What to expect
This is a typical consulting room which I may see you in. Here I will learn of your problem by listening to you. Most of the diagnosis is actually made by talking to you and learning of your symptoms . Once we have talked with me listening to you and understanding your issue I will examine you.
After the examination we often have your diagnosis but on occasions we may need further investigations such as a simple plain x-ray, an ultrasound scan or an MRI scan.
I am mindful of ordering scans as they cost money, whether you pay yourself , are an NHS patient or have private medical insurance I shall only do a scan if I believe that it will add to your management plan and treatment
Diagnosis
Having taken a thorough history, after listening to you, examining you and looking at the results of any special investigations we will then start to talk about how we can help you by discussing your treatment options
I shall use a combination of anatomical models such as this one, - x-rays and my website thekneeconsultant.com to show you what the problem is and how I can address it
Consent
We shall go through the procedure through a consenting process. Obtaining your consent is a 2-way process within which I shall give you information in a way that you understand, that you can retain and that you can use to weigh up the pros and cons of the different treatment options that we will have discussed.
Once you and I agree on a surgical treatment procedure we will go through the formal part of the consent process where I will use a consent form and write down the procedure you are having done and the pros and cons of this procedure that we will have already discussed and then we shall both sign it. Please remember that this form is not a binding contractual agreement and you are entitled to change your mind at any time
Preoperative Assessment
You may be asked to attend a pre-assessment appointment if the treatment plan involves surgery. Think of this as general health check before surgery. This is a nurse-led check-up to help you get ready and ensure that we can safely proceed with the operation.
Your general health and medications will be discussed and you will be advised on which ones to stop or to continue. On occasions and depending on your health you may be required to see one of my anaesthetic colleagues to make sure that you are fit for surgery.
As always, please get in touch if you are in any doubt – my team and I are here to help.
Day before surgery
You will find information about when to arrive and what to do in your booking letter – if you have any questions, please contact my team and they will be happy to confirm any details.
Give yourself plenty of time to travel to the hospital and make sure you have everything you need with you. Your admission time will be a few hours before your operation so that you are not rushed or stressed prior to going down to theatre - perhaps bring a good book or some music to listen to. If any changes to the order of the list are required, the team will keep you informed.
If you are having a general anaesthetic or sedation, it is important that your stomach is empty during the procedure, so please do not eat anything or chew any gum for six hours before your admission. You may drink sips of clear water up until two hours before your surgery and you will see both myself and your anaesthetist before the operation.
Day of the operation
On the day of your surgery you will be seen by several people today before your procedure. A nurse will check you in and you will also meet your anaesthetist, who will finalise your anaesthetic and pain management plan.
We will discuss your surgery again, marking the correct side for the operation and countersign the consent form. After surgery, you will be transferred to the recovery room where the nurses will take care of you and keep you comfortable.
I will see you again after surgery but, owing to the effects of the anaesthetic, it is quite normal to not remember this conversation clearly and I will be more than happy to answer any questions you may have when we meet again in clinic.
Of course, feel free to contact my team if you have any questions at any point.
Operating theatre
Welcome to the operating theatre. It may appear a little intimidating with all the screens, lights and monitoring equipment but be reassured as all this is to make your procedure be as safe as possible with you and your safely being the number one priority for both my team and me.
2nd opinion
Sometimes your case could be complex and a 2nd opinion from another colleague may be required. This does not mean that we do not know what to do or do not have a plan but means that a number of options are available and choosing the best one for you is not straight forward. Both asking and giving 2nd opinions is relatively common in modern medicine
Osteoarthritis of the Knee
Osteoarthritis is the most common form of arthritis. This condition causes pain, stiffness and limited movement of the affected joint. Articular cartilage Is the tissue that covers the end of the bone within the joint. Amongst its many functions it allows the joint to glide. This cartilage can wear away over time, exposing bone and causing symptoms.
The knee is a hinge joint made up of the bottom end of the thigh bone (the femur), the top end of the shin bone (the tibia) and the kneecap (the patella) that sits on the end of the thigh bone. Wear of the articular cartilage in these areas is what causes the symptoms of arthritis and depending on the area affected and the amount of wear that you have will govern the treatment options I can offer to you.
Meniscal debridement/ repair
The meniscus Is another type of cartilage within the knee and one of its functions is to act as a shock absorber. As seen on this model there are 2 , one inner and 1 outer within the knee and they both sit on top of the shin bone – the tibia. A variety of injuries can cause the meniscus to tear and depending on the type of tear , your age and your symptoms I can repair or trim away known as debride the torn portion.
ACL Reconstruction
In a normal healthy knee the anterior cruciate ligament or the ACL is responsible for keeping the shin bone (the tibia) in alignment with the thigh bone (the femur), providing stability to the knee joint. When the ACL is torn or injured control of the tibia can be lost leading to instability.
Treatment options include augmented repair or more commonly reconstruction of the ACL using tissue from elsewhere in your body, and by drilling holes in your femur and tibia fixing this tissue into these holes. In my practise this procedure is usually done arthroscopically meaning by keyhole surgery and as a day case procedure meaning that you can be home the same day.
Osteoarthritis of the Hip
Osteoarthritis is the most common form of arthritis. This condition causes pain, stiffness and limited movement of the affected joint. Articular cartilage Is the tissue that covers the end of the bone within the joint. Amongst its many functions it allows the joint to glide. This cartilage can wear away over time, exposing bone and causing symptoms.
The hip joint is a ball and socket joint made up of the top of the thigh bone (the femur) – the ball - and part of the pelvis called the acetabulum - the socket. Wear of the articular cartilage in these areas is what causes the symptoms of arthritis and depending on the amount of wear that you have will govern the treatment options I can offer to you.