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Your Questions Answered

General Questions

When do I have to be admitted to hospital ?

Patients tend to be admitted to hospital on the day of their operation. Prior to admission, patients are given instructions regarding eating and drinking restrictions necessary for the surgery. When having a general anaesthetic it is important to eat nothing in the 6 hours prior to your operation. Patients can drink clear fluids up until 3 hours before the operation. Prior to your procedure you will have an opportunity to discuss any concerns. Your surgeon will then run through the consent process and highlight once more the potential risks of the procedure. An arrow will then be drawn on your shin to mark the relevant knee. You will also be seen by the consultant anaesthetist who will assess you and explain the different aneaesthetic options. The nurses will get you into a gown and prepare you for theatre.

What happens prior to surgery ?

You will be taken from the ward to the operating theatres. Once in the anaesthetic room, you will have a tourniquet applied to your thigh. This resembles a large blood pressure cuff which, once inflated, limits any surgical bleeding. Depending on the length of the surgical procedure, the tourniquet may be inflated for up to 2 hours. This might lead to some minimal post-operative discomfort at the top of the thigh. Your knee will be shaved in the anaesthetic room to minimise the risk of infection.

What kind of anaesthetic will I need ?

Most patients undergoing knee surgery have a general anaesthetic. This certainly applies to young fit patients undergoing arthroscopic surgery. For patients with medical problems, such as heart or lung disease, a spinal anaesthetic may be preferred. Sometimes both techniques are used, with the spinal anaesthetic providing post-operative pain relief. You will have opportunity to discuss any other details regarding your anaesthetic with your anaesthetist before the surgery.

What happens after the surgery ?

After your operation you will be taken to the recovery suite where you will be monitored until you are awake enough to return to the ward.

 

You will have a bulky bandage around your knee (and or a protective splint / knee brace). Depending on the procedure you may have a drain (thin plastic tubes) that collects and measures any post-operative bleeding. Drains are removed on the ward the following day. They are only used for bigger operations, where there is a risk of bleeding ( eg a total knee replacement). With key-hole procedures (this includes most operations, but not knee replacement surgery) you will be given photos and a DVD of your operation. During your hospital stay, your progress will be monitored by your surgeon, the ward nurses and the physiotherapists.

What pain relief will I need after my operation ?

The amount of pain relieving medication that you will require post operatively will depend of the type of procedure you are having. With simple key-hole surgery, there is a invariably minimal discomfort post operatively. All patients are given an injection of local anaesthetic into the knee at the end of the procedure. This is extremely effective at managing discomfort for up to 12 hours following surgery. With ligament reconstruction and osteotomy surgery, stronger pain-killers may be needed. With major surgery, such as a total knee replacement, an injection into the spine and/or a patient controlled pain-killer infusion may be used to make you more comfortable. Combinations of different pain relieving techniques are used, including nerve blocking injections (regional anaesthesia). We have recently started using a "new" technique for post-operative pain-relief which involves injecting a large volume of local anaesthetic solution in and around the knee. This technique gives consistently excellent results, with our patients experiencing very good pain relief following the surgery. This technique is only used for longer and bigger operations and is not needed for simple key-hole surgery.

How long will I need to stay in hospital ?

This depends on what kind of an operation you are having. Simple key-hole surgery can be done as a day case, although some patients prefer to stay overnight. The same applies to simple ACL reconstruction surgery. If more than one ligament is being reconstructed then a longer operating time is likely so patients tend to stay for a day or two extra.

 

For osteotomy surgery, a stay of 3-4 days is standard. For joint replacement surgery most patients remain in hospital for 5-7 days.

What are the risks of surgery ?

We are committed to minimising risk to our patients. However, all surgical procedures carry some risk. Your surgeon will discuss the risks of surgery with you at the time of your consultation. You will also have a further opportunity to ask questions about your operation on the day of your procedure. It is important hat you fully understand the risks and benefits of your planned procedure before you can decide whether surgery is the right course for you. The risks of surgery vary from operation to operation and from patient to patient. The general risks of knee surgery include the following:

 

  • Deep venous thrombosis and pulmonary emboli – clots in the legs and lungs. Each patient's individual risk for blood clots is determined and precautions taken accordingly. These include foot pumps for all patients (the pumps encourage good blood flow in your leg veins) and blood thinning medications for high-risk patients. The best, and simplest way, of preventing blood clots is early mobilisation following your surgery.

 

  • Bleeding – this is a rare complication especially following key-hole surgery. The use of a tourniquet and or surgical drains minimises the risk of bleeding. In a very small number of patients undergoing major knee surgery, such as a total knee replacement, a blood transfusion may be required.

 

  • Infection – Infection is a rare but serious complication. Steps are taken before, during and after your surgery to minimise the risk of infection. Infection can be superficial (in the wound ) or deep ( around an artificial joint). In the vast majority of cases, the infection settles down with simple measures such as a course of antibiotics. Further surgery may be necessary to eradicate amore serious infections.

 

  • Delayed wound and bone healing – this is more common in smokers, diabetics, very overweight patients and patients on certain medications, such as steroids. Patients are encouraged to stop smoking at least two weeks prior to any major knee surgery. For osteotomy patients who smoke they must stop 6 weeks prior to the procedure and to remain non-smokers for at least three months following the operation.

 

  • Anaesthetic complications – serious complications are extremely rare. Although uncommon, amy post operative nausea can be well controlled with appropriate medication.

 

Great steps are taken before, during and after your surgery to minimise the risk of all the above complications.

How much will my treatment cost ?

Your surgeon will be able to give you an estimate of the total cost of your treatment (including surgical, anaesthetic and hospital fees), before your operation. This is only an estimate as the actual cost of your treatment will only be known afterwards. If further treatment is necessary, costs may arise. You should speak to one of the secretarial staff if you need any further clarification of our fee schedule. For more details please refer to the "Fees and Terms" section of this website.

How is my physiotherapy arranged ?

You will be seen and advised by the ward physiotherapy during your hospital stay. Arrangements will be made by the team for any out-patient physiotherapy that may be required. Some operations are quick to rehabilitate from and others take longer. Rehabilitation is an extremely important part of the treatment of most knee conditions. The importance of compliance with your physiotherapist cannot be over-emphasised.

When can I go home ?

Various factors will influence this, including: the type of operation you have had, your general fitness, your home circumstances and whether or not you are safely mobilising on the ward. Prior to discharge, we need to be sure that it is safe for you to do go home. We will also need to arrange your post discharge care, including any medication, out-patient physiotherapy and follow-up arrangements.

When can i go back to work ?

This will depend on what kind of operation you have had, how you travel to work and what your work involves. After simple key-hole surgery, most patients are able after 48 hours of rest . Most individuals can get back to work a week following surgery. If your job is physically more demanding and you have to be on your feet a lot, two or three weeks off work may be more appropriate. For bigger operations such as an osteotomy, a knee replacement and ligament surgery most patients have approximately 6 weeks off work.




SURGERY RELATED QUESTIONS

The varying complexity of knee operations and patient individuality means that risks, benefits, recovery and rehabilitation vary from operation to operation and from patient to patient.

What to expect after arthroscopic surgery ?

Simple arthroscopic surgery is safe. The cumulative risk of any major complications is significantly less than 1%. After your operation, you might be comfortable enough to go home the same day, although some patients prefer to stay in hospital overnight. You will be given a DVD and photos taken during your operation. This is your record of the operation. The two small arthroscopy portals are sealed with sticky plasters, or occasionally, stitches. The nursing staff on the ward will give you instructions regarding your dressings and wound care.

What to expect after meniscal repair surgery ?

There are two main differences between a meniscal repair and simple arthroscopy. There may be an additional wound on the inner or the outer aspect of your knee (dissolvable stitches are usually used). Also, in order to protect the meniscal repair and allow it to heal, your rehabilitation may need to be prolonged. You can discuss this further with you physiotherapist and surgeon. Most patients are still able to go home the day after their operation.

What to expect after chondral / cartilage surgery ?

If you have had a microfracture procedure for an area of significant cartilage damage, you will need to use crutches for six weeks after your operation. This creates the best environment for your cartilage repair and gives it the best chance of working. If you have had an osteochondral grafting (OATS), or cartilage transplantation (MACI) procedure, your rehabilitation will depend on exactly where in the knee the cartilage surgery was carried out. Following all these procedures, patients normally go home the next day.

What to expect after patellar stabilisation surgery ?

This will depend on whether you have had a ligament reconstruction to stabilise your patella (MPFL reconstruction) or a bony realignment procedure on the shin bone (bony realignment). The post-operative stay tends to be two days. Depending on the type of operation you have had you might need to wear a brace or use crutches post-operatively. Your physiotherapist and/or surgeon will ensure a correct rehabilitation protocol is prescribed and followed.

What to expect after knee ligament surgery ?

Repair/reconstruction of a single ligament such as the anterior cruciate (ACL) or medial collateral (MCL) takes around an hour of operative time. Although most patients go home the next day, the rehabilitation process is demanding and lengthy. If you are having more than one ligament reconstructed, this is likely to prolong your hospital stay, as well as your rehabilitation. Therefore, the more complex the surgery, the longer the in-patient stay and post-operative rehab.

What to expect after osteotomy surgery ?
A high tibial knee osteotomy is a very reproducible and reliable operation. The fixation plate is placed under the skin on the top of the shin bone and fixed with a number of screws. The operative time is around an hour and in-hospital stay around 2-3 days. Although the fixation plate is very strong and it is safe for you to walk straight away, you are likely to be mobilising with crutches for the first two weeks, in order to encourage wound healing. Recovery from this type of surgery takes around 6 weeks. Some patients chose to have the fixation plate removed - we recommend you wait for at least a year before you undergo plate removal.
What to expect after knee replacement surgery ?

A knee replacement is a major operation. If you have a total knee replacement you are likely to be in hospital for around 5-7 days. If you have a partial knee replacement, your recovery tends to be a little quicker, the knee feels more like "a normal knee" and you can maintain a more active lifestyle following the surgery.


It takes quite a long time to recover from this type of surgery. A strong commitment to physiotherapy is required in order to achieve the best result. Sometimes, a knee can become stiff after knee replacement surgery. This can be remedied with a simple procedure, aimed at increasing the range of movement of the knee. This procedure is called a manipulation under anaesthetic (MUA).


Following knee replacement surgery, the knee can stay warm to touch and somewhat swollen for up to 6 months. This should continue to improve as weeks and months go by. If you experience any sudden increase in your knee pain or swelling you should inform us immediately.

Orthopaedic consultation

Orthopaedic consultation

Orthopaedic consultation

Orthopaedic consultation

Key-hole  knee surgery

Key-hole knee surgery

Mr Wilson carrying out knee arthroscopy surgery

Mr Wilson carrying out knee arthroscopy surgery

Scrub team before ACL surgery

Scrub team before ACL surgery

Mr Wilson and team performing surgery

Mr Wilson and team performing surgery

Live knee surgery being filmed

Live knee surgery being filmed

Filming a live surgery with Mr Wilson and team

Filming a live surgery with Mr Wilson and team

Mr Wilson carrying out knee arthroscopy surgery

Mr Wilson carrying out knee arthroscopy surgery

Anaesthetist - Dr Nick J looking over the drapes

Anaesthetist - Dr Nick J looking over the drapes

Scrub team before ACL surgery

Scrub team before ACL surgery

Mr Wilson examining a patient's knee

Mr Wilson examining a patient's knee

Arthroscopic knee surgery

Arthroscopic knee surgery

Anterior cruciate ligament reconstruction

Anterior cruciate ligament reconstruction

Anterior cruciate ligament reconstruction

Anterior cruciate ligament reconstruction

Knee injection with PRP

Knee injection with PRP

Mr Wilson in surgery

Mr Wilson in surgery

Mr Wilson examining a patient's knee

Mr Wilson examining a patient's knee

Setting up for knee surgery

Setting up for knee surgery

Mr Wilson during a knee consultation

Mr Wilson during a knee consultation

Orthopaedic consultation

Orthopaedic consultation

Key-hole  knee surgery

Key-hole knee surgery

Mr Wilson carrying out knee arthroscopy surgery

Mr Wilson carrying out knee arthroscopy surgery

Scrub team before ACL surgery

Scrub team before ACL surgery