Orthopaedic and Inpatient Terms and Conditions
Payments for procedures are taken in advance of treatment and in full (See our General Term and Conditions)
Cancellations of Orthopaedic and Inpatient procedures must be requested 14 days prior to the treatment or procedure being completed.
For procedures where a Pre-Assessment has been conducted a charge of £350 is payable. Note this will be deducted from the procedure payment.
For procedures cancelled 7 days prior to the appointment a 40% cancellation charge of the procedure price shall apply.
For procedures cancelled from the date of the procedure and 6 days prior to the procedure a cancellation charge of 60% shall apply.
Note no refunds will be given for consultations or service prior to Orthopaedic or Inpatient procedures.
Orthopaedic Self-Pay Package
Included in the package price:
- Pre-admission outpatient tests, which includes standard pathology and diagnostic tests (ECG & Chest X-ray), if required.
- Recovery and accommodation which includes up to a up to 1 night stay in a private en-suite room. There is no reduction in reduced length of stay.
- Ward medications, ward dressings and ward nursing consumables.
- Theatre Procedure: Replacement of hip joint procedure, including anaesthetic drugs and theatre consumables.
- Standard post–op medication issued and used during the inpatient stay.
- Standard B Braun Prosthesis for main procedure only. If any other brand prosthesis is used these will be charged on top.
- Standard red cells, platelets, fresh frozen plasma and other blood products.
- Inpatient physiotherapy, occupational therapy, surgical stockings and crutches, if required.
- Discharge medication pertaining to the condition being treated by this package (up to £50).
- All patient meals and non-alcoholic beverages (light meals for day cases).
Excluded from the package price:
- Consultants Surgeon and Consultant Anaesthetist professional fees (charged directly).
- If High Dependency or /Intensive Care accommodation is required within the package, an additional supplement of £4000 per night is chargeable retrospectively.
- Diagnostic tests, ultrasounds, MRI, CT, PET and nuclear medicine scan, unless stated above.
- Prosthesis e.g. implants, grafts, mesh etc … including any non B Braun prosthesis.
- Procedures carried out as additional procedures will be charged as follows:
| LA | GA | |
| Additional Minor | £615 | £675 |
| Additional Inter | £810 | £885 |
| Additional Major | £1185 | £1385 |
| Additional Extra Major/Major plus | £1290 | £1680 |
(Please note, prosthesis for additional procedures will be billed in addition.)
- Additional pathology and supplies not pertaining to the condition being treated by the package.
- Histology tests (analysis of specimen, if taken), unless otherwise stated above.
- Neurophysiology, audiology and speech therapy.
- Take out supplies.
- Companion beds and catering for relatives / visitors
- Personal expenses – telephone calls, additional catering, ambulances, etc…
- Re-admission for return to theatres
- If pathology test Resistant Organism Screen (Mdr) is required, £165 will be charged in addition.
- f microbiologist services by Dr Gant are required, an additional initial fee of £250 will be chargeable. Thereafter a follow up fee of £200 will be chargeable.
A further discount is offered up to a maximum of 2 nights to cover accommodation, nursing, routine drugs and dressings and is chargeable as follows, after which normal billing applies:
a. Additional nights in ITU after the Package are chargeable @ £3,795 per day.
b. Additional nights in HDU after the Package are chargeable @ £2,735 per day.
c. Additional nights in Ward after the Package are chargeable @ £1,200 per day.
d. Additional nights in Specialised ward after the Package are chargeable @ £1,530 per day.
Please note extra procedures, diagnostic, pathology tests or therapy, are chargeable on top of the above accommodation rates, thereafter normal billing rates apply.
Please note that should you be claiming back from an insurer, another third party or a sponsor this package is not valid and a full itemised invoice will be raised. In these circumstances Primary Care Holdings Limited (Living Room Health, Fitzrovia Hospital, Cromwell Hospital or a location as per your booking) reserves the right to charge the standard tariff and not the package price.
Understanding The Risks
Information About Anaesthetic
- What is a ‘spinal’?
For many operations, it is usual for patients to have a general anaesthetic. However, for operations below the waist, it may be possible for you to have a spinal anaesthetic instead. This is when a local anaesthetic is injected into your lower back (between the bones of your spine). This provides anaesthesia from the waist down so that you do not feel any discomfort during the operation. With a spinal anaesthetic, you can stay awake during the procedure. Typically, the effects of a spinal anaesthetic last for a few hours. Other drugs may be injected at the same time to help with pain relief for many hours after the anaesthetic has worn off.
During your spinal anaesthetic, you may be:
– Fully awake
– Sedated – with drugs that make you relaxed or drowsy, but you will not be completely asleep, and you may be aware of your surroundings.
For some operations, a spinal anaesthetic can also be given before a general anaesthetic to give additional pain relief after your operation.
- Why have a spinal?
Based on your personal health, there may be benefits to you from having a spinal anaesthetic. The anaesthetist will discuss this with you and help you decide about what will be best for you.
The advantages of having a spinal compared with having a general anaesthetic may be:
- Lower risk of a chest infection after surgery.
- Lower risk of developing blood clots in the legs.
- Less negative effect on the lungs and breathing.
- Good pain relief immediately after surgery.
- Less need for strong pain-relieving drugs that can have side effects.
- Less sickness and vomiting.
- Earlier return to drinking and eating after surgery.
- How is the spinal performed?
1. You may have your spinal in the anaesthetic room or in the operating theatre. You will meet the aesthetic assistant who is part of the team that will look after you.
2. The anaesthetist or the assistant will connect monitors to measure your heart rate, blood pressure and oxygen levels and any other equipment as required.
3. Your anaesthetist will first use a needle to insert a thin plastic tube (a ‘cannula’) into a vein inyour hand or arm. This allows your anaesthetist to give you fluids and any drugs you may need.
4. You will be helped into the correct position for the spinal.
5. You will either sit on the edge of the bed with your feet on a low stool or you will lie on your side, curled up with your knees tucked up towards your chest.
6. The anaesthetic team will explain what is happening so that you are aware of what is taking place.
7. Local anaesthetic is injected first to numb the skin and make the spinal injection more comfortable.
8. The anaesthetist will give the spinal injection; you will need to keep still for this to be done. A nurse or healthcare assistant will usually support and reassure you during the injection.
9. Sometimes, a urinary catheter (a flexible tube to drain urine from your bladder) may be required. If you need one, it will be inserted after the spinal has started working.
- What will you feel?
A spinal injection is often no more painful than having a blood test or a cannula inserted. It may
take a few minutes to perform, but can take longer, particularly if you have had any problems with your back or if you have obesity. A few attempts may be required in some cases.
- During the injection, you may feel pins and needles or an unusual sensation in one of your legs if you do, try to remain still, and tell your anaesthetist.
– When the injection is finished, you will usually be asked to lie flat if you have been sitting up.
– The spinal usually begins to have an effect within a few minutes.
- To start with, your legs and tummy may feel warm, then numb to the touch. Gradually you
will feel your legs becoming heavier and more difficult to move. This is perfectly normal and
means that the anaesthetic is working.
- When the anaesthetic is working fully, you will not be able to lift your legs up and you will not feel any pain in the lower parts of the body.
- Testing if the spinal has worked.
Your anaesthetist will use a range of simple tests to see if the anaesthetic is working properly, which may include:
- Spraying a cold liquid and asking if you can feel it on your legs and tummy.
- Gently touch your legs and tummy with a blunt-ended instrument asking you to lift your legs.
It is important to concentrate during these tests so that you and your anaesthetist can be reassured that the anaesthetic is working.
- During the operation (spinal anaesthetic alone)
In the operating theatre, a full team of staff will look after you. If you are awake, they will introduce themselves and try to put you at ease.
The anaesthetist and the anaesthetic assistant will be looking after your safety and well-being throughout the operation.
You will be positioned for the operation. You should tell your anaesthetist if there is something that will make you more comfortable, such as an extra pillow or an armrest.
You may be given oxygen to breathe, through a lightweight, clear plastic mask, to improve oxygen levels in your blood.
You will be aware of the ‘hustle and bustle’ of the operating theatre, but you will be able to relax, with your anaesthetist looking after you.
You may be able to listen to music during the operation. If you are allowed, bring your own music, with headphones. Some units supply headphones or play music in the operating theatre.
You can talk with the anaesthetist and anaesthetic assistant during the operation. This will depend on whether or not you have been given sedation.
If you have sedation during the operation, you will be relaxed and maybe sleepy. You may snooze through the operation, or you may be awake during some or all of it. You may remember some, none, or all of your time in theatre.
- Procedure Risks
As part of our consent procedure, the following risks were discussed with you during your consultation:
Risk of infection – The procedure carries a risk of infection and the national infection rate for these procedures stands at 0.5% to 5%. Our experienced surgeon has an infection rate of 1 in 3000 patients.
Risk of general anaesthetic – There are risks associated with having a general anaesthetic or, indeed a spinal anaesthetic. Some people have an adverse reaction, which can be fatal in very rare cases. In the United Kingdom, we must give you a worst-case scenario as part of the consenting process. The chances of an adverse reaction to an anaesthetic agent is extremely low and the chances of having a fatality from this are vanishingly low.
Risk of thrombosis or blood clots – There is a risk of having a blood clot either in your calf or your lungs. This is called a deep vein thrombosis that occurs in the calf or a pulmonary embolus if it occurs in the lungs. The risk of this happening is extremely low with this procedure. The national average quoted is 1 per 1000 hip replacements performed. With the technique that is carried out by Dr Kley, most patients are able to walk on the day of surgery or the day following really quite comfortably, and it is early mobilisation that reduces the risk of thrombosis or blood clots. As mentioned above, these can occur and they can be fatal, but again, we are giving you the worst-case scenario as part of the consenting process, which we are legally obliged to follow in the United Kingdom.
Risk of nerve or vessel damage – There is a risk of damaging a nerve or a vessel when carrying out the hip replacement. The risk of this is extremely low. With the particular approach that we are carrying out, we are as far away as we could be from the front nerve, the femoral nerve and the back nerve, the sciatic nerve and this is not a complication that Dr Kley has experienced in his series of over 3,000 cases.
Intra-articular fracture – There is a possibility that during the procedure, a fracture could occur either when the cup is inserted into the pelvis or when the stem is inserted into the femur. This is something that is detected at the time and then dealt with. This may affect your rehabilitation which might be a little slower. Fractures can occur late following the surgery and this is something that we will monitor in the outpatient department. We pick this up with an x-ray. Fortunately, the chance of this complication is extremely low.
Leg length discrepancy – There is a risk that when we insert the new hip that to get this into the right level of tension such that the hip is balanced and stable, we can make the leg slightly longer or shorter. We do digital templating as part of our preoperative planning process using software, and we normally get the prosthesis to within 5 mm. It is extremely uncommon for the leg length to change by more than 15 mm, and it is at this point where patients detect a difference. It can occur, and it is something we need to make you aware of, but it is extremely unlikely.
Risk of stiffness – Most patients do extremely well following a hip replacement and significantly improve their range of motion. Some patients even return to a normal level of motion, but that is uncommon. Most patients will still experience a minor amount of stiffness following a hip replacement procedure, but their range of motion will be infinitely better than it was prior to the procedure, as most hips are extremely stiff prior to a total hip replacement.
Risk of dislocation – There is the possibility that the hip can dislocate. The national statistics quote between 1 and 5% of total hip replacements being carried out in the United Kingdom dislocate. Over 100,000 are carried out each year, meaning between 1000 and 5000 patients have this complication. Sadly, this does occur, which normally means that the implants aren’t optimally positioned, and the surgery needs to be revised and repeated. With the approach that Dr Kley uses in his series, he has never experienced a single case of dislocation in over 3,000 hip replacements implanted.
Risk of chronic pain – With any major surgical intervention, there is a chance of developing chronic pain to a mild-to-moderate or significant degree after surgery. Fortunately, total hip replacement surgery carries the greatest improvement in quality of life other than cataract surgery. These two together are considered to be the procedures that we carry out in surgery and across all surgical fields to improve life quality more than any other surgical intervention. Having said that, some patients don’t do well and go on to develop pain to a mild-to-moderate or significant degree. This is extremely uncommon.
Risk of early failure of the implant – Your hip replacement should last a significant amount of time. The 10-year survivorship is in the high 90s, and the 20-year data is in the high 80s regarding the percentage of hip replacements that fail. In other words, most patients get at least 20 years out of their hip replacement before they need to have it changed. We are even beginning to see some good 30-year data. Having said that, the hip prosthesis could fail early, within a few months or a few years. This will manifest itself with pain and stiffness; we would then normally detect this on an X-ray. The answer to this would be a revision hip replacement. As mentioned above, the long-term survivorship of modern total hip replacement implants is extremely good.
