Private patients

Having either self-referred or been referred by your GP or physiotherapist, an appointment date will be scheduled to see one of our consultant partners. You should bring with you all relevant previous investigation results.

Following this initial consultation, further investigations such as X-rays or an MRI scan may be required. A review appointment will be organised to discuss your investigation  results. Surgery may be necessary; in which case, we will arrange a date that is convenient for you and conduct a pre-operative assessment to ensure your safety for anaesthesia.

After taking a detailed history of your symptoms and an examination, your specialist consultant will often be able to diagnose the problem. However, further investigations are sometimes necessary. All our specialist consultant partners work closely with local musculoskeletal imaging (expert radiologists), holding regular weekly meetings to discuss scans and complex cases. The following paragraph tells you about some of the tests and scans you may need to undergo:

• Blood tests can help distinguish between inflammatory arthritis and osteoarthritis and help rule out infection in painful joint replacements. Some routine blood tests are usually required as part of the pre-operative assessment for large operations.
• X-rays can help assess bone injury and the distribution and severity of arthritis. Special views, including weight bearing or stress views and long leg alignment films, may be necessary in arthritic patients.
• CT scans use radiation like X-rays but can provide useful 3-dimensional assessment of alignment and bone damage.
• MRI scans do not use radiation. They give an assessment of bone problems around the joints, but are most effective at showing injuries to the ligaments or cartilage, within the hip – labrum, within the knee – meniscus.
• Ultrasound scans, when performed by experienced musculoskeletal radiologists, can provide an excellent dynamic assessment of soft tissue around the joint, as well as being used to provide accurate guidance for targeted injections of either steroids or platelet-rich plasma (PRP).

For information on specific procedures, see our Specialisms pages:

Hip procedures

Knee procedures

All surgery carries some risk, although for most procedures the risks are low. Your surgeon will discuss in detail the risks specific to any procedure that is planned, but here is some general advice to help reduce the likelihood of complications occurring.

• If you have any pre-existing medical problems that are not under control, be sure to have these checked by your GP well before the date for surgery.
• If necessary before the procedure, you will have a ‘pre-operative assessment’ to judge your fitness for surgery. Problems picked up at this stage may need to be sorted out beforehand and surgery may need to be delayed.
• Swabs looking for MRSA are done before any major joint replacement operation and if you test positive this will be treated before surgery.
• Elective joint surgery cannot proceed if you have any active source of infection e.g. you must finish treatment for any chest, urine or dental infection before proceeding. If you have any open wounds, ulcers, cellulitis, thrombophlebitis or severe sunburn affecting the legs, surgery will be postponed.
• Diabetics and patients on immunosuppressive drugs have increased infection risk and should ensure these conditions are optimised and stable prior to surgery.
• If you are due to have a joint replacement, do not have a steroid injection in the knee in the preceding 2-3 months.
• Ensure your muscles are as strong as possible before surgery to aid more rapid post-operative rehabilitation. Strong muscles also help to reduce stiffness and the risk of clots.
• We operate in Ultra-clean Air (UCA) laminar flow theatres to reduce infection rates. It is important that every person who comes into contact with you on the ward (including staff and family/visitors) uses the alcohol hand gel provided.
• Wound dressings are disturbed as little as possible in the first 5 days  to allow the wounds to ‘seal’.
• Post-operatively, you must keep the wounds dry until they are sealed and the stitches or clips have been removed or dissolve. The nurses can advise you on how to achieve this whilst still maintaining general personal hygiene.
• Following surgery, you should immediately contact the hospital or surgeon if there is any concern about ongoing bleeding or oozing from the wound, infection or severe swelling.
• The risk of clots is highest in patients with specific risk factors, which include: previous clots, family history of clots, obesity, age, prolonged immobility, and cancer. Your individual risk will be assessed and your type of surgery taken into account. The key to reducing clots is early mobilisation, but you may also require: stockings, calf compression devices, and tablets or injections to thin the blood. This medication will usually start once we are happy there is no severe bleeding risk, and may continue after discharge.
• Long-haul air travel carries a risk of clots. You should avoid long-haul flights for four weeks before and after major joint replacement. If this is not possible, additional scans for clots may be required before surgery or before flying.
• Good nutrition helps with recovery after surgery as it aids the healing of your wounds and enables you to cope with energetic physiotherapy. If you have any nutritional problems, these should be addressed prior to major surgery. If you have any unusual dietary requirements, let the hospital know before you are admitted.
• There is good evidence that outcome is better and the risks are lower in hospitals and with surgeons performing high volumes of joint replacement surgery.
• We follow the WHO Safer Patient Initiative guidelines, which involve a safety briefing at the start of each operating list and each case. This ensures the whole team have checked the side of the operation, whether the patient has any medical problems, and the availability of all the kit needed to carry out the operation.

If you already attend a Physiotherapist we are happy for that Physio to complete your rehabilitation course. Most physiotherapists are recognised by all the major insurers. You will need to check your policy to see whether or not physiotherapy is included. The number and frequency of sessions required will be individually tailored to, and guided by your progress. Physiotherapy is often very helpful preceding (prehabilitation) as well as following an operation (rehabilitation).

Costs and Medical Insurance

All our consultant partners are recognised by the major healthcare insurance companies (Beneden, H3, BUPA, BUPA International, AXA PPP, WPA, Norwich Union Aviva, Standard Life, Vitality, Simply Health, Cigna etc.)

As consultant surgeons we are able to provide diagnostic services in addition to day case and inpatient surgical treatment.

Your insurance policy may have an excess, and on occasions there may also be a shortfall in the coverage provided by your insurance company to cover the incurred costs. In these situations, an outstanding payment will be required.

Below is a fee explanation note produced by FIPO (the federation of independent practitioner organisations) outlining the important principles governing the provision of medical care under private medical insurance.

Click here to download a PDF of the fee explanation note.

Self-funding patients

Increasingly patients without private medical insurance are opting to fund their own medical treatment in the private sector.

Following an initial consultation and subsequent investigations, at a review consultation, a diagnosis will be made and a management plan formulated. Based on this plan a fixed price cost for any surgical treatment may be provided. In general, private hospitals will require payment in full before the treatment is provided.

If you are paying for your own treatment, then a referral is not necessary although in general it is preferred. The majority of insurers will require a GP referral before authorising a consultation, investigations or any treatment. Many of my referrals come from physiotherapists and some insurers will now accept that mode of referral.

We increasingly see patients for this reason. We request that you notify our Practice Manager if you are seeking a second opinion so that an appropriate time slot can be organised.

We aim to provide as comprehensive a service as possible. We are unable to provide 24/7 cover. However if you have any urgent queries you should initially contact the hospital ward in which you had your surgery. If the treating surgeon is unavailable then one of the partners is usually able to provide a review.

On some occasions you may be advised to attend your local accident and emergency department.

If you already attend a Physiotherapist we are happy for that Physio to complete your rehabilitation course. Most physiotherapists are recognised by all the major insurers. You will need to check your policy to see whether or not physiotherapy is included. The number and frequency of sessions required will be individually tailored to, and guided by your progress. Physiotherapy is often very helpful preceding (prehabilitation) as well as following an operation (rehabilitation)

The number of further consultations you need will depend on the operation you have had and how closely we need to monitor your progress. In general we aim to continue to see you until you have fully recovered from any procedure.