Your consultant will already have discussed your procedure with you in detail and highlighted any potential risks or complications associated with it. We will then send you a pre-operative questionnaire to fill in and bring with you on the day of your procedure.
When you have your pre-operative assessment, either over the phone or during an appointment, we’ll ask you some questions about your health and you’ll also have an opportunity to ask questions or discuss any concerns you may have. You’ll be given a time to arrive on the day of your surgery and some instructions about preparing for surgery.
- Don’t eat anything for at least six hours beforehand (although you can drink water up until three hours before your operation)
- Avoid alcohol for 24 hours before surgery as this may affect the anaesthetic
- For some operations such as joint preservation surgery you will need to stop smoking three months before surgery and not smoke for at least three months afterwards
- For all other major surgery, we advise you to stop smoking at least two weeks before your procedure
- For minor procedures you must avoid smoking on the day of your operation. However, it’s best to stop altogether or reduce the amount you smoke for a few weeks beforehand
- If you are diabetic, let hospital staff know and ask your GP for advice about fasting
- If you are taking blood-thinning medication, please let us know and discuss this with your GP before your procedure
- Please have a bath or shower before you come into hospital
If, for any reason, you can’t attend your appointment, please contact us as soon as possible.
Your consultant will discuss with you not only the prospective benefits of your treatment but also possible complications and how the risk of such complications occurring can be managed. They consider what is best for each patient on an individual basis. As with all careful and responsible orthopaedic surgeons, they have regard both to national guidelines (such as those produced by the National Institute for Health and Care Excellence in relation to preventing blood clots https://www.nice.org.uk/guidance/ng89) and local protocols (which will differ, depending on where your treatment is being provided). If they consider, when exercising their clinical judgment in relation to your care, that your interests would be best served by treatment that does not follow a national or local guideline, they will explain to you why your particular circumstances justify a different form of treatment. Our consultants believe that decisions about your treatment and care should be made jointly, and so they will welcome any questions you might want to ask.
What to expect during your visit
It’s a good idea to wear comfortable, loose fitting clothes, cotton underwear and flat shoes. Please don’t bring any valuables such as large amounts of money or jewellery (apart from a wedding ring, which can be covered). Please remove make-up including nail varnish and/or artificial nails before you arrive.
- Your insurance documents and/or card for payment
- A list of medications you are taking as well as any allergies you may have
- Any medicines you are taking including inhalers, in their original packaging
- Spectacles, contact lens case and solutions, and hearing aids/walking aids
- Books/magazines/electronic devices to fill any spare time
When you arrive at reception you will be asked to sign any outstanding paperwork and confirm your payment details. One of our nurses will meet you and show you to your room. They will ask some more questions about your health and also check your blood pressure, pulse and temperature. They will give you a hospital identity bracelet and ask you to change into a hospital gown.
Your consultant will come and see you and discuss your procedure. He will then go through the consent process with you, highlighting any potential risks or complications associated with the procedure. After this, you’ll be asked to sign a consent form. You will also be seen by the consultant anaesthetist who will explain the different anaesthetic options; together you’ll agree the method that’s best for you (normally a general anaesthetic). You will have an opportunity to discuss any concerns about your anaesthetic with your anaesthetist before the surgery.
You are welcome to bring a friend or relative with you and they can stay with you until it’s time for you to go to the operating theatre.
You will be taken from your room to the operating theatre. Once in the anaesthetic room, you will be given the appropriate anaesthesia. Most patients undergoing knee surgery have a general anaesthetic. However, patients with medical problems such as heart or lung disease may be offered a spinal anaesthetic instead. Sometimes both techniques are used, with the spinal anaesthetic providing post-operative pain relief.
When you wake up in the recovery suite you will be closely monitored until you’re ready to return to your room; you’ll be offered appropriate pain relief as and when you need it. Depending on the type of surgery you’ve had, you may be able to return home once you’ve had something to eat and drink and are feeling steady.
During your hospital stay, your progress will be closely monitored by your consultant, along with a team of ward nurses and physiotherapists. When you wake up, you may have a bulky bandage around your knee (and/or a protective splint/knee brace). Depending on the type of procedure you’ve had, you may also have a thin plastic tube, or drain, to collect and measure any post-operative bleeding. These are used for more complex procedures where there is a risk of bleeding, such as a total knee replacement. If you’ve had keyhole surgery, you’ll be given photos and a DVD of your operation if you would like to have them.
This depends on the type of surgery you have had. All patients are given an injection of local anaesthetic at the end of the procedure which helps to reduce pain for up to 12 hours after surgery. With some operations such as ligament reconstruction and knee realignment (osteotomy) surgery, stronger painkillers may be needed. With major surgery, such as a total knee replacement, an injection into the spine and/or a patient controlled painkiller infusion may be used to make you more comfortable.
This depends on the type of procedure you have had. Keyhole surgery is normally carried out as a day case procedure, although some patients prefer to stay overnight. The same applies to simple ligament reconstruction surgery. However, for more complex operations such as joint replacement you may need to stay in longer. You’ll be able to discuss this during your pre-operative assessment.
All surgery carries risks. However, we are committed to minimising risk to our patients. Your consultant will discuss the risks of surgery with you beforehand and you’ll have an opportunity to discuss any concerns before you decide to go ahead. It’s important that you fully understand both the risk and benefits of any procedure before you decide whether surgery is right for you.
The risks of surgery vary from procedure to procedure, but can include:
- Deep vein thrombosis (DVT) (blood clot in the legs)
- Pulmonary embolism (blood clot in the lungs). Each patient’s individual risk for blood clots is assessed and precautions taken such as 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 getting up and moving about as soon as possible after surgery
- Bleeding: this is a rare complication, especially after keyhole surgery. The use of a tourniquet and/or surgical drain minimises the risk of bleeding. In a very small number of cases, for patients who have major surgery, such as a total knee replacement, a blood transfusion may be needed
- Infection: this 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 itself) or deep (around an artificial joint). In the vast majority of cases, the infection settles down with a course of antibiotics. However, in rare cases, further surgery may be necessary to treat 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
- Anaesthetic complications: serious complications are extremely rare. Post-operative nausea, a rare complication, can be well controlled with appropriate medication
Your consultant will be able to give you an indication of costs before your procedure. However, the actual cost of treatment may be higher if further unexpected treatment is required. Please contact us for further information.
During your hospital stay, one of our physiotherapists will advise you about your rehabilitation programme, including any follow-up physiotherapy appointments. Your surgery is likely to be more successful if you understand what your limitations will be after surgery and plan in advance so that you are well supported when you return home. Carrying out your rehabilitation exercises as advised will help you to recover as quickly as possible.
This depends on the type of procedure you have had as well as your general fitness and your circumstances at home, including how much help is available. You will need a responsible adult to accompany you home and stay with you for at least the first 24 hours following a general anaesthetic.
Before you go home, we will arrange any follow-up appointments, including physiotherapy, as well as any medication you may need.
This depends on a number of factors including what type of procedure you have had, how you travel to work and what your job involves. Your consultant will be able to provide more specific advice.
After keyhole surgery, most people can return to work after about 48 hours; however, for more complex operations such as joint preservation surgery it can take up to six weeks.
The risk of any major complications after keyhole surgery is less than 1% (one in every 100 procedures). 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 to take home with you if you would like to have them. The two small arthroscopy incisions are sealed with sticky plasters, or occasionally, stitches. The nursing staff on the ward will give you instructions about how to look after the dressings and wounds.
This is normally carried out using keyhole surgery, although in some cases you may need to have open surgery. Recovery is usually similar to keyhole surgery although there may be extra incisions with dissolvable stitches. In most cases, you can bear weight straight after surgery and walk without crutches, but this can depend on the type of meniscal surgery you have had. You’ll be offered advice about your rehabilitation, and how to care for your wound before you leave hospital. Most patients are able to go home the day after their operation.
If you have had a microfracture procedure to treat a knee cartilage injury, you’ll need to use crutches for up to six weeks after your operation. 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.
This will depend on whether you have had medial patella-femoral ligament (MFPL) reconstruction to stabilise your kneecap, trochleoplasty or bony realignment surgery. In most cases, you’ll stay in hospital for up to two days. Depending on the type of operation you have had, you might need to wear a brace or use crutches after surgery. You will be given a rehabilitation programme by one of our physiotherapists before you go home.
Repair/reconstruction of a single ligament such as the anterior cruciate ligament (ACL) or medial collateral ligament (MCL) takes around an hour of surgery. Although most patients go home the next day, there can be a long rehabilitation process. If you are having multi-ligament surgery, you are likely to have to stay in hospital longer, and have a longer rehabilitation period.
A high tibial knee osteotomy takes around an hour of surgery, with a hospital stay of up to three days. Although the fixation plate is very strong and it is safe for you to walk straight away, you are likely to need crutches for the first two weeks to help with wound healing. Recovery from this type of surgery takes around six weeks. Some patients chose to have the fixation plate removed; however, we recommend you wait for at least a year before you have this procedure.
Recovery from this type of surgery can be a long process and it’s important to carry out your exercises, as advised by your physiotherapist, to achieve the best possible outcome. If the knee becomes stiff after surgery, this can usually be corrected by having an additional procedure known as manipulation under anaesthetic (MUA).
After your knee replacement surgery, the knee can feel warm to touch and swollen for up to six months, although this should gradually improve. However, if pain or swelling suddenly becomes worse, you should let us know as soon as possible or contact your own GP.
Planning your knee osteotomy operation
During your pre-surgery appointment, your consultant will measure your knee joint using specially designed software to calculate which bones need to be cut and how to precisely realign the knee joint.
High tibial knee realignment (osteotomy) surgery is when the tibia, or shinbone, is cut and reshaped to remove pressure from the knee joint. It’s normally used to treat arthritis and to correct a bowlegged deformity that has caused damage to one side of the knee. It can delay – or even avoid the need for – joint replacement surgery.
- Your consultant makes a cut at the top of the tibia (shinbone), within a few centimetres of the knee. A surgical instrument is used to widen this cut into a pie-shaped wedge which, when it is closed, straightens the leg and allows the knee to carry weight more evenly as well as reducing pressure on the painful side
- The next step is to fix the opening in place so that the bones remain aligned. A strong plate is screwed in place into the bone to hold the wedge securely
- The screws holding the plate in place extend most of the way through the bone
- The incisions are then closed and the operation is concluded
Distal femoral knee realignment (osteotomy) involves changing the shape of the knee joint in order to take the load off the side of the knee affected by arthritis and increase the load on the other side. In some cases, it can delay – or even avoid – the need for joint replacement surgery. It is similar to having a high tibial osteotomy in terms of planning your operation but the cut in the bone is made in the lower end of the femur (thigh bone) to correct a knock-kneed deformity.
- The operation is usually carried out by removing a wedge of bone from the inside of the thigh bone
- The gap created is then closed and held rigid with a strong plate and screws. This corrects the alignment of the bones and the closure of the wedge provides much greater stability after surgery
- The two sections of bone that are fixed together will heal completely after surgery to form one bone
Research carried out by the World Health Organization demonstrated that patients who have the knowledge, skills and confidence to manage their own condition enjoy better outcomes. 1Your experience of having osteotomy surgery is likely to be more positive, and your recovery faster and more successful, if you make sure that you understand the procedure, prepare for surgery, and carry out any exercises you have been given as part of your rehabilitation programme – including strengthening the muscles around the knee joint before surgery.
After you’ve had your pre-operative tests, it’s important to follow the advice you’ve been given. This includes:
- If you smoke, you must stop at least three months before the operation and not restart for at least three months afterwards. This is because the toxins in smoke can affect blood flow through your bones and prevent healing. Smoking also increases your risk of healing slowly, having an infection, and other complications
- Following the instructions from your healthcare team about taking any medication in the week before your surgery, the day of surgery and afterwards. This is particularly important if you are taking blood-thinning drugs such as warfarin which can increase bleeding during surgery
- Following any instructions you’ve been given about fasting (including drinking) before your operation. This is to avoid problems associated with the general anaesthetic, such as nausea
- You may be advised to use a muscle stimulator before surgery – and up to 12 weeks afterwards – to improve your muscle strength. This in turn will help your bones to heal faster and enable you to be as mobile as possible after your operation
- Arian will also advise you about the level of activity you can safely do while you are waiting for surgery
1 Kings Fund. Supporting People to manage their health. Available at: https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/supporting-people-manage-health-patient-activation-may14.pdf. Accessed 22 November 2016.
You’ll be encouraged to get up and move around within a few hours to help blood flow and reduce your risk of deep vein thrombosis (DVT). Moving your knee joint will also ease stiffness.
During your operation, your consultant will inject local pain relief into your knee joint so that when you wake up you should have little or no pain. After this, you’ll be given pain relief as and when you need it and, once you return home, you can take over-the-counter painkillers as advised by your doctor for the following days. However, it’s important to avoid taking anti-inflammatory painkillers such as ibuprofen after surgery as these can prevent the bone healing.
Although the risks from having knee realignment (osteotomy) surgery are low, complications can include: infection, blood clots, stiffness of the joint, injuries to vessels and nerves and problems with healing.
It’s important to contact your consultant or your own GP as soon as possible if:
- You have pain that becomes worse – lasting for more than a few days – in the knee joint
- You have a temperature and/or feel unwell – this could mean you have an infection
- Your knee joint is very inflamed, swollen or the wound is bleeding/oozing
- You have extreme discomfort in your lower leg (this can be a sign of DVT)
After your operation, you’re likely to stay in hospital for two to three days. You’ll need to use crutches and, in some cases, wear a knee brace for four to six weeks after surgery to protect your knee while the bone is healing.
You’ll be encouraged to begin some exercises straight away as part of your rehabilitation plan; these will help to maintain the range of motion and restore strength in the knee joint. Adrian will be able to advise you about the type of activities you can do after surgery and how to build up your fitness so that you can return to normal levels of exercise as soon as possible. In most cases, you’ll be able to drive again around four to six weeks after surgery.
Foot and ankle FAQs
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