Why our farmers knees are buckling under the strain of NHS waiting lists
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A Bedfordshire farmer has joined up with leading orthopaedic experts as part of a comprehensive, new report [Under Pressure: A Report on the State of the Nation’s Knees] which investigates the current challenges faced by patients across the UK who are seeking solutions to the chronic pain and immobility associated with knee osteoarthritis (OA).
Les Goldhawk, (who has spent around 45 years working on his family farm) agreed to contribute to the insightful new, report saying; "Sadly, this manual work has taken its toll on my body, particularly the knees and hips.
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“Farming is really intense, physical labour, working with heavy machinery day in, day out,” says Les, 66.
“So, over the years, my joints have begun to suffer. I’ve also had a couple of accidents at work, making my right knee particularly sore and swollen. Until recently, I was experiencing pain in my knees every day, so I was taking painkillers to take the edge off the pain and help me get through my working day.”
Spending many hours wearing wellies on rugged, unforgiving surfaces around the Bedfordshire farm in all weathers hasn’t helped his knees either. Nor did his sideline business of hiring out a horse-drawn carriage for weddings. He admits it was extremely hard clambering up into the driver’s seat of the carriage each time.
As a solution, Les considered knee replacement surgery, but was worried about the recovery time impacting on his work. After reading a newspaper article about Arthrosamid® and encouraged by his wife Debbie, he booked an appointment to have both knees injected with it in December 2022.
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The independently authored review, which was launched on 4 June highlights the huge waiting lists faced by many patients referred for physiotherapy or potential surgical intervention. However, the report (commissioned by Contura Orthopaedics Ltd.) also aims to provide a more positive perspective to the current landscape by setting out the debate around the benefits of non-invasive treatments entering the market, such as Arthrosamid®, an injectable hydrogel that is a simple one-step procedure, which many patients – wishing to delay or even avoid knee replacement surgery - are simply not aware of.
Supported by the key findings of a national opinion poll1 - also commissioned by Contura Orthopaedics Ltd - the report reflects the levels of anxiety surrounding joint problems and a worrying misconception of “inevitability”, with 80% of respondents fearing that joint pain is just an unavoidable part of getting older. 67% of people go on to say it was their “biggest concern” about ageing, above dental issues (37%) or hair loss (26%).
Almost a quarter of people (22%) questioned said that joint pain makes it harder for them to sleep or take part in pastimes such as gardening or golf - but when asked about effective ways of managing their pain, almost half (48%) said that they worry about the long-term effect of prescribed pain killers.(1)
It is estimated that 10 million people live with osteoarthritis and from these figures, it can be extrapolated that about 5.4 million of those people are living with this degenerative disease in their knees (2). And, each year in the UK, an estimated 350,000 people will be diagnosed with osteoarthritis, with 55 being the average age when symptoms are noticed (2).
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With much of the UK population now working well into their 60s, and even 70s, the active workforce includes a significant number who are trying to manage their osteoarthritic knees. It’s believed that someone with arthritis is 20% less likely to be in work than someone without the condition – creating a negative economic impact (2).
According to the Office of National Statistics (ONS) in April this year more than 800,000 people were waiting to be treated for cases of trauma and orthopaedics (3), a figure which includes a high number awaiting osteoarthritic knee surgery. And latest figures from NHS England show that only 54% of those awaiting orthopaedic and trauma surgery were seen within the promised 18-week timescale (4).
However, for those who undergo surgery, the Royal College of Surgeons of England reports that it will take most patients about six weeks before they are pain free and 3-6 months before they are able to resume normal activities (5).
Indeed, the new survey findings featured in the “Under Pressure” report show that more than one in five people (23%) say they “can’t afford to take the time off work to recover from knee surgery” (1).
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Even then, a knee replacement operation is not always the end of the story.
The report also highlights that whilst 90% of total knee replacements (TKR) are still working a decade later, in patients aged under 55, this drops to around 75% after 15 years (6).
In essence, the younger patients are, when undergoing TKR surgery, the more likely they will be to require a further operation to replace the then worn-out replacement joint – which can be challenging surgery, often with poorer outcomes than the initial knee operation.
As a result, there are growing calls from both patients and healthcare professionals for greater awareness and improved access to nonsurgical, treatment options. And, as the new report highlights, the published research around the cutting-edge injectable hydrogel Arthrosamid® is hugely encouraging, delivering long-lasting respite from the pain and immobility of knee osteoarthritis (even three years post-treatment), without the need for surgery.(7-8)
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Les adds: "I was only at the clinic for an hour. I did experience some discomfort in the 24 hours after the injection but since then, my recovery has been very positive. The constant pain in my knees has gone and I’m so much more mobile.
“As well as improvement to my mobility issues, there’s been a huge impact on my sleep. Due to the agonising pain I’d been experiencing, I wasn’t able to sleep properly. In fact, I hadn’t had a decent night’s sleep for over three years which was really affecting my quality of life. The difference in how I feel on a day-to-day basis is huge. It’s one of the best things I’ve done.”
Joint pain (whether caused by progressive osteoarthritis or wear and tear, exacerbated by years of manual work, heavy lifting and prolonged periods of load-bearing on all limbs) has long been accepted as an agricultural occupational hazard.
And, whilst many farmers will go to great lengths to avoid lameness in livestock, their own wellbeing often lags behind in the pecking order
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Rakesh Tailor, CEO of Contura Orthopaedics said: “Far too many people know the painful reality of living with osteoarthritis in their knees. It can mean suffering discomfort on a daily basis, with the knowledge that it’s only likely to get worse. The aim of this new report is to highlight the plight of these patients struggling with access to treatment options in the UK. Although your doctor will be doing their best for you, the truth is that, for some time, there’s been a lack of options they can offer their patients with osteoarthritic knees.
“The story of Arthrosamid® is a fascinating one. First used in the veterinary world to treat lame horses, it’s now used in a pioneering way to treat the ‘human knees’ which are being damaged by osteoarthritis – and already, in less than three years, some 10,000 people across Europe have had Arthrosamid® injected into their knees.” (9)
Arthrosamid® is the first and only approved injectable treatment that permanently combines with the knee’s synovial tissue (10) - decreasing joint stiffness, diminishing pain, improving the function of the knee, and enhancing quality of life. (8,11,12,13). With joint replacement surgery having previously been the only option for those with late-stage knee OA, Arthrosamid® is widely acknowledged as redefining treatment for patients living with knee pain. Arthrosamid® is administered via a simple, one-step procedure performed under local anaesthesia by a qualified physician, such as an orthopaedic surgeon or rheumatologist (14) — ensuring you’re in and out of the clinic the same day.
References:
1 An online survey was conducted by Atomik Research among 1,504 respondents from across the UK. The research fieldwork took place on 11th March – 12th March 2024. Atomik Research is an independent creative market research agency that employs MRS-certified researchers and abides to MRS code.
2 Versus Arthritis: 2023 State of MSK Health Report.
3 The Office for National Statistics, April 2024
4 NHS England, April 2024
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5 The Royal College of Surgeons of England, Recovery Tracker
6 Total Knee Replacement Surgery patient information booklet, Maidstone and Tunbridge Wells NHS Trust
7 Bliddal, H., et al. (2023) A Prospective Study of Polyacrylamide Hydrogel Injection for Knee Osteoarthritis: Results From 3 Years After Treatment. Osteoarthritis and Cartilage. Vol 31(5): 682-683.
8 Bliddal, H., et al. (2024) 3-year follow-up from a randomized controlled trial of intra-articular polyacrylamide hydrogel injection in subjects with knee osteoarthritis. Poster LB-31, OARSI 2024 World Congress on Osteoarthritis.
9 Contura Orthopaedics, data on file
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10 Christensen, L., et al. (2016). Histological Appearance of the Synovial Membrane after Treatment of Knee Osteoarthritis with Polyacrylamide Gel Injections: A Case Report. Journal of Arthritis. Vol 5: 217.
11 Bliddal, H., et al. (2021) Polyacrylamide Hydrogel Injection for Knee Osteoarthritis: A 6 Month Prospective Study. J Orthop Res Ther. Vol 6 (2). 1188. ISSN 2575-8241
12 Bliddal, H., et al. (2022). One-year performance of polyacrylamide hydrogel vs. hyaluronic acid: A randomised controlled study. Osteoarthritis and Cartilage, Vol 30, S1, S371.
13 Bliddal, H., et al. (2023) A Prospective Study of Polyacrylamide Hydrogel Injection for Knee Osteoarthritis: Results From 3 Years After Treatment. Osteoarthritis and Cartilage. Vol 31(5): 682-683.
14 Arthrosamid®, Instructions For Use (IFU) Release Date March 2022. 10082-003.