2005 NEWSLETTER

Dear General Practitioners,

We hope you are all having a good year. This is our yearly newsletter which hopes to bring you up to date with some of the many developments in Orthopaedics over the last 12 months. We know you all have busy practices and find it difficult to keep up with the latest developments in all specialties. Below we have outlined developments which are currently available and patients may ask you about.

Orthosports is a group of Orthopaedic surgeons, physicians, physiotherapists and radiologists in Sydney Australia. All doctors in the practice have particular subspecialty interest areas with most having at least one area of particular expertise in which they have undergone fellowship training. This enables us to deliver expert care and keep up to date with the latest advances throughout the world.

Our rooms are located at Randwick, Concord and Hurstville and we operate in a number of private and public hospitals throughout Sydney. Orthosports runs continuing education programmes for general practitioners and physiotherapists. Most of the Orthosports surgeons have an appointment at a major teaching hospital.

One of the more recent developments is our website www.orthosports.com.au. This is an exciting project which we believe to be an extremely useful tool in patient care. On the website you and your patients can familiarise yourselves with our staff, surgery locations and facilities but more importantly with common Orthopaedic conditions and some of their treatment options.

It includes descriptions of surgical procedures, operative videos and illustrations of the more common procedures such as arthroscopy and joint replacement. We believe this allows your patients to make a better informed decision on whether to proceed with surgery and reduce the anxiety associated with surgery.

It is an ongoing project and will be continually updated to keep you and your patients better informed.

Thank you again for your past and ongoing support.

WEBSITE

www.orthosports.com.au

Our website provides information on Orthopaedic operations, Orthopaedic conditions, Sports Medicine, Paediatric Orthopaedics, Rehabilitation medicine and Physiotherapy services. It features information handouts for patients, interactive presentations and operative videos. The website is updated regularly and this newsletter can also be found on our website.

COMPUTER NAVIGATION

A new and perhaps revolutionary technique in hip and knee surgery is the use of navigation to place hip and knee components more accurately. This is an emerging and ongoing science which may one day become mainstream. It allows the components to be placed on the bones at very precise angles which can be visualized on a monitor whilst operating.

Dr Bruce and Dr Walker are using this technique at Concord Hospital in selected patients as an ongoing study to determine its accuracy and other possible benefits. This is not yet in common use due to expense and lack of long term follow up.

CARTILAGE TRANSFER

This is a technique whereby the patients own cartilage cells can be harvested and cultivated in a laboratory. These cells are then seeded onto on a membranous type material and placed into the defect in the knee. These cells continue to mature into articular cartilage.

INDICATIONS

• patient <50 years
• localised lesion of cartilage
• no instability or malalignment
• well motivated patient

STEPS

• 1. Cells harvested via arthroscopy
• 2. Cutivation in laboratory
• 3. Arthrotomy to debride lesion
• 4. Place membrane into defect
• 5. Rehabilitation

LUMBER DISC REPLACEMENT

Back pain due to degenerate discs is common. Previously the only definitive treatment was fusion of the affected level. The idea of replacing a disc and preserving some motion is attractive. The CHARITE Disc Prosthesis was developed in 1987 and has been implanted in Europe in more than 10 000 patients. Dr Loefler has been using the CHARITE for more than 3 years in a selected group of patients with mechanical back pain. Patients are encouraged to mobilize early. There is no need to wait for a fusion to consolidate as the prosthesis works once it is implanted. Most patients are able to return to physical work and sports. Disc replacement is an alternative to fusion in many patients with discogenic back pain.

SUBACROMIAL CORTISONE INJECTION

Subacromial cortisone injections may be indicated for:

Impingement, Rotator cuff tears, Calcific tendonitis or to make a diagnosis.

Below is the technique which has Dr Goldberg well over the last 15 years in Orthopaedic practice. It should be noted that these injections are simple to give and can provide gratifying results in patients who are in acute or chronic pain.

An understanding of anatomy is needed to ensure the injection is placed in the correct position. The aim is to inject the cortisone into the “bursal” area.

I use a 10 ml syringe with a 23 gauge needle attached. I generally use 2 ampoules of Celestone Chronodose combined with 8 mls of 1% Xylocaine.

Infection can be a problem and a “no touch” technique can be used using an alcohol wipe or Betadine. If you are not confident with a “no touch” technique then you should wear gloves and use a prep tray.

The aim of the injection is to place it under the acromion and above the rotator cuff, into the bursal area. This is a fairly large area and to make it easier to access, I have the patient sitting upright, so the weight of the elbow opens the subacromial space even wider. I approach the subacromial space from an anterolateral direction. Many doctors find the posterolateral direction more to their liking, and it is up to each doctor to use the approach with which they feel most comfortable. Once the injection is in position push the plunger of the syringe, and the fluid should enter the subacromial space with ease. If there is any resistance, stop, and reposition the needle.



Given correctly this injection is rarely painful but the patient may get some rebound pain after 2 hours when the local anaesthetic wears off.

With any procedure there are risks and complications. These include but are not limited to infection, allergic reactions and severe pain. All of these are exceedingly rare. It should be noted that diabetics may get a transient rise in their BSL.

MINIMALLY INVASIVE HIP SURGERY (MIHS)

Dr Bruce in collaboration with two overseas surgeons has designed a set of instruments to allow us to do total hip replacement (THR) through incisions ranging from 6 to 9 cm. THR was previously done through incisions ranging from 20 to 25cm. In the last 50 cases the patients undergoing MIHS left hospital 1.5 days earlier and lost an average of 210mls less blood. The operative time was 7 minutes longer and the patients discarded crutches much more quickly. There was no increase in morbidity. This procedure is very encouraging in its early results.

ORTHOPAEDIC SURGEONS AND THEIR INTERESTS

Dr Warwick Bruce – HIP AND KNEE
M.B., B.S.(Syd), F.I.C.S., F.R.A.C.S., F.A. Ortho. A.

Fellowships in Sports medicine and reconstructive hip and knee surgery. Travelling fellow in USA in joint replacement surgery. He consults at all Orthosports rooms ,operates at Calvary Hurstville Community Hospital, Canada Bay Hospital and Concord Hospital. He has published and written extensively and has been on the design team for hip and knee replacements.

Dr Jerome Goldberg - SHOULDER
M.B., B.S., F.R.A.C.S., F.A. Ortho. A.

Fellowship at the New York Orthopaedic hospital. Special interests include arthroscopic instability and rotator cuff surgery. He consults at all Orthosports rooms, operates at Calvary Hurstville Community Hospital, Canada BayHospital and Prince of Wales Private Hospital.

Dr Andreas Loefler – SPINE, TRAUMA, HIP AND KNEE
B.S.C., M.B., B.S., F.R.A.C.S. (Ortho.)

Anzac traveling fellowship of the Australian Orthopaedic Association. He consults at all the Orthosports rooms and operates at Calvary Hurstville Community Hospital, Prince of Wales Private and Public Hospitals.

Dr Stuart Myers - HAND AND WRIST
M.B., B.S. (Hons), F.R.A.C.S., F.A. Ortho. A.

He consults at the Hurstville and Randwick rooms and operates at Calvary Hurstville Community Private Hospital, Prince of Wales Private and Public Hospitals.

Dr John Negrine – ADULT FOOT AND ANKLE
M.B., B.S. (Syd), F.R.A.C.S.

Sydney Orthopaedic trained. US accredited Fellowship in foot and ankle surgery at Baylor University Medical Centre, Dallas Texas 1994. Member Australian, American and European Foot and Ankle Societies. He consults at all three Orthosports rooms and operates at Prince of Wales Private Hospital, Canada Bay Private Hospital and Calvary Hurstville Community Hospital.

Dr Rodney Pattinson - PAEDIATRICS
M.B.B.S (1983) F.R.A.C.S (Ortho.)

Fellowship at the Hospital for Sick Children in London and Princess Margaret Rose Hospital in Edinburgh. He also operates on adults with hip and knee conditions. He consults at all Orthosports rooms, operates at Canada Bay Private Hospital and Sydney Children's Hospital and St George Hospital.

Dr Ivan Popoff – SHOULDER, KNEE AND ELBOW
BPhEd(1987), MBChB(1991), F.R.A.C.S. (Ortho.)

Fellowship in Sports Medicine, Shoulder and Knee Surgery, Dalhousie University, Halifax NS Canada. He consults at all the Orthosports rooms and operates at Calvary Hurstville Community, Prince of Wales Private and Canada Bay Private Hospitals.

Dr Doron Sher – KNEE, SHOULDER AND ELBOW
M.B., B.S. (NSW), M.Biomed.E., F.R.A.C.S. (Ortho.)

Fellowships in upper and lower limb surgery. Sports Medicine Knee and Shoulder Surgery- Canada, Elbow surgery-Mayo Clinic, Upper Limb Surgery- New York. He consults at the Randwick and Burwood rooms and in Bondi Junction and operates at Prince of Wales Private, Concord Public and Canada Bay Private Hospitals.

Dr Allen Turnbull - HIP AND KNEE
M.B., B.S., F.R.A.C.S., F.A. Ortho. A.

Fellow in joint replacement surgery. Interest in sporting injuries involving the knee and joint replacement. He consults at the Hurstville office and has his own rooms in Sutherland and St George Hospital. He operates at Calvary Hurstville Community Hospital, Kareena and St George Private Hospitals and St George Public Hospital.

Dr Peter Walker – HIP AND KNEE
M.B., B.S., F.R.A.C.S. (Ortho.)

Awarded Zimmer travelling fellowship.Two accredited fellowships in hip and knee surgery in Boston and Toronto. He consults at all the Orthosports rooms and operates at Canada Bay Private Hospital, Prince of Wales Private, Calvary Hurstville Community, Concord and Canterbury Public Hospitals.

Dr Craig Waller - HIP AND KNEE
M.B., B.S. (Hons) NSW, F.R.C.S. (Ed.), F.R.A.C.S., F.A. Ortho. A.

He was awarded the University medal and graduate prize in surgery. He consults at the Burwood and Randwick rooms and operates at Canada Bay Private Hospital and Prince of Wales Private Hospital.

SPORTS MEDICINE

Dr John Best
B.Med., Dip. Sports Med. (London), F.A.C.S.P.
Sports Physician

Dr Hugh Hazard
M.B., B.S., Grad. Dip. Sp. Science, F.A.C.S.P.
Sports Physician

Dr Mel Cusi
M.B., B.S., Cert. Sports Medicine (RACGP), F.A.C.S.P.
Sports Physician

Dr Angus Bathgate
M.B., B.S.
Sports Physician

Dr Paul Annett
M.B., B.S. (Hons. I), F.A.C.S.P.
Conjoint lecturer UNSW

Dr Ameer Ibrahim
M.B., B.S.
Sports Physician