Patient Information
Knee injuries
MRI scan of the knee showing a front view on the left and a side view on the right |
The knee is a modified hinge joint. The surfaces of the joint are covered with cartilage which provides a smooth, slippery surface for painless movement. In addition the knee contains several soft tissue structures including menisci and ligaments.
These structures can all be injured and cause pain, instability and loss of function. Diagnosing such injuries is usually made with plain x-rays and an MRI scan (as seen on the right). Treatment involves having an arthroscopy, which is a “key hole” operation performed as a day case.
The following injuries can be treated arthroscopically:- Meniscal tears
- Damaged cartilage
- Loose bodies
- Ligament injuries
The anterior cruciate ligament is the ligament most frequently injured during sports and skiing etc. Sometimes people are aware of a “pop” when the ligament snaps. After the pain and swelling resolves people often notice that the knee feels unstable and tends to give way. The initial treatment is a course of physiotherapy directed at muscle strengthening. If physiotherapy does not restore sufficient stability ligament reconstruction will be necessary.
Osteoarthritis of the Knee
An example of osteoarthritis of the knee. The inside part of the joint has worn out causing the leg to become bowed |
Osteoarthritis is a disease of the joints in the body and frequently affects the knee. The surfaces of the joint are normally covered with cartilage which provides a smooth, slippery surface allowing painless movement. In arthritis this cartilage becomes worn away and the knee becomes painful, stiff and swollen. Osteoarthritis is common and affects 10-20% of people over the age of 65. It can be inherited or follow an injury but often the cause is unknown.
Treatment options include lifestyle modification, weight loss if appropriate, physiotherapy, painkillers/anti-inflammatory drugs, injections and surgery. Surgical treatments include arthroscopic washout (keyhole surgery), cartilage repair techniques, osteotomy, partial knee replacement or total knee replacement. All of these operations are described in more detail in the knee surgery section. For more information on arthritis of the knee click on the links below:
Arthritis Research Campaign: www.arc.org.uk/about_arth/booklets/6027/6027.htm
NHS-Direct: www.besttreatments.co.uk/btuk/conditions/5927.html
Osteoarthritis of the hip
An example of osteoarthritis of the right hip. In comparison, the normal “ball and socket” of the left hip is preserved |
Osteoarthritis is a disease of the joints in the body and frequently affects the hip. The hip is a ball and socket joint. Normally the surfaces of the head of the femur (the ball) and the side of the pelvis (the socket) are covered with cartilage which provides a smooth, slippery surface allowing painless movement. In arthritis this cartilage becomes worn away and the joint becomes painful and stiff. Osteoarthritis is common and affects 10-20% of people over the age of 65. Osteoarthritis can be inherited or follow an injury but often the cause is unknown.
Treatment options include lifestyle modification, weight loss if appropriate, physiotherapy, painkillers/anti-inflammatory drugs and surgery. Surgical treatments include total hip replacement or hip resurfacing (the Birmingham Hip). These operations are described in more detail in the hip surgery section. For more information on arthritis of the hip click on the links below:
Arthritis Research Campaign: www.arc.org.uk/about_arth/booklets/6018/6018.htm
NHS Direct: www.besttreatments.co.uk/btuk/conditions/4477.html
Your Anaesthetic
We provide a range of anaesthetic options including general anaesthesia, spinal or epidural anaesthesia and local anaesthetic nerve blocks. This allows us to custom make your anaesthetic to provide the best quality of stay in hospital. For information on specific procedures please visit:
This site provides a series of clear and helpful patient information guides produced by The Royal College of Anesthetists and The Association of Anaesthetists of Great Britain and Northern Ireland. Of particular relevance are: Anaesthetic choices for hip and knee surgery and Your spinal anaesthetic.
Frequently asked questions
Q. Will I see the anaesthetist before the operation?
A. Yes. Your anaesthetist will visit you beforehand and discuss the plan for your anaesthetic and pain relief. If there are special problems we can arrange for an anaesthetic review in outpatients clinic.
Q. How long should I starve before surgery?
A. Before your operation you should not eat for 6 hours. This includes milk, milk containing drinks such as white tea or coffee and fresh fruit drinks. You can drink water until 2 hours before your operation. We will give you estimated times to stop eating and drinking before your admission.
Q. Should I take my normal medicines?
A. In general you should take your medicine as normal. For specific medicines such as insulin or ACE inhibitors we will give you advice in advance.
Q. Will I feel pain after my operation?
A. We will use a variety of techniques to reduce your pain after the operation. This will include the use of local anaesthetic during the operation and regular tablet pain killers afterwards. We may use strong painkillers such as morphine. If we do, this is often given via a pump that you control, called a PCA. Alternatively, your anaesthetist may recommend a spinal or epidural anaesthetic that may also be used to help with your pain relief after the operation.
Q. What should I do if I have a cough or cold?
A. If you are feeling unwell please contact us before coming to hospital. It is possible that it would be safer to reschedule your operation.
Your Admission to Hospital
You will receive a letter from the hospital giving you details of exactly when and where to go on the day of admission. Once you have settled in Mr Pollock will see you to explain the finer points of your operation and answer any questions you may have. He will then ask you to sign a consent form. You will also see Dr Cooper, the anaesthetist who will discuss the anaesthetic options.
You should bring with you the following items:
- Any medication you take at home
- A list of current medications and dosages
- Copies of medical information (x-rays, records etc)
- Your insurance (or sponsor/embassy) details – including your completed insurance claim form (if not already submitted) and the pre-authorisation number your insurer has given to you
- Items to help pass the time (books, magazines, writing materials etc)
- Nightwear, dressing gown
- Slippers
- Toiletries (the hospital provides standard personal items such as towels and soap)
More information relating to your admission can be found on the hospital links:
BUPA Bushey: www.bupahospitals.co.uk/bushey/hospital_bushey.asp
The London Clinic: www.lonclin.co.uk