Trauma & Injuries

When is the right time to have joint replacement surgery?

The right time to have joint replacement or arthroscopic surgery is when the pain you experience is interfering with your life and you really want something done about it. Some people decide to have surgery because they are no longer able to work and this surgery can make a significant difference to their lives. Some cannot walk around the golf course and cannot bear the thought of being unable to play. Others will put up with pain and wait a long time, choosing only to have surgery when they can no longer walk from the bed to the bathroom. It’s a personal and very subjective decision. I always advise patients to take their time, really think it over and have surgery when it suits them.

Your first consultation will determine what, if any, surgery is required. This visit takes about 30 minutes.

Dr Vera Kinzel will look at your x-rays and other imaging, and do a physical examination to assess your shoulder, knee or upper limb issue/problem.

There is a fee payable on the day for this consultation, some of which you will get back from Medicare. You must bring a referral from your GP or medical specialist.

If you are a Workers Compensation of CTP patient please bring along your approval to see Dr Kinzel.

Choosing a date for surgery

For patients in a lot of pain, we can usually find you an early surgery date which means you don’t have to wait in pain for too long. Many patients will need to make arrangements with family or arrange time off work and typically we will find a surgery date, which is 2 – 3 months away. There is absolutely no pressure to have surgery until you feel ready.

Surgery Cost and Quotation for services

Dr. Kinzel’s staff will provide you with a quotation, which specifies fees payable. The cost of surgery is discussed with you at the consultation and you will be given a written quotation. If you are an Australian resident, fees are partly covered by Medicare, partly covered by your private health fund and there will be an amount to be paid which is called an “out-of-pocket” cost – this is paid by you.

Your quote will contain item numbers. We strongly recommend you contact your health fund to find out exactly what they will pay for the item numbers listed, so you can calculate what your out-of-pocket cost will be. Hospital expenses should be discussed directly with the admission staff at the hospital, and/or with your Health Fund.

Consent forms and admission forms

Your surgery consent form will be completed at the time of your consultation with Dr. Kinzle. When a date is set for your surgery, the hospital will send you an electronic admission form, or post one to you. This needs to be completed and returned to the hospital prior to your admission date.

Other consent forms

Dr. Kinzel may collect information about your surgery for the purposes of patient management and research. You might be given a database consent form, which is to be completed and given back to Dr. Kinzel’s secretary prior to your surgery. Dr. Kinzel does research which is published and presented at international meetings. This work makes a hugely valuable contribution to the overall body of knowledge on joint replacement and makes a difference to patients around the world – today and in the future. Patient information is de-identified and patient privacy is not compromised.

Anaesthetic

Dr. Kinzel works closely with a small number of expert anaesthetists to optimise the pain relief and recovery after the surgery. The anaesthetist for your surgery will depend on which day your surgery is scheduled. The anaesthetist will usually contact you to discuss your anaesthetic beforehand. You should ask them to provide you with a quotation for their services.

Your Teeth

Tooth decay and mouth infections can be a cause of infection in joint replacement. It is very important you talk to your dentist to address abscess and tooth decay prior to having surgery, as infections in the mouth can cause infections in other parts of the body. Even years after you have surgery, it is important to ensure you are vigilant about dealing with decay in your mouth, or any small infections on other parts of your body. Please take to your dentist, a copy of the current advice from the Arthroplasty Society of Australia, which outlines recommendations for mouth care after joint replacement surgery.

Pre-operative testing

You will need to have a chest x-ray, ECG and blood tests done prior to surgery. These are standard tests for all patients. These are usually done 2 weeks prior to your pre-admission appointment. These investigations can be done at hospital or at a pathology location that is convenient for you. The results are required for your pre-admission appointment. Results need to be back in time for your pre-admission appointment.

Pre-Admission Clinic

Pre-Admission Clinic at Mater Hospital

The hospital will contact you a few weeks prior to your surgery to make an appointment for you at the pre-admission clinic. At this appointment, you will be fully assessed and given all the information you need about your hospital stay and procedure.

A general practitioner can be present at your pre-admission appointment if it is necessary.

Test results from your chest x-ray, ECG and blood pathology will be discussed with you and your anaesthetist may come see you at the pre-admission appointment.

The day before your admission to hospital

A nurse from the pre-admission clinic will contact you after 4pm, the day prior to your surgery. The nurse will inform you what time you need to arrive at the hospital, and will give you instructions on when to begin fasting (nil by mouth).

Managing your medications

Prior to your surgery, we will discuss your medications with you. You will be given important instructions about what you should and should not take prior to surgery. Please do not hesitate to contact our office if you are unsure about these instructions. Also, some patients with complex medical conditions will need appointments with other medical specialists to ensure that it is safe to proceed with surgery. We will let you know if this is something you need to do.

About the Operating Room

Very frequently, Dr. Kinzel uses two operating rooms, with a separate clinical team in each room. They function sequentially, which means that after one operation is finished, Dr Kinzel may start the next operation in the other operating room. This allows adequate time after an operation for the room to be cleared and set-up for the next patient.

If everything is okay and a patient feels good, he/she can go back to the normal life already in two weeks after having a surgery. The doctor always informs a patient about it.

Find out your Oxford Knee Score.

The Oxford Knee Score questionnaire is a test used by orthopaedic surgeons around the world to assess patient hip function. Orthopaedic Scores has created an online version of the Oxford Knee Score questionnaire (12 questions) for you to use. Answer the questions to find out your score. It may help you decide whether to see a surgeon for an opinion.

Anaesthetists

Dr. Kinzel has a hand picked team of anaesthetists Dr Mark Bukofzer, Dr Tish Stefanutto and Dr Alastair D’Vaz regularly look after patients having surgery, although other anaesthetists are used at times. Our anaesthetists are familiar with the surgical procedures and have worked closely with Dr. Kinzel to ensure the anaesthetic regimen allows the patient to mobilise very quickly after surgery. Your anaesthetist will contact you prior to surgery to discuss your medical history and answer your questions.

Assistant Surgeons

It is usual for Dr Vera Kinzel to have one or more surgical assistants in the operating room. Commonly, the assistant surgeon working with Dr. Kinzel will already be a fully qualified orthopaedic surgeon or an Australian trained doctor (registrar) who is completing the Australian Orthopaedic Association (AOA) surgical training program. These surgeons at times perform simple steps of the procedure under very careful and close supervision. You will meet these doctors during your episode of care.

Nurses and other medical staff

A team of nurses perform a variety of important roles in the operating room. Theatre nurses are employed by the hospital.

Important things to remember in the first six weeks after knee replacement surgery

Things you should do:

-Find a sleeping position that is comfortable

-Use walking stick as needed

-Elevate the leg if you are experiencing a lot of swelling

Things to avoid:

-Putting a pillow under your operated knee is not recommended

-Don’t kneel on your operated knee

-Wound care

Generally, a wound from knee replacement surgery requires very little care. Most people have sutures that dissolve themselves and do not require removal. Before leaving the hospital, your dressing will be changed. It is important to keep the wound dry for 2 weeks.

In some cases, if the wound is inflamed or oozing, oral antibiotics may be required for a short period of time. If this occurs you should contact Dr. Kinzel’s rooms, the hospital you had the operation at or your GP immediately. The wound should be covered until it has healed.

Hydrotherapy

Patients can proceed with hydrotherapy 4 weeks after surgery, if they meet the following criteria:

Wound is clean and dry with no scabs, drainage or blisters

Wound is reviewed by rehabilitation physician prior to doing hydrotherapy.

Please contact the office if you are at all concerned about participating in hydrotherapy.

Swelling

It is common to have swelling in the knee, lower leg and ankle following total knee replacement. This can remain for up to six months following surgery. The amount of swelling is generally dependent on your activity level.

Stockings

Dr. Kinzel is up-to-date with recent research and does not require routine wearing of TED (thromboembolic disease) stockings.

However, if there is swelling or a history of DVT (deep venous thrombosis) or pulmonary embolism you will be asked to wear them for a period of time. You should talk to the rehabilitation staff about your situation, so you know what is best for you.

Pain medication

Patients generally only need Panadol or Panadeine after discharge from hospital. Dr. Kinzel will ask you to see your GP if stronger pain medication is needed, as your GP is in the best position to manage your overall health and all your medications. Dr. Kinzel does not prescribe narcotics to patients after they leave hospital.

Activities

During the first six weeks after your surgery, we recommend limiting your activities to walking with support, gentle swimming in the shallow end once you have been given permission to get the wound wet.

We recommend you refrain from exercises such as pilates, golf and social tennis until three months after the date of your surgery. Be aware that it is quite common to hear or feel a clicking noise in your knee in the months after surgery. This usually settles down in time. High impact activities such as running/jogging and activities which put your body into extreme poses, such as yoga, are not recommended at any time after knee replacement.

If you are enthusiastic about a particular sport, please seek instructions from Professor Walter, as there are often ways you can modify your movement to keep your knee safe.

Sex

You can have sex whenever you feel ready.

Driving

The Roads & Traffic Authority recommends you should generally not drive for six weeks following a knee or khip replacement. In order to be safe driving a car after a knee or hip replacement, you must be able to control the pedals properly and you must not be taking strong pain medications that could impair your judgement or reaction time.

As you get to the six-week mark, ask yourself if you would be able to stop quickly if a pedestrian ran in front of your vehicle. If you feel you could not react quickly enough, wait a little longer.

Travel

It is usually safe to take a short flight a week after surgery as long as you do not have blood clots in your legs. Long flights are best avoided during the first few months after surgery as there is a risk of deep vein thrombosis (blood clots in the legs).

If you must travel, we recommend you wear TED stockings, mobilise throughout the flight as much as possible and if possible keep your legs elevated when seated during the flight. If it is necessary to travel long distances, then speak to your GP or Dr. Kinzel prior to doing so.

Infections (and a special note about your teeth)

After joint replacement, (even years after your surgery) pay particular attention to infections anywhere on the body, and deal with them immediately. Pay special attention to tooth decay and mouth infections, as these may be a cause of infection in joint replacement.

If you need to visit your dentist, tell them you have had a joint replacement and give them a copy of the current advice from the Arthroplasty Society of Australia, which outlines recommendations for mouth care after joint replacement surgery.