Frequently asked questions
Please choose a category from the list below, then click on the question to see the answer.
- 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.
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.
There is an out of pocket charge for blood tests.
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.
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.
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.
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.
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.
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.
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 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.
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.
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.
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
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
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
- 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.
- Infection; the chances of this are low and precautions are taken reduce this risk.
See, Anterior Cruciate Ligament (ACL) Reconstruction
Elbow: Distal Biceps Rupture
Any work involving heavy lifting would need to be avoided until 4–6 months after your surgery.
Shoulder: Osteoarthritis of the shoulder
- It has been at least six weeks after the surgery, and
- 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.
Shoulder: Rotator Cuff Repair
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.
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.
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 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
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.
See the Related links on this page.
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
Orthopaedics WA – Perth
Suite 51, Mount Medical Centre
146 Mounts Bay Road
Perth WA 6000
Tel: (08) 9312 1135
Fax: (08) 9332 1187
Office Hours: 9am–5pm
Monday to Friday (closed public holidays)