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The majority of knee injuries represent a simple strain or sprain.  This can result from over-activity or alternatively from a relatively minor injury.

Pain occurs because the tissues around the knee joint have stretched but are not permanently damaged.

Simple treatment includes rest, ice, compression and elevation (RICE).  Simple painkillers such as ibuprofen and paracetamol often taken in combination are very effective at settling the symptoms.

In terms of recovery, most simple strains and sprains will settle over a few weeks after the injury allowing a return to sport.  The return to sport should be gradual with low impact exercises initially steadily returning to normal activity.

There are several features which suggest that the injury is not a simple strain or sprain such as rapid swelling of the knee, an inability to get the knee fully straight or instability in the joint.

If this situation is present it would be prudent to seek expert help.  Simon would be happy to provide appropriate advice.

How to make an outpatient appointment

Simon’s practice management team make appointments to see him at all the hospitals where he practices. Hana and her team can be reached on 01622 620920 or simonellis@kentmedical.co.uk and they will talk through which appointments are available at the hospital of your choice.

They will ask if you have had any previous X-rays or MRI scans as it is very helpful for Simon to see these at the consultation – and as long as you can remember where this was done they will source the imaging for you.

If you are insured you will need to see your GP first as your insurance provider will not authorise your appointment with Simon without a referral letter from your GP. If you are planning to pay for your consultation yourself, Simon will see you without a referral letter.  Although a GP letter is always useful, Simon’s primary interest is to listen to you talking about what’s happened and what your symptoms are.

During your consultation, depending on what Simon gleans from talking to you and examining your knee, he will probably need you to have an X-ray (usually for osteoarthritis) or an MRI scan (for soft tissue injury – such as cartilage or ligament).

An X-ray can be done in clinic but you usually have to book an MRI scan for a different day and time (although sometimes it is possible to arrange it on the day).

If you only have an X-ray Simon will probably be able to decide upon the next step which could be physiotherapy or surgery; however if you have an MRI scan this will need to be reported by a consultant radiologist and you will need to come back to clinic again to get your results.

At the end of your consultation Simon will dictate a letter to your GP for you to hear. This letter will then be faxed to your GP and emailed to you in encrypted form so that it is not possible for anyone other than yourself with your personal password to open it. If you are paying for your consultation yourself your invoice will be sent with your letter. If you are insured the invoice will be sent to your insurance company for them to deal with.

If Simon recommends surgery for you he will arrange a date with you. You will be contacted by the hospital where your surgery is going to take place to attend the pre-admission clinic for an assessment to ensure you are medically fit for surgery.

You will be sent a copy of Simon’s letter to your GP as well as consent information which you can also find here on the website here.

Once you have agreed with Simon that surgery is required for your knee problem, he will discuss an appropriate date for surgery.

Approximately 2 weeks before your surgery is due you will be provided an appointment for the preadmission clinic.  The aim of this clinic is to ensure your safe and timely admission, operation and discharge.

The preadmission clinic appointment is carried out by an experienced nurse who will take a full medical history and then establish which further tests are required to ensure that your surgery is as safe as possible.  Orthopaedic patients are routinely screened for MRSA by taking swabs from your skin.

There is a small chance that the swabs will be positive in which case your surgery will be deferred and you will undergo an eradication programme.  Once clear your surgery can be rescheduled.

Following your preadmission clinic appointment if necessary any medical issues will be discussed with an experienced anaesthetist who will make the final decision as to whether it is safe to go ahead with your surgery at the hospital.

On occasions the anaesthetist may request extra information from your doctor or instigate further tests.  Whilst this may delay your surgery, it is imperative to minimise the potential risk of surgery to you.

On the rare occasion the anaesthetist is not happy to proceed, Simon's team will get in touch with you and your doctor to explain the next steps – which may mean that you require a referral to another hospital who are able to manage your medical problem or to live with your symptoms if surgery has too higher risk to your health.

When attending the preadmission clinic it is important to bring a list of your current medication, and in particular mention any allergies from which you suffer.

In addition to drug allergies, other very relevant allergies include latex, shellfish and if you are undergoing joint replacement, metals.  If the preadmission clinic reveals an allergy which is not mentioned in your original letter to your general practitioner, it would be helpful if you could bring this to the attention of Simon's practice manager in addition.

The majority of patients are passed fit and go forward with their surgery as planned.  Once you have been passed fit by the preadmission clinic (and anaesthetist if appropriate) your admission to hospital will go forward as planned.

If you are having a joint replacement, if appropriate you will be provided with preoperative drinks at the preadmission clinic which will need to be taken on the morning of your operation.  The time at which you need to take these drinks will be advised to you by Simon's practice manager the day before your surgery.

You can eat up to 4 hours before the preoperative drink time and should drink water only up to the preoperative drink time.  If you have any questions please do not hesitate to contact Simon's practice management team.

Magnetic resonance imaging (MRI) uses a strong magnetic field and radio waves to produce detailed, usually 2-D images of the inside of your body. MRI scans can show muscles, joints, bone marrow, blood vessels, nerves and other structures within your body and are commonly used to examine the brain, spine, abdomen and pelvis.

Benefits
MRI scanning is one of the safest imaging techniques available and can be used to produce images of almost any part of the body from all angles. The detail in these images is so good that a lesion as small as 2mm can be seen.

The Procedure
You can drink and eat as normal before most MRI scans. An MRI scan should take between 30 to 60 minutes and is carried out by a radiographer.

The procedure is painless, but can be very noisy. You will lie on a comfortable couch, which is moved into and through the MRI scanner, which is like a short tunnel, open at both ends. You will be asked to lie very still and will be able to speak to and hear the MRI staff at all times. For a knee MRI scan you will go into the tunnel feet first so your head will remain outside.

It’s important to tell your radiographer before your scan if you have a:

  • Cardiac pacemaker
  • Artificial limb or joint artificial heart valve
  • Metal clips on blood vessels in your brain
  • Screws, plates or staples from previous surgery
  • Cochlear (inner ear) implants
  • Contraceptive coil fitted
  • Metal particle in your eye

If you are pregnant, or there is a possibility you may be, please tell the radiographer before your scan.

 

As you are having an operation we ask that you do not eat for 6 hours prior to your surgery. Food includes any drinks with milk or sugar and chewing gum.

We do however encourage you to drink water up to 2 hours before your operation.

If you are being admitted at 7am, we recommend nothing to eat after midnight. When you wake in the morning you should drink water and take your normal medication unless you have been instructed otherwise. As the operating list starts at 8am unless instructed otherwise, do not drink water after 6am.

If you are being admitted later in the day then you should have breakfast at 7am and drink plenty of water only up to 11am unless Mr Ellis’ practice manager has contacted you and given instruction to continue drinking later.

Eating where instructed and drinking water are both important as it has been shown that patients who are well hydrated at the time of their operation recover more quickly and generally feel better with less nausea.

If you are having a joint replacement, you will be provided with high carbohydrate drinks when you come to the per-admission clinic if these are not contraindicated for you. Mr Ellis’ practice manager will contact you to give you the time by which you should drink the preoperative drinks. It is important that up to that time you continue to drink plenty of water.

It may be that following your admission if there is time the nursing staff will continue to give you water up to 2 hours before your surgery.

In preparation for your admission you should pack a dressing gown and slippers as well as comfortable clothes with loose fitting trousers to go over the bandage around your knee.

If you are having a knee replacement procedure the staff will encourage you to dress in everyday clothes the morning after your surgery as this has also been shown to enhance patient recovery. Remember you are not ill, you have had a knee operation to make your knee better.

Each hospital is equiooed with Wifi to allow you to access the internet if you would like to and in addition please bring your mobile telephone for relatives to contact you easily.

On the day of your operation you will be seen by Mr Ellis who will confirm your consent for the procedure and mark your leg. He will ask you for the number of a member of your family you would like him to contact.

Generally he will ring them once your procedure is complete to let them know. He appreciates that your family will be anxious to know you are fine at the earliest opportunity.

Following your surgery you will be moved from the operating theatre to the recovery room where you will be closely monitored by the nursing staff until it is safe for you to be taken back to your room.

For some operations such as anterior cruciate ligament reconstruction and joint replacement a post-operative x-ray is required and this may be carried out en route back to your room.

Once the effects of the anaesthetic have worn off you will be encouraged to eat and drink and will be mobilised as soon as is practicable.

If your procedure is a day case, you will be seen by the physiotherapists following your surgery who will ensure that you are suitably mobile and safe to be discharged home.

Simon will come back to the ward to review you and discuss your procedure with you before you go home.  You will normally be given an injection into the abdomen prior to discharge to reduce the risk of deep vein thrombosis.

If your procedure requires an overnight stay in hospital, Simon will return to the ward to review you and discuss your procedure in addition to making plans for your post-operative rehabilitation whilst in hospital.

You will be seen regularly by the nursing staff and physiotherapists to progress your initial recovery and once you are fit to be discharged home, this will be discussed with Simon who will in turn explain the plans to you.  If you are unsure about the timing of your discharge or are concerned then it is imperative that this is discussed with Simon directly.

Before your discharge you will be provided with an appointment to be reviewed by the nursing staff either to reduce your dressings in the case of arthroscopy or to remove clips which happens at the 2 week post operative stage.

You will also be provided with details of physiotherapy follow-up as well as being provided with a post-operative appointment to see Simon himself.  If you have any questions about these post-operative appointments, please discuss them with the nursing staff always Simon directly.

Simon's practice manager will arrange for you to be sent a copy of your operation note which has also been forwarded to your general practitioner.  In addition to details of the procedure carried out, this note also has details of your appointment with the nursing staff and with Simon.

In order to gain maximum benefit from your procedure, it is vital that you follow the rehabilitation instructions given to you by the physiotherapists and continue to carry out the exercises once you get home.  For the majority of patients the post-operative recovery is smooth however every procedure carries a risk of complication.  If you have concerns about your post-operative recovery following discharge please telephone the nursing staff at the hospital or contacts Simon's practice manager so that an appropriate arrangement can be made to review you earlier than planned if needed.

One of the most significant complications of knee surgery is deep vein thrombosis.  Whilst it is not uncommon following knee surgery for you to experience some calf pain, occasionally this becomes increasingly severe and limits your ability to walk.  If calf pain is associated with swelling and pain on walking then it is important to exclude deep vein thrombosis.  This is best achieved by contacting the hospital directly to arrange a clinical review followed by an ultrasound scan of your calf if required.

Very rarely deep vein thrombosis can give rise to pulmonary embolism which results in acute shortness of breath.  If you should experience this then you should dial 999 who would dispatch a paramedic to assist you.

Simon requests that he is kept informed of any concerns that you may have following your surgery as early recognition and appropriate treatment of complications results in the best outcome.

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