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Will my shoulder last forever or will I have to have it replaced in years to come?
It is expected that the time-span for the prosthesis will be 10–20 years.
It is expected that the time-span for the prosthesis will be 10–20 years.
We do not recommend soaking in a bath until your wound has healed completely. You will need some assistance with showering until you become more confident. To dress easily, always put your operated arm, through your sleeve first.
Driving a motor vehicle is usually not recommended until two conditions are met: 1. It has been at least six weeks after the surgery, and 2. The shoulder is comfortable enough so that when you are standing you can raise your arm to the horizontal position straight out in front of you twenty times.
Using these criteria, we avoid placing the shoulder, passengers, other drivers and pedestrians at risk from a shoulder that cannot perform in emergency situations.
You will have some pain following the surgery but each day this will improve with regular pain relief and as the swelling settles down. It is worth noting that patients who have had this surgery regularly say that while it is painful after the surgery, it is often nowhere near as bad as that which they had before the operation!
The sling only needs to be worn for the first few days after the operation then we encourage you to come out of it as much as possible. It is a good idea though to wear the sling when going out of doors to avoid others from knocking or bumping your shoulder.
Usually three to five days but it always depends on how you are feeling.
This is entirely up to you and always depends on how well you manage normally and whether you have help at home.
No, autologous blood donation is not required and post-operative blood transfusions are rare after this type of surgery.
Eventually you will need to see a physiotherapist but initially you are considered the best physiotherapist. You will be encouraged to gently start using your arm the day after the operation and will be shown some very simple exercises to do yourself three times a day. You usually start to visit a physiotherapist about six weeks after your operation.
It really depends on the type of work that you do. If your work is office based and deskwork you could expect to be back at work within a week or two, so long as you had some way of getting there.
Any work involving heavy lifting would need to be avoided until 4–6 months after your surgery.
You cannot drive whilst wearing a sling – so not for 6 weeks.
Often just one day but maybe overnight depending on how you feel after your general anaesthetic.
There will be a moderate amount of swelling after the operation for the first 2–3 weeks, particularly above the kneecap.
See, Anterior Cruciate Ligament (ACL) Reconstruction
Possible complications that may occur, but are very low with this procedure, include: 1. Blood clots developing in the legs (deep vein thrombosis) that can travel up to the lungs (pulmonary embolism). Precautions are taken to try and prevent this whilst you are in hospital and after your discharge.
See, Anterior Cruciate Ligament (ACL) Reconstruction
You can return to sporting activities nine months after this procedure. See, Anterior Cruciate Ligament (ACL) Reconstruction
Most people need 14 days off work if they are office-based; however, if you are involved in physical work, you will need at least 6 to 12 weeks off work. See, Anterior Cruciate Ligament (ACL) Reconstruction
The sutures will be removed 10–14 days after surgery. See, Anterior Cruciate Ligament (ACL) Reconstruction
You can shower straight away after this operation. You will need to wear waterproof dressings that you will be given in the hospital. If they wash off in the shower, they can easily be reapplied. See, Anterior Cruciate Ligament (ACL) Reconstruction
A physiotherapist will see you whilst you are in hospital and when you are discharged.
After discharge, arrangements will be made for you to have physiotherapy at a place convenient to you. You will need physiotherapy twice a week for the first six weeks after this procedure, and then less frequently for six months after surgery to completely rehabilitate the knee. See, Anterior Cruciate Ligament (ACL) Reconstruction
Most people have some weakness in the quadriceps (thigh) muscle after this operation, so a brace will be supplied which may need to be worn for the first two weeks after the procedure. See, Anterior Cruciate Ligament (ACL) Reconstruction
Most people stay in hospital for 24–48 hours after this procedure. See, Anterior Cruciate Ligament (ACL) Reconstruction
Walking and normal daily activity is encouraged after TKR, but impact sport is probably damaging.
If you are to have any invasive procedures after a TKR such as dental work, bowel surgery etc. please inform your treating professional that you have a joint replacement, as you may need to be given antibiotics to protect the prosthesis from infection. The highest risk for this is within the first three months. See, Total knee replacement.
Unlike arthritis in the hip, the majority of knee arthritis is caused by injury to the structures within the knee, or wearing out of the cartilage. There are other secondary causes such as infection, malalignment, trauma, dysplasia, inflammatory disease, avascular necrosis, and knee disease often runs in families suggesting an inherited problem. See, Tibial osteotomy.
It used to be thought that arthritis of the hip was nearly always caused by just wear and tear (primary Osteoarthritis).
More recently, it has become apparent that actually in the vast majority of cases a structural abnormality can be identified that has caused the arthritis to develop (secondary Osteoarthritis). The majority of these abnormalities occur before birth, or in childhood and include, developmental dysplasia of the hip, femoro-acetabular impingement, slipped upper femoral epiphysis (link) and Perthes disease.
Other causes of secondary arthritis include conditions that cause damage to the cartilage including; trauma, avascular necrosis, infection, and inflammatory arthritis. Even within those cases, where no obvious cause is found for the Osteoarthritis (primary Osteoarthritis), there is often a strong family history of hip disease, suggesting a genetic weakness in the patient’s cartilage. See, Total hip replacement
Hip resurfacing is a specialised kind of hip replacement where the minimal amount of bone is removed from the head of the femur. See, Hip resurfacing
Advantages of this implant are preservation of bone and anatomy, a hardwearing bearing, hip stability, and potential for very high levels of patient activity. It is the only hip that potentially allows the patient to return to any activity including running, climbing etc. Resurfacing is best suited to high activity, young, male patients without significant bony deformity.
It has become apparent that the cause of hip arthritis in the majority of these young athletic males is femoro-acetabular impingement, and resurfacing is ideally suited to deal with the pattern of arthritis that this causes.
Joint replacement was previously reserved for elderly patients because we know that over 80% of implants will survive 20 years, but much less will survive in the more active and demanding younger patients.
There is no doubt that joint replacement can make an enormous positive difference in the quality of life in younger patients, and should not be denied to them.
Advances in technology such as high performance hip replacement bearings and implants have improved implant survival in this group. However, the likelihood of further re-do surgery is inevitable, and this presents potential future problems for these patients.
Options more suited to the younger hip patient are joint preserving procedures such as osteotomies around the hip, impingement surgery, alternative bearings and resurfacing of the hip.
The decision to undergo total hip replacement always remains with you, the patient. The surgeon will make sure of the diagnosis and advises you of the implications and possible complications. Pain and loss of function are the most important indications for joint replacement surgery. See, Total Hip Replacement
Our routine hip replacement patients will usually be able to go home on the second to third day post operatively (although individual requirements vary). See, Minimally invasive hip replacement
Thrombosis is an abnormal formation of solid blood constituents within the veins. This can move into the lung where it is called a pulmonary embolus. Minor thrombosis is very common after joint replacement surgery, but only requires treatment in about 1% of people, when it produces excessive pain and swelling of the calf and/or thigh. Pulmonary embolus is rare occurring in less than 1 in 1000 patients after joint replacement, but can be life threatening. Prevention of these conditions is controversial, and many treatments have been tried. All drug treatments for this have significant potential side effects, and it is the balancing of the risks of developing this problem, and the complications of taking the anticoagulants, compared to the benefits of the medications that is difficult to define.
Orthopaedics WA assess all our patients for risk of DVT/PE. Our routine regime for prevention after hip or knee replacement is:
Spinal/epidural anaesthetic
Good hydration
Early mobilisation
Foot/calf pumps
Aspirin on discharge for 30 days.
As well as this, the hospital currently requires us to use Low Molecular Weight Heparin (LMWH).
Orthopaedics WA class patients as being very high risk if they have had a previous DVT or PE, are having bilateral surgery, or have a strong family history of DVT/PE. We will usually fully anticoagulate these patients with warfarin for six weeks, or use LMWH for an extended period.
We believe that this regime reduces the risk of DVT/PE while minimising the risk of complications from other treatments.
Yes. See the Useful Documents page for a list. See more about physiotherapists here.
If you have problems at home, then your first port of call is to ring the ward in the early period.
Contact numbers for the wards are:
St Francis 9428 8558
St Rose 9428 8569
St Catherine 9428 8580
Pre admission 9366 1444
Otherwise, Orthopaedics WA can be contacted during the day on: 9312 1135
Orthopaedics WA have a long-standing interest in optimising pain control after surgery. This fits in with the advances in minimally invasive surgery and early mobilisation.
We have a rolling program of research and investigation into this subject. The aim is to speed recovery, minimise pain and maximise function.
Pain relief is multimodal and multidisciplinary, involving the patient, the surgeon, the anaesthetist, the nurses, the physiotherapists, and the pain team. All patients are individual, but Orthopaedics WA feel that we have made great advances in this area over the last six years. See Pain Management.
Toiletries, all relevant X-rays and other investigations, daytime clothes, non-slip flat shoes, all medications.
We will assess if any changes need to be made to your medications before admission. If you are on a single anticoagulant such as aspirin, for a medical condition, then we will usually continue with this. If you are on two anticoagulants, or warfarin, then they need to be stopped five days before surgery. Sometimes an alternative medication will need to be used in this period.
Stopping smoking will greatly reduce your risks of chest complications, infection, and poor wound healing, as well as benefit your long-term health.
Exercise, weight loss and healthy eating will all improve your outcome.
Problems with your skin, teeth and nails need to be brought to our attention, as they can be a serious infection risk.
Professor Yates is usually uses Dr Alex Swann as his anaesthetist.
Assoc Prof Gareth Prosser usually uses Dr Clinton Paine as his anaesthetist.
Mr Gohil usually uses Dr Matt Harper as his anaesthetist.
Occasionally, we will arrange for you to see another specialist in order to optimise your medical condition before the surgery. See Anaesthesia.
There is no absolute guideline as this is a very individual interpretation based on the patient’s own expectations of mobility and function. For convenience the surgeon will record the ability to put on socks, cut toe nails, go up and down stairs, get in and out of a car etc. —as a measure of function.
Different people have different pain thresholds and also respond to painful diseases differently. We often try and quantify pain by the number of painkilling tablets or analgesics patients take each day, what the pain stops the patient from doing, and if their sleep is affected. If this pain cannot be controlled by other measures, then surgery is indicated.
Orthopaedics WA consultants are no gap providers for all health funds (provided your health fund covers the procedure), meaning that, for the surgery, there no extra costs charged to the patient for the surgery or anaesthetic above that which is covered by the health funds.
The Initial consultation cost is $200 and Follow up appointments are $100.
There are no further costs for post-operative visits for the first six weeks, after which time the cost of each visit is $100.
Workers compensation and MVIT consultation fees will be sent direct to the insurer. However, if the claim number is not provided you will be responsible for settling the account on the day.
Blood tests
There is an out of pocket charge for blood tests.
Radiology
X-rays as an inpatient are covered, but outpatient X-rays and CTs within the hospital have an out of pocket cost.
MRI costs vary considerably depending on where they are done. Please ask for more details.
Physiotherapy
Costs as an inpatient are covered, but the level of cover/rebate from health funds for physiotherapy as patient or outpatient will vary depending on the fund, so please contact your physio and/or health fund for details.
Cardiology
For ECG (heart tracings) we use WA cardiology as appointments are not needed. There is a charge above the Medicare rebate.
Medical reports and insurance forms
Medical reports and insurance forms are charged at a rate representing the time taken to complete the forms.
Full payment at the appointment time is appreciated. Cash or credit cards are acceptable means of payment. For bank and personal cheques, please make prior arrangements with the reception.
-A referral from your GP or specialist doctor in order to be eligible for a rebate from Medicare. (Backdating of referrals is illegal). -Medicare or Veteran Affairs card. -Your health fund information. -Claim number for MVIT or workers compensation. -Operation records, medical records, X-rays, MRIs, CT scans etc. from previous doctor visits.
Yes, a written referral from a registered practitioner in Australia is required. A referral from a GP lasts 12 months, and a referral from another specialist lasts three months. The referral from your GP or specialist doctor must be current in order to be eligible for a rebate from Medicare. The backdating of referrals is illegal.