Blogs

Orthopaedics

Mr Richard Cove

Richard Cove is a Consultant Orthopaedic Surgeon at Private Health Professionals with a specialist interest in knee, foot and ankle surgery including arthroscopic surgery, knee replacement surgery, and surgery for foot and ankle pain and deformity. Mr Cove is the most senior Orthopaedic Surgeon in North Devon. He underwent orthopaedic training in the South West region and completed fellowships in foot and ankle surgery in Ireland and knee surgery in Bristol. He was awarded a Master of Science degree for his research into the treatment of early arthritis of the knee.

Appointed in 2012 to the Orthopaedic Department of North Devon District Hospital, Mr Cove has developed the service with day case foot, ankle and knee surgery, and arthroscopic surgery including arthroscopic ankle fusions. He was Clinical Lead for Trauma and Orthopaedics between 2017 – 2022 at North Devon District Hospital. Mr Cove is proud to be part of a team that has excelled in terms of productivity, safety and patient outcomes. Mr Cove is actively involved in the training of junior doctors and trainee orthopaedic surgeons. Mr Cove is excited about his new venture with Private Health Professionals.

  1. Tell us a bit about yourself and the experience you have?

 

I’m an Orthopaedic Surgeon and work in North Devon District Hospital. I’ve been there for twelve years. I trained in the region of the South West and specialise in knees and feet. I was Clinical Lead for Trauma and Orthopaedics for five years at North Devon District Hospital before and during the Covid epidemic and was proud of the work I did there. We lost three consultants to retirement during that time and were down to two permanent consultants so the department was in quite a bad way but thankfully we turned it around. Since then it has gone from strength to strength. Our length of stay has gone down and our safety and security has been good and patient satisfaction is generally very high. I am particularly proud of the Jubilee Ward, which was highlighted as an extremely productive and well managed ward during the covid pandemic. All of our private patients are seen on the Jubilee Ward. It’s a lovely spacious ward with great nurses. The Jubilee ward also has couple of side rooms with en suite bathrooms and two bays with four beds in each as some patients like having other patients around to talk to.

 

  1. Why do you live in North Devon, and what do you like about it?

 

My wife is from Devon, she comes from Plymouth and I grew up in Dorset, which is in the South West region so both sets of parents are close by. It’s a beautiful place to live with great people. The patients in particular are great here – you really feel like you’re helping them.

I trained in every hospital in the South West. I was a locum consultant in Torbay before I came to North Devon District Hospital for a year.

 

  1. What type of surgery do you specialise in?

For the knees, the most common operations are knee replacements. There are two types of knee replacements: a partial knee replacement where you just replace a section of the knee. A lot of knee arthritis affects one out of three compartments of the knee. A partial knee replacement will replace part of it which has some advantages but also some disadvantages. The other option is a total knee replacement. The other surgery we can perform is an arthroscopy, which is keyhole for torn meniscus or similar problems, which has dropped out of favour recently as studies show it doesn’t work in the context of significant arthritis but if you find the right patients it can work very well.

At Private Health Professionals I can perform any diagnosis related to knee health. I also have access to X-rays, MRI’s and CT scans at North Devon District Hospital and other private hospitals in the South West with no waiting list.

  1. What type of surgeries and treatments will you be delivering for Private Health Professionals?

 

I will be offering the following surgeries for Private Health Professionals:

  • Knee Replacement Surgery Partial / Unicompartmental Knee Replacement Day-case knee replacement surgery and Knee Arthroscopy
  • Hallux Valgus Surgery/Bunion surgery (Bunionectomy)
  • Fusion of big toe
  • Cheilectomy
  • Ingrown toenail (and ingrown toenail surgery),
  • Forefoot reconstruction surgery
  • Ankle ligament repair
  • Flat foot correction
  • Achilles repair or reconstruction Ankle Arthroscopy (key hole surgery)
  • Ankle fusion

 

  1. What private surgeries do you offer at NDDH?

 

If you book via Private Health Professionals, it is less than 3 months between consultation and surgery depending on the patient. NHS is approximately 12-24 months.

  • Arthroscopy (key-hole) surgery of the knee and ankle
  • Knee replacement (either total or partial)
  • Ankle Fusion
  • Bunion Surgery
  • Correction of foot and toe deformities.

 

  1. Do you have a waiting list?

 

If you book via Private Health Professionals, it is less than 3 months between consultation and surgery depending on the patient. NHS is approximately 12-24 months. The consultation will last between twenty and thirty minutes within a private relaxed environment with a private waiting room housed within the new Tarka Leisure Centre in Barnstaple. Mr Cove has his own private medical secretary and you will be offered tea and coffee on arrival.

 

  1. If I wanted a total knee replacement, how long would I wait until the procedure?

 

Before the patient can have a Total Knee Replacement they will need an assessment appointment either by Mr Cove or a private GP within Private Health Professionals. If you have an NHS GP that would like refer you privately we also welcome this.

Once you have had your initial assessment by Mr Cove or a Private GP within Private Health Professionals you will be referred for an X-ray and if severe arthritis is confirmed within the X-ray the patient will be listed for surgery. We do try and optimise the patients best outcomes beforehand so this will mean a course of rehabilitation at the Tarka Leisure Centre or in our private rehab gym.

  1. Do you use robotics for your surgery?

 

I could be in Beljum learning about robotics at this very moment, as I was offered a course to do it but I decided not to as I remain fairly cynical about robotics. It has a lot of theoretical advantages but no proven advantages, as of yet. Orthopaedic history is littered with the latest, newest thing and I’ve always been a bit weary of that, as I like to rely on tried and tested methods with longer term, proven results. Metal on metal hip replacements for instance didn’t work out well. Even though theoretically it made a lot of sense it was a disaster and a whole load of hips had to be replaced. Why it was one of those methods that came and went. Similarly ‘shape to match knees’, which is having jigs made up from CT’s and MRI’s, was the latest, newest thing a few years ago and this has since fallen out of favour. Robotics, while it’s the ‘the thing’ at the moment, doesn’t necessarily translate into getting results.

 

  1. What does an arthroscopy entail?

 

An arthroscopy is a key hole surgery which can repair degenerative meniscus which is procedures on cartilage, micro fractures or removal of loose bodies. People have floating bits in their knees that cause problems and these can be removed.

Due to extensive research by the Royal College of Surgeons, young sports knees tend not to be operated on if at all possible. We try to encourage at Private Health Professionals, a 6-8 week course in rehabilitation with our specialist sports therapist and trainers which should completely rehabilitate the knee to get them back to their full potential in sport. If this fails we will recommend surgery.

 

  1. How long does it take to get back to sports after arthroscopy?

 

It’s highly variable and dependent on the patient. But with the right Physiotherapy package at Private Health Professionals we can help you to be back to your full potential in 2-4 months but this depends on the severity of the knee injury and the commitment to the rehabilitation process at Private Health Professionals.

 

  1. How long does it take to get back to walking on the beach following total knee replacement?

 

The average length of stay is one day and some patients leave the same day. We encourage patients to walk straight away – immediately post op and put all their weight through it and go for it. There is a bit of a “no pain, no gain” because it is sore to start with but it gets better every week and by two weeks patients should find that their wound is well healed. I encourage patients to let me know if their wound isn’t dry and healthy at two weeks. I start with a dissolvable stitch with a knot at the end that needs trimming at two weeks.

Patients at six weeks generally feel they don’t need crutches around the house. Sometimes they might need a crutch when they’re out and about. Some patients don’t need any support at all and feel quite a lot better and can be back at the beach at six weeks. But you can measure an improvement from a knee replacement for up to two years. I normally see patients at six weeks and a year post operation.

 

  1. What is ankle surgery?

 

The most common thing I am treating is arthritis. We can help with keyhole surgery in early arthritis, which can help with ankles that have problems with cartilage inside or overgrowth of bones. Equally you can treat severe arthritis with a fusion. I will always discuss the possibility of ankle surgery with a patient. Although I don’t do ankle replacements myself but I can direct patients to the right people if they need it. There are other joints within the foot that become increasingly arthritic and need surgery.

 

  1. What types of foot surgery can you do?

 

I have patients with high arches and flat feet. A non operative course of care can be prescribed for high arches with insoles, strengthening and advice. You can fully correct a flat foot with a joint preserving procedure, tendon transfers and osteotomies, breaking bones or fusions.

 

  1. What does bunion surgery involve?

 

Bunion surgery is a common issue. Patients will often see me after seeing a podiatrist or chiropodist. The common presentation is patients who struggle to find footwear that fits. Normally with bunions, wide fitting shoes help a lot but if these are not working, it is possible to do a day case surgery with a 6 week recovery time, which requires them to walk around on their heels in a special shoe. The wound should be healed and dry by two weeks. They will feel as if they are over the worst at six weeks. If they are runners, it can take many months to fully settle down.

 

  1. What is the waiting time for an x ray?

 

We can refer for private X-rays and MRI’s which can be done at North Devon District Hospital Radiology Department, Nuffield Private Hospitals or Taunton Diagnostic Centre. These can usually be performed within a week. For an X-ray or MRI you will need to be referred by a private GP, one of our specialist Physiotherapists or Mr Cove. The reason for referral from a specialist is so the results can be managed and explained appropriately.

 

  1. Reasons for a steroid injection?

 

These are useful for patients who have painful joints or as part of the non-operative treatment plan for arthritis. It can be either diagnostic or therapeutic or both. In the feet, we’re quite often using steroid injections to figure out where the pain is coming from because there are a lot of joints in the feet. For the knees it can provide a certain amount of pain relief. This can be useful for patients, though steroid injections do not provide a long term solution to arthritis. We also advise a good rehabilitation programme which we can provide at Private Health Professionals

 

  1. Can you tell us about arthroscopic ankle fusions?

 

Arthroscopic ankle fusions remove degraded parts of joints caused by arthritis from ageing or a past injury and fixes the joint together using metal screws and shaped plates. This aim is for the bone to grow across and fuse the joint.

 

  1. What foot surgeries do you have to stay overnight for?

 

  • Fusions of ankles and joints in the foot
  • Hallux Valgus surgery/Bunion surgery (Bunionectomy)
  • Cheilectomy

A one night stay is generally the norm. Everything else can be treated on a day case. Arthritis of the big toe or bunions for instance.

  1. Would I need someone to pick me up in the morning?

 

Yes you would as you will be unable to drive for 6 weeks.

  1. Would I get physio at the hospital or come straight to PHP for all of my after-care?

 

You would come to Private Health Professionals for all your physiotherapy and this would be provided in a package.

PHP offers a Prehab and Rehab packaging comprising two physiotherapy and ten strength and conditioning appointments. Patients can choose to schedule these appointments before or after surgery or split some appointments before and some after surgery. 

Patients of Consultant Orthopaedic surgeon Mr. Cove can enjoy access to a Prehab and Rehab packages from Private Health Professionals, to support with recovery from Total Knee and Ankle Replacement surgeries.

According to research from the Arthritis Foundation, individuals preparing for knee replacement surgery with a six-week strength and conditioning training regimen reduced their likelihood of requiring inpatient rehabilitation by as much as 73%.

At Private Health Professionals, our primary aim is to fully restore mobility and get our patients back to their daily life with full range of motion and decreased pain. Why we are offering patients for Total Knee and Ankle Replacement surgery access to highly trained physiotherapists and a strength and conditioning coach as part of their treatment journey.

The Prehab and Rehab package, which combines 2 x Physiotherapy and 10 x Strength and Conditioning appointments, is delivered by one of our highly skilled Physiotherapists and Rick Fielder, Private Health Professionals’ Strength and Conditioning coach.

Rick Fielder is an experienced rehabilitation specialist and associate member of the Chartered Society of Physiotherapy. Rick also holds a GP referral qualification that allows him to treat patients with chronic health conditions and illnesses, ensuring safe and effective exercise for those with medical conditions.

Tim Hill is an experienced sports therapist who specialises in rehabilitation, he has a level 5 Sports Therapy Diploma and has worked as a personal trainer since 2005. Tim’s approach is to identify strength and flexibility in balances pre and post-surgery and prescribes nutritional advice and exercises with a progressive overload to achieve the best results. Tim is experienced in working with people pre and post-surgery.

Rick and Tim work alongside Mr Cove and his physiotherapy team at Private Health Professionals as an Orthopaedic specialist rehabilitation practitioner. He trains patients at Private Health Professionals’ private 1:1 gym and in the main Tarka Leisure Centre gym as they progress. Both gyms are equipped with state-of-the-art rehabilitation equipment.

Rick aims to prevent the development of scar tissue after knee and ankle surgery, which is something that naturally builds up in the knee causing stiffness and pain post-surgery. His rehabilitation plans are designed with the latest clinical evidence in mind, meaning patients will always be given the most up to date guidance for their condition.

Physiotherapy with Private Health Professionals prior to surgery will focus on passive exercises to strengthen the muscles around the knee and ensure that the knee is in an optimal condition to guarantee a more successful surgery.

 

Private Health Professionals is currently offering a 10% discount on the Prehab and Rehab package to support Total Knee and Ankle Replacement surgeries. 

 

  1. Do you do hyaluronic acid injections? Ankles or knees?

 

For patients who want to try it, yes. We provide hyaluronic acid to ankles and knees.

 

  1. Do you offer toe amputations, what would you do that for?

 

Yes Mr Cove offers amputations typically for more elderly patients who are suffering from problematic toes. Advantages of amputating toes are that wounds are healed within two weeks and rehab is easy and safe. They can have a flat surgical shoe to walk in after and can walk straight away. You can straighten out toes but that can take 6 weeks to settle down. If you would like to book in for rehabilitation of the feet, we can provide this at Private Health Professionals.

 

To book a consultation with Mr Cove call Private Health Professionals on 01271 316 015 or use the online booking form.

 

Testimonials

 

“My total knee replacement was carried out with complete professionalism by Mr Cove and my new knee seems to be progressing extremely well after 9 weeks” 

Mrs E G – 80yrs

 

“I visited Mr Cove to discuss xrays of my right knee following a very successful 1/2 knee replacement on the left earlier this year. He is always very personable and explains the current state of the joint and all of the treatment options available. He helps you make a decision that is right for you and I trust his expertise 100%!

To be able to see him at the PHP centre made it an easy experience with plenty of parking, happy reception staff and a calm environment”.

MRS T L – 56yrs

 

“I saw Mr Cove for a follow up today and was very happy with the service received. Mr Cove, Lisa his secretary and Rachel at PHP were kind, warm and welcoming”

MRS M L – 84yrs