It is perhaps not surprising that the process of obtaining adequate informed consent prior to surgery has become increasingly more complex over the last few decades. As we see the increased application and introduction of new advances in surgical technology and techniques in orthopaedic surgery, there inevitably follows a wider choice of treatment. We are therefore not only duty bound to explain to our patients the different treatment options and to assist them in understanding the choices they need to make between surgical and nonsurgical treatments but also the exact nature of these procedures and the proposed benefits and inherent risks therein. There is an understandable temptation to assume that the act of taking consent is a “tickbox exercise” merely required to prevent medicolegal litigation. Indeed, there appears to be a general misconception that to operate on someone without written consent would necessarily be construed as an act of criminal assault. This view mistakes the true purpose of gaining consent, namely, to explain the thinking behind the surgeon’s recommendations for treatment and to appropriately manage the patient’s expectations of what can occasionally go wrong with an intervention whilst outlining the relative merits and outcomes of such an intervention.

Just how we should obtain the “perfect consent” is not clearly defined in the literature, as no such document actually exists. What we hope to achieve in this brief chapter is to bring together all the various guidelines that exist, indicating how we believe it is best to currently undertake this important process for the benefit of both the patient and the surgeon. We feel that it is only by embracing the opportunity that consent gives the clinician to better communicate with the patient that we can hope to make the whole process of mutual value for surgeons and patients alike. We will examine how, where and when consent should be completed, as well as the principles of what to include.