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Surgical Excellence

Hip Replacement Surgery

Total hip replacement is one of the most successful procedures in orthopaedic surgery, providing significant improvements in pain relief, mobility, function, and health-related quality of life. While the primary aim of hip replacement is to relieve pain, it also helps patients regain independence, improve everyday activities, and achieve a better overall quality of life.

Mr. Madhu Rao performs both minimally invasive and standard approaches to hip replacement surgery, tailoring the surgical technique and implant choice to each patient’s individual needs, anatomy, activity level, and clinical condition.

He has extensive experience using a wide range of hip replacement implants, including cemented, hybrid, uncemented, and dual mobility systems. Implant bearing choices are carefully selected according to patient requirements, ranging from ceramic-on-ceramic articulations in younger, active patients to ceramic-on-polyethylene and metal-on-polyethylene options where appropriate.

Mr. Rao is experienced in managing complex primary hip replacement cases, including patients with developmental hip dysplasia and challenging hip anatomy. He also performs simultaneous bilateral hip replacement surgery in carefully selected patients when their medical condition and hip pathology make this an appropriate option.

His approach combines specialist expertise, modern surgical techniques, and personalised treatment planning to help patients achieve the best possible outcomes following hip replacement surgery.

Patient Guidelines

Preparing for Hip Replacement

Before your hip replacement surgery, Mr Rao and your healthcare team will discuss the steps you can take to optimise your health and improve your recovery.

This may include advice on:

Performing muscle-strengthening exercises before and after surgery to aid recovery.
Losing weight if you are overweight, which can reduce the stress on your new joint and lower the risk of complications.
Stopping smoking, as smoking can slow wound healing and increase the risk of infection.
Maintaining a healthy diet and keeping alcohol consumption within recommended limits.

Taking these steps while awaiting surgery can help reduce the risk of complications and support a smoother, faster recovery.

Rehabilitation & Recovery

Preparing for Recovery at Home

Planning ahead can make your return home safer and more comfortable following surgery.

Consider:

Arranging help with daily activities during the early stages of recovery.
Ensuring frequently used items are easily accessible.
Preparing and freezing meals in advance.
Organising transport, as you will not be able to drive for several weeks after surgery.
Discussing your return-to-work plan with your employer if applicable.
Obtaining any useful aids or equipment, such as a raised toilet seat, shower chair, long-handled shoehorn, or a grabber device for picking up objects without bending.

Your healthcare team or physiotherapist will advise you on equipment that may be beneficial and where it can be obtained. Being well prepared before surgery can help improve your comfort, confidence, and recovery after your hip replacement.

Pre-Admission Assessment

A few weeks before your operation, you will usually attend a pre-admission clinic. This assessment ensures that you are fit and ready for surgery.

You will undergo:

Blood tests
X-rays
Urine tests to check for infection
An electrocardiogram (ECG) to assess your heart health

This appointment is also an opportunity to meet members of your care team, learn more about the procedure and recovery process, and ask any questions you may have.

Recovering from Hip Replacement

It may take several months to recover from a hip replacement. This can vary depending on your age and general health. It's important to follow the advice you have been given on looking after your hip to have a good recovery.

Recovering in Hospital

After surgery, you’ll spend some time in a recovery room where you may be given medicines to help with the pain. You’ll continue to have painkillers in the days after the operation as your hip will be sore. You may also have a tube in your hip to drain away any fluids.

You'll have help from nurses and physiotherapists to start walking as soon as possible after the operation so you can go home as soon as possible. You'll need crutches or a walking frame at first.

Recovering at home

You can usually go home if your wound is healing well and you can safely get around.

If you are generally fit and the surgery went well then you can usually go home around 1 to 3 days after the operation.Before you go home a physiotherapist or occupational therapist will talk to you about managing daily activities and home exercise programmes.

Following the exercises early on in your recovery will help with the long-term strength and movement in your hip.You'll probably have some pain and swelling in your legs and feet. These symptoms usually get better in a few weeks. You'll usually be given painkillers to help manage the pain.

A nurse will take out your stiches or clips after about 10 days. You'll also have a follow-up appointment around 6 to 12 weeks after your surgery to check how you are recovering.

Do:

Regularly walk every day as far as it is comfortable – talk to your physiotherapist if you have any problems
Follow the exercises your physiotherapist has recommended
Wait at least 6 weeks to drive (check with your doctor that you’re fit to drive)
Try to avoid sex for 6 to 8 weeks after your operation
Return to work when you feel ready – this usually takes about 6 weeks, but will depend on the type of work you do
Sit in a reclining position, but also try to avoid sitting still for long periods of time – this will help with swelling

Don't:

Do not sit with your legs crossed
Do not bend your hip more than 90 degrees (a right angle)
Do not bend down to touch your feet or ankles
Do not sit down in a low chair or toilet seat, or a chair without arms, as you will have problems pulling yourself up again (raised toilet seats are available)
Do not do exercises involving jumping, sudden turns, or where there is a high risk of falling while your hip is recovering
Do not lift or move heavy objects until you're told it's safe for you to do so.

Risks & Safety

Possible Complications of a Hip Replacement

A hip replacement is a common and safe procedure. However, as with any type of surgery there are risks. Your doctor will explain these to you.

Blood Clots or DVT (deep vein thrombosis)

Blood clots or DVT (deep vein thrombosis) are possible after a hip replacement because of how the blood flows and clots after surgery.

If you have a blood clot that causes pain or swelling, your doctor can give you anticoagulant medicines to help.

A blood clot that forms in the leg can sometimes travel to your lungs (pulmonary embolism). This can cause serious complications. To reduce the risk of blood clots it is likely that you will be given compression stockings to wear.

Wound Infection

There’s a small chance that your hip wound could get infected after surgery. This is usually treated with antibiotics. If the infection spreads deep into the hip joint, you may need further surgery.

Difference in Leg Length

Hip replacement surgery can sometimes mean the leg where your hip has been replaced ends up slightly longer than your other leg. Your surgeon will try hard to avoid this. Often, the difference is so small that most people do not notice it. Sometimes you may need to wear a raised heel, or similar, on your other leg.

Damage to Nerves or Tissue

During surgery, there’s a chance that a blood vessel, nerve or ligament around the hip joint could be damaged. This is not common and can either be repaired during surgery or will heal afterwards.

Implant Care & Longevity

Hip Dislocation, Wear & Metal Implants

Hip Dislocation and Wear

Sometimes your hip replacement can dislocate. This is not common, but can be painful or cause swelling. Some people may also hear clicking or popping noises coming from the joint.

It could happen soon after surgery before the joint is fully healed. It can also happen many years after surgery.

Modern hip replacement joints are designed to last for at least 15 years. But they can get worn over time causing pain or swelling. If your replacement hip dislocates or wears out, you may need another surgery to fix it.

If you are worried about your hip replacement, contact your GP or care team.

Metal Hip Replacements

Metal-on-Metal Hip Replacements

In the past, many hip replacements used a metal ball and a metal socket. These are sometimes called metal-on-metal implants.

Metal-on-metal implants can wear over time causing health problems. If you have a metal-on-metal hip implant, you should have regular check-ups.

Contact your GP or care team if you notice any problems with your metal-on-metal hip joint, such as:

New hip pain
You feel less mobile than usual
A popping or clicking sound coming from the joint

Urgent Medical Care

When to Seek Immediate Help

Ask for an urgent GP appointment or get help from NHS 111 if you’ve recently had a hip replacement and you have:

Throbbing or cramping pain in your hip or leg
A high temperature, or you feel hot, cold or shivery
Oozing or pus from your wound
Redness, tenderness, swelling or pain in your hip or leg that is not getting better or is getting worse

These could be signs of an infection or a blood clot. You can call 111 or get help from 111 online.

Call 999 or go to A&E if you have pain and swelling in your hip or leg, and:

You're having difficulty breathing
You have chest pains

This could be a blood clot in the lungs (pulmonary embolism), which needs to be treated immediately.

Knee Care Excellence

Knee Replacement Surgery

Knee replacement surgery is one of the most commonly performed joint replacement procedures and is recommended when knee pain becomes severe, persistent, and begins to interfere significantly with everyday activities. The most common cause for knee replacement is osteoarthritis, a condition where the cartilage within the knee joint gradually wears away, leading to pain, stiffness, and reduced mobility.

During knee replacement surgery, the damaged surfaces of the knee joint are carefully removed and replaced with a metal implant, with a specialised plastic bearing insert positioned between the components to allow smooth movement. The main aims of the procedure are to relieve pain, restore function, and improve quality of life.

Mr. Madhu Rao uses enhanced recovery pathways and modern rehabilitation principles for patients undergoing knee replacement surgery. Following consultation, diagnosis, and appropriate investigations, patients are admitted on the day of surgery and are encouraged to begin mobilisation early, often walking on the same day or the following day after surgery.

Patients typically spend around 1-2 nights in hospital, depending on their individual recovery and medical needs. Most patients make significant progress within approximately six weeks, although improvements in strength, mobility, and function can continue for up to a year following surgery.

Mr. Rao’s approach combines careful patient selection, modern surgical techniques, and personalised rehabilitation planning to help patients achieve the best possible outcomes after knee replacement surgery.

Pre-Op Guidelines

Preparing for Knee Replacement

Preparing for your knee replacement surgery can help reduce the risk of complications, improve your recovery, and help you return to your normal activities more confidently. Your surgeon and healthcare team will provide advice tailored to your individual circumstances.

Improve Your Fitness Before Surgery

While waiting for your knee replacement, you may be advised to:

Perform exercises to strengthen the muscles around your knee and improve mobility.
Maintain an active lifestyle within the limits of your pain and ability.
Lose weight if you are overweight, as this can reduce strain on your knee and may lower the risk of complications.
Stop smoking, as smoking can affect wound healing and increase the risk of infection.
Eat a healthy, balanced diet and keep alcohol intake within recommended limits.

Improving your general health before surgery can help support a smoother recovery.

Pre-Operative Assessment

Attend Your Pre-Operative Assessment

A few weeks before your operation, you will usually attend a pre-admission clinic. This assessment ensures you are fit and ready for surgery and may include:

Blood tests
Urine tests to check for infection
X-rays or other imaging if required
An electrocardiogram (ECG) to assess your heart health
Review of your medical history and medications

You will also have the opportunity to meet members of the healthcare team, discuss your operation and recovery, and ask any questions you may have.

Prepare Your Home for Recovery

Planning ahead can make your return home safer and more comfortable after knee replacement surgery.

Consider:

Arranging support from family or friends with everyday activities during the early stages of recovery.
Keeping essential items within easy reach.
Removing trip hazards such as loose rugs and clutter.
Preparing meals in advance or stocking your freezer.
Arranging a comfortable chair with good support.
Considering useful equipment such as a walking aid, raised toilet seat, shower chair, or grabber device if recommended by your healthcare team.

Plan for Your Recovery

Before surgery, it is helpful to:

Arrange transport home from hospital, as you may not be able to drive for several weeks after surgery.
Discuss your expected recovery time and return-to-work plans with your employer.
Follow your surgeon’s instructions regarding medications, exercises, and preparation for admission.
Understand the importance of physiotherapy and regular exercises after surgery to regain movement and strength.

Being well prepared before your knee replacement can help you approach surgery with confidence and maximise your recovery.

Recovering from a Knee Replacement

It may take several months or longer to fully recover from a knee replacement. This can vary depending on your age and general health.

Recovery for a partial knee replacement should be shorter than a total knee replacement.

It's important to follow the advice the hospital gives you on looking after your knee to have a good recovery.

Recovering in Hospital

After the operation, you'll spend some time in a recovery room where you may be given medicines to help with the pain.

You'll continue to have painkillers in the days after the operation as your knee will be sore.

You'll have help from nurses and physiotherapists to start walking soon after the operation so you can go home as soon as possible. You'll need crutches or a walking frame at first.

Recovering at Home

You can usually go home if your wound is healing well and you can safely get around. Most people can leave hospital 1 to 3 days after the operation.

Before you leave, a physiotherapist or occupational therapist will talk to you about managing daily activities and home exercise programmes. Following the exercises early on in your recovery will help with the long-term strength and movement in your knee.

A nurse will take out your stitches or clips after about 10 days. You'll also have a follow-up appointment about 6 weeks after the operation to check you're recovering well.

Do:

Use crutches or walking sticks at first – go down to 1 crutch then a walking stick when you feel confident
Try walking without an aid after about 6 weeks if you feel ready
Get up and walk around for 5 minutes every hour to prevent blood clots
Wait at least 6 weeks to drive again if you've had a total knee replacement or 3 weeks if you've had a partial knee replacement – check with your doctor that you're fit to drive
Avoid twisting your knee, bending down and reaching up as much as possible
Follow the exercises your physiotherapist has recommended
Keep your leg raised as much as possible to reduce swelling
Return to work when you feel ready – this is usually after about 6 to 12 weeks but will depend on the type of work you do

Don’t:

Do not sit with your legs crossed for the first 6 weeks
Do not sleep with a pillow under your knee (you do not need to sleep in a special position after the operation)
Do not kneel on your new knee until your doctor says you can
Do not stand for long periods of time as this could cause swelling in your ankles
Do not do household tasks that involve lifting or moving anything heavy (like vacuuming) for the first 3 months

Risks & Safety

Possible complications of a knee replacement

A knee replacement is a common and safe procedure. However, as with any operation there are risks. Your doctor will explain these to you.

Most people who have a knee replacement have no complications. If there are any, they are usually minor and can be treated.

The risk of having complications depends on your age and general health.

Blood clots or DVT (deep vein thrombosis)

Blood clots or DVT (deep vein thrombosis) are possible after a knee replacement because of how the blood flows and clots after surgery. This is often not serious.

If you have a blood clot that causes pain or swelling, your doctor can give you anticoagulant medicines to help.

A blood clot that forms in the leg can sometimes travel to your lungs (pulmonary embolism). This can cause serious complications.

To reduce the risk of blood clots your doctor might suggest wearing compression stockings or taking anticoagulant medicines.

Wound Infection

There's a small chance that your knee wound could get infected after the operation. This is usually treated with antibiotics.

If the infection spreads deep into the knee joint, you may need further surgery.

Damage to nerves or tissue

During surgery, there's a chance that a blood vessel, nerve or ligament around the knee joint could be damaged.

This is not common and can either be repaired during surgery or will heal afterwards.

Problems

Problems with your new knee

Most people find their daily life improves after a knee replacement. However, it's possible that you may have ongoing issues with your new knee, including:

Problems bending the knee
Ongoing pain and stiffness
The knee being unstable when you stand up or walk

Physiotherapy and certain exercises may help with these problems.

Most knee replacements last for about 20 years or more. Depending on when you had the operation you may need another replacement later in life, but this is not common.

Ask for an urgent GP appointment or get help from NHS 111 if you've recently had a knee replacement and you have:

Throbbing or cramping pain in your leg
A high temperature, or you feel hot, cold or shivery
Oozing or pus from your wound
Redness, tenderness, swelling or pain in your knee that is not getting better or is getting worse

These could be signs of an infection or a blood clot.

You can call 111 or get help from 111 online.

Call 999 or go to A&E if you have pain and swelling in your leg and:

You're having difficulty breathing
You have chest pains

This could be a blood clot in the lungs (pulmonary embolism), which needs to be treated immediately.

Find your nearest A&E

Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance.

Bring any medicines you take with you.

Partial Knee Replacement

Unicompartmental / Partial Knee Replacement

When arthritis affects only one area of the knee, it may be possible to replace just the damaged compartment rather than the entire knee joint. This procedure is known as a unicompartmental knee replacement or partial knee replacement.

Depending on the location of the arthritis, partial knee replacement may involve:

Medial unicompartmental knee replacement – replacement of the inner compartment
Lateral unicompartmental knee replacement – replacement of the outer compartment
Patellofemoral joint replacement – replacement of the kneecap joint

The key advantage of partial knee replacement compared with total knee replacement is that only the diseased area is treated, while the healthy parts of the knee are preserved. The major ligaments of the knee are maintained, allowing more natural knee movement, improved stability, and a more normal feeling in the joint.

Because the procedure preserves healthy bone, cartilage, ligaments, tendons, and surrounding tissues, patients may benefit from:

Smaller surgical incisions
Less soft tissue disruption
Reduced blood loss
Preservation of more natural knee function
Faster recovery compared with total knee replacement
Reduced bone removal

Mr. Madhu Rao specialises in partial knee replacement surgery and uses minimally invasive techniques through smaller incisions where appropriate. This approach aims to reduce post-operative pain, facilitate earlier mobilisation, and support a quicker return to normal activities while maintaining excellent long-term outcomes.

Careful patient selection is essential, and Mr. Rao assesses each patient’s symptoms, knee alignment, ligament function, and pattern of arthritis to determine whether partial knee replacement is the most suitable treatment option.

Knee Arthroscopy

Knee Arthroscopy (Keyhole Surgery)

Knee arthroscopy is a commonly performed minimally invasive procedure used to diagnose and treat a variety of knee conditions. It is usually carried out as a day-case procedure under general anaesthesia.

During arthroscopy, a small telescope with a camera (arthroscope) is inserted into the knee joint through tiny incisions. The camera projects images onto a monitor, allowing the surgeon to clearly view the internal structures of the knee. Specialised keyhole instruments can then be used through additional small incisions to treat specific problems within the joint.

Mr. Madhu Rao offers a range of arthroscopic knee procedures, using minimally invasive techniques to help relieve pain, improve function, and support rehabilitation.

Meniscal Injuries

Meniscal Injuries of the Knee

The menisci are two specialised pieces of cartilage that act as cushions between the thigh bone (femur) and shin bone (tibia). Each knee has two menisci:

Medial meniscus – located on the inner side of the knee
Lateral meniscus – located on the outer side of the knee

Meniscal tears can occur during sporting activities involving twisting, sudden changes of direction, or impact injuries. However, they can also occur during everyday activities, particularly where the knee is under stress, such as rising from a deep squat.Depending on the type, location, and extent of the tear, treatment may involve either trimming the damaged portion of the meniscus (partial meniscectomy) or repairing the tear (meniscal repair).

Mr. Rao assesses each patient carefully and arranges appropriate investigations, including MRI scans and X-rays where required, to establish an accurate diagnosis and recommend the most suitable treatment. Following arthroscopic surgery, patients may either be allowed to fully weight bear immediately or may require a period of restricted weight bearing, depending on the procedure performed. A structured rehabilitation and exercise programme helps restore knee movement, strength, and function.

Knee Procedures

Arthroscopic Knee Procedures Offered by Mr. Rao

Meniscal Repair

Where a tear is suitable for healing, particularly larger tears involving the peripheral blood supply of the meniscus, repair may be performed to preserve as much of the natural meniscus as possible. Preserving the meniscus can help maintain knee function and reduce the risk of future degenerative changes.

Partial Meniscectomy (Meniscal Trimming)

When a torn section of the meniscus cannot be repaired, the damaged tissue is carefully trimmed and removed while preserving as much healthy meniscal tissue as possible.

Removal of Loose Bodies

Loose bodies are small fragments of cartilage or bone that move freely within the knee joint. They may cause pain, swelling, catching, or locking of the knee.

Loose bodies can occur following sports injuries, fractures, trauma, osteoarthritis, rheumatoid arthritis, or conditions affecting bone and cartilage. Arthroscopy allows these fragments to be identified and removed through small keyhole incisions.

Radiofrequency Chondroplasty

Radiofrequency Chondroplasty (Coblation Chondroplasty)

Damage to the articular cartilage of the knee is a common cause of pain and reduced function. In selected younger patients with partial-thickness cartilage damage, where more extensive surgery is not appropriate, Mr. Rao may use radiofrequency chondroplasty as a minimally invasive treatment option.

This keyhole procedure uses controlled radiofrequency energy to smooth and stabilise damaged cartilage surfaces. Although it does not regenerate cartilage, as articular cartilage has limited healing capacity, it can reduce symptoms, improve knee function, and potentially delay the need for more major procedures.

Mr. Rao combines careful diagnosis, appropriate patient selection, modern arthroscopic techniques, and personalised rehabilitation to achieve the best possible outcomes for patients with knee problems.

NICE – Arthroscopic Radiofrequency Chondroplasty for Discrete Chondral Defects of the Knee

This patient information resource from the National Institute for Health and Care Excellence (NICE) explains arthroscopic radiofrequency chondroplasty for selected cartilage defects of the knee. It describes how the procedure is performed using keyhole surgery, where a radiofrequency probe is used to smooth and stabilise damaged cartilage surfaces, and provides information about the purpose and technique of the treatment.

Microfracture Technique

Microfracture Technique & Chondroplasty

Microfracture is a specialised arthroscopic technique used to treat small, localised areas of damaged articular cartilage within the knee joint. It is most suitable for selected patients who have a focal cartilage defect rather than widespread arthritis.

The aim of microfracture surgery is to stimulate the body’s natural healing response and encourage the formation of new cartilage-like tissue. The procedure is usually performed through keyhole surgery (arthroscopy), allowing treatment of the damaged area with minimal disruption to surrounding tissues.

How Microfracture Works

During the procedure, the damaged and unstable edges of the cartilage defect are carefully cleaned and smoothed. Small holes are then created in the underlying bone surface. These tiny openings allow blood and bone marrow elements, including stem cells and growth factors, to enter the defect and form a clot.

Over time, this clot remodels and develops into fibrocartilage, which helps fill the cartilage defect and improve the smoothness and function of the joint surface. Fibrocartilage is not identical to the original hyaline cartilage and is generally less resilient, but it can provide significant symptom relief and improve knee function in appropriately selected patients.

Chondroplasty

Chondroplasty is an arthroscopic procedure used to treat damaged or irregular cartilage surfaces. During surgery, loose or unstable cartilage fragments are removed, and rough areas are carefully smoothed to create a more stable joint surface.

Mr. Madhu Rao uses techniques such as microfracture and chondroplasty in carefully selected patients, based on factors including the size and location of the cartilage defect, patient age, activity level, symptoms, and overall knee condition. These procedures aim to reduce pain, improve function, and preserve the knee joint where appropriate, potentially delaying the need for more extensive surgery.

OrthopaedicsOne – Microfracture and Chondroplasty 

This resource provides information about arthroscopic cartilage procedures including microfracture and chondroplasty. It explains the principles behind treating focal cartilage defects, including smoothing damaged cartilage surfaces (chondroplasty) and stimulating repair by creating small channels in the underlying bone (microfracture). These procedures are typically considered for selected patients with localised cartilage damage rather than widespread arthritis.

Royal Orthopaedic Hospital – Microfracture/Chondroplasty of the Knee 

This patient information page explains knee cartilage damage, arthroscopic chondroplasty, microfracture technique, and the rehabilitation process following surgery. It describes how microfracture aims to encourage formation of repair tissue by allowing blood and growth factors from the underlying bone to reach the cartilage defect.

Specialist Hip Care

Abductor Muscle Tears After Hip Replacement

Pain around the outer aspect of the hip following hip replacement surgery can be caused by conditions such as trochanteric bursitis and tears of the hip abductor muscles. While abductor muscle tears are relatively uncommon, they can be a significant and debilitating complication after total hip arthroplasty.

Injury or degeneration of these important stabilising muscles can lead to persistent lateral hip pain, weakness, difficulty walking, a noticeable limp, and, in some cases, the need for walking aids such as a stick or crutch. These problems can significantly affect mobility and quality of life.

Mr. Madhu Rao has developed a specialist interest in the diagnosis and treatment of these challenging hip conditions. Through his research and clinical experience, he has developed and refined a novel technique for repairing hip abductor muscle tears following hip replacement surgery. He has successfully used this technique to treat many patients, helping to relieve pain, improve hip stability, and restore mobility and function.

Rao M, et al. "Repair of the abductor mechanism of the hip after total hip arthroplasty."

Revision Hip Replacement

Revision Hip Replacement (Redo Hip Replacement)

Modern hip replacement implants are designed to provide long-lasting pain relief and improved function. However, over time, some hip replacements may require further surgery. Although many implants function well for decades, wear, loosening, or other complications can occur, sometimes requiring revision hip replacement surgery.

One of the most common reasons for revision hip surgery is aseptic loosening, where the implant becomes loose without infection. Patients may experience increasing pain, reduced mobility, a feeling of instability, or difficulty with everyday activities.

Another important reason for revision surgery is infection following hip replacement. Although infection after joint replacement is uncommon, it requires specialist management. Depending on the type of infection, the causative organism, and individual patient factors, treatment may involve either a one-stage revision or a two-stage revision procedure.

A two-stage revision involves removal of the infected hip replacement during the first operation, thorough cleaning of the joint, and placement of a temporary antibiotic-loaded hip spacer. After a period of treatment, commonly around 6–8 weeks or longer depending on the clinical situation, a new hip replacement implant is inserted once the infection has been successfully treated.

Other reasons a hip replacement may require revision include:

Recurrent dislocation or instability of the hip replacement
Periprosthetic fractures (fractures around the hip implant)
Persistent pain due to mechanical problems such as leg length discrepancy or altered hip biomechanics
Significant bone loss around the implant
Soft tissue damage associated with previous metal-on-metal hip replacements

Revision hip replacement is a technically demanding procedure because patients often have reduced bone stock, scar tissue, weakened muscles, and more complex anatomy compared with primary hip replacement surgery. Careful planning, specialised implants, and advanced reconstruction techniques are often required to achieve a successful outcome.

Mr. Madhu Rao has extensive experience in complex revision hip replacement surgery and has been performing these challenging procedures for many years. His expertise includes managing cases involving implant loosening, bone loss, infection, instability, and complex reconstruction. His approach focuses on careful assessment, personalised surgical planning, and helping patients regain mobility, reduce pain, and improve quality of life.

Revision Knee Replacements

Revision Knee Replacements (Redo Knee Replacement)

A revision knee replacement surgery is a procedure that is performed to replace a knee implant that is no longer functioning properly. Most knee replacements last around 15 years and some longer. However, there are also times when a knee replacement needs to be redone after many years or even rarely earlier than that.  

Some of the more common reasons needing revision knee replacement include Aseptic loosening of the implant, infection of the joint, instability of the knee, malalignment of the prosthesis and fractures around knee replacement.  

Understanding why a knee replacement has worn out is critical to performing a successful revision knee replacement. When performing a revision knee, often some damaged bone has to be removed, and some may be lost as a result of the problem with the implant. Maintaining adequate bone to support the new implant can be challenging. Finally, obtaining a knee that is flexible enough to allow for motion, yet stable enough to keep you steady, is also more difficult in revision situations.  

Mr Rao is well experienced in revision knee replacement surgery and has done immense work in dealing these bony defects using Trabecular Metal cones and modern implants. Mr Rao analyses each individual patient and offers the most appropriate solution for each patient.

Periprosthetic fractures

Periprosthetic fractures of Hip and Knee

His expertise in this area reflects his commitment to advancing treatment options for complex hip problems and improving outcomes for patients with conditions that can otherwise be difficult to manage.

The management of periprosthetic fractures requires careful assessment of several factors, including the location and pattern of the fracture, the stability of the implant, and the quality of the remaining bone stock. Depending on the individual circumstances, treatment may involve internal fixation to stabilise the fracture or revision joint replacement surgery to address a loose or damaged implant and restore function.

Mr. Madhu Rao has a specialist interest and extensive expertise in the management of periprosthetic fractures around hip and knee replacements. He has undertaken significant research in this field, contributing to a better understanding of the surgical techniques and decision-making required for these challenging cases.

He has shared his expertise by teaching fellow orthopaedic surgeons on the management of periprosthetic fractures and has published his work in peer-reviewed journals. His research and clinical experience have been presented at international meetings across Europe, America, and Asia, reflecting his contribution to advancing the treatment of these complex orthopaedic injuries.

American Academy of Orthopaedic Surgeons (AAOS) – Fracture After Total Knee Replacement 

This patient information resource explains periprosthetic fractures (fractures occurring around or near a knee replacement implant). It describes the causes, symptoms, diagnosis, and treatment options for fractures after total knee replacement, including when treatment may involve fixation with plates and screws or revision knee replacement surgery. It also explains factors that influence treatment decisions, such as fracture pattern, bone quality, and whether the existing implant is loose.

American Academy of Orthopaedic Surgeons (AAOS) – Fracture After Total Hip Replacement 

This patient information resource explains periprosthetic fractures after total hip replacement (fractures occurring around or near a hip replacement implant). It covers the causes, symptoms, diagnosis, and treatment options for these complex injuries. Treatment decisions depend on factors such as the location and pattern of the fracture, the quality of the remaining bone, and whether the existing hip implant is stable or loose. Options may include fixation of the fracture with plates, screws and cables, revision hip replacement, or a combination of techniques.

Periprosthetic fractures

Periprosthetic fractures of Hip and Knee

Periprosthetic fractures occur around existing hip or knee replacement implants. Management requires evaluating fracture patterns, implant stability, and remaining bone quality.

Treatment options include internal fixation (plates, screws, cables) or full revision joint replacement.

Mr. Madhu Rao has published extensively on periprosthetic fracture management and regularly teaches orthopaedic surgeons internationally on advanced fixation and revision decision-making.

surgery preparation with hip replacement

Distal Femoral Replacement

Distal & Proximal Femoral Replacement

Mr. Madhu Rao has undertaken extensive work in the management of complex fractures occurring around knee replacements, known as periprosthetic fractures. These challenging injuries often affect elderly patients and require specialised surgical expertise to restore mobility and function.

His research has included a comparative study evaluating Distal Femoral Replacement (Distal Femoral Arthroplasty) versus traditional internal fixation techniques for the treatment of distal femoral periprosthetic fractures. The findings demonstrated that, in appropriately selected patients, distal femoral replacement can provide improved clinical outcomes, facilitate earlier mobilisation, and help patients regain independence more quickly following injury.

This work was presented at the 34th SICOT Orthopaedic World Congress and at the British Association for Surgery of the Knee meeting in 2013. It was also selected for presentation at the American Academy of Orthopaedic Surgeons Annual Meeting in San Diego, USA, reflecting the growing international interest in this evolving approach to the management of complex periprosthetic fractures.

Mr. Rao continues to apply evidence-based surgical techniques in the treatment of complex trauma and revision arthroplasty, with a particular interest in helping patients achieve early recovery, improved function, and the best possible long-term outcomes.

Proximal Femoral Replacement

Proximal Femoral Replacement and Complex Reconstruction Surgery

Reconstruction of complex periprosthetic fractures around loose hip and knee replacement implants, or revision of failed hip and knee replacements associated with severe bone loss, can be technically challenging and requires specialist expertise.

In selected cases where there is significant loss of bone stock, procedures such as proximal femoral replacement or distal femoral replacement may be required. These are complex and specialised reconstructive techniques that can restore stability, improve mobility, and allow appropriate patients to regain function and return to weight-bearing more quickly.

Mr. Madhu Rao has expertise in performing these rare and complex reconstructive procedures. He has successfully managed challenging cases involving severe bone deficiency following joint replacement surgery, using advanced surgical techniques to help patients achieve improved mobility and quality of life.

Trauma Surgery

Trauma Surgery and Fracture Management

In addition to his specialist hip and knee practice, Mr. Madhu Rao has extensive experience in the management of both simple and complex orthopaedic trauma. He specialises in the treatment of lower limb fractures, as well as fractures of the wrist, forearm, and elbow, providing both operative and non-operative care tailored to each patient's individual needs.

For private and insured patients who sustain acute orthopaedic injuries requiring surgical treatment, Mr. Rao offers prompt assessment and management through the Chichester Suite at St Richard's Hospital. This provides timely access to specialist trauma care, diagnostic services, and surgical intervention when required, helping patients achieve the best possible recovery and return to their normal activities as quickly and safely as possible.

Contact Details

Chichester Suite, St Richard's Hospital

Telephone: 01243 788122 Ext. 35287

Email: uhsussex.chichester.suiteadmissions@nhs.net