Bondi Junction construction; Dr Kohan at conferences,Doctor's Toolbox referral

It’s like GPS Navigation for your knee

new technology means better results for patients

The latest piece of technology for the Orthopaedic surgeon’s toolbox works like a global positioning system adapted for human anatomy. This computer generates a 3D image-guided navigational system in real time, to pinpoint and map the ideal surgical outcome for the patient.

The computer is used in conjunction with the experience of the Orthopaedic surgeon to produce a higher level of normal anatomical function for the patient.

The positive application for this computer enables the surgeon to have

• Optical tracking of extremity and instruments
• Intra-operative alignment.
• Intra-operative ligament balancing.
• More accurate flexion and extension gaps.
• Close to normal anatomy, positioning of components.

The introduction of this equipment will minimize variability and improve precision for the surgeon. Smaller incisions and a reduction of operating time coupled with an early mobilization program will reduce the complication rates and improved component life expectancy for the patient.

to top of page >

Letter from Dr Kohan

Is there a “right” time for arthritis surgery?

There is no specific, clinically identifiable “ideal” time. There is little to be gained by pre-emptive surgery for established osteoarthritis, unlike in the case of an injured joint, where repair can influence long term prognosis.

For an osteoarthritic joint, the main symptom we are trying to relieve is pain, and we need to strike a balance between the relief of pain with surgery, which may require the patient to be

subjected to some risks, and their ability to persevere with the symptoms taking other treatment options, like medications or activity modification.

But for the vast majority of patients, there is no doubt in their mind when “the right time” has arrived.

Lawrence Kohan

to top of page >

Dr Kohan answers your questions

Why are my muscles so sore?

Patient’s undergoing hip resurfacing often complain about thigh and knee pain postoperatively.

The operative technique requires dislocation of the hip joint during surgery. While the resurfacing technique reduces the trauma to the joint, muscle soreness post operatively is very common among many patients in the post-operative period.

Bruising and swelling occurs around the joint and into the thigh and knee. Adhesion from scar tissue can also cause stiffness.
Early mobilization and good pain control helps reduce the problem of muscle soreness in the early stages of recovery. Massage therapy has huge benefits in the recovery of muscle tissue.

to top of page >

Joe’s Hip To Pelvic Revolution

JOE Slupik can’t believe how much fun it is simply to stand on his own feet.

He is one of the first Hunter people to undergo ‘revolutionary’ hip resurfacing surgery as an alternative to the conventional total hip replacement.

Mr Slupik, of Lochinvar, had been in constant pain and moved with the aid of a walking stick since breaking his pelvis in an industrial accident in August 1985. Because of his weight and age he had not been able to have a traditional hip replacement.Mr Slupik is 51 and weighs about 150kg.

‘This is the first time in 16 years that I’ve been pain free,’ he said yesterday.

‘It feels like a miracle and I want as many people as possible who are out there suffering to know that they don’t have to stay that way; they can regain their lives.’

The resurfacing involved fitting a chrome and cobalt metal ball over the end of his thighbone and a chrome and cobalt socket onto his pelvis.

Joe Slupik shows off the chrome and cobalt metal ball and socket fitted to his thighbone and pelvis - pcture by Ruth Hartmann

‘This is revolutionary for people who are overweight or too young and can’t get a replacement as doctors won’t operate because traditional replacements only last seven to 15 years,’ Mr Slupik said.

to top of page >

New JOC Website Benefits Both Patients And Doctors

State-of-the-art procedures animations, downloadable brochures, medical protocols, wide-ranging information

The latest upgrade to the Joint Orthopaedic Centre website uses advanced techniques to bring much-needed facts and clear explanations on knee and hip procedures to patients, and also provides a valuable resource for doctors.

The website is now really three sites in one: JOC Procedures, Patients Centre and the Doctor’s Toolbox.

Clarity and ease of understanding the guiding principles

In Procedures, step-by-step animations clearly explain what the various operations involve, and it is possible to download and print out a brochure on individual procedures (in full colour, if you have a colour printer). Detailed explanations in easy to understand language covering everything from who is suitable, what is involved, right through to post-operative recovery can be found in this section, including full details of our clinic facilities and personnel.

In the Patients Centre, you can find facts about anaesthesia, registration and consent forms, price guidelines, quality surveys and much more (it’s still under development).

Doctor’s Toolbox is a key facility for practitioners

The Doctor’s Toolbox provides useful resources for our referring doctors, including a secure Online Referral Form, full details of times and locations for patient consultation, including operating days, an extensive list of the various protocols we follow categorised by procedure, and full details of our staff and facilities, including Dr Kohan’s curriculum vitae. More features, such as clinical data links and online feedback forms are soon to be implemented.

to top of page >

The new Joint Orthopaedic website really has three home pages

This is a downloadable, printable brochure on hip resurfacing; the full size is A4

An example of a procedure animation, this one is the beginning of the Knee Resurfacing video

FOCUS ON...
Stefan Czyniewski, Bsc.

I recently graduated from the University of Sydney having completed a Bachelor of Medical Science majoring in anatomy and pharmacology. I am currently performing a research fellowship at the Joint Orthopaedic Centre. Spending several years as a ski instructor made me very familiar with hip and knee pain which helps me relate to our patients and research.

Current research involves prosthesis survival analysis and post-operative patient satisfaction data analysis. The aim of my position is to ensure the highest level of post-operative patient follow-up and to monitor prosthesis function.

Stefan Czyniewski, Bsc.

to top of page >

Less Pain For Hip And Knee Surgery

The rapid mobilisation short-stay joint replacement treatment for osteoarthritis of the hip and knee is making surgery an option to be considered

Patients who suffer from osteoarthritis, may be in pain, with limited mobility, but they are not ill. If surgery is indicated, we aim to ensure that the treatment does not add to the problem, but even in the short-term, maximises the speed of recovery. By controlling pain, we aim to enhance mobility, and allow a rapid return of function.

Post-operative pain is one of the major outcomes of surgical intervention, and severe pain may leave the patient terrified even of minor surgery. Relief of the patient’s distress is therefore an important goal in its own right, as well as allowing improvements in other aspects of care. Pain management is a process, and not an event.

The combination of a pain management programme with the use of joint replacement components which are stable, allowing immediate weight bearing, has meant the patient is able to mobilise immediately upon recovering from the operation, certainly within four hours. By adopting this approach, the secondary effects of immobilisation, disuse, stiffness and apprehension have been minimised.

Intra-operatively, local anaesthetic blocks are provided, to minimise the operation site pain, for as long as 20 hours. Oral analgesics are also given, to supplement the local block. A fine catheter is left in place, at the site of the operation, and the block is augmented the following day. This allows pain minimisation over a period of approximately 40 hours. By that time, the post-operative discomfort has usually subsided to a level where it can be controlled by simple oral medications.

With this process, we have been able to restore patient mobility, and concentrate on the rehabilitation aspect much earlier than it would have been possible otherwise. By restoring these generally active patients to a level which approaches normality, we have been able to minimise the impact of surgery, particularly from the point of view of joint stiffness, deep venous thrombosis, and infection.

Article by Dr Kohan reprinted from St Lukes newsletter

to top of page >

Dr Kohan and Dr Kerr discuss a knee prosthesis

An x-ray of knee replacement prosthesis in situ

Joint Orthopaedic News

• As many of you are aware, Bondi Junction has a lot of construction work going on at the moment. 99 spring street is also under refurbishment. The work will be completed by December. The Joint Orthopaedic Centre will function as normal.
• Dr Kohan will be at Orthopaedic Conferences in October. The office will be open as usual but there will be no clinics.
• The Doctor’s Toolbox section of our website will be brought online in stages, but the Secure Referral Form is already working. Please let us know if there are other features you would like.