Bath · London · 020 7183 8022

Pioneering Knee Surgery

An increase in sporting related injuries to the knee has resulted in rapid technological advances in the management of knee ligament and meniscal injuries, resulting in an earlier return to functionality and rehabilitation.

We use innovative surgical techniques for the management of arthritis such as half or Uni-compartment knee replacement, patello-femoral (knee cap joint) replacement, osteotomy as well as performing total knee replacement.

NB: Many of the people we treat are returned to tip-top performance without the need for surgery.


How biological surgery can repair your knees

The best joint you’ll ever have is the one you’re born with and so our job as surgeons is to preserve your knee for as long as possible. The tissue you have at the start of your life is not going to be bettered by artificial tissue.

Biological surgery uses cells to try and regenerate normal human tissue. Using your own living tissue, and encouraging its  re-grow, we can  now provide a biological solution. This preserves function in the knee joint long-term and takes away the pain.

The nature of joint reconstruction surgery is changing

There’s a new wave of thinking in how surgeons manage knee injuries. Keeping your knee functioning, with your own cells, is the future. Many people, including the young, the middle-aged and athletes are benefiting more and more from the new wave of biological surgery.

All over the world research and development programmes are looking at new and innovative techniques to provide biological solutions for injured joints. Exciting areas include the use of stem cells which are cells which have the ability to turn into different tissues.

Watch Neil Bradbury performing a meniscal transplant and cartilage repair. The Holy Grail of orthopaedics has always been the regeneration of articular cartilage.

Listen to Neil Bradbury’s views on biological techniques developed to preserve the life of your knee.


Some of the country’s leading orthopaedic surgeons are now using advanced robotic-arm assisted technology to provide even greater accuracy for patients during surgery.

The state-of-the-art technology generates a personalised surgical plan bespoke to a patient’s unique anatomy ensuring precision accuracy for hip and knee replacements.

Just over 500 Stryker Mako robots exist globally, over 50 of these are now placed in Europe but the vast majority are in America.

Designed by Stryker, one of the world's leading medical technology companies, Mako robotic-arm assisted technology provides patients with a more predictable surgical experience.

What is Mako robotic-assisted surgery?

The treatment begins with a CT scan of your joint which is used to generate a 3D model. The Mako technology then uses the virtual 3D model to create a personalised surgical plan based on your anatomy.

The robotic-arm doesn’t perform surgery, nor can it make decisions on its own or move without the surgeon guiding it. Mako technology assists the surgeon during your joint replacement by guiding the surgery, within a pre-defined area, whilst allowing the surgeon to optimise implant alignment. This results in less than 1mm precision accuracy in the placement and alignment of your knee implant.

During the operation your surgeon moves the joint through a full range of motion, capturing more data during joint motion and picking up tensions in the soft tissues. This allows your surgeon to adjust your personalised surgical plan as it takes into account the complex interaction of the joint surfaces on the bones and ligaments. The surgeon then guides the robotic arm, within the predetermined areas of the joint, to place the prosthesis in the precise position.

Older technologies have been available that help to plan the position of a prosthesis, however, Mako robotic-arm assisted technology combines enhanced planning, dynamic balancing (the ability to change the plan if required mid-procedure) and precision bone cuts - which are all helping to improve outcomes such as early function and reduce post-operative pain.

The benefits of Mako technology explained

Alignment of the knee implant and stability following surgery are two key factors influencing outcomes following surgery.

In clinical studies, Mako technology demonstrated very accurate placement of the implants, in hip and knee surgery, in accordance with the surgical plan.

The superficial and unintentional damage to surrounding tissue during surgery leads to bleeding, swelling and pain. Protection of the soft tissues around the joint is an important factor when performing the surgery. Mako robotic-arm assisted surgery protects more of the soft tissues and provides more accurate bone cuts**.

Infection, instability, stiffness, and misalignment can lead to dissatisfaction with the outcome of the hip or knee replacement procedure resulting in early revision surgery*.

With Mako, robotic-arm assisted surgery the patient benefits from less pain, better and quicker recovery and excellent long-term outcomes following surgery with these implants.



**Iatrogenic Bone and Soft Tissue Trauma in Robotic-Arm Assisted Total Knee Arthroplasty Compared With Conventional Jig-Based Total Knee Arthroplasty: A Prospective Cohort Study and Validation of a New Classification System. Kayani B, et al. J Arthroplasty. 2018. J Arthroplasty. 2018 Aug;33(8):2496-2501. doi: 10.1016/j.arth.2018.03.042. Epub 2018 Mar 27.


Each implant is created specifically for you and exactly mirrors the surface contours of your knee, providing bone preservation. The implants also provides an anatomic fit with less bone cutting than traditional treatments.

Patients with unicompartmental disease are able to preserve their knee for future treatments and may also experience faster recovery time and reduced post-operative pain than with traditional total knee replacement. In addition, the unique instrumentation can improve alignment and provide a more natural feel to the knee, which can reduce implant wear and extend the life of the knee joint.


The Chondrotissue Graft is the latest development in articular cartilage repair and or replacement surgery.

Damage to articular cartilage or damage to both the cartilage and the underlying bone does not repair itself spontaneously and results in joint pain and poor function. Thinning and roughening of the articular cartilage can progress to severe wear and eventually patches of bare bone rubbing on bare bone in the knee leading to arthritis.


For osteoarthritis sufferers a single protein injection, harvested from a patient’s blood could replace the need for knee surgery.

nSTRIDE Autologous Protein Solution (APS) is a groundbreaking therapy designed to treat pain and slow the progression of cartilage degradation which can lead to destruction of the knee.

The new procedure involves the extraction of blood from the patient, separation in a centrifuge to obtain a concentrated suspension of platelets via plasmapheresis, followed by injection of part of the fluid into the knee.

During this process the blood undergoes a two-stage centrifugation process to separate the solid and liquid components. Blood is extracted from the patient’s vein, mixed with an anticoagulant and centrifuged at high speed for approximately 15 minutes, causing the blood to separate into three layers: a yellow blood plasma; a red blood cell concentration; and a ‘platelet-rich plasma’, a solution comprising platelet cells and some white blood cells.

The initial phase separates the plasma and platelets from the erythrocytes and leukocytes. The second stage uses a hard spin to concentrate the platelets further into platelet rich and poor plasma components. The platelet-rich plasma is extracted and centrifuged again for an additional two minutes until surgeons end up with a 3ml protein liquid. The final platelet rich plasma, known as autologous protein solution is then injected into the knee joint space.

The final product contains concentrated white blood cells, platelets, and plasma proteins in a small volume of plasma. The output is approximately a 2 to 3 cc anti-inflammatory solution.

The proposed nSTRIDE Autologous Protein Solution (APS) mechanism of action is a process of reducing osteoarthritis-related upregulated inflammatory cytokines by introducing antagonistic cytokines, which inhibit the inflammatory cytokine activity. nSTRIDE Autologous Protein Solution (APS) has been shown to reduce production of proteins associated with osteoarthritic inflammation and pain responses in vitro.

There is growing evidence to support its use for select indications in osteoarthritis (Kellgren-Lawrence Grade 2-3).  Clinical studies have demonstrated the effectiveness of one single injection. Studies suggest one injection can last at least 12 months, with new evidence showing evidence upto 2 years post injection.

Read the latest reviews on nSTRIDE Autologous Protein Solution for the treatment of knee osteoarthritis.


There are two shock absorbers in the normal knee each called a meniscus. They are frequently injured or torn and tend not to heal because only the outer edge has a blood supply.

Some tears can be repaired by stitching the meniscus so that it can heal. The majority of meniscal tears are removed with an arthroscopy (keyhole surgery). If the amount removed is small most patients have no further problem but in patients where a large part of the meniscus is lost there is a risk of developing pain and early arthritis in the joint.

One solution for some patients is insertion of a meniscal scaffold. This is a procedure where a meniscus like scaffold is sewn into place with the aim of allowing the body’s tissue to grow into the scaffold and produce a new meniscus like shock absorber. It is a relatively new technique which has shown promising results.

There are two most frequently used scaffolds, the CMI implant and the Actifit implant. We offer both types of surgery.

Rehabilitation following this type of procedure is lengthy and patients require several weeks off work and months off sport.


For patients in which all of a meniscus is lost and a meniscal scaffold is not suitable, it is possible to insert a meniscal allograft.

An allograft is a human meniscus from a donor in much the same way that patients can have corneal or kidney transplants but without the need to prevent rejection with on-going drugs.

The patient’s knee is sized by X-ray and MRI scan and a matching meniscus is ordered for implantation. There are a number of sources for this type of implant.

This is complex surgery but can be performed using a keyhole technique. It is a relatively new technique and tends to be reserved for younger people in whom other treatments have failed.

Rehabilitation following this type of procedure is lengthy and patients require several weeks off work and sport.