Investigating your knee problem

You will be asked a detailed series of questions about your knee problem followed by a thorough examination of your knee. Very often this will be enough to diagnose the problem. Often, additional tests are required to confirm the diagnosis and gather further information regarding your knee problem.

Below is a list of tests which you may need to undergo.

• X-rays: these are necessary in almost all patients. They are very helpful in diagnosing arthritis, its extent and severity. They are also useful following knee injuries to exclude any broken bone (fracture) or loose pieces of bone within the joint.

• MRI scan: this is commonly required following knee injury. It is particularly good for looking at injury to soft tissues such as ligaments, shock-absorber cartilages (menisci) and the "gristle" or articular cartilage lining the bones. It is commonly used in diagnosing numerous other conditions around the knee, such as arthritis, avascular necrosis, tendonitis and bursitis. Unlike X-rays or CT scans it does not use radiation.

• CT scan: this is normally performed in patients who have a problem following previous surgery. It can be used to create 3-dimensional images of the knee joint and is of use in the assessment of painful knee replacements and unstable knees following ligament reconstruction.

• Ultrasound imaging: this is a quick and safe imaging method which, in experienced hands, can be helpful in diagnosing soft tissue problems such as tendonitis and bursitis. It is commonly used for guiding injections into and around the knee joint e.g. steroid or platelet-rich plasma (PRP).

• Blood tests: these are commonly required prior to major surgery or in patients with significant medical problems. They are also used in the investigation of the painful knee replacement and in those with suspected inflammatory arthritis (e.g. rheumatoid arthritis).

How to reduce the risks of surgery

Unfortunately, no operation is without risk. For most knee operations the risks are low. Prior to any operation, Mr Barnett will discuss in detail with you what the operation involves and what the specific risks are related to the procedure. You will find information relevant to most procedures on this website, however, below is some general advice to help reduce risk and the chance of a problem occurring.

Before your Operation

• Please consult your GP well in advance of your operation if you have any pre-existing medical problem which is not currently well controlled. This is to reduce the chance of your operation being cancelled because you are not fit for surgery.
• All patients will attend a pre-operative assessment clinic to establish whether or not you are fit for surgery. If any significant issues are found, your operation may need to be postponed until they are sorted out.
• MRSA swabs are taken prior to your operation. If you have a positive test, you will require treatment for this condition and will need a "clear" swab prior to surgery.
• If you have any active source of infection e.g. chest, dental or urinary tract infection, this must be appropriately treated prior to surgery. In addition, if you have any spots, grazes or open wounds on your limbs, your surgery is likely to be postponed. Please contact Mr Barnett's secretary prior to your admission date to inform the team.
• If you are awaiting a knee replacement you must avoid having a steroid injection into the knee joint for 6 months prior to surgery.
• If you have diabetes or you are on immunosuppressive medication (e.g. steroids), then your infection risk is increased. You should ensure that these medical conditions are stable and optimised prior to your operation.
• Strong limb muscles help prevent stiffness and pain postoperatively. This will improve your mobility and prevent the risk of bloods clots occurring. Make every effort to ensure that your muscles are as strong as possible before the operation, so called "prehabilitation". This can be achieved by seeing a physiotherapist prior to surgery.
• By following the World Health Organisation Safer Patient Initiative guidelines, we ensure that there is a safety briefing at the beginning of every operating list and before every individual case. This ensures that the whole theatre team have checked they have the correct patient, the correct limb is marked and that they clarify any medical problems the patient has and make certain that all the kit required to do the operation is available.

After the Operation

• Please ensure that any staff or family who visit you on the ward thoroughly clean their hands with the alcohol gel provided.
• You must ensure that your wounds remain dry and dressings remain in place until the wounds have healed and stitches removed.
• If there is any concern regarding swelling, infection or ongoing bleeding you must contact the hospital or Mr Barnett urgently.
• Carry out regular exercises that you were shown by the physiotherapist. This will give you the greatest chance of making a good recovery following your operation.
• Blood clots are best prevented by early mobilisation. Your risk for developing blood clots will be individually assessed before your operation and this will guide your treatment following surgery. In addition to early mobilisation, you may require foot pumps until you are mobile, stockings and special medication to thin your blood.
• You should avoid long-haul flights for 1 month prior to and six weeks after major surgery. This is to reduce the risk of blood clots.
• Ensure optimal nutrition both before and after surgery. Good nutrition is proven to aid wound healing, prevent infection and will provide energy to help you rehabilitate afterwards.