Frequently asked questions

Questions and answers are grouped in categories.
Please choose a category from the list below, then click on the question to see the answer.
General enquiries
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.
  • 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.
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 $180 and Follow up appointments are $90.

There are no further costs for post-operative visits for the first six weeks, after which time the cost of each visit is $90.

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.
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.
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.
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.
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.
Toiletries, all relevant X-rays and other investigations, daytime clothes, non-slip flat shoes, all medications.
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.
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
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.
 
Hip questions
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
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
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.
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.
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
 
Knee questions
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.
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.
 
Knee: 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
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
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
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
You can return to sporting activities nine months after this procedure. 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.

  2. Infection; the chances of this are low and precautions are taken reduce this risk.

See, Anterior Cruciate Ligament (ACL) Reconstruction
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
 
Elbow: Distal Biceps Rupture
Often just one day but maybe overnight depending on how you feel after your general anaesthetic.
You cannot drive whilst wearing a sling – so not for 6 weeks.
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.
Shoulder: Osteoarthritis of the shoulder
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.
No, autologous blood donation is not required and post-operative blood transfusions are rare after this type of surgery.
This is entirely up to you and always depends on how well you manage normally and whether you have help at home.
Usually three to five days but it always depends on how you are feeling.
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.
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!
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.
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.
 
Shoulder: Rotator Cuff Repair
You will have pain but this should be relieved by the pain relief medication you are discharged from hospital with. Please let the hospital staff know of any allergies or sensitivities you have to any medication. You will need to take these regularly for the first week and then decrease them as the pain lessens.
Patients who have had this surgery describe a similar pattern of pain: it is sore day and night for a few days then the pain settles during the day but is sore again at night until eventually (and this may take up to six weeks) the night pain settles.

In addition to medication, the following points may help you to get comfortable more quickly:

Ice. This may help to numb your shoulder for the first 48 hours though after this is may be of less benefit. Remember to always cover the icepack with a cloth so that it never makes direct contact with your skin.

For others heat works well. It is a good idea to assess the effect of heat on your shoulder under the shower – if the warm water is soothing, you know a hot pack will help, but again, remember to cover the hot pack before applying it to your shoulder and/or neck area.

Come out of your sling. Often straightening your arm out and taking the pressure of the strap off your neck is a great way to ease discomfort.

Use your hand, wrist and elbow to do small movements at desk level. The gentle return to normal activities is beneficial in avoiding stiffness which can cause pain.

Avoid lying flat in bed at night. Arrange either 3 or 4 pillows into a “boomerang” shape behind you so that when you lie back, your shoulders are off the mattress and well supported by the pillows.

Please advise us at Orthopaedics WA if your pain is not relieved by taking the tablets regularly or if it suddenly becomes worse or severe.
You should not need to change or remove the dressing that will be on your wound. These dressings are waterproof enabling you to shower and wash without worrying about wetting the wound. You may see some blood beneath the dressing but this will not cause any harm and can remain as is until you are seen about one week after your operation. If this dressing should come off do not worry, just replace it with another waterproof dressing.
We do not recommend soaking in a bath until your wound has healed completely but showering is perfectly fine. Please take your sling off to shower. You may prefer to have some assistance with showering until you become more confident. As you are unable to raise your arm to wash under it, you should bend forward so that your arm gently swings forward enabling you to wash your armpit.
Many patients have told us that they find it difficult to get comfortable. Try setting up a “tri-pillow” or boomerang-shaped arrangement so that your back and shoulders are supported by pillows and also remember to take your pain relievers before going to bed. Note that if you are sleeping a lot during the day it is unlikely that you will be able to have a full night’s sleep.
Your arm is rested in a sling for comfort and to rest it while it heals. If the sling is not comfortable please let the staff know as soon as possible.

The sling will be worn for a period of six weeks after the surgery, however if at home, just resting or watching TV, you can come out of the sling so that your arm is resting in a more natural position.

It is OK to straighten your arm out just do not lift it up by itself or lift anything in that hand which is heavier than the weight of a full coffee cup. Doing these things can tear the tendon off the bone again.

It is imperative that you wear the sling on the outside of your clothes when going out of doors so that it is clearly visible to others and to therefore avoid being knocked or bumped.

While wearing a sling, you may find it easier to wear button-up shirts as these can be put on easily with minimal movement of your operated shoulder.

It is recommended when dressing that you place the arm that has been operated on into the sleeve of your clothing first.

Thus, when undressing, take your un-operated arm out first.
You will see us when your stitches are removed and then further follow-up will be determined according to your rate of progress. You should expect to see Orthopaedics WA one week after the surgery, five weeks later, and at three and six months after surgery.
Driving a motor vehicle is usually not recommended for six weeks after the surgery, when the arm is comfortable and the vehicle can be safely controlled in an emergency. Driving with one arm in a sling is not recommended. We recommend you check with the RTA regarding the legalities and requirements for driving while your arm is in a sling.
Some employers will not allow a worker to return wearing a sling and therefore in those circumstances you should expect to be off work for six weeks. Patients needing to go back to light manual tasks would need to allow an average 4–6 months recovery. They would not be able to lift overhead or do repetitive actions above shoulder level for about 6–12 months.
You cannot return to contact sports until your shoulder has been reassessed six months after surgery, and then only if you have excellent strength and coordinated control of your shoulder.
Yes, though a formal physiotherapy programme does not usually commence until you come out of your sling completely six weeks post op. For the first six weeks, you are the best physiotherapist and at your first visit after surgery, you will be shown some simple exercises to do at home. Even though your arm is to remain in a sling for the next few weeks, you must remove the sling three times a day for passive motion exercises. These exercises must be performed passively, which means all the effort is made by the muscles of your un-operated arm. It is important to try to relax while doing these and it is much easier to relax if your pain is under control.

The repair that will be made will remain quite weak until your body has time to complete the bonding of tissue to bone. As previously stated this may take as long as six months.

Using the arm before the healing is complete can cause the repair to fail. On the other hand, immobilising the shoulder for a long period to protect the repair can cause shoulder stiffness. For these reasons careful postoperative rehabilitation is an essential part of your surgery. There are two aspects of the rehabilitation programme; preventing unwanted scar formation and protecting your repair.

Protect your repair by being careful that your arm does not participate in lifting, pushing or pulling and that it is not raised away from your body under its own power. Raising the arm even a small amount places tension on your repair and should be avoided. If you have had biceps surgery, you need to protect this repair by performing no resistance elbow flexion for four weeks. Your doctor will advise you about this.
The secret to successful rotator cuff surgery is for you to be patient in order to achieve the desired result.
The tendon generally takes three months to reattach to the bone and then it takes you another three months or longer for you to achieve a functional range of motion and strength.

We always tell patients that the result of surgery depends on the patient’s tendon quality not our surgery. If you have a thin and poor quality tendon then the result will not nearly be as good as someone that has a thick and robust tendon that can easily be reattached to its anatomical position.

Patients also have to understand that pain can continue over the first three months and then it generally settles with time.

Be patient as there are no shortcuts in this surgical procedure. It will take 6 to 12 months to get over the procedure and the majority of patients are glad they have had the operation.
Shoulder: Reverse Total Shoulder Replacement
You can reasonably expect to be in hospital for 2–3 days after your surgery.
You should wear your sling when going out of doors for a period of 6 weeks though this is just to alert the general public to the fact that you have had surgery done and that they should give you a wide berth!

At home, you can come out of your sling after 3 to 4 weeks. While out of the sling, we would request that you don’t lift anything heavy with that arm and also that you avoid lifting your arm up by itself.
Very few patients go to rehab following their reverse shoulder replacement. You will be discharged from hospital with gentle exercises which we prefer you do yourself.
You should feel confident to drive again about 5–6 weeks after your surgery though we always recommend that you do a short drive, at a quiet time of day in your local area to assess for yourself whether you feel able to control the steering wheel in an emergency situation.
Yes, though this does not usually commence until about 6 weeks after your surgery. Initially, you will be the best physiotherapist.
In the majority of patients there is a significant improvement of function and range of motion and a significant loss of pain. The majority of patients are very happy they have had the operation done.
Yes, the majority of my patients can lift their arm up comfortably above their head and out to the side.
See the Related links on this page.
Practice Head Office
Orthopaedics WA
Suite 15, Wexford Medical Centre
St John of God Hospital Murdoch
3 Barry Marshall Parade
Murdoch WA 6150
Tel: (08) 9312 1135
Fax: (08) 9332 1187
Email Us

Office Hours: 9am–5pm
Monday to Friday (closed public holidays)
Related links:
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