Orthopaedic Service

Ankle arthroscopy

What’s involved in ankle arthroscopy surgery?

Ankle arthroscopy is a surgical procedure allowing consultants to treat ankle problems. A small camera is inserted into the ankle joint, displaying an image on a television screen. The consultant uses these images to guide miniature surgical instruments to correct and repair the damage.

There are different types of ankle surgery and arthroscopy is applied in a variety of different ways to treat foot and ankle conditions. It can be used to diagnose problems by providing the surgeon with a clear image of all the joints and structures inside the foot and ankle.

Ankle arthroscopy may be used to perform the following:

Arthritic joint debridement

Osteoarthritis and injury can result in excessive scar tissue and diseased cartilage forming in the joint. Arthroscopy removes the diseased parts of the joint, along with any bone spurs or loose fragments of bone.

Arthroscopy following an injury

Chronic ankle symptoms can arise following a sprain or injury. The ligaments can be torn and the cartilage can be damaged. This damage can be treated by arthroscopy.

Footballer’s ankle

A common problem for people involved in kicking sports – a large spur of bone at the front of the ankle can be painful when the foot is extended. The spur can be removed by arthroscopy.

Symptoms

• Swelling or tenderness in the ankle
• Pain in the ankle

About ankle arthroscopy

Ankle arthroscopy is usually performed under general anaesthetic and the procedure can take between 30-45 minutes depending on the case and the severity of the ankle problem.

Several tiny incisions are made in the ankle, allowing a tiny camera to be inserted through one of the incisions and small surgical instruments to be inserted through the others.

The camera will project an image of the inside of the ankle joint on a screen and the surgeon will be able to examine the problems in the area and treat them accordingly.

Any damaged or diseased cartilage or bone spurs will be removed and repaired.

Following the procedure the incisions may be closed with stitches or steri-strips and the ankle may be bandaged.

Ankle arthroscopy aftercare

The expected length of stay for an ankle arthroscopy is a day case.

After surgical treatment the patient will be encouraged to walk on the foot from the day of surgery. However, crutches may be needed to assist with walking in the initial days after surgery.

The wounds must be kept dry until the stitches are removed.

An exercise programme involving physiotherapy will be drawn up and it is to be started straight away. The patient should be able to return to work within a week following surgery. A full return to sport will usually be expected after six weeks following treatment.

Some swelling in the ankle may be apparent post treatment but this should settle down over the first few weeks.

Even after you’ve left hospital, we’re still looking after you every step of the way. After an ankle replacement, typically our consultants will want to see you after your procedure to see how you are doing.

Is ankle arthroscopy surgery available on the NHS?

Ankle arthroscopy are currently being restricted by the NHS in some areas of the UK and waiting lists are becoming significantly longer. For these reasons many people opt for private treatment.

Why should I consider having ankle arthroscopy surgery at a Spire hospital?

Whether you have medical insurance or are paying for your treatment yourself, with Spire Healthcare you will be seen quickly by the consultant-grade surgeon of your choice at a time that suits you. You will be treated in a premium private hospital with some of the UK's highest standards of cleanliness and infection control. What’s more, you’ll be able to recuperate in your own private room with friends and family able to visit when you wish.

Ankle replacement surgery

What’s involved in ankle replacement surgery?

The ankle is a complex joint because it needs to flex and rotate. Furthermore, it receives a lot of strain compared to other joints in the body. Ankle replacement is an operation to remove the diseased and damaged parts of the ankle and replace them with an artificial joint.

The procedure is most commonly performed on patients who are suffering with advanced ankle osteoarthritis.

The aim of the replacement is to reduce pain and increase function and mobility. However, the best results have been on older patients because their ankles are under less stress than the young.

Symptoms

• Severe ankle osteoarthritis
• Pain in the ankle even when relaxing
• Extreme bone fracture
• Severe infection

We pride ourselves on our clinical excellence, you'll be looked after by our experienced multi-disciplinary care team.

About the ankle replacement operation

Ankle replacement is carried out under a general anaesthetic or a spinal epidural.

The surgeon will make a cut in front of the ankle to expose the ankle joint. All tendons, nerves and blood vessels will be preserved and only damaged bone and cartilage will be removed before the artificial joint is inserted.

The degenerated natural surfaces of the ankle joint are replaced with an artificial cover known as prosthesis.

The ankle replacement is made up of three components. Two components are fixed to the joint. One of these is fixed to the tibia (lower end of the shin bone) and is flat and integrated into the bone with a short stem. The other one is fixed to the talus (top of the foot bone) and is curved and fixed into place with pegs. The third component is in the middle and remains mobile. This allows for the greatest range of movement and reduces stress between the bone and the implants.

All of the components are covered in a bioactive coating which encourages the patient’s own bone to grow into artificial fixtures. This will hopefully preserve the movement that they already had and facilitate extra mobility.

The cut is then closed with stitches and a splint, lightweight cast or brace may be fitted to prevent the ankle from moving.

Ankle replacement aftercare

The expected length of stay is 1-2 nights. This depends on each individual patient and will be set once you have seen the consultant.

Following surgery, no weight must be put upon the treated ankle. Walking assistance such as crutches can be used to aid mobility.

Physiotherapy is important to help improve the ankle’s full range of movement and to gradually weight bear.
Recovery can take up to six months post-surgery and it can be up to a year before the patient is fully recovered and the ankle replacement surgery can be completely evaluated.

Even after you’ve left hospital, we’re still looking after you every step of the way. After an ankle replacement, typically our consultants will want to see you after your procedure to see how you are doing.

If you have any questions or concerns about your recovery, we're ready to help

Is ankle replacement surgery available on the NHS?

Ankle replacements are currently being restricted by the NHS in some areas of the UK and waiting lists are becoming significantly longer. For these reasons many people opt for private treatment.

Why should I consider having a ankle replacement operation at a Spire hospital?

Whether you have medical insurance or are paying for your treatment yourself, with Spire Healthcare you will be seen quickly by the consultant-grade surgeon of your choice at a time that suits you. You will be treated in a premium private hospital with some of the UK's highest standards of cleanliness and infection control. What’s more, you’ll be able to recuperate in your own private room with friends and family able to visit when you wish.

Foot bunions removal and treatment

Spire Thames Valley Hospital is a leading private hospital, based in Buckinghamshire near Gerrards Cross and Windsor. The hospital caters for a wide range of patients from Gerrards Cross, Windsor, Slough, Uxbridge, Berkshire and Buckinghamshire, as well as from other parts of the United Kingdom and abroad. We use highly experienced and skilled consultants to carry out all our services including the removal and treatment of bunions.

Mr Mike O'Neill, Consultant Podiatrist at Spire Thames Valley Hospital, treats and removes foot bunions.

What is a bunion?

A bunion is a lump of bone on the knuckle of your big toe. Sometimes the big toe points towards the other toes on the foot (hallux valgus).

Arthritis, or wearing tight or ill-fitting shoes over a period of many years, may increase the risk of bunions. However, they can have other causes. Bunions are more common in women and sometimes run in families.

Exercises and corrective footwear can sometimes help foot bunions. However, when these non-surgical treatments don't work, surgery can relieve pain and correct the deformity.

Bunion removal is usually done under general anaesthesia. This means you will be asleep throughout the procedure.

The operation can be performed as a day-case, but a night or two in hospital is sometimes required. Your surgeon will explain the benefits and risks of having a bunion treatment, and will also discuss the alternatives to the procedure.

About the operation

Your surgeon will make an incision in the top or side of the big toe joint. The exact procedure will vary depending on the type and size of the bunion being treated.

Your surgeon may cut through the joint, remove a small piece of bone and re-align the toe. The joint may be stabilised using screws or tiny wires to keep it in place.

At the end of the operation, the incision will be closed with stitches and your foot will be bandaged or placed in a plaster cast. The operation usually lasts about an hour and a half.

A physiotherapist will visit you after your operation and give you some advice about how to move around safely with your dressing or cast. You may also see the physiotherapist again after your cast or dressing is removed.

Bunion removal is a commonly performed and generally safe operation. For most people, the benefits in terms of improved symptoms are much greater than the disadvantages. However, all surgery carries an element of risk.

Complications specific to bunion removal include:

• the tendons in your big toe can be damaged during surgery and this can affect how well your toe moves
• the nerves in the toe can also be injured and you may find your toe is numb in places
• occasionally, the pain and swelling may be persistent, lasting for a few weeks, or some cases for longer. Some people develop a callus (a hardened area of skin) on the bottom of their foot

It's also important to know that although your surgeon will be experienced at this type of surgery, your bunion may come back.

The chance of complications depends on the exact type of bunion treatment you are having and other factors such as your general health. Ask your surgeon to explain in more detail how any risks apply to you.

Knee ligament surgery

What is knee ligament surgery?

Knee ligament surgery, including anterior cruciate ligament (ACL) reconstruction, is usually performed to repair damage caused by an injury. In the operation a graft is taken from another part of your knee, or in some cases from a donor or made from a synthetic material, and is fixed in place of the affected ligaments.

Why do people choose to have knee ligament surgery?

Tearing the anterior cruciate ligaments can be a fairly common sporting injury, causing swelling, restricted movement and pain. Depending on a number of factors, including how much pain you are experiencing, surgery may be the best option for recovery.

If you choose a Spire Healthcare hospital you will be treated by an experienced surgeon who will discuss your available options (including any alternatives to surgery) before agreeing the best course of treatment for you.

What happens in knee ligament surgery?

Knee ligament repair is usually performed through keyhole surgery and under general anaesthetic. Keyhole surgery is carried out with the use of specially designed instruments which are inserted through small incisions, with the added benefit that this less invasive work generally involves a shorter recovery time.

During the knee ligament operation, special cameras will be inserted through the incisions to enable your surgeon to get a clear picture of the knee area. The torn ligaments are then trimmed and the knee is prepared for the replacement graft. The graft is shaped and fixed in place, and the incisions are closed with stitches or adhesive strips.

Knee ligament operation aftercare

After the operation it is likely that you will experience some pain, stiffness, swelling and bruising around your treated knee. This is completely normal and should last a few weeks, gradually improving as your knee heals.

Anterior cruciate ligament reconstruction is a commonly performed and generally safe operation. For most people, the benefits in terms of improved symptoms are much greater than the disadvantages.

The chance of complications depends on the exact type of operation you are having and other factors such as your general health. Ask your surgeon to explain in more detail how any risks apply to you.

Knee ligament surgery from Spire Healthcare

With Spire Healthcare you will see an experienced consultant of your choice at a time that suits you. You will be treated in a premium private hospital, not a clinic, and you can be assured of our commitment to healthcare standards and infection control excellence. What’s more, you’ll be able to recuperate in your own private room with friends and family able to visit when you wish.

Knee arthroscopy surgery

What is a knee arthroscopy?

Arthroscopy is a “keyhole” operation that is used to look inside and treat joints, especially the knee joint. It is performed through very small cuts in the skin, using a narrow, tube-like telescope called an arthroscope.

Arthroscopy is useful for finding out what is causing symptoms, to deliver treatment for conditions such as arthritis and inflammation, to take small samples of tissue, or to repair damage to tissues and cartilage. The procedure is usually done as a day-case.

Arthroscopy knee surgery is usually done under general anaesthesia, which means that you will be asleep during the procedure, or for some patients, epidural or spinal anaesthesia is preferable. This will completely block the feeling in your legs but you stay awake. Your surgeon and anaesthetist will discuss with you which type of anaesthesia is most suitable in your case.

Your surgeon will also explain the benefits and risks of having a knee arthroscopy, and will discuss the alternatives to the procedure.

About the knee arthroscopy operation

Your surgeon will make two small cuts (about 5mm long) in the skin around the knee joint. The first cut is used to pump sterile fluid into the joint to help produce a clearer picture. The second cut is used to insert the arthroscope.

Your surgeon will view the joint, by looking directly through the arthroscope, or at pictures it sends to a video screen. If necessary, other instruments can be inserted to repair any damage or remove material that interferes with movement or causes pain in the knee.

Afterwards, the fluid is drained out and the cuts are closed with stitches or adhesive strips. Then a dressing and a bandage is wrapped around the knee. An arthroscopy can take from 30 minutes to over an hour, depending on how much work your surgeon needs to do inside the joint.

Before you go home, a physiotherapist will also visit you to guide you through exercises to get your joint moving.

Following your operation, you are likely to have some pain, stiffness and swelling around the joint, which may last a few weeks. Gentle knee exercises will help reduce stiffness and discomfort.

Arthroscopy is a commonly performed and generally safe surgical procedure. For most people, the benefits in terms of improved symptoms, or from having a clear diagnosis of a joint problem, are greater than the disadvantages. However, all surgery carries an element of risk.

Specific complications of arthroscopy could include accidental damage to the inside of the joint or a loss of feeling in the skin over the knee. Uncommonly, it’s also possible to develop a blood clot in the veins of one of your legs (deep vein thrombosis, DVT).

The chance of complications depends on the exact type of operation you are having and other factors such as your general health. Ask your surgeon to explain in more detail how any risks apply to you.

Is knee arthroscopy available on the NHS?

This procedure is currently being restricted by the NHS in some areas of the UK and waiting lists are becoming significantly longer. For these reasons many people opt for private treatment.

Why should I consider having a knee arthroscopy at a Spire hospital?

Whether you have medical insurance or are paying for your treatment yourself, with Spire Healthcare you will be seen quickly by the consultant-grade doctor of your choice at a time that suits you. You will be treated in a premium private hospital with some of the UK's highest standards of cleanliness and infection control. What's more you'll get your own room and en-suite, and be able to have friends and family in to visit you whenever you wish.

Knee replacement operation

What's involved in knee replacement surgery?

A knee replacement is an operation to replace the damaged or worn parts of the thigh and shin bones which form the knee joint. During a knee replacement operation, the damaged or worn parts are replaced with metal and plastic parts that glide over each other smoothly.

During the operation, a single incision (usually 15 to 30cm long) is made down the front of the knee. The kneecap is moved to one side so the joint can be reached. When the joint has been replaced, the incision is closed with stitches or clips.

A knee replacement usually takes one to two hours and normally requires a hospital stay of up to five nights.

How long does it take to recover from a knee replacement?

While you are in hospital, a physiotherapist will visit you every day to guide you through exercises to help you recover. You will be encouraged to move your new knee from the first day after the operation. You will be discharged once you can walk safely with sticks or crutches - usually after 3-5 days.

How long does an artificial knee joint or knee replacement last?

An artificial joint will usually last for at least ten years, after which it may need to be replaced. Your surgeon will explain the benefits and risks of having your knee replaced, and will also discuss the alternatives to the procedure.

Is knee replacement surgery available on the NHS?

Knee replacements are currently being restricted by the NHS in some areas of the UK and waiting lists are becoming significantly longer. People with the most advanced symptoms of knee pain and immobility are being prioritised. For these reasons many people opt for private treatment.

Why should I consider having a knee replacement operation at a Spire hospital?

Whether you have medical insurance or are paying for your treatment yourself, with Spire Healthcare you will be seen quickly by the consultant-grade surgeon of your choice at a time that suits you. You will be treated in a premium private hospital with some of the UK's highest standards of cleanliness and infection control. What’s more, you’ll be able to recuperate in your own private room with friends and family able to visit when you wish.

Hip replacement surgery

What is hip replacement surgery?

Hip replacement surgery is an operation to replace a damaged or worn hip joint with an artificial version. It is regarded as a long term solution for joint pain and immobility and is often the most effective treatment.

Why do hips need replacing?

The hip is a “ball and socket” joint which is susceptible to wear and damage. This can be caused by various forms of arthritis (most commonly osteoarthritis), bone diseases, bone abnormalities, and injury.

Why do people choose hip replacement surgery?

Due to the nature of the hip joint, damage and wear will not improve over time but will usually deteriorate. A hip replacement operation to alleviate pain and increase joint movement may therefore be the best treatment option. However, the decision to have the procedure is solely yours.

A hip replacement operation may be worthwhile for you if:

• You suffer from severe pain
• The pain and lack of mobility is diminishing your quality of life and leaves you feeling depressed
• The pain and lack of mobility leave you unable to have a social life, work or complete everyday tasks
• Medications and treatments that you have tried have failed or cause severe side effects

Benefits of hip replacement surgery

The most common benefits that patients report after the operation are:

• Reduced pain
• Improved mobility
• Improved movement of the joint
• Improvement to their quality of life

What happens in a hip replacement operation?

In the hip joint, the ball is formed by the top of the thigh bone (femur), whilst the socket is part of the pelvis. In the operation, your surgeon will remove the top part of the thigh bone, replacing it with a ball on a stem, which is inserted into the centre of the thigh bone. A plastic or metal cup will often be used to replace the socket.

Some patients choose to receive a general anaesthetic before the operation, so that they are asleep for the duration of the procedure. A hip replacement can also sometimes be performed under regional anaesthetic. The operation usually lasts two hours.

Hip replacement aftercare

After surgery, you will be required to stay in hospital for two to five nights. Your hip is likely to be sore for several weeks; however this should ease as the area heals. Hip replacement surgery is considered a generally safe surgical procedure, which, for most, has benefits that outweigh the risks. Your surgeon will explain any risks of a hip replacement and how they apply to you.

Is hip replacement surgery available on the NHS?

Hip replacements are currently being restricted by the NHS in some areas of the UK and waiting lists are becoming significantly longer. People with the most advanced symptoms of hip pain and immobility are being prioritised. For these reasons many people opt for private treatment.

Why should I consider having a hip replacement operation at a Spire hospital?

Whether you have medical insurance or are paying for your treatment yourself, with Spire Healthcare you will be seen quickly by the consultant-grade surgeon of your choice at a time that suits you. You will be treated in a premium private hospital with some of the UK's highest standards of cleanliness and infection control. What’s more, you’ll be able to recuperate in your own private room with friends and family able to visit when you wish.

Joint pain treatment (joint injections)

About joint injections

Injections of steroid medication into joints are given to ease pain and reduce inflammation caused by injury or arthritis. The aim is to help you move the joint more comfortably and easily.

The steroids injected are similar to those produced naturally by the body - not the same as the anabolic steroids used by body builders. Your consultant may also inject a local anaesthetic, mixed with the steroid in the same syringe. Local anaesthetic drugs block the way nerves carry pain signals to your brain. This provides instant pain relief at the time of the injection.

If you have a joint injection without local anaesthetic, it may take a few days until you feel the benefits of the injections. These can then last anything from a few weeks to several months.

Injections are often given under X-ray control. This means that X-ray pictures are used to help your consultant see the inside of the joint and direct the steroid to exactly the right spot.

Joint injections are usually performed as an out-patient or day-case procedure, sometimes with sedation. Sedative drugs relieve anxiety and cause temporary relaxation without putting you to sleep. Some joint injections are routinely done under general anaesthesia, which means you will be asleep throughout the procedure and will feel no pain.

Your consultant will explain the potential benefits of having a joint injection and discuss the associated risks and alternatives to the procedure.

About the treatment

Before the treatment, your consultant will feel and flex the joint. If you are having an injection under X-ray control, the X-ray machine will be positioned over the affected joint. A thin needle is inserted into the joint. Then the steroid, plus any local anaesthetic, is injected. You may have more than one injection.

If you have arthritis you may have too much fluid in your joint making it feel tight and uncomfortable. If this is the case, your consultant may draw the fluid out with a syringe before injecting the joint. This is known as joint aspiration.

Afterwards, you’ll usually need to rest on a bed for an hour or two. Before you go home, a physiotherapist may visit you. He or she will assess the movement you have in your joint and may give you some exercises to do at home

Joint injections are a commonly performed and generally safe procedure. For most people, the benefits in terms of pain relief and improved mobility are greater than the disadvantages. However, all medical procedures carry an element of risk.

Specific complications are uncommon but there is a small risk that injecting a joint can introduce infection. This may need treatment with antibiotics. Other rare complications include damage to nerves or tendons near the joint that has been injected.

If you have repeated joint injections you may be at risk of damage to the soft tissue or cartilage in your joints. You may also increase the chance of steroids building up in your body, which has been linked to problems such as osteoporosis.

The chance of complications depends on the exact type of procedure you are having and other factors such as your general health. You should ask your consultant to explain how any risks apply to you.

Back surgery

About your back

Your spine is made up of bones called vertebrae, which are essentially the building blocks of your back. These bones are cushioned by discs of tissue which act as shock absorbers. Your spinal cord runs through a channel in the spine, and it is here where nerves branch off to the rest of the body. Occasionally though, these nerves can become compressed and create pressure which can be very painful.

What is back surgery (spinal surgery)?

When one or more nerves in your spine are put under pressure they can cause pain; back surgery is usually performed to relieve some of this pressure. The type of back surgery recommended will depend on your individual needs, as there are several causes of nerve compression. These include:

• Disc prolapsed/herniation – more commonly known as a ‘slipped’ disc, this occurs when a disc of tissue bulges out between two vertebrae.
• Spinal stenosis – this happens when the spinal canal becomes narrow due to cartilage in the vertebrae becoming worn or inflamed.
• Spondylolisthesis – this is the name for when a vertebrae slips out of position.

What does back surgery involve?

There are different types of back or spinal surgery depending on the source of the back pain. During a back operation, a surgeon may perform more than one type of procedure if it is needed. Back operations are generally done under a general anaesthetic, which would mean that you would be asleep throughout the procedure.

What are the symptoms of nerve compression?

Pressure on the spinal nerves causes problems with the traffic of nerve signals to and from the brain. Compressed nerves can also lead to sciatica, which is usually seen with these symptoms:

• Pain in the lower back, buttock, leg and foot
• Pins and needles
• Muscle weakness and/or wasting
• Loss of sensation

What treatments are available?

Your surgeon will discuss with you which type of back operation is most suitable for your pain. The operation may be done by an open surgery – involving a large cut being made in the back – or a keyhole surgery which is done by using a thin and long microscope and other special instruments through several small incisions on your back. Commonly performed treatments include:

• Discectomy
  During this procedure, the centre of the disc that is affecting the spinal cord or nerve is removed; this relieves the pressure and the pain caused by the protruding disc.
• Nerve root or spinal decompression
  The nerve root or spinal decompression method is done to remove any bone, disc tissue or other material that is putting pressure on the nerve or spinal cord areas.
• Spinal fusion
  In this procedure, your vertebrae are joined together by metal implants, or bone taken from your hip.

Are treatments available on the NHS?

Surgery for chronic back pain is available on the NHS, generally after a series of treatments including a combination of painkillers or stronger medication, exercise, physiotherapy, and cognitive behavioural therapy. Spire Healthcare is able to offer back surgery to you privately, with a physiotherapist on hand to discuss exercising after the operation, and to help make sure you are comfortable.

Back surgery aftercare

The amount of time needed for recovery is dependent on the type of treatment undertaken. Generally you are required to stay in hospital for two to seven days to recover from the surgery described here. Your physiotherapist will be able to help you exercise whilst you are in bed, and then will be able to help you get up and down the stairs before you are discharged. Your consultant will provide you with more advice about back surgery aftercare.

Carpal tunnel syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a fairly common condition that occurs when there is too much pressure on a nerve in the wrist.

The nerve enters the wrist through a narrow channel made of bones and a ligament, called the carpal tunnel. Because there isn’t much room in the tunnel, any swelling of the tissue in or around the carpal tunnel can compress the nerve, causing tingling, numbness or pain in your hand, wrist and forearm.

Surgery is needed if medicines or wrist splints have failed to relieve pain, or if your symptoms continue to get worse.

The operation is usually done under a local anaesthetic, which means that your wrist and hand will be completely numb but you stay awake.

The procedure is routinely performed as a day-case, with no overnight stay. Your surgeon will explain the benefits and risks of having carpal tunnel surgery, and will also discuss the alternatives to the procedure.

About the operation

There are two main types of surgery - open and keyhole. Your surgeon will discuss which technique is appropriate for you.

Open surgery

A single cut (about 5cm long) is made in the front of the wrist at the base of your palm. Your surgeon opens the carpal tunnel and cuts the ligament to relieve the pressure on your nerve.

Keyhole surgery

A small cut (about 2cm long) is made in your forearm just above the wrist or in the palm of your hand. A thin flexible telescope (endoscope) is passed into the cut to help see inside the wrist either by looking directly through this, or at pictures it sends to a video screen. Using a special instrument attached to the endoscope the ligament is cut.

After surgery, the skin cut is usually closed with dissolvable stitches. The operation can take 10 to 20 minutes.

The operation to relieve carpal tunnel syndrome is a commonly performed and generally safe procedure. However, all operations carry risks as well as benefits.

Complications specific to carpal tunnel surgery include a small risk of injury to other nerves, blood vessels or tendons in the hand.

Most people have little or no pain and numbness in their hand after surgery, but for some people it can take several months for discomfort to disappear.

In some cases, the symptoms of carpal tunnel syndrome can return, or you may experience a temporary loss of strength when pinching or gripping objects.

The chance of complications depends on the exact type of operation you are having and other factors such as your general health. Ask your surgeon to explain in more detail how any risks apply to you.

Is carpal tunnel treatment available on the NHS?

Carpal tunnel surgery is currently being restricted by the NHS in some areas of the UK and waiting lists are becoming significantly longer. For these reasons many people opt for private treatment.

Why should I consider having carpal tunnel surgery at a Spire hospital?

Whether you have medical insurance or are paying for your treatment yourself, with Spire Healthcare you will be seen quickly by the consultant-grade doctor of your choice at a time that suits you. You will be treated in a premium private hospital with some of the UK's highest standards of cleanliness and infection control.

Ganglion removal operation

What is a ganglion on the hand or wrist?

A ganglion cyst is a swelling filled with jelly-like fluid, that sticks out from the lining of a joint or tendon. It most often occurs around the wrist or ankle, or at the base of the palm of the hand. Surgery to remove it is needed if the ganglion is painful or when attempts to treat it, including draining the fluid, have not worked.

The operation to remove a ganglion is routinely performed as a day-case procedure, with no overnight stay. Your surgeon will explain the benefits and risks of having the ganglion removed, and will also discuss the alternatives to the procedure.

About the ganglion removal operation

If you are having the operation under local anaesthesia, your surgeon will usually need to wait at least 20 minutes for the anaesthetic to take effect before starting the operation.

Once the anaesthetic has taken effect, a cut is made over the ganglion. It is removed from the joint or tendon lining without disturbing the surrounding structures. Where a ganglion is tricky to remove, the cut will be larger than the size of the lump. At the end of the operation, the cut is closed with stitches. The operation usually lasts about 30 minutes.

Removing a ganglion is a commonly performed and generally safe operation. For most people, the benefits are greater than the disadvantages. However, all surgery carries an element of risk.

Complications specific to removal of a ganglion are rare. They include excessive swelling, delayed healing and damage to surrounding skin nerves. Occasionally, a ganglion reappears in the same place, but this is not common.

The chance of complications depends on the exact type of operation you are having and other factors such as your general health. Ask your surgeon to explain in more detail how any risks apply to you.

Is ganglion cyst removal available on the NHS?

Ganglion removal from the hand or wrist is currently being restricted by the NHS in some areas of the UK and waiting lists are becoming significantly longer. For these reasons many people opt for private treatment.

Why should I consider having a ganglion cyst removal operation at a Spire hospital?

Whether you have medical insurance or are paying for your treatment yourself, with Spire Healthcare you will be seen quickly by the consultant-grade doctor of your choice at a time that suits you. You will be treated in a premium private hospital with some of the UK's highest standards of cleanliness and infection control.

Dupuytren's contracture (palmar fasciectomy)

What is palmar fasciectomy for Dupuytren's contracture?

Dupuytren's contracture is a fixed flexion contracture of the hand where the fingers bend towards the palm and cannot be fully extended (straightened).

The usual operation for Dupuytren’s contracture is called palmar fasciectomy. It involves removal of a section of the tissue (the fascia) under the skin on the palm of the hand. The operation is either performed as a day-case, or will involve one night’s stay in hospital.

Palmar fasciectomy may be done under general anaesthesia, which means you will be asleep throughout the procedure. But it can also be done under regional anaesthesia, which means that you will still be awake but your hand will be numb.

Your surgeon will explain the benefits of having the surgery, and discuss the associated risks and alternatives to the operation.

About the palmar fasciectomy operation

Once the anaesthetic has taken effect, a tourniquet is put around the upper arm to control bleeding during the operation. Incisions are made into the affected fingers and palm. The affected tissue is removed, and the fingers are allowed to relax into their normal position.

In most cases, the cuts are stitched together to create a zig-zag scar that heals to allow the fingers to move freely. Sometimes stitches are not used because some surgical incisions heal better without them, causing less scarring and discomfort.

If the skin is also affected by Dupuytren’s disease, some of it may need to be removed. If this happens, a skin graft may be necessary. Skin will be taken from another part of the body to replace skin on your hand. This is a more complicated operation known as dermofasciectomy.

Local anaesthesia is usually injected around the operation site so that your palm and fingers are numb and you will not be in pain immediately after the operation. The operation may take an hour or more, depending on how many fingers are involved.

Once the local anaesthesia wears off, it is likely that you will have some pain or discomfort for a few days. Also, your hand will probably be swollen and bruised. This should settle down in two to three weeks.

The scar may be tender for a couple of months and the surrounding skin may become very dry. This can usually be relieved with a moisturiser such as E45. Ask your surgeon or nurse for advice.

A palmar fasciectomy is a commonly performed and generally safe operation. However, all surgery carries an element of risk.

Though surgery can help to improve the flexibility in your fingers, it does not stop the process of Dupuytren’s disease. So the contracture may return, requiring another operation.

Some other complications specific to palmar fasciectomy are shown below.

• In a few people the hand becomes stiff and painful. This is usually treated with physiotherapy.
• In severe cases, it may not be possible to fully straighten the fingers. Splints may be used afterwards to improve the results.
• The nerves to the fingers may be damaged, causing numbness in part of the finger. This is more likely to happen when a repeat fasciectomy is done. It may be possible to repair the damage with further surgery.
• Skin grafts may not “take” successfully in some cases.
• Very rarely, a finger may be lost. If you have had lots of previous hand surgery, have a disease that affects your circulation such as diabetes, or are a heavy smoker, this risk will be higher.

The chance of complications depends on the exact type of operation you are having and other factors such as your general health. Ask your surgeon to explain how any risks apply to you.

Why should I consider having a palmar fasciectomy for Dupuytren's contracture at a Spire hospital?

Whether you have medical insurance or are paying for your treatment yourself, with Spire Healthcare you will be seen quickly by the consultant-grade doctor of your choice at a time that suits you. You will be treated in a premium private hospital with some of the UK's highest standards of cleanliness and infection control.

Shoulder Arthroscopy

What's involved in a shoulder arthroscopy operation?

Shoulder arthroscopy is a “keyhole” operation that is used to look inside and treat the shoulder joint.

During the procedure a tube-like telescope called an arthroscope, which is about the thickness of a pencil, is inserted into the shoulder joint. The joint can be viewed either directly through the arthroscope, or at pictures it sends to a video screen, If necessary, other instruments can be inserted to repair any damage or remove material that may be interfering with movement or causing pain in the shoulder.

The operation usually takes 30 to 60 minutes and is routinely performed as a day-case, although some people stay in hospital for one night.

Why should I consider having a shoulder arthroscopy at a Spire hospital?

Whether you have medical insurance or are paying for your treatment yourself, with Spire Healthcare you will be seen quickly by the consultant-grade surgeon of your choice at a time that suits you. You will be treated in a premium private hospital with some of the UK's highest standards of cleanliness and infection control.

Shoulder replacement surgery

What’s involved in shoulder replacement surgery?

Each shoulder is made up of three joints. These joints work together to help the shoulder move. The largest of these joints is a ball and socket joint. The “ball” is formed by the top of the upper arm bone, which glides around on a “socket”, which is part of the shoulder blade.

During shoulder surgery, a metal ball on a stem is inserted into the upper arm bone and a plastic surface is fitted onto the socket.

Shoulder surgery is usually done under general anaesthesia, which means that you will be asleep during the procedure. However, for some patients, regional anaesthesia is preferable. This blocks the feeling in your shoulder and arm but you stay awake. Your surgeon and anaesthetist will discuss with you which type of anaesthesia is most suitable in your case.

You will need to stay in hospital for two to five days.

An artificial joint will usually last for at least ten years, after which it may need to be replaced.

Your surgeon will explain the benefits and risks of having a shoulder replacement surgery, and will also discuss the alternatives to the procedure.

About the shoulder replacement operation

A single cut, usually around 10 to 20cm long, is made along the upper arm and shoulder. When the joint has been replaced, your surgeon closes the cut with stitches or clips. The operation usually takes up to two hours.

Afterwards, a physiotherapist will visit you every day in hospital to guide you through exercises to help you recover. You will be encouraged to move your new shoulder from the first day.

After surgery, your shoulder area is likely to be sore for several weeks. You may also feel temporary pain and swelling in the upper arm.

Having a shoulder replacement is generally a safe procedure. However, all surgery carries an element of risk.

Some of the complications specific to shoulder replacement are listed here:

• infection of the wound or joint. Antibiotics are given during surgery to help prevent this.
• for up to six weeks after the operation, it is possible to develop a blood clot (DVT) in the veins in the leg. This clot can break off and cause a blockage in the lungs. In most cases this is treatable, but it can be a life-threatening condition. Compression stockings and blood-thinning injections are used to help prevent DVT.
• occasionally, small cracks in the bone result in a fracture of one of the shoulder bones during the operation. This can be treated but may slow down your recovery.
• damage to the nerves or blood vessels controlling the arm and hand. This is usually mild and temporary.
• the new joint may dislocate. This is most likely to happen immediately after the operation and you may need further surgery to treat this.

The chance of complications depends on the exact type of operation you are having and other factors such as your general health. Ask your surgeon to explain how these risks apply to you.

Why should I consider having my shoulder replacement surgery at a Spire hospital?

Whether you have medical insurance or are paying for your treatment yourself, with Spire Healthcare you will be seen quickly by the consultant-grade surgeon of your choice at a time that suits you. You will be treated in a premium private hospital with some of the UK's highest standards of cleanliness and infection control. What's more, you will have your own room with en-suite bathroom, and visitors can come to see you whenever you wish.