# Anyone had Apos therapy for bad knees?



## Marrabone

Hi all,

I had an arthroscopy (key hole op) on my knee 2 and a half years ago. It had been better for about 2 years. Now though, the old familiar symptoms are back i.e. stiffness pain etc and l am hobbling worse than ever. I live on my own as l have been widowed for 4 years.

I was told that, if this happened, l would have to have a replacement joint, something which l really do not relish as l have heard that this depends on total accuracy for its success and have heard many horror stories about them not being done too well.

I have been reading up about it and have come across this Apos therapy which involves you wearing special boots for up to an hour or so each day. These are designed to alter your gait. There are very good reports about it online but, without getting an independent view, l am still sceptical. I believe the cost is about £3.5K and involves trips to their Bupa clinic in London. This is not an easy trip for me and l would have to go on my own.
I would really like to hear from anyone with experience of this treatment.

Marilyn


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## 747

I am starting to get bother with my knees (after a lifetime of abuse including working in low coal seams). As we walk the dogs every day, I have found that a knee support worn for a few days gives me a few weeks of relief.

The best one I have is the one given to my wife by the Physio when she tore her knee Cartilege. It is just an elasticated cylinder shape and seems to work much better than the shaped Scholl supports. It is comfortable to wear and because it is relatively thick, it helps a lot in the cold weather by insulating the knee joint.

Hope that helps.


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## aldra

Marilyn

You should not have to resort to expensive private treatment

Ask for a referral back to your consultant, you do not have to go along with an operation if you don't want to

but they can recommend solutions that can help

Aldra


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## Grizzly

If this treatment is as good as the company says it is then the NHS would have taken it over long ago. It would cost them less than knee ops and monitoring and providing pain relief etc. That they have not done so leads me to think that it is another brand of snake oil. 

Someone who is paying 3.5k for a treatment is already thinking themselves into the right frame of mind to feel better anyway.

As others have said; go back to your consultant. Bear in mind, as well, that this is the optimum time of year to suffer from problems in already damaged joints so it is no wonder they are giving you problems

G


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## mikebeaches

Marrabone said:


> Hi all,
> 
> I had an arthroscopy (key hole op) on my knee 2 and a half years ago. It had been better for about 2 years. Now though, the old familiar symptoms are back i.e. stiffness pain etc and l am hobbling worse than ever. I live on my own as l have been widowed for 4 years.
> 
> I was told that, if this happened, l would have to have a replacement joint, something which l really do not relish as l have heard that this depends on total accuracy for its success and have heard many horror stories about them not being done too well.
> 
> I have been reading up about it and have come across this Apos therapy which involves you wearing special boots for up to an hour or so each day. These are designed to alter your gait. There are very good reports about it online but, without getting an independent view, l am still sceptical. I believe the cost is about £3.5K and involves trips to their Bupa clinic in London. This is not an easy trip for me and l would have to go on my own.
> I would really like to hear from anyone with experience of this treatment.
> 
> Marilyn


I have looked at Apos therapy, which as you say, appears to have positive feedback. But at the moment, have not gone beyond reading about it and one inquiry phone call to find out the prices.

I first spoke to my GP about my knee 18 months ago and had it X-rayed. GP just said looks like the onset of osteoarthritis. Your best course of action is physiotherapy at this stage. She referred me to the local NHS service, which was OK, but I certainly wasn't too enthusiastic about the assistance I received.

I have, however, found a book by Jim Johnson - an American Physio - quite helpful. The title is 'Treat your Own Knees'. I've got this edition:

http://www.amazon.co.uk/Treat-Your-...9889/ref=sr_1_1?ie=UTF8&qid=1331567916&sr=8-1

but I see there's a newer one published June 2011. Easy to folow, and once into a routine, takes very little time. I'm sure it's helped me.

Anyway, I went back to the GP a couple of weeks ago and said I was interested in investigating key-hole surgery. To which she said, the NHS doesn't fund it in North Somerset (my authority) and if I wanted to go down that road I'd be paying for myself. I also asked about having an MRI scan, and she said she was not authorised to request one.

She did refer me for another X-ray and I'm awaiting the results. I understand I can then be referred to another NHS specialist, who can decide about an MRI?

But I'll be interested to hear if anybody has tried Apos therapy. Oh, and apparently, it's a new treatment developed in Israel. And my nearest centre would be Reading (which I'd prefer to Central London).


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## Grizzly

Before I went ahead with anything like this I'd ask them to show me the clinical trial results. I can't find any. It's one thing saying that the device is:



> Clinically-proven, [unquote]
> 
> but there do not appear to be any clinical trials that have been reported. Fitting the device to patients and then asking them if they feel better afterwards- or, to be blunt, asking on here if people felt better after treatment- does not prove that they are effective.
> 
> How long have they been marketing these devices and is it long enough to see if they cause long-term damage to other parts of an osteoporotic/ osteo-arthritic body over time ? Altering the gait by inducing instability seems to me to be a recipe for back and neck problems. How long do they follow-up and monitor patients ?
> 
> G


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## Marrabone

I'm not asking for 'proof' Grizzly, just trying to make an informed decision if at all possible and maintain an open mind.

To my way of thinking, taking pot luck as to whether l get a surgeon who can do a good accurate job is not exactly ideal either.

I cannot manage as l am and l don't want to make things worse. I would still like to hear from anyone who has tried this system for good or ill.


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## Grizzly

Marrabone said:


> I'm not asking for 'proof' Grizzly, just trying to make an informed decision if at all possible and maintain an open mind.
> 
> .


Sorry..my fault, I put my response badly. I know you're not asking for proof but I do think that proof should be demanded of the people who market this therapy.

As has happened thousands of times before, throughout history, it is easy to convince people that some medicine or procedure is the ultimate answer to their problem and to sell it to them at a high price. What should always be demanded is a proper, scientific trial. I can't see evidence that this has happened with this firm and that makes me uncomfortable.

I sympathise hugely with your particular problem; my sister-in-law is very much in the same boat and I know how much it affects her life and her ability to do her tough job. She is single and has no-one to rely on either so it is even more difficult.

Have you though of discussing these boots with a physiotherapist- NHS or private ( sports centre ?) ? They, I suspect, would have a good idea of the effect of this sort of exercise on your condition and might be able to answer your questions one way or another.

G


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## mikebeaches

It looks as though there might be some evidence about the outcomes of Apos Therapy:

http://www.library.nhs.uk/booksandj...fld.title&sr=bnj.pub&did=20637534&pc=14&id=24


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## Grizzly

mikebeaches said:


> It looks as though there might be some evidence about the outcomes of Apos Therapy:
> 
> http://www.library.nhs.uk/booksandj...fld.title&sr=bnj.pub&did=20637534&pc=14&id=24


I did see the Assaf-Harofeh Medical Center recruitment request:

http://clinicaltrials.gov/ct2/show/NCT01266382

and think this could be the same. Where are the results though ? Is it an on-going study or did they fail to recruit ? Who are the 
Assaf-Harofeh Medical Center and are they related to the Apsos company ?

G


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## mikebeaches

Grizzly said:


> mikebeaches said:
> 
> 
> 
> It looks as though there might be some evidence about the outcomes of Apos Therapy:
> 
> http://www.library.nhs.uk/booksandj...fld.title&sr=bnj.pub&did=20637534&pc=14&id=24
> 
> 
> 
> I did see the Assaf-Harofeh Medical Center recruitment request:
> 
> http://clinicaltrials.gov/ct2/show/NCT01266382
> 
> and think this could be the same. Where are the results though ? Is it an on-going study or did they fail to recruit ? Who are the
> Assaf-Harofeh Medical Center and are they related to the Apsos company ?
> 
> G
Click to expand...

As I mentioned earlier, the treatment was recently developed in Israel (2009/10?) .

Organization name	Assaf-Harofeh Medical Center
Organization study ID	93/09
Sponsor	Assaf-Harofeh Medical Center
Collaborator	Apos Medical and Sports Technology LTD.
Health Authority	Israel: Ministry of Health

I assumed the results of the trials were in a medical research paper held by the NHS Library (so presumably on the NHS radar), but it would be interesting to get to the bottom of the matter and see the published results.


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## aldra

If its developed in Israel

worth a second look

not that I am biased :lol: :lol:

Aldra


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## Grizzly

mikebeaches said:


> ....., but it would be interesting to get to the bottom of the matter and see the published results.


You're right, it would. The imagination boggles as to how they could do a trial of such a device however ! I've been trying to work out a method all evening !

It would be the long-term effects that would concern me though - on hips, back and so on.

G


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## mikebeaches

Grizzly said:


> mikebeaches said:
> 
> 
> 
> ....., but it would be interesting to get to the bottom of the matter and see the published results.
> 
> 
> 
> You're right, it would. The imagination boggles as to how they could do a trial of such a device however ! I've been trying to work out a method all evening !
> 
> It would be the long-term effects that would concern me though - on hips, back and so on.
> 
> G
Click to expand...

I'm afraid that's the point - if the system was only developed in 2009/10, there won't be any long term results.

However, the theory is that the approach can help correct any gait imbalance, and so should presumably improve/enhance the function of other related joints.

But as I said 'the theory' - it would be good to view the trial results thus far.


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## Grizzly

The best I can find is (From Apos website):

_Clinically proven to provide significant and lasting pain relief

Many AposTherapy patients report some level of pain relief as early as their initial consultation, when experiencing the AposTherapy unique biomechanical system for the first time. An independent survey, conducted by Network Research in November, 2009, indicated that 85% of the 150 AposTherapy patients who participated reported a reduction in pain, the vast majority in just over a month. What's more, pain relief is lasting. One recent clinical trial re-examined knee osteoarthritis patients two years after using AposTherapy and found a significant 63% reduction in pain._

What would be more useful would be a report after 2 years that said patients had a significant reduction in the degeneration of bone and cartilage in the affected joint. Pain is highly subjective and simply having someone take notice and reassure you can be enough to reduce pain in some instances.

G


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## trevd01

I don't usually get involved in medical posts because I am "in the trade". No - I'm not a doctor, before you ask.

But this thread caught my attention, mainly because I am due to have my own arthroscopy on my knee this month.

None of the following is professional advice, I'm just setting out a few thoughts that the original poster can consider when deciding what do do.

A few thoughts, then:

The APOS treatment at £3.5k is about the same price an NHS hospital would get paid for doing a knee replacement.

From memory, I think about 100,000 people have a knee replacement in England each year (I'd need to be at work to look up the exact figure), so some surgeons are doing a lot of these, and the trick is to find one you can be happy with, if you were to have an operation.

I see you are in the South Midlands. For all orthopaedic surgery in the NHS you can choose to go anywhere for your surgery. There are half a dozen specialist orthopaedic hospitals in England. It happens there are two specialist orthopaedic hospitals not far away in the West Midlands, the Royal Orthopaedic in Birmingham and Robert Jones & Agnes Hunt in Oswestry. These hospitals only do orthopaedics, nothing else.

In those specialist hospitals surgeons will do many more knees or hips than at a district general hospital (DGH) and you will probably find surgeons that only do knees, day in, day out there. Practice makes perfect, and you will tend to find these specialist hospitals have a much lower 'revision' rate (having to repeat the operation) and lower infection rates than most DGHs.

When I needed a hip resurfacing I chose to go to Oswestry, even though it is 100 miles away from where we live, choosing a surgeon that specialises in hip resurfacing in younger patients. But for my arthroscopy in a couple of weeks I am content to go more locally, as it is a more minor proceedure.

If you talk to your GP, they ought to know a knee specialist at one of these specialist hospitals, and you have a right to ask to go there on the NHS.

Remember this is NOT advice. Only you can decide. But do talk to your GP

Hope that helps.


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## mikebeaches

Trevor - many thanks for your post, a very helpful insight and much appreciated.

One further observation about Apos Therapy - when I spoke to the organisation offering the programme I was asked if I had BUPA or any other private health insurance. As I understand, apparently, the treatment has been accepted by BUPA and others, as one that they will fund. Since I don't have any private health insurance, not sure how significant their approval is in terms of recognising the efficacy of Apos Therapy?

Good luck with the forthcoming procedure on your knee.


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## DeeGee7

Marrabone said:


> Hi all,
> 
> I had an arthroscopy (key hole op) on my knee 2 and a half years ago. It had been better for about 2 years. Now though, the old familiar symptoms are back i.e. stiffness pain etc and l am hobbling worse than ever. I live on my own as l have been widowed for 4 years.
> 
> I was told that, if this happened, l would have to have a replacement joint, something which l really do not relish as l have heard that this depends on total accuracy for its success and have heard many horror stories about them not being done too well.
> 
> Marilyn


Hi Marrabone, I have had both my knees replaced successfully. I too had an arthroscopy on one of them some years ago and the relief from pain only lasted about a month. My first knee was replaced about 4 years ago, when I was 63, and the other was done last year. I was up out of bed the day after the latest operation and within 4 days was able to walk a few hundred yards to the car park to be ferried home. The most important thing about this operation is to exercise your leg muscles, especially the quads, this will go a long way to ensure a successful outcome. I hope this will help.


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## barryd

about 18 months ago I had an MRI scan on both knees. Basically at 46 years of age I have two knees with advanced / bad Arthritis.

They told me however that they wouldn't operate as I was too overweight and far too young. My doctor also told me it was a bad idea as they can go wrong! 8O 

So I was just given a blue badge and told to go away and get on with it.

I have since lost five stone (couple to go) and despite going to Physio and seeing all these doctors who have done nothing for me I discovered a sports injuries specialist at my local gym who has helped me immensely. Losing weight has helped but what he has done is show me specific exercises to build up the right muscles around the knee. The difference is amazing. Some days a couple of years ago I couldn't walk more than 100 yards. Now I can do two or three miles. It still hurts though and it isn't going to get better. The problem is finding these people. Ive been to doctors, surgeons and physio's none of which were any help. I just happened to bump into this guy who took over managing our gym and his advice and care has all been FOC!

At some point I am going to need surgery assuming they will let me have it. Trevor your post is useful. I didn't realise you could choose where you went. Only problem is my GP seems pretty useless and not really concerned to be honest.


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## Marrabone

Thanks everyone for your input, Trevor in particular as l didn't know about the Royal Orthopaedic Hospital in Birmingham which would be a good option for me. 

I have looked at their website and they do seem to have an excellent record with a long list of highly qualified consultants. There is a slight worry about it being a teaching hospital - l know everyone has to learn but l'm only human!

I don't think l will go for the Apos system as it is very expensive and although great claims are made from surveys of their patients. l always think of the times l have sat through a boring, useless training course and filled in a questionnaire at the end saying how wonderful it was, just because l was handing it back to the tutor in person and wanted to get out of the door as quickly as possible.

I suppose if they guaranteed satisfaction it would be a start but then how many would say it hadn't worked even if it had helped, just to get their money back? 

It looks as if l need to make and appointment with my GP and discuss the way forward.


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## trevd01

Teaching hospitals? This specific designation means they are attached to / associated with a University medical school.

The senior medical staff there teach in the medical school (many are professors) as well as treating patients in the hospital.


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## patp

You would not be offered a knee replacement if there were any other option.
Mr Patp has had both his knees replaced. He was booked in for two half knee replacements as these are less invasive. When they tried, though, they found that one knee would not balance and he had to have a total knee replacement on that leg.
He tell everyone what a wonderful thing the NHS is. From only being able to walk a hundred yards with the use of sticks he can now walk miles and even climb hills etc.
The only things he finds difficult is kneeling, as the gel cushion did not regenerate, and standing on ladders.
All done at the local, Norwich, general hospital by the wonderful Mr Glasgow.


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## sleepylawyer

Hi Just thought a personal account of Apos therapy might help the first poster here. I do not have shares or any commercial interest in Apos I am just a user of it.

I have had the shoes for 13 months. I have gone from having knee pain every night to a couple of times in the last year when I have had to take painkillers for knee pain. Before I could not walk up or down stairs without pain. I could not swim without pain. I had had two arthroscopies on one knee and due for one on the other knee. I could walk upstairs without pain from the day I had the shoes fitted just from wearing them in the Clinic. I can now swim go up and down stairs and use all gym equipment. I can happily recommend Apos to anyone. I feel that if people had the pain I had they would try anything to alleviate it. I agree the price is high but there is solid medical research behind it and 7 years of clinical trialling which all puts the price up. Also every Apos therapist is a chartered Physiotherapist first which also makes it more expensive.

I am a member of BUPA so got the shoes for nothing. BUPA is legally obliged to spend members money wisely so would not use APOS unless they were satisfied with the efficacy of it. If anything they are conservative in their endorsement of new treatments. I would say that is a strong reassurance that BUPA will pay for Apos therapy. At the end of the day there is no surgery no unknown drugs just a pair of shoes tailored to you. The basic treatment is that you get knee pain because in a damaged/OA knee the right muscles guard ie turn off to stop you using them so the joint can rest. We plough on moving so the wrong muscles take over. After doing the wrong job they complain ie hurt especially at night saying please stop using me. Apos shoes turn off the wrong muscles and turn on the right ones. They make you walk properly and stand properly turning on the right muscles and make them get stronger. IT IS NOT A CURE IN THAT IT DOES NOT GROW NEW ARTICULAR CARTILAGE AND DOES NOT CLAIM TO BUT IT DOES TAKE THE PAIN AWAY OR REDUCE PAIN SUBSTANTIALLY AND CAN BE USED BEFORE AND AFTER SURGERY TO HELP REHAB INCLUDING TOTAL AND PARTIAL KNEE REPLACEMENT.

I hope this explains the therapy and helps you to decide. Cheers yours in bad knees.


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## Marrabone

Thank you, sleepy lawyer, for such an informative post. Luckily my knee has improved considerably since l originally posted.

I do know how quickly they can deteriorate though and will bear in mind what you have said if it should start to trouble me again. 

Thanks again
Marilyn


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## CocoRobin

I am interested to read the debate here... but sad at some of the bad advice and assumptions banded about with authority...

I had an accident 3 years ago which resulted in me tearing my meniscus in my left knee. i hobbled about for 9 months hoping it would settle down on its own...but eventually had to see the doctor who sent me to a physio and he sent me on to a surgeon who did an arthroscopy. 18 months later i haven't had a single day when knee pain wasn't front and central in my dally life. Utterly boring... but there seems so little on offer from the medical profession.

On Friday I went along to the BUPA centre and checked out this miracle cure APOS THERAPY. I was very cynical... but with nothing else on offer I thought it was worth a try. After all it does not involve taking drugs... a general or a hospital stay: What's not to like? 

I was very impressed with the thorough examination of both legs... checking out knee, hip and ankle. Getting me to walk along a mat that records your gait as well as how long your stride is and how long you spend on each foot.

After this I was asked to walk up and down while the Apos clinician watched and conferred with a colleague. He took a very precise history. 

Eventually came the moment of truth. I had some boots fitted and adjusted - with two sets of discs on each boot. I got down off the chair and walked across the floor - and for the first time stopped limping and had no pain. My cynical inner voice was dumb. Its three years since I have walked like that... and there's no way this was a placebo effect: pain is pain.. and it was gone.

I actually wept tears because it was SO amazing to realise that I will be able to work towards walking without dealing with pain.

To the person who said that if it worked the national health would have it on offer: That is a statement ignorant of the way the NHS works. Change is slow... very slow and anything that doesn't involve drugs or operations is viewed with enormous cynicism. This therapy has only been around for 3 years... there is no doubt in my mind that it will eventually become standard practice... because it will work and save millions of pounds... and be more successful that most of what is on offer right now.

To those who say its too expensive I say: How much is walking pain free worth? I would rather that than have a car, holiday, meals out, almost anything. It's about priorities. To me... to get my life back is worth a small fortune... and I would willingly pay twice as much. I am paying 2.5K but that includes a year's worth of consultation and follow up appointments for adjustments (just like you have with an optician)

Each to their own - and I have only had two days of experience - but I wanted anybody out there who is worried to hear from someone who has actually tried it out.

By the way.. it works by changing the area on the knee taking the weight and building up the supporting muscles. I felt as if I had been to the gym last night - tired muscles - after walking in the boots for 20 mins. Incredible.


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## patp

I am so pleased for you CocoRobin. Anyone who has had constant pain will also be pleased for you.

I agree with your statement about the NHS too. Doctors are trained in the use of drugs. That is it. They diagnose and use drugs to treat what they find.

I have pain in both legs. I have been trying to resolve it for two years. The thing that has had the most effect is Acupuncture. I cannot get a doctor to take any notice. I have to pay for the sessions with with a physio. My dogs have acupuncture in a surgery setting and they doze off when the needles are inserted. You cannot tell me that is a placebo.

I think the trouble is that there have been some awful quacks out there trying to sell snake oil so that anything that doesn't come from a drug company and has not gone through double blind trials etc cannot be accepted as therapeutic.

I do hope you continue to improve. Do keep us informed.


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## Easyriders

Marrabone said:


> Thanks everyone for your input, Trevor in particular as l didn't know about the Royal Orthopaedic Hospital in Birmingham which would be a good option for me.
> 
> I have looked at their website and they do seem to have an excellent record with a long list of highly qualified consultants. There is a slight worry about it being a teaching hospital - l know everyone has to learn but l'm only human!
> 
> I don't think l will go for the Apos system as it is very expensive and although great claims are made from surveys of their patients. l always think of the times l have sat through a boring, useless training course and filled in a questionnaire at the end saying how wonderful it was, just because l was handing it back to the tutor in person and wanted to get out of the door as quickly as possible.
> 
> I suppose if they guaranteed satisfaction it would be a start but then how many would say it hadn't worked even if it had helped, just to get their money back?
> 
> Please don't worry about teaching hospitals, the very best hospitals are teaching hospitals. make sure they teach surgeons though, not just nurses!
> 
> It looks as if l need to make and appointment with my GP and discuss the way forward.


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## Easyriders

Tried to post with the above quote about teaching hospitals, but gremlins got in the works, and my reply doesn't show. So here it is again:

Please don't worry about teaching hospitals, the very best hospitals are teaching hospitals. make sure they teach surgeons though, not just nurses!


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## ThesmallBopper

Dear Marrabone,
I have no connection with Apos, save being a client.
I thought long & hard before I went to see them. They do a free assessment of your problem, and, if they can't help you, they will say.
I had dreadfully painful knees, from Osteoarthritis, and decided to take their treatment, in spite of the cost. The results I have achieved in two months (out of 12 programmed) have been brilliant. The continuous pain has all but disappeared. I can go up & down stairs much less painfully.
I expect all pain to have disappeared after the 12 months.
Consider hard, before you have a knee replacement. You can never kneel down again, and the new knee has a limited life.
The thing that swung it for me, was that Apos have been bought by BUPA, who find their treatment cheaper and less invasive than a replacement knee.
ThesmallBopper


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## Zebedee

Interesting that three of the last seven posts on this old thread are from "_first (and only) post_" non subscribers.

Hmmmm - just an observation.

Dave


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## morgwn

I don't believe the NHS would take it on! From my own experience with having to endure a trip to Egypt mid revolution to a private clinic to have a procedure the NHS refused to do, but it definitely improved my life along with the other people who had also travelled for it. The NHS has become a joke thanks to wasted funds, the huge amount paid to NICE, I refuse to see my GP or consultant neither have helped


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