Author Archives: David Slattery

Dr Slattery (FRACS MBBS (Hons) LLB FAOrthoA) is an internationally fellowship trained and recognised specialist in complex pelvic, hip and knee surgery. He specialises in anterior minimally invasive hip replacement, periacetabular osteotomy, and hip arthroscopy, as well as the latest in hip and knee replacement surgical techniques. Click here to view full author biography.

Can I run after a hip replacement?

If you have been informed that you require a hip replacement at a young age, chances are that you want to remain as fit and active as possible. Dr Slattery sees many young people who are highly active, playing sports, having highly physical jobs, and running around after young families.  Expectations following hip replacement are quite different to 15-20 years ago, when hip replacements were traditionally thought of as only being for older, less mobile patients. These days, most patients after hip replacement are able to get back into most of their pre-replacement activities.  Commonly I get asked: “Can I run after hip replacement?”. Well, firstly this depends if you were running, or trying to run before your hip replacement. Jogging and running are important physical outlets for many people and the endorphins released and positive psychological effects of running is highly beneficial, as is the physical nature of the exercise. Many patients can continue running after they have undergone a hip replacement or a hip resurfacing procedure.  There have been traditionally concerns regarding the risk of ‘wearing out’ the implants over time, but this has not been shown in the literature, and recent studies do not show any higher failure rates in patients who return to sports and activities.  Most of the studies done on hip replacement procedures and running have been in older patients, and using older techniques and implant designs.  There were historically concerns regarding posterior hip replacements dislocations, and old types of plastic hip replacement components (LMWPE) wearing out with excess use. With modern implant designs, materials and methods of implantation (such as robotic and anterior hip replacement), there is not the same level of concern regarding implants ‘wearing out’, and hip replacements are more stable, therefore more patients are able to run on their hips. Some studies have even shown that up to 100% of patients can return to sports after hip replacement surgery, however, other studies have only shown 40% of patients can return to sport, therefore this requires careful analysis of your circumstances and the activities you wish to perform.  Generally, high intensity […]

How long will my hip replacement last?

If you have been informed that you require a hip replacement, one of the most common questions is how long is it likely to last.   There have been huge advances in hip replacement technology, with new minimally invasive anterior approaches that quicken recovery times and mean you are back into action faster, but how long does a hip replacement actually last, and what is your risk of needing to have it changed over? Most people believe that a hip replacement will only last 10-15years, and that if you have a hip replacement at a young age, that you are going to need to have it replaced again. The answer to this question is that your chances of having a hip replacement revised are due to many factors, including: your age when you have the first procedure the reason for having the hip replacement (eg Osteoarthritis vs other causes) the types of bearings (moving parts of the hip replacement) the type of fixation used (cemented vs uncemented hips) Your gender (women’s hips last longer than mens) your body mass your activity levels   How long will my hip replacement last? Approximately 90% of hip replacements should last at least 20yrs from when they were implanted. If you look at the graph below, based upon Australian Data of over 100,000 hip replacements at 20yrs the rate of revision (change over of the hip replacement) is approximately 8-10%.  This means that only 1 in 10 people who have had a hip replacement have required exchange surgery. And yes, you can exchange (revise) a hip that has been exchanged already. Things to consider when deciding whether the time is right to have a hip replacement: It is a difficult decision to have a hip replacement, however, hip replacement surgery is highly effective at alleviating your symptoms and returning to you to function.  If you have symptoms of hip pain which are: Not responding to medications (or the medications are causing side effects) interfering with your ability to walk interfering with your work preventing you from exercising and you are putting on weight interfering with […]

Questions to Ask when Choosing an Orthopaedic Surgeon

If you have been informed that you require an orthopaedic procedure or if you have been diagnosed with an orthopaedic problem with respect to your bones or joints, it can be very difficult to choose an orthopaedic surgeon to treat you. With so many orthopaedic surgeons practising in Melbourne, this can be a very overwhelming choice to make. Therefore, it is important to come prepared with a number of questions to ask your preferred orthopedic surgeon so you can determine the best one for your needs. Finding the best orthopedic surgeon in Melbourne At David Slattery, we strongly recommend that you carefully assess who you have been referred to in terms of their training, expertise, and experience. By treating your orthopedic surgeon like a candidate for a job interview, you can find the right person for the procedure. Keep in mind the following questions to ask when choosing a good orthopaedic surgeon:   Where were they trained?   The Australian Orthopaedic Association training program is one of the leading Orthopaedic Training programs in the world, as it is a competency based assistant, and it is the benchmark by which other training systems are evaluated. We would highly recommend that you choose a surgeon who has gone through the Australian Orthopaedic training program to ensure a high level of surgical expertise and competence.   What Fellowships have they completed?   This directly relates to the surgeon’s sub specialist interest and should give you an indication of what subspecialty they are an expert in. For anterior hip replacement surgery, in particular, it is essential that surgeons have completed a dedicated period of training to perform this procedure without significant complications. It is wise to choose a surgeon who has done at least 1-2 recognised 6+ month Fellowships in the subspecialty of the area of their practice. Most surgeons complete 18 months to 2 years of fellowship training to become an expert in their field.   How many of these types of procedures has the surgeon performed?   Most surgeons improve their results with practice, and it is appropriate to ask how many […]

What’s Causing my Hip Pain?

It is critical that your hip pain is evaluated by a hip specialist, as hip pain can be caused by structures around the hip, or it can be referred from the back or abdominal organs. If you are experiencing hip pain, being evaluated by an orthopaedic hip surgeon is essential to ensure a correct diagnosis and treatment plan. Structures in the hip which commonly cause pain include the labrum, cartilage, ligaments, tendons and muscles. There can be considerable overlap in the structures which are causing pain, as multiple problems can be occurring at the same time to cause your hip to be painful. Hip arthritis Hip arthritis is the most common cause of hip pain in older patients, as joint degeneration causes inflammation and irritation which causes pain and limping. Normally, the pain is worse with walking and activity, and it is relieved by rest and anti-inflammatory medication. Patients can sometimes have both hip arthritis, and tendon problems that are causing their pain. Inflammation Hip pain which is felt over the outside part of the hip, and which is worse with direct pressure or lying on the side, can be caused by inflammation of the soft tissues or bursa, and whilst it is an annoyance and can cause limping, is not normally restrictive and as functionally debilitating as arthritis pain. Hip pain in younger patients In younger patients, common causes of hip pain including hip dysplasia, labral tears, femoroacetabular impingement (FaI), stress fractures and overuse injuries. It is vital that if you are a younger patient with hip pain, that you are evaluated by a hip specialist as these diagnoses are commonly missed. In children, common causes of hip pain include hip dysplasia, perthes disease, slipped femoral epiphysis (SUFE/SCFE), and infections. In summary, there are many causes of hip pain, and it is essential that you are evaluated by a hip specialist to determine the cause of yours.

Tips on Returning to Work After Surgery

It can be very difficult to know when to return to work after having an orthopaedic procedure performed. When you will be fit to return to work depends upon a number of factors including the type of work you do, the type of surgery you have undergone, your weight-bearing restrictions, the use of a gait aid or crutches, your age, and other medical comorbidities. Type of surgery The type of surgery has a distinct bearing on when you will be able to return to work. Even with rapid recovery protocols and minimally invasive techniques, most surgeons would recommend a period off work for any procedure. Having an anaesthetic would generally mean that you are unfit for most jobs for 24 hours, and from there it will depend upon the type of procedure performed. For simple keyhole knee and hip surgery, it may only require a few days, to a week off; however, for more extensive procedures such as hip and knee replacement, you may require 2-6 weeks off work. Some patients are able to return to work quickly after a total hip replacement, depending on the type of work which they perform and their medication use. Many patients are able to get back to desk-based, office duties at 2 weeks from an anterior hip replacement, however, more physical jobs will require at least 6-12 weeks off work. For example, heavy labourers and tradespeople will typically require 4-6 weeks off work. This is also influenced by crutches use, which is typically necessary for 2 weeks after a hip replacement. Use of medications Other factors influencing a return to work include the use of medications and analgesia, and how these affect your ability to drive. You should not drive or operate commercial equipment when you are taking opiate analgesia, as this may delay your reflexes and impair your judgement. Getting to and from work Another key factor in returning to work is how you will get to and from work, and whether or not you can drive a car or catch public transport. If you have had right-sided lower limb surgery, you […]

Why Should You Consider Robotic Knee Replacement Surgery?

If you suffer from a form of arthritis, your doctor may recommend a robotic knee replacement. An evolving technique that has become increasingly common since 2008, robotic knee replacement uses high-precision computer-controlled instruments to replace the weight-bearing surfaces of the knee joint.  Dr David Slattery has extensive experience performing both traditional and robotic knee replacements and is able to advise patients on the most suitable approach for their condition. For the purposes of helping patients make the most informed choice for their health, Dr Slattery has prepared this article highlighting the benefits of robotic knee replacement and the conditions under which it may be considered as an option.  What does robot knee replacement offer over traditional techniques?   Robotic knee replacement offers several advantages over traditional techniques, with these benefits realised throughout the treatment process. At the diagnostic stage – when coupled with a CT scan – these technologies allow doctors to create a three-dimensional model of the patient’s knee, allowing them to select and position the prosthesis to better match your anatomy.  During the operation, the robotic surgical system enables more precise removal of diseased bone, reducing the risk of surgical error and allowing better alignment of the prosthesis with your existing anatomy. When conducted by an experienced professional trained in the use of the system, the result is often a better fitting prosthesis. As several studies have shown that component positioning is a key factor in the survival of a knee replacement, use of this system can reduce the need for revisions and enhance component longevity, with the majority surviving over 15 years. Robot-assisted surgical techniques are used for both total and partial knee replacements. Who can benefit from robotic knee replacement surgery? While many Australians struggle with knee pain and arthritis, not every patient will be a candidate for robotic knee replacement. Dr Slattery’s preference is always to pursue conservative, non-operative treatment options prior to considering surgery – where a patient’s arthritis fails to respond to these treatments, robotic knee replacement may be discussed.  Additionally, patients who have previously undergone knee surgery and require revision, or presenting with […]

Can Physical Therapy Help Me Avoid Hip Replacement?

While advances in technique have reduced the amount of recovery time required after a hip replacement, it’s understandable that patients want to consider conservative options prior to surgery.  Dr David Slattery has extensive experience providing pre-operative support for osteoarthritis patients. A key component in his conservative treatment schedule is the use of physical therapy. In this article, Dr Slattery discusses the utility of physical therapy for osteoarthritis patients, its effect on existing cases of hip arthritis, and its use in a post-operative context.  What physical therapy as a conservative treatment can achieve  If you’re yet to undergo a hip replacement, it’s important to note first and foremost that physical therapy won’t treat the underlying osteoarthritis, but it may be able to alleviate symptoms. By strengthening the musculature around the hip, weight is offloaded from the hip and the stability of the gait improved. As the pain from hip osteoarthritis partially results from bone-on-bone friction due to a loss of cartilage, better supporting of the hip minimises stress at the joint, potentially reducing pain resulting from physical activity. As such, targeted physical therapy is often recommended alongside more general exercises such as walking or swimming, helping to strengthen a variety of muscles. Why physical therapy is recommended after surgery  Dr Slattery utilises enhanced recovery techniques to help patients return to their normal activities as quickly as possible. Physical therapy forms an important part of these techniques, speeding up recovery and reducing rehabilitation time after hip replacement.  Should you decide to proceed with a hip replacement, Dr Slattery will prescribe a physical therapy program for you to follow. Beginning from your first day in the hospital, this program will evolve alongside your growing level of mobility, ensuring consistent progress throughout your recovery. In the days immediately following your surgery, you’ll progress from bed-based motions such as ankle pumps and leg raises to resistance-based standing movements and ultimately more dynamic exercises. Regular physical therapy can strengthen the muscles around the hip, minimising the amount of time required with a crutches or a frame and allowing you to progress to independent walking and more […]

How do you know when it’s time for hip replacement surgery?

We understand that sometimes it can be difficult to know what is causing your recurring hip pain, and working through the process of getting a diagnosis can be very frustrating. No one should be suffering chronic pain in their hips as there are options available to rectify the problems you are having.  Hip pain can have a myriad of causes but not all of them can be relieved by a hip replacement. Anything from sciatica to rheumatoid arthritis can cause stiffness and other long lasting issues that radiate through the buttocks and legs, ultimately causing your pain in the hip area. Getting to the root of the cause is always incredibly important when it comes to hip replacement symptoms. Hip replacement surgery is a fantastic and effective option for people who are suffering long term issues but haven’t seen proper relief through alternative treatments. So, how do you know it is time for a hip replacement? We’ve put together some of the hip symptoms and complaints that are most often presented to us that will often lead into undergoing hip replacement surgery.   Treatments have failed Have you gone down the road of trying to work through your hip replacement symptoms by using non surgical procedures or measures like pain management or physical therapy? If you’ve tried the following paths without suitable symptom relief then we recommend coming for a consultation with our team: Anti inflammatory medications Pain killers Over the counter medications Non operative measures Physiotherapy Osteopathy Exercise Weight loss Other surgical operations If those endeavours were once effective but are no longer showing you any relief from pain in your hip, then it could be time to consider hip replacement surgery. Normal activities are hindered When any type of pain, stiffness or discomfort is hindering your everyday life, it is definitely cause for concern. This weight bearing set of joints is involved in just about every movement you’re making, from walking to bending down to tie up your shoelaces, you will be engaging your hips, buttocks and legs. Being unable to enjoy activities or perform the following everyday […]

What are the best recovery exercises after knee replacement surgery?

The road to recovery after a knee replacement can seem daunting, but the pay off for the hard work is life changing, especially if you have been living with chronic pain and recurring injuries in your knee. A strong commitment to physical rehabilitation after a knee replacement surgery is absolutely imperative to having the best chance at a full recovery. After your surgery, your physiotherapist will provide you with knee replacement exercises and it is best to maintain them as per your personalised schedule. Returning to regular exercise after a knee replacement  Ultimately, the aim with knee replacement exercises after surgery is to help you strengthen the muscles and regain movement, hopefully restoring some normality back to your life. On average, patients are able to walk unassisted within 4 – 8 weeks of surgery. The months of rehabilitation in the lead up will help to get your life back to normal as soon as possible. It is good to remember that everyone has a different recovery period and expectations may need to be adjusted accordingly.  As full weight bearing and unassisted walking are two of the main goals in recovery from a knee replacement, a whole host of great mobility increasing exercises will be recommended as homework to be taken on every day. These types of exercises include heel slides, knee bending and straightening, leg lifts, ankle pumps and circles, thigh squeezes and others, depending on your progress. Clinical pilates with a professionally trained instructor, hydrotherapy, swimming laps, walking, cycling and other low impact activities are all fantastic forms of knee replacement exercise.  With any postoperative recovery period, there will be movements that could cause damage to the newly reconstructed or repaired soft tissue and bones. Some knee replacement exercises to avoid are anything that involves running, jumping, heavy lifting – high impact on the knee joint will be detrimental and should be discussed with your physician before. Sports like football, basketball, skateboarding, watersports, tennis or aerobics can exacerbate the injury and potentially cause your knee damage. Yoga can sometimes be recommended for post op patients as is it a […]

Rehabilitation After Hip Replacement Surgery

If you’re considering hip replacement surgery, one of the key areas you’ll discuss with your healthcare professional is your post-operative recovery.  Dr David Slattery has extensive experience in complex hip surgery, with specialisations in minimally invasive muscle sparing hip replacement and hip arthroscopy. Central to his practice is patient communication – to that end, Dr Slattery has prepared this article outlining a few key points about post-operative rehabilitation and recovery after hip replacement surgery. Is rehabilitation necessary? Rehabilitation after an operation can help you return to your previous level of activity sooner. Hip replacement is a major operation which your body needs time to recover from. Following a proper rehabilitation program can ensure that your body has the best chance of recuperating after the surgery, strengthening the muscles around your new joint and allowing you to get back to life.  What is involved in rehabilitation?  Rehabilitation can take various forms depending on the specific needs of the patient after surgery, but broadly can encompass a programme of rest, targeted exercise, physical therapy and assisted movement. You’ll begin exercising before you’re upright, doing basic seated exercises while in hospital in order to begin to strengthen the surrounding muscle. From two weeks after your operation, more vigorous – but still low-impact – exercise such as a stationary bike, with hydrotherapy recommended from four weeks.  Additionally, you’ll be required to walk with the assistance of crutches or a walker for up to four weeks. Walking on your new hip is one of the best ways to strengthen it, so walking for exercise purposes is recommended from eight weeks onwards. Expect to see a slow return to all activities and pre-operative levels of strength and balance over the following months, with some patients taking a full year to regain everything.  What is enhanced recovery after surgery & can it help me?  Enhanced recovery after surgery is a series of evidence-based practices employed before, during and after a procedure in order to help patients recover as quickly and as fully as possible. Within the context of hip replacement surgery, enhanced recovery after surgery could look […]