PAC

All patients undergoing joint replacement surgery will need to attend the Pre Assessment Clinic (PAC).

At the PAC, you will be seen by a Nurse, an Anaesthetist (If necessary) and a physiotherapist, the PAC in Shoalhaven Public Hospital will also have a doctor who sees you. They will explain the process of admission, preparation, anaesthetic and post operative care in detail so that you are fully informed of what to expect.

Patients undergoing smaller operations may need to attend PAC if they are over 65 or have major health issues. Dr. Thornton-Bott will advise if this is necessary.

Patients in the Public system will be contacted by the PAC for their appointment prior to surgery. All other patients will need to contact the hospital for their PAC appointment.

Laboratory Tests

You will need to get laboratory investigations completed prior to your surgery. ALL joint replacement patients will have a wide range of labs, swabs, ECG etc. Smaller ops will require less tests, and young fit patients only a few.

Labs should be done ASAP as they will usually be needed at the PAC appointment. Sometimes the labs identify unknown medical conditions which may require assessment and management prior to your surgery and may delay your operation. e.g. unknown diabetes.

If you are having your surgery in a Private Hospital, Dr. Thornton-Bott will provide you with the necessary forms at your consultation.

If you are having your surgery in the Public Hospital, the Labs will be done when you attend for the PAC appointment.

Investigations

You may need further investigations prior to surgery such as special scans, an ECG (heart tracing) or Chest Xray. If you are referred to a Cardiologist or Chest physician prior to surgery you may require other specialist investigations.

All the investigations are to ensure you are as fit as you can be before you have your surgery. These tests can identify conditions that increase your risk of complications during or after the surgery.

With all the informations we get from Labs and investigations we can ensure your operation is performed as safely as possible.

Yes, your new joint CAN set off the alarms as you pass through Airport Security. However, thousands of people have joint replacements so you can usually just inform the security guard that you have a knee or hip replacement. They may wish to see your scar for proof. I can provide a letter of confirmation but there is no guarantee it will be accepted as proof.

Any operation, large or small has a level of risk and complications. In todays world of surgery, these risks are very low, are understood and measures taken to reduce them to a minimum. We do everything we can to mitigate these risks and have been successful in doing this with constantly improved surgical techniques, anaesthetic techniques, medications etc. Patients with certain medical problems may have a higher than normal risk, for example, patients with diabetes have a slightly higher risk of infection.

We are integrated with Medicare and can have your refund paid directly into the account you have registered with Medicare.

I perform bilateral joint replacements for knees and hips, using the Direct Anterior Approach.

As long as you are stable, confident and comfortable in the shoes of your choice then you can wear them. Just be careful that you are stable!

I use Computer Navigation for both Hip and Knee Joint Replacement Surgery.

Accurate positioning of the implants used in joint replacement surgery improves the likelihood of a successful long term outcome. Computer Navigation assists the surgeon with the accuracy of this implant positioning. The bones and damaged joint surfaces are first ‘registered’ in 3 dimensions using special cameras and computer software. In total knee replacement surgery, the jigs used to guide the bony cuts are then positioned using the data from the navigations system Once the position of the the jigs are established and they have been secured to the bone, the bony cuts are made and the implants applied. In hip replacement surgery, computer navigation helps me to accurately assess the position of the Cup in the socket and the stem in the femur to ensure the total hip replacement will provide an excellent long term function.

All orthopaedic surgeries are covered by Medicare item numbers. These numbers have an associated rebate. The government determines these rebates and the private health insurance companies supplement these rebates. The amount of rebate varies with each insurance company.

There are several costs to surgery. Most patients believe the bills they are paying are for the surgeons. In reality there are multiple providers who are sending out bills to the patients and the health insurance company:

Surgeon’s Fee

This is the fee payable to the surgeon who performs your operation. This may vary. A newly qualified, generalist surgeon may charge no gap, whereas an experienced sub-specialist surgeon may charge a known gap, or a set fee, usually related to the AMA rate. This is the fee at which the Australian Medical Association believe a surgeon should be reimbursed for a specific operation. The Medicare rebates and Insurance Fund rebates often fall way short of the AMA rate and haven’t changed much in the last 20 years! I try to reduce the out-of-pocket expenses of my patients to a minimum, but as an experienced, sub-specialist hip and knee surgeon I set my fee at the relevant level.

Assistant’s Fee

Most orthopaedic operations require an assistant. It is commonly set at 20% of the surgeon’s fee. The assistant fee may include a gap.

Anaesthetist’s Fee

Again, this may attract no gap, a known gap or be a set fee. This is dependent upon your personal circumstances, past medical history and the experience of the anaesthetist.

I and my team will explain the fees to you at the time of booking of your surgery.

Hospital Fees

Theatre usage and Bed Fees
These are usually covered by your insurance cover but some levels of cover are different from others. Always confirm your level of cover with your insurer.

Pathology and Radiology Fees
These are performed before, during and after your surgery and may incur additional fees. Check with your insurer.

Implant Costs
These are the bits of metal and plastic that are used to replace joints, fix fractures etc. These are usually covered by your insurer, but please check.

I understand the difficulties and stresses that can be caused trying to access specialist surgical expertise and care if you are based in a country or regional area.

I provide a service in Milton, Nowra and Shellharbour to help those in the South Coast access sub-specialist care more easily. You can have an appointment and be followed up locally, or at the other extreme you can have your appointment in Milton, have your surgery in Sydney and your rehab in Nowra, or any combination that works for you. Some patients choose to come to Sydney for their surgery and it is possible for country or interstate patients having straightforward surgery to make just a single trip to Sydney.

Regardless of whether or not you have a referral, you can contact us and send your x-rays to us for an initial review. This does not replace a full consultation, but may help you. Please see our guidance on Telehealth.

Many issues we need to discuss with you can be done by phone, this can sometimes include your Pre-Admission clinic interview (which is normally done in-person at the hospital a week or two prior to your surgery). If facilities are available to you, tests and imaging can be done in your hometown and results sent to us. We can also often access test results and x-ray images online (depending on the facility you use) meaning it may not be necessary to send hard copy x-rays to us.

If you require straightforward uncomplicated surgery (e.g. primary hip or knee replacement or scope surgery) and are in reasonably good health, then under certain circumstances, your face-to-face consultation, admission and surgery can be done in a matter of days. I always need to know however that the decision has not been too fast for you. Remember, it is YOU who is making the decision to have surgery. I will advise you and facilitate the procedure at your pace.

If your surgery and health issues are more complex, we work with you to make arrangements that suit you best. In this case, much of the necessary paperwork, consent forms etc. can be done in advance of your arrival by email/mail – or on the day before your surgery.

For patients requiring a cardiac check prior to surgery we can coordinate appointments as needed. In Sydney, A/Prof Peter Vale (vascular physician and cardiologist) is based in the same consulting rooms as myself which can make life easier as well.

We are available for you over the phone at any time. Many of your medical issues and questions you have can be dealt with over the phone. Please call as often as you need to. My team will help you wherever possible.

No, you don’t. The difference is, if you come to see me directly, you are not entitled to claim an initial consultation Medicare rebate of $73.

I may charge No Gap, a Known Gap or a Set Fee for performing your operation. There are many factors that will affect your potential out-of-pocket costs, including your insurance cover. I and my staff will discuss all fees and costs with you when your operation is booked.

Yes!

South Coast

• At PTB Orthopaedics, 33 Bridge Road, Nowra there is off street parking at the rear of the property, street parking and overflow parking in the Shoalhaven Entertainment Centre parking area.
• At Shellharbour there is on site parking for the hospital and Specialist Suites.
• At Nowra Private there is on site parking for the hospital.
• In Milton there is parking at both the Medical Centre and the hospital.

Sydney

• At The Mater. Sydney, there is on-site parking for both the Clinic and the hospital.

I can see you if you are covered by a Workers Compensation Scheme. All Workers Compensation patients MUST supply the office with the following information:

Your Employers Name and Address
Your Insurers name and Address - we need the name of the office that your insurance claim is going through.
Your Claim Number
The date of your Injury
The case manager’s Name, direct telephone number and fax number.
As the patient, it is YOUR responsibility to provide this information to us, if it is NOT available then the patient will be charged the Workers Compensation Fee and will need to claim this back from their Insurer.

We can bill the Insurer if the information is provided, however if the Insurer denies the claim or does not pay the entire of the account, the patient remains liable for this.

ALL Workers Compensation patients MUST have an approval letter from the Insurance company for each consultation.

The Direct Anterior Approach (DAA) for hip replacement surgery is an excellent approach. It allows patients to mobilise immediately with less post-operative restrictions than a posterior approach. It can be technically challenging and so it is important to make sure your surgeon has been trained in this approach and has experience in its use.
I will use the DAA whenever I can, but not all patients are suitable for this approach. I have Fellowship training in the DAA, have significant experience in performing the DAA and teach the approach to other surgeons.

I also perform the DAA in some women using a ‘Bikini-line incision’. This puts the small incision in the region of the underwear and can create an almost invisible scar.

If you need a hip replacement and are keen to have the Direct anterior Approach, I will be happy to discuss this with you at your consultation.

I always keep my practice up to date. There are always new and exciting technologies available in orthopaedic surgery, and many of these are reported in the news, social media etc. This doesn’t necessarily mean they are the best option for all patients. I only use new a technology when it has been proven in proper trials to be effective and safe for patients, and this can take many years. New technologies also involve learning and this needs to be done in the correct manner before I will begin using new technologies on my patients. If you have seen or heard of something new that you are interested in, please discuss this with me at our consultation.

It is recommended you do not drive for 72 hours following a general anaesthetic.

If you have surgery to your hip or knee then this will affect your ability to drive. There is no definitive law regarding this, other than your ability to do an emergency stop. Studies have been done which show that the braking response in patients following hip or knee surgery is slower for up to six weeks following surgery.

If you have had a right leg surgery then this is obviously more important than if you have had left leg surgery and drive an automatic vehicle. People having had a Direct AnteriorApproach hip surgery feel able to return to driving earlier than for a posterior approach.

Being able to perform an emergency stop without hesitation or pain is the absolute test before returning to driving. It is recommended that you try this initially with the car stationary.

You may be obliged to inform your insurance company that you have had major surgery.

I will discuss this with you at the consultation.

I would prefer you didn’t fly for 5-7 days after surgery and then only Interstate. Overseas travel should be delayed for a min of 6 weeks after surgery, this is a cautious approach but I want you to have the best outcome. I recommend using compression stockings and taking aspirin for 3 days when flying overseas as well as doing foot and ankle exercises during flight. This is to reduce the risk of blood clots forming in the veins of the leg which occurs more frequently following knee or hip replacement surgery. If you have had a different operation, the risks may be lower and the restrictions less so. I will discuss this with you after your surgery. If you have holidays booked we can always schedule your surgery to reduce your risks.

The quality of implants used in hip and knee joint replacement has improved significantly over the last few decades. The fixation techniques have been optimised and the bearing surfaces (the parts that move over each other) have been improved significantly as well.

As such there are many implants available that work extremely well. Some have up to 35 years successful outcome.

So if the implant, its fixation and the bearing surfaces are sorted, one factor in the longevity of your joint replacement is how well it is put in! And that relies upon your surgeon. I have significant experience in joint replacement surgery including dual Fellowship training at the Mater Hospital in Sydney with some outstanding surgeons. I pride myself in ensuring you will get the very best operation. I have a very low revision rate and expect the vast majority of my joint replacements to last as long as my patients need them.

Other factors that result in early revision include the age of the patient. So if you come to me with advanced joint arthritis at aged 50, then I WILL give you a new joint, so as to allow you to maintain a pain free and active life, go to work, play with your kids etc. However, your new joint is unlikely to last more than 15-20 years if you are young and active and you are likely to require a revision procedure.

Some patients will require revision even earlier. This may be due to loosening, fracture, early wear etc. Revision procedures vary in complexity from simple to hugely complex, requiring bone graft, metal cages, cables and all sorts of complex metalwork! Again, you need to ensure your surgeon has the skills to manage these issues.

I am a very experienced revision surgeon. If you have an existing joint replacement that is causing you problems, I can identify the cause of this in most patients and discuss with you the option of revision surgery if necessary.

Individual recovery times vary after joint replacement surgery. The accepted guidelines recommend that patients should avoid high impact exercise altogether after joint replacement.

Low impact activities including golf, doubles tennis, swimming, cycling and walking are all recommended. Most people are able to commence these activities approximately 3 months after surgery. These are general guidelines, I will talk to you about your own personal recovery plan.