structural biological reality that you are aligned like that. It must play a fairly big role because with fellas, when you jump and land or change direction, it is an inward movement of the knee. If your anatomy is already aligned to move inward, it is hardly surprising that you are going to end up with increased risk. There are other areas that are mentioned, like hormonal and stuff like that; it is not as clear cut. There is some speculative stuff about ligaments being a bit more lax at various stages of the menstrual cycle, but I think the structural one stands out to me. Moran says that recovery time is largely consistent between the genders – ranging from six months to a year. Meanwhile, he documented the kind of programmes he often prescribes to patients in their rehabilitation. He also suggests that these same programmes can be used by players to mitigate the risks, even if they cannot be eliminated entirely. These include neuromuscular balance training and muscle strengthening. He adds: “We do testing here at four months and eight months, roughly speaking, after ACL reconstructions. The first thing we do is test the strength of the hamstrings and quads, and you compare the opposite side and normal values in relation to it. We have got a spread of the average and what the top 1% are at and all the rest so they know what to aim at.

There is also functional testing where, at the four-month test, we don’t want to do rotational stuff, so we would be doing jump, hop, and land and control. When we do the second test at about eight months, it is full on. It is a dress rehearsal for the return to function. We can advise at each of those stages what the changes to make are to their programme, feed that data back to their own physio, and we have fairly good data to show that the re-entry rate can be held to a very civilised level by following the programme. The influence of those programmes can apply to pubertal kids because young teenagers are quite prone to it as well. You will never get rid of the risks, but you can minimise them as best you can. You do it for males and females, but the need for it is greater for females because the risk factor is higher.”

WORK IN PROGRESS

Ray Moran stresses that risks of sustaining knee ligament injuries will not be avoided outright; however, as sports science continues to evolve, he is confident knowledge of how to mitigate against those factors will grow in tandem. There is a fair amount of input at a medical and paramedical level with teams nowadays. I think it is evolving all the time.

I think the use of a physio, probably the use of an A-tier athletic therapist as well, to advise with regards to preventative measures as part of a training programme is an area that is evolving and will continue to evolve as we move forward. It is strong in the States, and I think it is going to get stronger here as well. It will always be there, but it is incumbent on us to minimise that risk going forward.”