General questions

What happens during my pre-operative assessment appointment?

Adrian 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.

What should I do to prepare for my procedure?

  • 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 knee realignment surgery you will need to stop smoking 3 months before surgery and not smoke for at least 3 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, please ask your GP for advice about fasting and let hospital staff know
  • 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.

What information will I be provided with before confirming my agreement to treatment?

Adrian will discuss with you not only the prospective benefits of your treatment but also possible complications and how the risk of the same occurring can be managed. He considers what is best for each of his patients on an individual basis. As with all careful and responsible orthopaedic surgeons, he has 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 he considers, when exercising his clinical judgment in relation to your care, that your interests would best be served by treatment that does not follow a national or local guideline, he will explain to you why your particular circumstances justify a different form of treatment. Adrian believes that decisions about your treatment and care should be made jointly, and so he will welcome any questions you might want to ask.

What to expect during your visit

What should I wear?

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.

What should I bring?

  • 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

What happens on the day of my procedure?

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.

Adrian 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.

Can I bring someone with me?

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.

What happens next?

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.

What happens after the surgery?

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 Adrian, 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.

What pain relief will I need after surgery?

This depends on the type of surgery you have had. All patients are given an injection of local anaesthetic into the knee at the end of the procedure which helps to reduce pain for up to 12 hours after surgery. With 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.

How long will I need to stay in hospital?

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 ACL reconstruction surgery. However, for more complex operations such as multi-ligament surgery you may need to stay in longer. You’ll be able to discuss this during your pre-operative assessment.

What are the risks of surgery?

All surgery carries risks. However, we are committed to minimising risk to our patients. Adrian 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, patients who have major knee 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

How much will my treatment cost?

Adrian 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.

How is my physiotherapy arranged?

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.

When can I go home?

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.

When can I go back to work?

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. Adrian 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 knee realignment (osteotomy) surgery it can take up to six weeks.

What should I expect after keyhole surgery?

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.

What should I expect after meniscal surgery?

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.

What should I expect after knee cartilage surgery or chondroplasty?

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.

What should I expect after kneecap (patella) stabilisation surgery?

This will depend on whether you have had medial patella-femoral ligament (MFPL) reconstruction to stabilise your kneecap 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.

What should I expect after knee ligament surgery?

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.

What should I expect after knee realignment (osteotomy) surgery?

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.

What should I expect after knee replacement surgery?

Knee replacement is a major operation. If you have a total knee replacement you are likely to be in hospital for around five to seven days. For a partial knee replacement, your stay may be shorter.

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.


To find out more or to book an appointment in London, complete this form, call us on +44 (0)208 050 0008 or email aw@ovelihealthcare.com.