Please click on the headers below to read more information.
Booking an appointment
An appointment can be made via Sarah by email or 07805075923, or directly through the hospitals/clinics
Information for Insured Patients
Mr Bache is registered and recognised as a provider by all of the major insurance companies and works within their guidelines.
Patients who have Private Medical Insurance will need to contact their private health provider prior to their appointment or operation to pre authorize. This will ensure that they are covered for their initial consultation, scans, x-rays and any other treatment that may be required. The insurance company will provide patients with a Pre Authorisation Number or Claim Number, it is helpful to provide this for administration and invoicing purposes and will allow us to deal with the insurance company directly for the payment of invoices.
Insured patients will usually require a referral letter from their GP, or another Healthcare Professional, this is usually stipulated by Private Medical Insurance Companies.
Information for Uninsured Patients
Mr Bache is happy to see uninsured patients in his private clinics. However it is important that uninsured patients appreciate that imaging (MRI and plain radiographs/or x-rays) may be required to achieve an initial diagnosis. If these have been performed elsewhere it is useful to obtain a copy on disc and bring this to the consultation. Consultation charges are available on request. Subsequent charges for imaging and if appropriate, surgical procedures can also be provided as necessary.
A GP or other Healthcare Professional referral letter is requested; this will provide a medical history and ensure that your GP is kept informed.
Uninsured patients will be invoiced following their consultation and payment may be made by cash, cheque or bank transfer.
Patients Having Surgery
Prior to admission Mr Bache will discuss the procedure in detail in your outpatient appointment; let him know of any planned holidays so that we can book a mutually convenient time for surgery.
The reservations department or private patient manager of the hospital will contact you and give you written information about admission dates, times and starving instructions. (if you do not receive any information as expected please contact Sarah)
If you are insured we will give you a procedure code, let you know the anaesthetist if needed as you will need to pre authorise the surgery with your insurers. If you are not insured we will let you know the costs involved.
Pre operative precautions
Generally if you are on the oral contraceptive pill you should stop taking this 6 weeks prior to surgery (it adds to the Thrombosis risk) also you should avoid flying 6 weeks pre and post operatively. Please let Mr Bache know of any regular medication you are on so that we can ensure all is well.
You will be admitted on the day of surgery and discharged later the same day (usually approximately 4 hours after an anaesthetic).
You will usually need to have a pre operative assessment, this allows the staff at the hospital the opportunity to take any swabs for MRSA and blood test that need to be taken prior to admission. It will also allow you to ask about your hospital stay and admission details. You will need to take your regular medication into hospital with you. Children will be operated on on the designated paediatric list and parents can often stay in the room if an overnight stay is needed.
It is important that there is somebody to collect you following surgery
*Following an intra articular hip injection there is a chance that some of the local anaesthetic can migrate down into the leg.
*Following an anaesthetic legally you must not drive for 48hours (Mr Bache will advise for hip arthroscopy patients).
It is advisable that somebody is with you the first evening following surgery for safety.
You will receive an outpatient review appointment through the post following surgery (please contact Sarah if you don’t)
Removal of stitches
Mr Bache uses dissolvable stitches so there is no need for this.
The hospital can issue these and when they run out you can get a repeat prescription from your GP
Prevention of Blood Clots
You will be issued with 2 pairs of T E D stockings please wear these for 6 weeks following surgery (they can be washed by hand and line dried)
Clexane will be issued for 3-4 weeks post operatively.
Also follow precautions re flights and oral contraceptive pill as previously mentioned.
Hip arthroscopy patient will usually need elbow crutches or sticks the hospital will charge for these so if you have a pair please bring them with you.
Mr Bache will let you know if you need physiotherapy post operatively. If you are going to have it at the hospital where you have the operation, the inpatient physiotherapist who will help get you up and give you an exercise regime for home will arrange this for you.
If this is not convenient please contact Sarah who can advise you of recommended physiotherapy clinics nearer to your home.
Please check with your insurers in advance, as you may not be covered for physiotherapy treatment, we can arrange alternative packages and nhs treatment if necessary.
DDH Children: Will hip spica delay development of my baby?
No. Your baby will be immobile in her spica for about 3 months and when the cast is removed the legs will be a little stiff. Most infants will be walking within 2-3 weeks (some babies will manage to walk even in the spica although this isn’t to be encouraged). If the legs are still stiff after 6 weeks then physiotherapy is occasionally required.
DDH Children: What about car seats/buggies etc?
Several specialist companies have developed adapted buggies and prams. Equipment can be purchased or hired through the STEP’s charity website.
DDH Children: How can I clean my baby in the hip spica?
Most types of hip spica are not waterproof and it will not be possible to bath your baby. There is enough access to wipe the groin area and bottom and to change nappies. It is important to maintain the spica as dry as possible as the skin can become sore if it is persistently damp.
DDH Children: What are the results of surgery for DDH?
Mr Bache has operated on more than 200 children with DDH. The most feared complication is redislocation. Most published studies have a redislocation rate of 3- 4%. Mr Bache has a redislocation rate of 2%. Babies will need to be reviewed in clinic until age 16 as a small percentage of children will require further surgery either for residual shallowness of the acetabulum or for minor leg length inequality.
Overall, more than 90% of children will have normally functioning hips into adult life although it is recognized that patients are at increased risk of developing osteoarthritis as they head into middle age.
Young Adult Hip Patients: Why not have joint replacement rather than joint preserving surgery?
Total hip replacement (THR) is a very successful operation. Short term results are excellent but over time it is inevitable that the artificial joint will either wear out or wear loose. A second replacement is possible but difficult and the results are nowhere near as good as with the first operation. Ninety percent of THR’s will last 10 years. Younger patients will need their THR to last longer and also tend to be more active resulting in increased wear of the prosthesis. In this age group joint preserving surgery is preferable but the amount of damage to the joint has to be considered and sometimes there is no other option. As a rule osteotomies are rarely appropriate for patients more than 35 years old and hip arthroscopy up to the age of 60 providing there is no evidence of arthritis.