Mr Raghbir Khakha is a consultant knee surgeon based at Guys and St Thomas’ Hospital for his NHS practice, while his private work takes place at the London Clinic. An expert in all things related to knee surgery, he is now taking on the role of Medical Director of Living Room Health, bringing his knowledge to bear on providing the best diagnostic services and, where appropriate, treatment for our patients.
The foremost offering for patients coming to Living Room Health is our outstanding diagnostic service. The NHS and its hospitals are amazing, but for someone suffering with joint pain, the process of getting their diagnosis in the first instance can be time consuming and difficult to access.
There’s a real mystery around hospital medicine; patients will typically go and see their GP, get really good service, get pain relief and whatever else they need – but they will never really know what’s going on with their joints, because getting access to secondary healthcare where all the images and diagnostics take place is an extremely difficult thing to do.
This is where Living Room Health is able to step in and demystify the entire process of medicine, by making it very easy for patients to walk into a medical centre that will allow them to have a high standard scan that shows them exactly what’s going on in their body. They will receive a report from a consultant radiologist whose job is to do exactly that – rather than receiving the report from a surgeon who has a rough idea of what is going on, but who then needs to send the patient on to an expert who can interpret the findings more comprehensively.
Instead of having to wait a long time to get a diagnosis, Living Room Health empowers patients to get the information they need immediately, so they can present it to their GP and say: “I have this specific problem, and these are my symptoms.” We’re not bypassing other healthcare professionals or the NHS; we’re just providing more information that other healthcare professionals can then use to make a judgement. The last thing we want to do is undermine the current process, and when I speak to my friends who are GPs and primary care practitioners, they tell me they would love to be able to access images and reports like the ones we’re producing. It provides the basis for better-informed treatment; for GPs to be able to look at an MRI and more quickly deduce that a physiotherapy injection is what’s needed, for example.
If you look at National Joint Registry figures from just a few years ago, there are approximately 17 million people suffering with joint pain in England, Scotland and Wales, waiting to go and see somebody about their problem. Even if you already have a diagnosis of osteoarthritis, you are still going to have quite a wait before you can get into physiotherapy or see an orthopaedic surgeon. In my private clinic work, if I see 10 new patients I typically give most of them an MRI scan, and of those, half won’t need any intervention from me. However, around 40% will actually need an operation – and the primary obstacle preventing most people getting the operation they need is not having the diagnostics. This is how Living Room Health can help speed things along.
As well as diagnostics, Living Room Health is also able to offer some different types of management for joint pain, depending on the diagnosis. We do things in a stepwise fashion, the first step of which is physiotherapy; often patients’ pain can be managed through simple physiotherapy that strengthens their muscle structures. Living Room Health works very closely with physiotherapy groups in order to put our patients in touch with the right healthcare professionals, because there are many different types of physiotherapy that people might not be aware of, and identifying the right practitioner who is interested in musculoskeletal pathology is extremely important.
Another adjunct that is rarely spoken about – but is certainly used extensively in my practice – is bracing. Having a brace for your joint is like having scaffolding on a house you’re refurbishing; it provides the support that’s needed for the work to be done. In the case of the knee, bracing can even be curative by relieving knee pain symptoms and taking pressure off arthritic parts of the joint – in fact, it can be just as effective as a procedure in some cases. A number of my patients are policemen who do a lot of walking and have arthritis, but who have been able to continue doing their jobs because I’ve given them the right brace. So bracing, along with physiotherapy, constitutes the interventional pathways we might try before we then consider injections.
There are a few different types of injection, but the most commonly used is a steroid-based injection. Steroid has been around for a long time and is a really good anti-inflammatory; if you consider your knee pain to be like a campfire, then a steroid injection is essentially like throwing a big bucket of water on top. It dampens the inflammation, and for some people that’s all they need, while for others it may need repeating. That is a standard treatment, but more recent developments include the injection of hyaluronic acid, which is a bit more like a joint lubricant as well as working as an anti-inflammatory. Another development in joint injections is platelet rich plasma therapy, which is another sort of anti-inflammatory injection that uses your blood cells. But the majority of what we’ll be focused on is the newer biological treatments, which can really help with joint pain.
Outside of those treatments, Living Room Health will be able to signpost patients towards the best possible medical care for any condition they might have – whether that be pointing them towards the regenerative clinic, or to Paddington for any kind of surgical intervention that might be necessary.
The most important thing to remember is that Living Room Health runs on the expertise of our consultant clinicians, with all of the decisions, treatment and advice being led by consultants. Our centres are hubs of clinical excellence situated in a nice, easygoing atmosphere for people to be able to walk in off the high street and explain to an expert clinical practitioner that they have a certain kind of pain. Within the day they can receive an MRI scan and a report that tells them exactly what’s going on. It’s a new, more efficient clinical pathway that provides rapid access to clinicians, imaging and diagnosis – and it’s the fastest possible route towards peace of mind about your health.