Orthopaedic surgery


What is orthopaedic surgery?

Orthopaedic surgery, or orthopaedics, is a surgical specialty that deals with trauma (physical injury) and conditions that affect the musculoskeletal system. 

The musculoskeletal system includes:

  • Bones
  • Joints
  • Muscles
  • Tendons
  • Nerves

Benefits of orthopaedic surgery can include: 

  • Pain relief
  • Improved mobility 
  • Functional independence 

Common musculoskeletal conditions

Orthopaedic surgeons often complete additional training to specialise in treating a particular area of the musculoskeletal system. The Royal Free Hospital Private Patients Unit offers expert treatment of upper-limb disorders, lower-limb disorders, spinal conditions and paediatric orthopaedic problems.

Upper-limb disorders

The upper limb refers to the shoulder, elbow and wrist joints, along with the bones, muscle and tendons of the upper arm and forearm. The hand is usually considered to be a specialist area in itself. 

Upper limb problems are often caused by trauma or overuse. Sometimes however, the cause may be less obvious.

Shoulder problems

Shoulder pain is the most common upper limb problem. 

Symptoms of a shoulder problem can include: 

    • Pain over the rounded part of the shoulder or in the upper arm 
    • Pain that worsens when lifting the arm, for example, to reach shelves  
    • Restricted shoulder movements, for example, affecting ability to put on a car seatbelt
    • Weakness when lifting with the arm away from the body
  • Difficulty with daily activities, for example, dressing

Shoulder impingement syndrome

Most shoulder pain is caused by problems within soft tissues, such as tendons (tough bands of fibrous connective tissue that connect muscle to bone). Shoulder impingement syndrome is a common problem that can cause a ‘painful arc’; pain that peaks when lifting the arm to around shoulder height, but may improve when reaching further overhead. 

Other names are sometimes used to describe this type of shoulder pain including ‘painful arc syndrome’ and ‘sub-acromial pain syndrome’. In most cases, a special programme of exercises under the supervision of a physiotherapist leads to a good recovery.

An orthopaedic consultant may offer an injection of steroid medicine into the shoulder, to help relieve pain. Occasionally, a minimally-invasive procedure called an arthroscopy (keyhole operation) may be recommended to look for other causes of shoulder pain or to relieve compression of soft tissues.

Rotator cuff injury

The rotator cuff is a cluster of tendons that stabilises, supports and helps to move the shoulder. Trauma to the shoulder can tear the rotator cuff. Acute (sudden) tears require urgent assessment by an orthopaedic specialist. In some cases, rotator cuff repair surgery may be recommended, either by arthroscopy or open surgery. 

Symptoms of a rotator cuff tear can include:

  • Pain, particularly when moving the arm against resistance
  • Weakness, particularly during movements such as reaching for a car seatbelt

Sometimes rotator cuff tears occur without an obvious injury. These ‘degenerative tears’ often occur in later life. Symptoms usually improve by following a programme of physiotherapy exercises.

Frozen shoulder

Frozen shoulder, or adhesive capsulitis, is a condition of pain and stiffness that develops in the shoulder over the course of many months. This problem can occur following shoulder injury or surgery, but in most cases the cause is unknown. Frozen shoulder is more common in people who have diabetes. 

Although the initial pain can be severe, frozen shoulder usually improves on its own. Nevertheless, some shoulder stiffness may persist for a few years. 

An orthopaedic surgeon may administer injections to relieve pain and refer for physiotherapy to help improve stiffness and regain function. Occasionally, surgery may be recommended.

Shoulder dislocation

The shoulder is the most commonly dislocated (dislodged) joint, often following a fall onto the affected arm. 

Shoulder dislocations can be very painful and require emergency treatment. In the emergency department (A&E), a doctor will usually:

  • Offer treatments to help reduce pain
  • Examine the shoulder and check for injury to nerves or blood vessels
  • Obtain an X-ray, to assess damage to bony structures
  • Manipulate the dislocated shoulder back into the correct position

Dislocations can damage important shoulder structures including supportive ligaments, leading to further dislocations. 

An orthopaedic surgeon will assess the shoulder injury and advise on how to minimise the risk of ongoing problems. Treatments may include:

  • Modification of normal activities 
  • Physiotherapy 
  • Surgery to stabilise the shoulder, if there is a significant risk of ongoing problems. This may involve arthroscopy or an open operation

Osteoarthritis of the shoulder or elbow

Osteoarthritis (‘wear and tear’, degenerative arthritis) may affect the shoulder or elbow, particularly after fracture or dislocation of these joints. Symptoms include:

  • Pain or crepitus (grinding sound) during movement
  • Stiffness
  • Functional impairment or disability, particularly with washing and dressing

Treatments for shoulder and elbow osteoarthritis may include medications or injections to relieve the pain, and physiotherapy. 

If pain or disability is severe, or affects daily activities, surgery may be recommended. The specialist team at the Royal Free Hospital Private Patients Unit includes leading consultants who have expertise in shoulder arthroscopy, shoulder replacement and total elbow replacement surgery (joint replacement surgery).

Tennis elbow (lateral epicondylitis)

Tennis elbow usually affects adults between 30 and 50 years of age and is often triggered by repetitive activities that use the elbow joint. Symptoms include:

  • Pain at the outside of the elbow or upper forearm, worsened by gripping, twisting or lifting
  • Tenderness of the bony lump on the outside of the elbow
  • Aching in the forearm

Tennis elbow usually disappears with time (often several months). It helps to rest from activities that worsen the pain. If pain is severe or persistent, an orthopaedic surgeon may recommend treatment such as: 

  • Physiotherapy
  • Injections of steroid medicine to relieve pain or platelet-rich plasma (PRP). PRP uses regenerative factors from a patient’s own blood to help the body to recover
  • Surgery (in rare cases)

Lower-limb disorders

Hip and knee problems are very common reasons to consult an orthopaedic surgeon. Our leading consultants specialise in the treatment of conditions that affect the bones, joints, muscles and tendons of the thigh, lower leg and foot. 

Common lower limb disorders include:

  • Hip or knee osteoarthritis
  • Sports injuries to the knee
  • Trauma; for example, ankle fractures in young, active people and hip fractures in older adults who are prone to falls

Hip or knee osteoarthritis

Osteoarthritis is common, especially in later life. Most often, osteoarthritis affects the hip or knee.

Symptoms of hip osteoarthritis include:

  • Aching pain in the groin, thigh, buttock or the knee
  • Stiffness, particularly after prolonged sitting
  • Loss of mobility

Symptoms of knee osteoarthritis consist of:

  • Pain and stiffness around the knee, often worsened by bending, kneeling or squatting
  • Swelling of the knee, particularly after exercise
  • Progressive deformity, for example bow-legged appearance
  • Loss of mobility

It is important to keep a healthy weight and to remain active if osteoarthritis of the hip or knee has been diagnosed. An orthopaedic surgeon will carry out an examination and may request X-rays to assess the severity of osteoarthritis. Exercise prescribed by a physiotherapist can help to reduce pain and improve mobility. 

For severe cases of osteoarthritis, an orthopaedic surgeon may recommend joint replacement surgery. 

Sports injuries of the knee

Knee injuries occur during many sports, including football, skiing and basketball. Our leading consultants at the Royal Free Hospital Private Patients Unit specialise in diagnosing and treating sports injuries

Following a knee injury, a medical review should be sought if any of the following occur:

  • A tense swelling that makes it difficult to bend the knee
  • Giving way, or collapsing of the knee
  • Locking of the knee (getting stuck in a bent position)
  • Difficulty walking or bearing weight
  • Pain that does not improve after one week of resting and applying ice packs to the knee

The menisci (shock-absorbing cartilages within the joint of the knee) are often torn during twisting injuries. Sometimes this injury requires an arthroscopy.  

Anterior cruciate ligament (ACL) rupture can be accompanied by a painful ‘pop’, followed by sudden swelling and persistent instability of the knee. An orthopaedic surgeon can provide a diagnosis and discuss options for ACL reconstruction surgery


Trauma can lead to fractures (broken bones) and soft tissue injuries. Orthopaedic surgeons treat fractures by immobilisation (often in a plaster cast), followed by rehabilitation. In some cases, orthopaedic surgery may be recommended to improve the outcome of the fracture and help resume normal activity. 

In later life, fractures are frequently caused by falls. Elderly females who have weakened bones (osteoporosis) are at particular risk. 

When hip fractures occur, orthopaedic trauma surgery reduces pain, improves mobility and increases the likelihood of returning to an independent lifestyle.

Spinal conditions

Lower back pain is the most common cause of disability globally. In most cases, pain will resolve within a few weeks and does not require specialist treatment. A practitioner can offer advice and may make a referral for physiotherapy. 

In very rare cases, urgent medical attention is required. The emergency department (A&E) should be attended immediately if any of the following symptoms develop:

  • Sudden loss of bladder or bowel control
  • Inability to pass urine
  • Numbness of the genitals or around the back passage
  • Sudden loss of power in one or both legs

Orthopaedic spinal surgeons are experts in the treatment of spinal fractures, and may be able recommend treatment for cases of severe back pain that affects one or both legs.

Common orthopaedic procedures

At the Royal Free Hospital Private Patients Unit, our leading consultants use state-of-the-art treatments such as platelet-rich plasma (PRP) injections and arthroscopy (keyhole surgery) to minimise the need for open surgery. Our specialist clinical team works closely with patients to identify the most effective way to meet their goals for recovery.

We are proud to offer access to the following procedures:

Arthroscopy (keyhole surgery)

Arthroscopy is a minimally-invasive operation that involves passing a camera and small tools into a joint through small incisions (surgical cuts). At the Royal Free Hospital Private Patients Unit, specialists regularly perform arthroscopy of the shoulder, elbow, wrist, knee and ankle.

Benefits of arthroscopy can include:

  • Information about diagnosis and prognosis
  • Treatment such as repair of meniscal tears or rotator cuff tears 

Arthroscopy is a very common procedure. Complications are rare, however, as with any surgery, there are some risks to arthroscopy:

  • The medications used in the anaesthetic may cause problems such as vomiting (sickness) after the procedure, in rarer cases, allergic reactions or breathing problems can occur
  • As with all surgical procedures, arthroscopy can also carry a small risk of bleeding or infection

Joint replacement surgery 

Severe osteoarthritis can be a disabling condition. Joint replacement surgery has been a huge breakthrough in helping those affected to remain mobile and independent. 

At the Royal Free Hospital Private Patients Unit, patients who require joint replacement surgery can expect the convenience, comfort and personalised attention of a private hospital combined with state-of-the-art technology and the professional experience you would expect from a top London teaching hospital.

Specialists at the Royal Free Hospital Private Patients Unit perform world-class shoulder replacement, total elbow replacement, total hip replacement and total knee replacement operations, along with specialist hip revision surgery. 

All joint replacement procedures are registered with the National Joint Registry, which offers in-depth information about joint replacement surgery for patients.

Benefits of joint replacement surgery can include:

  • Pain relief
  • Increased mobility
  • Improved independence.

Although uncommon, as with any other surgery, there are risks to joint replacement surgery. These include infection, bleeding and adverse reactions to anaesthesia. Other complications can include:

  • Deep vein thrombosis (blood clot in the leg) or pulmonary embolism (blood clot in the lung)
  • Persistent joint stiffness
  • The need for further surgery.

Anterior cruciate ligament (ACL) reconstruction surgery

ACL rupture is a common injury of the knee that can lead to recurrent giving way and difficulty participating in sports and exercise. ACL reconstruction involves using healthy tissue (usually from the thigh) to recreate a functional ligament, followed by a programme of rehabilitation.

Benefits of ACL reconstruction followed by rehabilitation can include:

  • Reduced pain and swelling, particularly after exercise
  • Freedom from the knee collapsing unexpectedly
  • Ability to return to sports

In addition to the risks of anaesthesia and surgery in general, potential complications of ACL reconstruction can include:

  • Pain over the front of the knee
  • Limited range of knee movement
  • Damage to nerves in the leg

Platelet-rich plasma (PRP) treatments

PRP is a state-of-the-art treatment that involves using the regenerative factors found in a patient’s own blood to encourage healing. 

At the Royal Free Hospital Private Patients Unit, specialists offer PRP as an injection-based, non-surgical treatment for certain conditions. Consultants also use PRP and other regenerative techniques during surgical procedures to improve tissue healing. 

As PRP comes from a patient’s own blood, the risk of an allergic or immune reaction to injection is very low. Other complications are also very rare, but may include:

  • Pain, inflammation or infection at an injection site

Trauma surgery

Our leading consultants are experts in the use of modern orthopaedic techniques for the treatment of traumatic injury, such as: dynamic hip screw (DHS) and hemiarthroplasty following hip fractures; intramedullary nailing for fractures of long bones including the femur and humerus; open reduction and internal fixation using state-of-the-art implants for fractures such as the wrist, ankle and clavicle (collar bone).

Here at the Royal Free Hospital Private Patients Unit we can offer convenience, comfort and personalised attention to your care. We aim to deliver the high standard of care and safety that you would associate with an acute NHS hospital and we have the capacity to admit both adult and paediatric patients for private orthopaedic surgery.

Trauma surgery will be recommended only in cases where the benefits are considered to outweigh the risks. Nevertheless, complications can occasionally occur and may include:

  • Anaesthetic complications, including allergic reactions
  • Deep vein thrombosis or pulmonary embolism 
  • Pressure ulcers (sores) from prolonged immobility
  • Bleeding, infection or wound healing problems
  • Damage to nerves or blood vessels

Our specialists are very experienced at performing these surgical procedures and will take every care to ensure your safety and comfort. 

World-class orthopaedic care

We are proud to offer world-class private care in the safety and assurance of an NHS foundation trust. We are committed to reinvesting the incomes from the Royal Free Hospital Private Patients Unit back into our NHS services, for the benefit of all our patients.

We look forward to welcoming you to our orthopaedic centre should you choose us to support your care.