How to arrange a consultation?
To arrange a consultation, email or ring us at 0203 763 7082. You can be seen at UCLH or one of the Independent hospitals. If you plan to use your Insurance, please get in touch with them simultaneously. Clinic dates and times are listed below and may be booked via this website.
Do I need surgery?
Mr. Konan will assess you clinically and arrange appropriate investigations before discussing your treatment options with you in detail. If you then decide to have surgery, he will be happy to undertake this for you.
Do I need Physiotherapy
Mr. Konan will assess you clinically and arrange appropriate investigations before discussing your treatment options with you in detail. Physiotherapy may be necessary as a part of your treatment whether or not you decide to have surgery. Mr Konan will be happy to refer you to a physiotherapist service.
More about knee arthroscopy/ keyhole
Knee arthroscopy or keyhole is a surgical procedure where the surgeon uses special instruments and camera to visualise the inside of your knee and repair, resect or reconstruct parts of the knee. Common conditions treated with arthroscopy are meniscal tears, cartilage lesions, removal of loose bits of cartilage and ligament reconstructions. Knee arthroscopy can also be used to diagnose painful knee conditions that are not amenable to diagnosis with scans or Xrays.
What is meniscus tear?
There are two menisci (medial/ inner and lateral/ outer) in each knee. They sit between the thigh bone (femur) and leg bone (tibia), where the bones meet to form the knee joint. The menisci are made of specialised cartilage (fibrocartilage) and serve important role of shock absorption, proprioception and control of dynamic knee motion. They can tear due to sports injuries or degeneration and become painful or catch and lock. Tears can be manages relatively easily by arthroscopic repair or partial resection.
Articular cartilage injuries and arthritis
All joints are lined by articular cartilage. Keyhole surgery can help with discreet lesions of the articular cartilage and in some cases early arthritis. This has to be assessed on case-to-case basis. Arthroscopy can be used to transplant cartilage.
In selected cases, cartilage tissue harvested from the knee can be grown in a lab to form larges pieces of cartilage and fixed back in the knee joint. This technique has a moderate success rate provided patient is chosen carefully.
Cruciate and other ligament injuries
The knees are stabilised by muscles and ligaments. There are some key ligaments that can be torn with sporting activities and these include the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL) and the postero-medial and poster-lateral ligament complex (MCL complex, PLC). Combined injuries of these ligaments can occur and are often serious injuries requiring urgent attention.
Open knee surgery
Some knee procedures require open procedures and typically are partial or full joint replacements, osteotomies and fracture fixations.
Knee replacement full/partial
Partial or full knee replacement is undertaken for end stage arthritis of part or the entire knee. Arthritis is extremely common but not all patients with arthritis require replacement surgery. Typically surgery is indicated for painful arthritis that stops the individual from carrying on simple activities of life, disturbs sleep and compromises overall quality of life.Todays techniques and technology ensure a very high level of success with joint replacements.
When an individual stands up, generally the centre of the hip, knee and ankle align in a straight line. A minor alteration to this can occur in majority of people and is normal but high degree of deviation from normal will enhance the wear and tear in the knee (or hip and ankle). This can be corrected by realigning the bone and is referred to as osteotomy.
Hip arthroscopy/ FAI
The technique of hip arthroscopy has developed rapidly in the last decade and it is now a common procedure. The commonest reason for hip arthroscopy is femoroacetabular impingement (FAI). It is a complex concept but explained simply involvesimpingement between the two joint surfaces of the hip joint namely the femoral ball and the acetabular socket. If ignored for long this may lead to arthritis of the joint. Hip arthroscopy can be used to resect the incongruency on the femoral ball (CAM lesion) or acetabular socket (pincer lesion). Hip arthroscopy can also be used for diagnosisngnon specific hip problems, treating labral tears (meniscus like tissue of the knee), removing loose bits of cartilage or fixing cartilage lesions.
Hip Replacements/ resurfacing
Once the hip joint is completely worn out and a constant source of pain, the surgical solution is resurfacing surgery or replacement. Both procedures involve replacing the socket but defer in what happens to the femoral head. In resurfacing the femoral head is capped (resurfaced) with a metal implant. In replacement the femoral head is replaced with a artificial ball attached to a pin (stem) that fixes to the inside of the femur. Replacement surgeries are one of the most successful orthopaedic procedures known to us today. Resurfacing surgery also has high success but is not suitable for everyone due to risk of metal-on-metal complications in some people.
Revision arthroplasty/ replacement
Replacement surgery of the hip and knee joint are hugely successful and may last well more than 30 years. However, if and when they fail, redo surgery can be undertaken (revision arthroplasty). Revision may also be necessary if the implant of bone breaks. This involves replacing parts or all of the joint replacement.
Complications are rare but not unusual following surgery. There are solutions for all complications but it is important that these are well understood before even they happen. Following surgery general complications are that related to the aesthetic or pain medications. The Anesthetist will go through this in detail depending on your other medical ailments and type of surgery.
Common surgical complications are wound infection, deep infection, blood clots (DVT, PE) swelling of joint, stiffness of joint, bruising and bloods loss, nerve irritation/ numbness, fractures and failure to completely resolve pain. In addition hip replacement has added risk of leg length discrepancy and dislocation. Measures are taken to minimise these complications during and after surgery and it is important you adhere to the post –operative instructions. Based on your medial ailments and type of procedure your high probability complications will be discussed with you.
Instructions before surgery
Based your procedure, you will be given specific instructions. You will also be told when to stop eating and drinking, what medications to take/not take and any other restrictions.
Instructions after surgery
Based your procedure, you will be given specific instructions. In general you will be encouraged to move out of bed early and commenced on joint movement and strengthening exercises. You will not be doing all activities straight away. As a general guide walking is commenced same or next day and progressed through to simple activities. Heavy activities or sports may take up to 3 months. Driving can take any time between 3 to 9 weeks depending on intensity of procedure. A detailed discussion can be held with Mr Konan before and after surgery.
Return to work
Patients are often keen to estimate time off work. It depends very much on the type of work, type of surgery as well as other factors such as practicalities of getting to work and modifications available at work place. It is often the case that the surgery itself does not limit your return to work. Mr. Konan will be happy to discuss this with you and advice based on your unique needs.
Flying after surgery
Flying after surgery may be limited by decreased mobility and crutches as well as with long-haul flight be associated with increased risk of blood clots. Mr. Konan will be happy to provide individual advice regarding this at your request.