Questions to ask your consultant orthopaedic surgeon April/May 2009 edition

Find out the best questions to ask your consultant orthopaedic surgeon with Dr Foster Health

If you have been referred by your GP to hospital for treatment related to your joints and bones, Dr Foster Health's Questions to Ask Your Consultant Orthopaedic Surgeon series will help you get the most out of your consultation experience.

Introduction

Orthopaedics is a branch of medicine focusing on the diagnosis and treatment, including surgery, of diseases and disorders of the musculoskeletal system, including bones, joints, tendons, ligaments, muscles and nerves.

Common orthopaedic operations include:

• knee replacement
• hip replacement
• knee arthroscopy
• carpal tunnel decompression
• repair of trigger finger
• repair of broken bones

Who will look after me in hospital?

Depending on what condition you've been diagnosed with, a team of different professionals may be involved in your treatment:

• Orthopaedic surgeons specialise in operating on muscles and bones
• Physiotherapists identify and improve movement and function of the neuromuscular and musculoskeletal systems
• Occupational therapists help patients cope by advising on specialist equipment to assist with daily activities
• Dieticians help patients maintain good health and prevent and control disease by assessing and advising patients on diet
• Pharmacists dispense medication to patients and advise them on their proper use and side effects
• Nurses provide a wide range of care and advice on recovering optimal health and function

General questions to ask about knee repair operations

How are knee injuries diagnosed?

Knee injuries are the result of damage to the bone, the surfaces of the joint (the cartilage) or the soft tissues (cartilage, ligament, muscle and tendons).

A doctor's examination will show if any areas around the knee are swollen, tender to touch, painful when moved and whether the joint has the full range of expected movement.

Some ligament injuries can be identified by physical examination or diagnostic tests. X-rays, for example, can reveal a fracture but they may not reveal joint surface or soft tissue injury in as much detail as an MRI scan.

Will I need any tests or scans?

You may have to undergo the following diagnostic tests, depending on the type of suspected knee problem:

• Blood tests to rule out inflammatory conditions or metabolic disease
• Magnetic resonance (MRI) scan
• Computerised tomography (CT) scan
• Bone density (DEXA) scan

What is keyhole surgery?

Keyhole or arthroscopic surgery is highly beneficial to patients because it involves a minimally invasive technique, is usually done as a day case and can result in a relatively rapid recovery. The arthroscopic surgeon uses a variety of small instruments that are passed in and out of small incisions around the knee. The majority of routine operations on the knee, including complex procedures such as ligament reconstruction, can now be carried out arthroscopically (using keyhole techniques).

What are the advantages and disadvantages of keyhole surgery?

Compared with conventional open surgery, arthroscopic surgery results in less scarring, trauma and pain. As a result, recovery times are quicker. Complications are rare but may include swelling or infection in a small proportion of cases. Not all knee conditions can be treated by arthroscopy. Some, such as knee replacement, still need an open operation.

Questions about knee ligament surgery

What is knee ligament surgery?

A ligament injury can range from a sprain to a complete tear. A sprain or a partial tear may heal by itself, while a complete tear often requires surgical repair.

The ligament most commonly injured is the anterior cruciate ligament (ACL), which stabilises the knee joint. Operative treatment for an ACL injury is often considered when the knee keeps giving way, usually when twisting or turning. Knee joint instability can make you lose confidence in the knee when walking and makes sport or other outdoor activities difficult or impossible.

ACL reconstruction may lessen the risk of further injury to the knee such as a torn cartilage. A torn ACL cannot be stitched together. Instead, surgery involves the torn ligament being replaced by a graft made from the patient's own hamstring tendons or a strip of kneecap tendon. Artificial tendons can also be used. The new tendon is inserted into the knee joint in exactly the same position as the original ACL, often using keyhole techniques that leave small scars and minimise post-operative pain. ACL reconstruction is successful in more than 90 per cent of cases ⁽¹⁾. You should be able to return to full sporting activity after between three to six months ⁽²⁾.

How long will I have to wait for ACL surgery?

The waiting times between different hospitals vary partly because many patients needing an ACL operation are less urgent than patients that are admitted as emergencies or need a more serious operation. You can ask your GP or consultant how long you will have to wait. Some hospitals also have a waiting list department that you can phone.

How experienced is my ACL surgeon?

ACL reconstruction is a specialised procedure and surgeons need considerable experience to carry it out successfully. You should ideally see an orthopaedic surgeon who performs this operation regularly (at least once a month). There is evidence that regularly undertaking an operation helps to maintain a surgeon's skill.

What happens after surgery?

The rehabilitation period is very important part of the overall treatment programme and you should make sure it is conducted under the supervision of a physiotherapist. Initially the emphasis is on straightening the knee properly. An aggressive programme of activity is often advised with supervised workouts in the gym. Other activities such as cycling and swimming may be recommended.