How to arrange a consultation?
To arrange a consultation, email firstname.lastname@example.org or text/ring us at 0203 763 7082 or 07956884528. Depending on the srequirements, both face to face and virtual consultations may be arranged. If face to face consultation is required, arrangements will be made for you to be seen in one of our clinics. If you plan to use your Insurance, please get in touch with them simultaneously. Any clinic letters/ scans are best transferred & stored electronically and you will be guided on how to do this. Clinic dates and times are subject to availability and urgency and you will be guided accordingly when you make an enquiry. If you are facing any difficulties, please ring the practice manager on 07904621686.
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.
Most conditions cmay be managed in more than one way and both surgical and non surgical options are often available to treat problems. In fact it is very important to understand the non operative options that are available even if surgery is imminent and advice often needs to be tailored to individual needs and requirements. This is where Mr Konan will use his clinical and research expertise and discuss the evidence around your particular condition.
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 or direct you to the best online resource for you to pursue self initiated physiotherapy.
More about knee arthroscopy/ keyhole
Knee arthroscopy or keyhole is a surgical procedure where the I will use special instruments and camera to visualise the inside of your knee and repair, resect or reconstruct damaged parts of the knee. Common conditions treated with arthroscopy are meniscal tears, cartilage lesions, and ligament reconstructions. Knee arthroscopy can also sometimes be used to diagnose painful knee conditions and make important decisions about management that are not amenable to diagnosis with MRI scans or Xrays.
A knee arthroscopy is a safe and simple surgical undertaking. It is performed under general anesthetic. It may be performed under regional anesthesia but general anesthetic offers quicker recovery and shorter hospital stay. If you are scheduled for one of these procedures, you will be invited for a day case hospital visit. You will be advised to avoid eating and drinking for six hours prior to surgery six hours prior to surgery stop stop. You will be reviewed by the anesthetist on the day of the surgery. The total procedure time will be approximately 1 to 1.5 hours and includes anesthetic time, surgical procedure time and time spent on recovery ward. Once you’re back on the day case ward the staff will ensure that you are safe to to be discharged home.
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.
Several tears can be managed with rest, local application of ice packs and activity modifications. It is possible that the tears become asymptomatic over time and permit return to sports and hobbies.
Some meniscal tears can cause mechanical symptoms and such as clicking, locking, giving way. If the knee is symptomatic from a meniscal tear then arthroscopic surgery will help repair the meniscus or partially resect it. Please refer to the section about on some considerations for arthroscopic knee surgery.
As the meniscal I play very important role in the biomechanics of the knee and preservation of the knee joint it is important to ensure that whenever possible these tears are preserved and excessive resection of the meniscus is not undertaken.
Articular cartilage injuries
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 general when dealing with isolated damage to small parts of the articular cartilage, there are 3 main surgical options. A microfracture involves surgically creating channels between the surface of the bone and the deeper tissue in order to recruit stem cells and enable cartilage regeneration.
Synthetic scaffolds may be used to cover up the defect. It is also possible to replace the isolated cartilage defects either with ones own (autologous) cartilage or donor cartilage.
Several factors decide the suitability and success of cartilage regeneration. It is best to discuss this on an individual basis.
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.
ACL injuries typically follow pivoting injuries sustained at sports. Often the immediate sign is that of pain, feeling off ‘snap’, swelling, bruising. Soon one may notice that the knee is unstable in certain positions.
It may be possible to treat some torn ACL injuries with exercises to strengthen the periarticular knee muscles. In the presence of stability it is usually appropriate to consider surgical reconstruction of the ACL using ones own harvested graft the tendon grafts. This kind of procedure is undertaken arthroscopically as day case. You will be allowed to weight-bear and walk straight after surgery. Usually tit takes 6 month physiotherapy following ACL reconstruction to return to pivoting sports. Other simple activities may commence much sooner.
Injuries to the other ligaments of the knee may happen in isolation or with multi-ligament trauma. The latter almost always requires surgical intervention. Depending on the individual presentation decision is made whether to operate or allow simple rehabilitation for individual ligament injuries.
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.
Depending on the location and severity of the damaged cartilage replacements may be partial; involving some part of the joint or total knee replacement involving the entire joint. The part of the joint that is replaced is the surface of the joint and most of the knee bone and ligaments are left well alone. It is more appropriate to consider this surgery as a form of resurfacing.
The indication for replacement surgery is end-stage arthritis of any reason with pain that is severely affecting sleep, work or quality of life and is not controlled with simple pain medications. Contrary to popular belief there is no age restriction on this kind of procedure. In fact it is likely to benefit people of all age groups. In the younger age group, it is however important to try and preserve the native joint and not undertake replacement unless it is absolutely necessary to do so.
The material used for replacement surgery is a complex alloy cobalt chrome and titanium, although ceramic type materials are also available. The bit that replaces the cartilage is a complex Polymer. Knee replacements are attached to the bone either directly or by means of a specific bone cement.
Replacement surgery may be undertaken as day case or short hospital stay procedures. Immediately after the surgery one should be able to weight-bear and mobilise and do exercises. The risks of the surgery are approximately 1% and include that of scar, infection, blood clots, swelling, stiffness and failure. In the immediate post-operative phase one may experience pain along the wound site, especially with exercises and this settles over the next few weeks with pain medications. Often the arthritic pain disappears immediately after surgery and is replaced by surgical wound pain that settles over few weeks.
The longevity of these replacement is up to 30 years and seems to be increasing especially with use of emerging technology such as navigation, robotics and other precision guidance equipments.
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.
Knee osteotomy is undertaken as day case procedure. Depending on the direction of deviation of the knee from the midline, A controlled surgical fracture is created on the leg or thigh bone close to the knee joint and it then fixed with metal plate and screws. It is possible to bear weight and walk straight after the surgery. Like any other fracture it can take up to 3 months for the osteotomy to heal up. In the right setting these are extremely successful operations to preserve the knee joint and for long term success.
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, involves impingement 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 diagnosing non specific hip problems, treating labral tears (meniscus like tissue of the knee), removing loose bits of cartilage or fixing cartilage lesions.
Hip arthroscopy is undertaken as a day case procedure. Under general anaesthetic, using a special traction table it is possible to gain entry into the hip joint with a special camera and instruments. X-ray guidance is used to make sure that the desired correction of bone has been achieved. Immediately after this kind of surgery you will be encouraged to walk with 2 crutches. It is important to keep these crutches for up to 4–6 weeks to mitigate the risk of fractures.
Very careful patient selection is essential to achieve the desired effect of hip arthroscopy. It may take up to 6 months to return to sports after this kind of procedure but other activities and physiotherapy commence much sooner.
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.
The hip replacement/resurfacing procedure can be undertaken as day case or short hospital stay procedure. The procedure may be undertaken under regional (spinal) or general anaesthesia. It is possible to undertake this with minimally invasive approaches taking particular care to preserve the abductors which are functionally the most important muscles in the early rehabilitation after surgery. Immediately after surgery you will be encouraged to get out of bed and bear weight. Crutches are used for up to 6 weeks to prevent the risk of falls and breaks. The replacement however is itself strong enough to withstand your weight. In the early days some simple physiotherapy exercises help rehab muscles. In general we do not follow any strict precautions and you may return to most simple activities and work as soon as you feel safe to do so.
Patient’s note is up to 99% benefit from this kind of operation in terms of pain relief and improved quality of life. It is often possible to get to a stage of the forgotten hip joint (where one forgets that they had an artificial hip joint implanted) after the first year of surgery. Return to sport of most kinds is possible from approximately 3-4 months. Driving may commence as early as 3-4 weeks.
The overall risk of this kind of surgery is 1% and include that of scar infection blood clot swelling stiffness dislocation leg length problems fractures and failure.
The longevity of hip implants is estimated to be well over 30 years. Improved technology such as robotics and navigation may help extend this further.
The material used hip replacements are often titanium implants which bond to your normal bone and some form of ceramic and highly cross-linked linked polyethylene in the moving (bearing) bits of the replacement. Hip resurfacing uses metal-on-metal (cobalt chrome implants).
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. Mr Konan has a special interest in revision surgery and undertakes a high number of these procedures successfully.
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 on your procedure, you will be given specific instructions before surgery. You will also be told when to stop eating and drinking, what medications to take/not take and any other restrictions.
Preassessment clinic: For inpatient procedure is we often arranged a preassessment clinic where you will have investigations such as blood tests and ECG and a review of your medications is undertaken. This is usually unnecessary for simple day case procedures and otherwise fit individuals.
On the day of surgery: You will be advised to stop eating & drinking generally 6 hours before surgery. Sips of clear water are usually allowed in small quantities for up to 2 hours before surgery. The hospital reception will direct you to your hospital bed. You will be reviewed by the anaesthetist who will go through the options of anaesthesia with you. You will also sign a consent form at this stage.
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.
Dressing and wound care: You will be discharged home with waterproof dressings covering the surgical wound site. It is advised that you do not interfere with these dressings. It is possible to shower with these dressings and dab them dry. You should not soak the dressings in a bath tub. Unless you notice significant discharge through the dressings there is no need to frequently review the wound. In case of any concerns with the dressing please get in touch with Mr Konan’s office or the hospital ward where your surgery was undertaken.
Emergency contact post surgery: A followup appointment is automatically booked for you 2 weeks post surgery. You will get details of this from the office. In case of any emergency you are encouraged to get in touch with the hospital ward or Mr Konan’s office or the local emergency department.
Analgesia/pain medications post surgery: You will be discharged home on the required oral medications. It is advised that you stick to the simple medications for pain relief. Opiate-type medication is have side effects and should only be taken on top of regular paracetamol and anti-inflammatories for break through pain.
Thromboprophylaxis for surgery: Most lower limb surgical procedures carry a risk of blood clots. Based on your individual risk factors as well as risk from the surgery you will be assessed for what type of thromboprophylaxis would be ideal for you. They range between mechanical aids such as TEDs stockings and Flowtron boots to medications such as aspirin and low molecular weight heparin. You will be prescribed the desired thromboprophylactic for the best recommended duration at discharge.
Mobilisation and remaining active after surgery: It is important to continue being active after surgery. It is not necessary to undertake long walks outdoors or engage in intense physical activities post surgery. In the immediate post-operative days it is best to carry on with your physiotherapy exercises and simple indoor activities with frequent breaks in between to rest the joint and place ice packs on it.
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.
In general it is advisable to avoid long-haul flights for 35 days post hip surgery and 14 days post knee surgery. Short-haul flights may be undertaken in some circumstances.