Please take a look at patients commonly asked questions or FAQ's Click on the categories below to reveal the answers
Knee & Hip Questions
Take some antiinflammatory medication and paracetamol if you are allowed and rest for 48 hours. Then restart normal activities, if in doubt see a specialist consultant orthopaedic knee and hip surgeon like Mr Imbuldeniya for further advice
Consult a specialist knee and hip orthopaedic consultant surgeon like Mr Imbuldeniya who will take a detailed medical history and ask questions to do with your pain. He will then perform a thorough but pain free examination of the painful area, organise relvant imaging tests eg. X-rays or MRI scans as needed, diagnose the problem and offer advice on treatment. This initially is normally non surgical treatments such as a strength and conditioning programme or he will refer you to a trusted physiotherapy colleague and a programme to help you return to full activity. If this does not help, or you are in too much pain, advanced therapies such as ultrasound guided injections and keyhole surgery are sometimes then recommended.
Knee pain and hip pain can definitely be related, sometimes knee problems cause pain in the hip and vice versa.
A knee injury can cause pain to be felt higher up in the leg around the hip area, though this is uncommon. For a precise diagnosis and advise on treatment, see a specialist knee and hip consultant orthopaedic surgeon like Mr Imbuldeniya
Knee pain and hip pain can definitely be related, sometimes knee problems cause pain in the hip and vice versa.
Knee pain after hip replecement surgery is uncommon but could be due to unrelated knee pathology that is now being felt, or potentially a complication from your hip replacement surgery such as a longer leg, a loose implant or a small crack in the femur bone. Eitherway it should to be investigated by your surgeon if it is getting worse or does not settle.
Consultant orthopaedic hip and knee surgeons are specialist medical doctors who train for over 15 years in the diagnosis and non surgical and surgical management of all hip and knee problems. Other doctors you might see initially with similar problems might be your GP, a sports medicine doctor or a rheumatology doctor. Physiotherapists , osteopaths, podiatrists and chiropractors are not medical doctors but all can play an important role in treating patients with knee and hip pain alongside your surgeon. Working together often produces to give the best results.
Seeing the right healthcare professional initially for a firm diagnosis. This could be a consultant orthopaedic surgeon like Mr imbuldseniya or a consultant sports physician. Often the best treatments are low risk and involve physiotherapy, strength and conditioning training, stretching, changing how you do certain activities, wearing supports and sometimes taking antiinflammatory or pain reliving medication or injections such as PRP, hyaluronic acid, cortisone or Arthrosamid.
Knee or hip pain that wakes you up from sleep is often a sign of osteoarthritis. There are other conditions that can cause pain at rest so best to consult a consultant orthopaedic knee and hip specialist to help find and treat the cause.
Sudden knee and hip pain is often an injury to the soft structires between the bones called cartilage, meniscus and labrum. In younger adults this is often associated with an injury playing sport or doing an activity. In older adults these pains can often start without an obvious cause.
Paying for you surgery
Private knee surgery fees that we quote generally include preoperative assessement tests, 1-2 nights stay in the hospital and associated fees, preoperative assessement tests, anaesthetic fees, surgeon fees, implant fees where applicable, post surgical xrays, first follow up visit, removal of stitches and dressings and often physiotherapy after surgery. Private knee surgery costs vary due to many factors including implants and technology used, hospital fees, surgeon fees, anaesthetic fees and complexity of the procedure. The range is normally between £5000 and £18,500.
You have to pay for your surgery before it happens. The hospital and anaesthetist normally bill together and the hospital will bill you in advance. The Clementine Churchill Hospital has facility for a payment plan. Mr Imbuldeniya's team will generally ask for full payment of his surgical fees 1-2 weeks in advance to secure your place on his operating list.
Pre-operative clinic before your surgery
This clinic visit happens in the hospital you will have your surgery eg. The Lister Hospital in Chelsea or The Clementine Churchill Hospital in Harrow. It is a nurse and anaesthetic led clinic to assess your general fitness and safety before surgery. All patients have MRSA swabs, Covid swabs, blood pressure, pulse, height, weight and temperature and a physical examination and medical history. Some will need additional blood tests, ECG, chest xray and other scans.
Usually pre-assessement happens 1-2 weeks before your date for surgery.
Yes, is the short answer. Patients undergoing knee or hip replacement surgery need MRSA, COVID swabs, blood pressure, temperature, ECG, blood tests and sometimes a chest xray and other scans if you have a complex medical history or suffer from other chronic illness. To assess you knee or your hip, calibrated and scaled xrays are generally needed, and sometimes an MRI scan or CT scan if robotic technology is used to help make an accurate 3D anatomical model we can plan from.
Anaesthesia and pain relief for your surgery
This is a safe type of anaestheisa used for surgeries below the waist such as knee or hip replacements. It involves a small needle being placed under local anaesthetic under the skin in your lower back in the small space between 2 spinal bones. A few millilitres of local anaesthetic are then injected into the fluid that bathes your spinal chord. It takes a few minutes to workf and gives you total pain relief for typically 3 hours. You are then given a sedative so you can sleep during your surgery or if you prefer, you can be awake and listen to your own relaxing music.
Click on this text to edit it.In short no. Spinal anaesthetic provides total anaesthesia and immediate pain relief, unlike an epidural which has the advantage of lasting longer as the local anaesthetic can often be topped up. Epidurals are commonly used in pregnancy and should not be confused with spinal anaesthesia used in knee and hip surgery.
After spinal anaesthesia with sedation, you wake up fresh, pain free and patients often say it is the best sleep they have had
Low blood pressure and diziness on standing and walking, difficulty passing water, headaches and itchiness around the injection site.
For short surgery eg knee arthroscopy, you will normally be under general anaesthetic, for longer surgery eg. knee or hip replacement, you have a spinal anaesthetic but are given some sedation to help you sleep. Please be reassured that you will be given the anaesthesia you choose in collaboration with our anaesthetic team based on your own preferences and also your safety, dependant on any medical conditions you might have.
Sedation is where the anaesthetist gives you some medication either orally or normally via an iv drip to relax you and make you have a nap.
After general anaesthesia you can sometimes feel confused and nauseous, there might be some discomfort from your surgical site so the recovery nurse will provide you with pain killers. Some patients might experience a sore throat for a few days.
It usually takes 2-10 minutes to wake up from general anaesthesia, though it can take longer if you have longer surgery or have certain medical problems affecting your lungs in particular. The risk of waking up during a general anaesthetic is very low at less than 1 in 1000
Nausea and vomiting, feeling sleepy, sore throat, shivering, itching, confusion, chest infection
Analgesia is the medical term for pain relief medication or pain killers. Common analgesia that can be used in combination is paracetamol, a non-steroidal anti-inflammatory medication (NSAID)eg ibuprofen, and an opiate eg. codeine phosphate.
Opiate analgesia can cause confusion, nausea and constipation. It is also addictive so should only be taken for a few days or weeks. Some patients experience sweating, or an inability to sleep when stopping them. Common opiate medications include morphine, oxynorm, oxycontin, tramadol and codeine.
keyhole surgery or arthroscopy is normally performed under general anaesthetic in the UK as it is often a short procedure that take under an hour. It is possible to perform it under a short acting spinal anaesthetic which is common in other countries.
On the day of your surgery
Yes, you should not eat any food or drink any milky drings 6 hours before your surgery time. You can drink clear water only up to 2 hours before your surgery time, You can have sips of water to help swallow any medication you take at anytime before surgery.
You should get to the hospital at 7am on day of surgery (normally a monday) and be nil by mouth, so no food or coffee from 2am and no water from 5am.
Surgery is normally on a monday morning at The HCA Lister Hospital in Chelsea or The Circle Clementine Churchill Hospital in Harrow.
All patients are asked to come in at 7am so they can be seen on the day by Mr Imbuldeniya for any questions you might have for him, and also for you to confirm consent for your surgery and for him to place a mark on the leg to be operated on. The Consultant anasethetist will also meet you and go through your anaesthetic options, Mr Imbuldeniya will then meet with his theatre team at 8am to ensure all staff are present and all equipment and instruments are present.
He often has 3-4 patients on his list so sometimes you may go for surgery late in the morning or early afternoon. If this is the case his admin team will normally prewarn you the week before so you can bring in a book or some work to pass the time.
The medical team on the day will also let you drink water whilst you wait for surgery later in the day. We are unable to accomodate you arriving later than 7am as due to the number of patients who need treating, we need to keep the theatre running once we start our first case.
We take great care to order patients on our operating list according to safety, medical conditions and practicality. In general, patients who are very frail or diabetic may go first on the list as they should not be left nil by mouth for too long.
Patients having day surgery or short procedures often go ahead of those having longer joint replacmenent surgery so they have time adequate to recover and go home before the evening.
After you surgery
You can normally drive 2 weeks after most surgical procedures, and Mr Imbuldeniya will assess this at your first follow up visit. You should also inform your insurance company and the DVLA that you have had a procedure if it affects your ability to drive.
Physiotherapy is essential after surgery to help you recover and gain mobility. We normally recommend you schedule an appointment soon after your 2 week follow up appointment with Mr imbuldeniya. Our trusted physiotherapy partners are listed on our site, they have looked after Mr Imbuldeniya's patients for many years with exceptional feedback and results. You need to initially work hard on regaining your full range of motion, then swelling managment ofr the first 2-6 weeks. From 3-4 weeks you can normally start to do resistance or weight training to begin building up your muscle bulk again.
Sports and running depend on the procedure you had but normally start from 6-12 weeks in many cases.
You can shower immediately, but you need to keen your waterproof knee dressings on and ideally have a second protective knee covering eg. clingfilm wrap and keep the operated knee away from water as best as you can. You can also buy a specialised waterproof cover online.
We almost always use a hidden, under the skin, dissolvable stitch that causes minimal scarring and reaction to the skin and does not need to be removed.
The stitches are generally dissolvable so do not need to be removed, but the wound needs to be assesses at around 2-3 weeks by Mr Imbuldeniya at your first follow up appointment with him.
The dressings you go home with need to stay on and dry till Mr Imbuldeniya sees you at the 2-3 week mark. He will take them off at your first follow up visit.
This depends on your job and what surgery you have, but many get back to working from home after one week if they want to. Most return to their workplace after 2 to 6 weeks, but everyone is different and we will support a safe return with sick notes where needed.
Best to keep your dressings as dry as possible for 10-14 days after your procedure to reduce the risk of an infection using a waterproof cover eg. cling film on top of your waterproof dressings as an added layer of protection.
Patients are normally safe to fly 6 weeks after knee or hip replacement surgery and potentially at 4 weeks if it's a short flight and less invasive keyhole surgery. This is to minimise the risk of a deep vein thrombosis (a blood clot in your calf) or worse, a pulmonary embolus (piece of clot lodging in a blood vessel in your lung).
Most patients need mild pain killers for 1-3 days if keyhole surgery, for bigger procedures such as knee and hip replacement surgery, pain killers are prescribed for 2 weeks.
Most patients who have keyhole surgery or day case surgery are sent home with a 2 weeks supply of pain killers that include anti-inflammatory medication such as ibuprofen, paracetamol and an opioid like codeine. Anti-inflammatories are very useful but need to be taken with food and stopped if you get any heartburn or stomach pain. They are safer in conjuction with a proton pumb inhibitor such as omeprazole.
If you have hip or knee replacement surgery, you will be sent home with additional medications, a blood thinner (14 days for knee replacement, 35 days for hip replacement) and 3 days of very powerful opiate (morphine based) medications. These medications can have powerful side effects including inducing sweating, itching, nausea, vomiting, constipation, bruising and swelling. They are temporary and will ease once you come off your pain killers in particular.
Pre-Operative Assessment
This is usually run as an independent service by the hospital you have chosen for your surgery, and the pre-operative nurses and doctors should contact your anaesthetist regarding any abnormalities found in your pre-operative tests. Full engagement in this process will permit the planning of your surgery and anaesthesia, allowing it to proceed smoothly.
In all but the healthiest people, there is frequently a lot of background information to be collected from your G.P. and any other hospitals you may have visited for medical problems in the past, so please attend as soon as possible after your surgery has been booked.
The tests you undergo will usually involve a few blood tests, and sometimes an ECG (electrocardiogram) which records the electricity generated by your heart when it is beating.
Sometimes there are unexpected findings which require further investigation, and so early assessment will allow this to happen in a timely fashion, and not delay your surgery.
Detailed information about you is what allows us to mitigate any risks, so this is a crucial part of the process.
Your Admission to Hospital
Please make sure that you have read the admission instructions carefully and follow them exactly. Of particular note are the instructions for starvation prior to your procedure.
Please make sure that any advice given to you in pre-operative assessment clinic regarding your medications has also been followed
When you are on the ward, you will be seen by one of the nurses who will complete your admission. This involves checking your blood pressure, temperature and pulse, asking for a urine sample which will be tested, and checking of other details.
You will also be seen by your surgeon and anaesthetist. Although the process of consent has been completed prior to your admission, this is the point at which you sign (or countersign and date) a form to agree to the surgery specified on the form.
This is usually your first contact with your anaesthetist. I will have a lot of questions for you in a short space of time, I will assess your airway, check that you have observed the pre-operative instructions exactly, discuss your anaesthetic with you and any special aspects (such as nerve blocks, differing techniques) and plan your post-operative pain relief with you.
Many of the checks will be repeated at every stage of your journey and this is done with the intention of improving the safety of the process. Please make sure that the wristband that is attached to you has exactly the right details on it as it will be used to continue with safety checks even when you are under your anaesthetic.
The Start of your Anaesthetic
When the time for surgery approaches, a nurse will bring you down to the operating theatres and into the anaesthetic room. Here you will get onto a trolley and then another set of checks is conducted, including checking your consent form and making sure that it matches the operative site marked.
Monitoring is attached, a needle is put into one of your veins (usually on the back of your hand) to allow the administration of drugs, and while you are breathing oxygen through a face-mask, you will gently drift off to sleep. Anything happening at this stage, even though previously explained, will be talked through as it happens.
Waking up and Recovery
Your anaesthetist is with you all the time you are anaesthetised as you require constant monitoring and modulation of the various components of your anaesthetic. When the surgery is finished, the anaesthetic is switched off and you will start to wake up.
You wake up quite quickly after modern anaesthetics, and this happens in a dedicated area of the theatre complex staffed by specialised ‘Recovery’ nurses skilled in post-anaesthetic care. Although the anaesthetic wears of quickly, the pain relief medication you will have had can leave you feeling sleepy. There is no rush, just wake up gently!
You will continue to be monitored closely, your anaesthetist is still looking after you, and as you become more aware we will make sure that you feel as comfortable as possible while you are with us in theatres.
Pain Relief (Analgesia)
Analgesia is a central pillar of your peri-operative care. Different modalities of pain relief are used during your surgery, and the pain relief you will be prescribed afterwards will be discussed with you on the morning of surgery.
Pain relief that you buy yourself (paracetamol, ibuprofen) is very effective, and may be sufficient for your post-operative recovery. These tablets may also form part of your post-operative plan, so please make sure that you have some at home if you are not prohibited from taking them for other reasons.
Stronger pain relief tablets that may be prescribed sometimes include paracetamol, so please be careful not to take more than eight tablets of any paracetamol-containing tablets within any twenty-four hour period.
Any painkillers stronger that those mentioned above will contain some form of opiate (morphine-like substance). These may make you feel sleepy, so sometimes one of the stronger tablets rather than two may be enough for your needs, so please adjust the number of tablets that you take as you feel necessary. Another side effect of opiate-based pain relief is that your intestinal tract (guts) slows its activity, and this results in constipation. Please make sure that you increase the fibre in your diet considerably, and drink enough fluids, as constipation can become more uncomfortable that the operative site…