For Helen Cole, sport has always been a huge part of her life.

So when injury struck at the age of 50, she was left facing the prospect of having to give up her favourite pastimes for good.

But thanks to a pioneering Carlisle surgeon, she is back playing squash, skiing and will soon attempt the iconic Inca Trail in South America.

Her problems were her knees. Until she met local consultant Matt Dawson, she thought there was no real option other than to wait until they got worse, and eventually undergo knee replacements.

But then her chances of being able to do all the things she loved would be virtually over – something she was desperate to prevent.

Mr Dawson offered her an alternative – an osteotomy – where he realigns the bone rather than replacing the knee joint.

It changed her life and before she knew she was back skiing at high speeds and playing squash three times a week.

Matt Dawson Matt, who is based at Carlisle’s Cumberland Infirmary, sees both NHS and private patients. He is desperate to see osteotomies become more commonplace and recently hosted a global conference in Newcastle to help educate surgeons about their benefits.

He is also taking part in a world first – a global trial of a new magnetic nail which is putting the Carlisle hospital on the map.

With the troubled Cumberland Infirmary often hitting the headlines for the wrong reasons, he is keen to show that there is a lot of great work going on and that Cumbrian patients are reaping the benefits.

A nail is used instead of traditional plates and is to date having great results. “This is new for the world. We are the first hospital to use this nail. We are setting the pace,” said Matt.

He stressed that osteotomies are not suitable for everyone, and in many cases knee replacements are a great option. But he said in younger, more active patients they are a perfect alternative.

His patients include construction workers who would have otherwise had to give up their jobs, and sportsmen and women like Helen whose active lifestyles would have also had to change.

Helen, 56, explained: “I was bandy-legged, both of my legs. It wasn’t excessive but after a life time of sport – playing squash since I was 15, tennis, fell running, mountain biking, rowing – it has taken its toll on my knees. It started in 2010 when I was 50. I was getting steroid injections for temporary relief.”

She had seen doctors, but they only seemed to look at the area where the pain was. Then she went to see Matt, after a recommendation from some medical friends, and things changed.

“It was like an electric light bulb moment. He said it was a classic problem and looked at the entire leg, hip down to ankle, rather than just the area that hurt,” said Helen, a project manager who lives with partner David Elliott near Burgh by Sands.

Helen Cole She had osteotomies on both legs in July 2014 and would now recommend it to anyone in a similar position.

“There was a lot of pain immediately afterwards but I’d go through that again because it made such a difference. Before the operation I was in so much pain I couldn’t sleep. I’m self- employed so needed to drive for work and I was really struggling. I kept falling over and after a lifetime of sport I wasn’t able to do anything,” said Helen.

Aside from a few minor complications she had the plates and screws removed in December and was back skiing in January.

Sellafield worker Gary Wilson, from Salterbeck, Workington, has had both knees done - one using the old plate system and one with the new nail. Now 54, his problems started five years ago.

“I was in excruciating pain all the time. I was seeing a specialist who just said I had osteoarthritis and gave me a knee brace.

“It wasn’t doing anything. I went back to my doctor who sent me to physio, who referred me for an MRI. That picked up all sorts of problems so I went back to the specialist. They drained a bit of fluid and gave me an injection but I was soon in agony again.

After hearing about Matt’s work he asked to be referred to him for a second opinion. “Straight away he said my knees were out of alignment.

After three more minor procedures he had his first osteotomy in 2014 and the second – making him one of the first in the UK to trial the new nail – in August last year. Gary, who lives with wife Carol, said his operation was filmed and watched by surgeons across the world.

Now back at work, he couldn’t be happier. “It’s made a lot of difference. If I’d carried on the way I was I don’t think I’d be working now.

“My job... I’m up and down scaffolding, concreting – I wouldn’t be able to do that. I’ve worked in construction most of my life, I don’t know what else I’d do,” added Gary.

Colin Bell Builder Colin Bell, 52, of Brampton, was also worried about the impact on his job when he started to suffer knee problems. At the time he was self-employed with two teenage children to support, and was suddenly facing the prospect of no income.

“I’ve always been an outdoor person and didn’t want to change job. But getting up and down ladders took me a long time and was I was in a fair bit of pain. Even getting downstairs in the morning was painful.

“It started in my early forties. I’d played a lot of sport when I was younger so it was just wear and tear,” he said.

A family friend of Matt, he went to see him for advice, which is when he heard about the new nail procedure. He had the operation in December last year and was back at work in February.

Colin, who lives with wife Debbie, son Alex, 17, and daughter Lucy, 14, said: “It’s not just the pain that’s stopped but I can get up and down ladders again. I know people who’ve had replacements and can’t bend their knees properly or kneel down. I didn’t want that at 52."

Finding a replacement for replacements

Matt Dawson photo

Matt Dawson, a leading consultant based at Carlisle's Cumberland Infirmary, believes too many surgeons rely on knee replacements because they don't realise other options are available.

He is now leading a global trial into a new osteotomy technique, he recently held a conference at St James Park in Newcastle which was attended by doctors from across the world.

He also invited staff from Carlisle, so they can help share the experiences of local patients who have benefited.

Osteotomy surgery is used to realign the legs using metal pins and plates, and most recently a new magnetic nail which is currently being trialed by Matt at the Cumberland Infirmary.

A specialist in sports injuries and knee problems in younger, active people, he wants to spread the word across his profession.

"I want more people to consider this as an alternative. In the UK it's gone out of fashion because of knee replacements and surgeons have been dumbed down. They think all they can do is a replacement but that's not the case," he explained.

"In the 1970s and 1980s knee replacements came along and there was a big commercial drive around that.

"Replacements can still be fantastic. I do plenty of them but surgeons have become over reliant on them. They see them as the only option and the alternative has disappeared over time."

Knee replacement revision rates are also high in under 55s, making doctors reluctant to operate until patients are older or the pain is so unbearable there is no other option.

Matt has now been performing osteotomies for almost 10 years after realising there was another option for the right patients.

"I realised that there are people with arthritis for who a knew replacement would simply be the wrong option. They are fine for walking but they do not allow you to run, climb or do a lot of other physical activity. A lot of sportsmen are told it's bad but not enough for a replacement - come back when it's really bad," he said.

"We've got people coming to see us aged 45 to 50. These are people who are hopefully going to live another 40 years at least. You are basically throwing them in the rubbish bin by giving them a replacement. With this, you still have the option of a replacement later.

"Nobody else would think about doing an osteotomy on a 67 year old but we are doing more and more, and keeping people active."

His patients have gone on to run marathons, go paragliding and much more. Now the Nuvasive magnetic nail he is trialing in Carlisle is having even better results. "This is new for the world. We are the first hospital to use this nail. We are setting the pace," said Matt, who will soon be publishing research papers to be sent around the globe.

And he said as well as improving quality of life, the finances also add up as it is cheaper than a traditional knee replacement.

And he said the wider impact of keeping people active makes far better sense economically. "What it does for society is also cost-saving. These people aren't going off sick, they don't retire early and can still contribute. They are staying fit and healthy," he added.

Because of Matt's expertise, the Cumberland Infirmary is doing far more of these procedures than other hospitals. With support from chief executive Stephen Eames he hopes they can influence Government policy to make this operation more commonplace. He's now used the new nail in more than a dozen patients and added: "The results are very satisfying because my patients are very happy."