Category Archives: Blog

Meniscal tear

Looking into the knee with a scope gives a surgeon the perfect picture of what is going on inside the knee joint. If you have torn some cartilage from the bone, or have some tearing of your meniscus from a sporting injury, an arthroscopy can fix this.

While looking at the inside of the joint Dr Ben can see the tear and either smooth the area so it not longer catches and causes pain or fix it back into place with a small stitch. This is done with fine instruments that can fit through a cut in the skin the width of a thumb nail.

Loose Bodies

Sometimes a small piece of cartilage or boney surface detaches due to injury. This causes pain inside the knee and can scratch and damage the joint surface. A knee arthroscopy is a good way to remove this problem.

Knee arthroscopies will not help people with bad arthritis who do not have any meniscal tears.

Northern Hemisphere Ski Season

We are now in the middle of the Northern hemisphere ski season, and from all accounts, there has been plenty of snow in all the major skiing destinations. So many people are planning exciting holidays to Japan, North America and Europe and skiing is often the big draw card.

What are the most common injuries?

The majority of injuries to the knee involve the anterior cruciate ligament (ACL) or the medial collateral ligament (MCL). Last year I saw a family that had returned from Japan where both Mum and Dad injured their ACL. Despite that, they’re already booked for this years ski season with their ACLs reconstructed.

How do they occur?

Most knee injuries occur in fatigued skiers. This often corresponds to the middle or end of your holiday and later in the day. If you are tired take a break, warm up inside for a bit and get your energy back.

It’s a common misconception that you need to be going fast to injure yourself while skiing. In actual fact, most knee injuries occur at low speed, often while turning at the bottom of a run when the knee is over rotated.

How do you know if your knee is severely injured?

This is normally it is pretty obvious to the skier. If you’ve heard a crack or pop then you have ruptured something, and severe pain or the inability to weight bear suggests significant damage.

A knee that feels unstable or gives way usually means a ligament is torn, and swelling in the knee post-injury may signify bleeding into the joint – an indicator of severe injury.

I have injured my knee skiing, what should I do?

If after the injury, you’re unable to ski, the knee is swollen, feels unstable or is very painful, then it is worth seeking medical help whilst still on holiday.

The ski patrol may have been involved in helping you off the snow, in which case you will usually be assessed at the ski resort medical centre. The staff here will be very experienced in knee injuries and can usually make an accurate diagnosis.

If this hasn’t occurred, a lot of ski resorts now have physiotherapists or medical centres nearby where you’ll receive an excellent knee diagnosis. You’ll usually need crutches and a splint, plenty of rest, ice and elevation of the injured leg.

I have been told I have ruptured my cruciate, what should I do?

Early on, it’s all about getting comfortable and reducing the swelling. That means rest, ice, compression, and elevation. There’s no hurry to have your ACL fixed, and certainly no need to have it fixed overseas. Most travel insurance companies will allow you to upgrade your return ticket to a class that provides you with additional leg room, so it’s certainly worth contacting them.

We are very used to liaising with injured patients while on holiday, so don’t hesitate to email or call us and we can arrange any scans and appointments as soon as you return to Perth.

Some top tips to consider before you ski:

Get fit: Skiing is physically demanding. Doing some leg strengthening exercises (running, walking, cycling, cross training) in the weeks leading up to your trip is a good idea. FIFA has a great series of exercises around the knees that decrease your risk of injury https://www.kort.com/uploadedFiles/KORT/Content/Services/Sports_Medicine/Concussion_Management/FIFA-the-11-Booklet.pdf

Avoid fatigue: If your legs are aching, have a rest day.

Alcohol at lunch: Always a bad idea. (Unless of course you’re already at the bottom of the slope!)

Insurance: Comprehensive overseas travel insurance is now very affordable and a wise investment.

Over 1.2 million Australians play netball regularly. It is the leading women’s participation sport and the top team sport for ages 15 to 24 . All ages play netball and it is a fantastic sport to develop health and fitness. Netball involves high speed, deceleration, twisting and pivoting. Because of this knee injuries are relatively common.
The knee is the most commonly injured joint in Netball. 25% of major injuries reported from netball involve rupture of the ACL. This is a devastating injury to netballers as it usually requires surgery, prolonged rehabilitation and time away from the sport. Other less severe knee injuries occurring during netball include ligament sprains, dislocated knee caps or torn cartilages.

Knee injuries from jumping or twisting

So, I have injured my knee while playing netball, how do I know if it is serious?

Most people that sustain a severe injury to their knee know straight away they have done something major. Other clues include:
– Snap or pop: If you hear or feel a noise it means something has broken or ruptured.
– Can’t walk on it : If it is too sore or unstable to play or walk on serious damage is likely.
– Immediate swelling: Usually signifies bleeding into the knee and thus, a serious injury.
If any of the above occur you should rest, ice , elevate and compress the joint and then get the knee examined as soon as possible. Your GP, Physio or Orthopaedic surgeon can examine your knee injury.

knee injuries could be an ACL rupture

Will I need surgery?

You will need surgery if you have ruptured your ACL or torn your cartilage.
ACL reconstruction is the standard treatment for a torn ACL. It involves surgery to replace the ruptured ACL with a tendon from elsewhere in your body. The rehab is long but the results are good. If you have torn a cartilage (meniscus) knee arthroscopy is usually required. This is simple day case keyhole surgery. Most people are back playing sport 4 to 6 weeks after arthroscopy.

How can I prevent knee injuries while playing netball?

There is now good evidence that injury prevention programs do work to limit the number of knee injuries. Netball Australia has a KNEE program that consists of a number of knee exercises that can be incorporated into the warm up and main part of netball training. These aim to improve player’s technique, strength and agility. Which is especially relevant to preventing knee injuries.

In conclusion Netball is a fantastic and safe sport. It is possible to injure your knee playing, but a good assessment and treatment plan can get you back on the court as soon as possible. Contact Dr Benjamin Hewitt, to arrange a consultation if you suffer a knee injury.

ACL Reconstructions

We are now well into the AFL and Netball seasons and are seeing the usual spike in anterior cruciate ligament (ACL) injuries. This article tells you what you can do to prevent an ACL injury, how we diagnose ACL injuries, and what are latest developments in ACL reconstruction.

How do I avoid rupturing my ACL?

It was once thought that there was nothing you could do to prevent rupturing your ACL. This is not the case. We now know that improving your strength, skill and coordination, prior to playing competitive sport, can reduce your chance of ACL injury and thus needing an ACL reconstruction. Most coaches are aware of this and preseason training is aimed at improving your strength, flexibility, stamina, agility and balance.

The FIFA 11 + program is one such set of warm-up exercises specifically designed for soccer but easily applicable to our football and netball players.

How do ACL injuries occur?

Most ACL injuries are non-contact and involve either twisting or hyperextending the knee. Often, there is a loud “crack” or “pop” and most players know they have suffered a major injury. The knee is swollen and you cant walk let alone play-on.

How do I know if I have damaged my ACL?

A history of a crack or pop with a very painful and swollen knee makes me highly suspicious of a ruptured ACL. Once I examine your knee, the diagnosis is usually confirmed. An MRI scan is not necessary in everyone but will usually put the diagnosis beyond doubt.

Sounds like I have injured my ACL, what next?

Treatment on the first day involves rest, ice, elevation and getting an urgent appointment. Callor email the office and we will always see badly injured knees within 2-3 days of the injury.

My ACL injured patients are generally very keen to get back into twisting, turning activities without risking further damage to their knees. To do this, you need an ACL reconstruction.

What is the latest and greatest way to fix my ACL?

In the last 10-years there have many new developments in ACL reconstruction. The operation is now exclusively done via the telescope, using mini incisions. A brace or plaster is not needed and most patients are off crutches by 1 week following the operation. Patients only spend 1 night in hospital and we begin rehab day 1 post operatively.

There has been much talk about artificial ligaments and their possible advantages. In some people they have been successful, but the results are still disappointing when compared to hamstring and patella tendon grafts. I believe the best graft for an ACL reconstruction is still your own tissue.

In summary, ACL injuries can be a devastating, season ending injury. With the latest techniques in ACL reconstruction they can be fixed, allowing patients to return to the activities they love.

For more information, contact us on (08) 9322 1900 or submit an enquiry form.

Shoulder Injuries – Swimming is painful

The Rottnest Channel Swim is over and the conditions this year were pretty tough. My practice always seems to be inundated at this time of year with swimmers who have sore shoulders. I see many types of shoulder injuries. If your shoulder hurts when you swim hopefully this article will provide some direction as to what to do next.

If you swim enough, at some stage you will get a sore shoulder. Usually the pain is due to bursitis or impingement in the subacromial space. That is when your shoulder tendons rub on the bone above.

Below are some of the common causes of painful shoulders that I regularly see:

Overtraining / Overloading: To swim to Rottnest you need to complete a 10km qualifying swim. Very few people swim 10km in a single training session, so don’t be surprised if you arms and shoulders ache after your first 10km. As you load up your training the muscles around your shoulder get fatigued and you lose shoulder balance. This sets up a vicious cycle of pain, muscle dysfunction and more tendon rubbing leading to more pain.

All swimmers need rest days and a coach that understands when to push and when to back off.

Poor technique: Perth is blessed with many great swimming coaches. Most coaches target body position, flat hand entry and high elbows. There is no doubt good technique places less stress on your shoulders. Video analysis is great fun and a powerful tool to correct your technique.

Getting old: Everyone likes to think they are as strong and flexible as when they 20. You are not. Shoulders develop spurs and tendons get old. Often this leads to more pain and shoulder injuries.

A lot of shoulders settle down with rest, training modification andanti-inflammatories, so when should you come and see me?

If you have any of the following its worth making an appointment:

Soreness that hasn’t settled in 2 weeks.

Pain that wakes you at night

Discomfort that stops you from swimming even a couple of laps.

A shoulder that is getting stiffer or weaker

Or you are just worried that your shoulder is failing you.

Knee Replacement Surgery

Knee replacementsurgery isnow a very common and successful orthopaedic operation, with the number of knee replacements performed each year increasing. In 2016, there were almost 60 thousand knee replacements performed in Australia.

Knee replacements are performed when a knee joint has become so arthritic or damaged that it can no longer function without causing severe pain and discomfort.

Other modalities / therapeutic methods that may play a role prior to replacement include:

Exercise, weight loss or physiotherapy
Medications such as anti-Inflammatories (e.g. Voltarin, Mobic, Naprosyn)
Injections: Steroids or Synvisc
Arthroscopy

A knee replacement is the last resort when the above treatment options have failed.

What is a Total Knee Replacement?

Technically, a knee replacement should really be called a “knee resurfacing”, as the knee isn’t replaced in its entirety. The only part Dr Benjamin Hewitt replaces is the worn-out surface cartilage.

During knee replacement, these parts are removed and a new bearing surface, made of metal or plastic, is cemented in position. The aim of this is a pain free and mobile joint post-recovery.

A knee replacement should really be called a knee resurfacing as not all the knee is replaced. The only part that I replace is the worn-out surface cartilage. During a knee replacement, these parts are removed and a new bearing surface made of metal and plastic is cemented in position. The aim is a pain free and mobile joint.

Do I Need My Whole Joint Replaced?

In most patients, only half of their knee is worn out, usually the inner side of the knee, and therefore only half of this needs to be replaced.

This is great option for surgery, as a half knee replacement is a much smaller operation. This means a quicker recovery period, and often the knee feels better than after a whole knee replacement.

What is Involved in Getting a Knee Replacement?

Timing: Once you’ve decided on knee replacement, all you need to do is pick a suitable time and Dr Benjamin Hewitt will do the rest.

Location: The best results post-knee replacement come from high volume surgeons working at high volume facilities. Dr Benjamin Hewitt performs his knee replacements at Hollywood Hospital. He firmly believes this is the best joint replacement hospital in Australia. Excellent nursing staff and state of the art theatresmakeit the ideal environment for your surgery and post-operative care.

Day of surgery: On the day of your surgery, we ask you arrive at Hollywood Hospital early in the morning. The specialist nursing staff will check you in and prepare you for your operation. The operation is performed under general anaesthetic and takes 1 to 2 hours to perform.

After your operation: Our aim is to make you as comfortable and pain free as possible. The day after your operation, our physiotherapists will commence your custom rehab programme and get you up and walking.

Length of hospital stay: As a rule of thumb, after 3-4 nights you’re normally safe to walk around unassisted. Once comfortable and safe, you’re ready for discharge.

My Neighbour Had a Knee Replacement That Didn’t Work

We are constantly hearing this, and believe it or not, there are people who’ve had knee replacements and aren’t happy. Most people who’ve undergone knee replacement are improved, finding they can walk further, their leg is straighter, and they have little or no pain.

Occasionally, some patients do suffer complications that can affect their recovery. Having said that, we firmly believe most patients who end up unhappy have had unrealistic or incorrect expectations.

Knee replacement is considered the last resort of treatment. It is for people crippled or severely disabled by pain or deformity. So, before you consider the surgery, ask yourself a few questions:

Can you only walk 200m before stopping due to pain?
Do you take a lot of tablets every day for your pain?
Do you have trouble sleeping due to pain?

If the answers are no, then perhaps we need to consider alternative options.

Total knee replacement is now a routine, major operation. It is a good option as a last resort for the severely arthritic knee. Contact us today for a consultation with Dr Benjamin Hewitt to discuss your options, or schedule your surgery.

Expectations After Knee Replacement Surgery

Knee replacement surgery is one of the most commonly performed orthopaedic operations in Australia with a very high success rate.

I perform about 100 knee replacements every year.

This article is designed to provide an insight into what you can expect following a knee replacement. And it will also bedetailing what you can do to maximise your recovery.

Before your knee replacement surgery

Once you have decided that a knee replacement is your best treatment option my team will help you pick a date for surgery.

Pre-hab is worthwhile. We encourage all our patients to try to stay as fit and healthy as possible. Good muscle strength before your operation often equates to a fast rehab.

So in the week before your knee replacement surgery Hollywood Hospital will contact you for an pre-admission assessment. This is an opportunity for our team to ensure there are no medical problems that may compromise your recovery. Andalso for you to ask any questions.

You will be admitted on the day of surgery , usually at 0630 am.

Early recovery / Hospital stay

After the operation you will be transferred back to the ward. The nursing staff will keep a close watch over you. Theyensure that you are comfortable and able to sleep off the anaesthetic peacefully.

Day 1 after the operation is a big day. Your leg will be x-rayed and a blood test performed.

The physiotherapists will stand you out of bed and ,if you feel up to it , you can start do some gentle walking. Most of your drips and catheters will come out today so you can have a shower.

With each day your knee should become more comfortable. And you will begin to walk greater distances. Normally after 2 days you are taking just a few tablets for pain.

The physiotherapy team will assist you walking. A physiotherapist will help with some simple leg exercises after knee replacement surgery.

During the first couple of weeks following knee replacement surgery it is vital that you do not overwork the knee. I advise to do only what you are comfortable with. Definitely do not push through any discomfort.

We let you go home when you are safe, comfortable and confident of being able to look after yourself. On average my patients spend 4 nights in hospital.

After leaving Hospital

When you leave hospital you will have enough medications to control any discomfort till your next appointment. This is usually within 1 week of your discharge.

There is no urgency with regards to exercising the knee. It is important to let the swelling subside before beginning strengthening exercises.

Most patients make steady gradual improvements in all aspects of their knee function in the months following kneereplacement surgery.

By 2 weeks most patients are only taking occasional pain relief. By 5 weeks not using any walking aids such as a crutch or stick. The majority of patients are driving by 4-6 weeks.

It is important to remember that my job is not just performing your knee replacement surgery. Ialso coordinate and advise you on your ongoing rehabilitation.

As always, my goal is for you to achieve the best possible outcome in symptom relief. And finallyimprovement of function in the shortest time possible. Contact me for an appointment.

Obtaining Quality of Life – No More Friction

Constant pain. Joint swelling. Stiffness. Fatigue.

6.1 million Australians, or 28% of our entire population, are currently living with the symptoms of arthritis and other related orthopaedic conditions. This effect their quality of life.

Symptoms such as pain, swelling and stiffness are very common and often debilitating.

The inability to walk, move or sleep without pain can impact almost every aspect of life.

For some people it may be the inability to play sport others may be unable to work or care for their family.

To stay fit and healthy we need to be able to move and exercise, loss of freedom of movement leads to a demise in general health and overall well being.

Arthritis Australia found that people with arthritis recorded significantly lower wellbeing scores compared to the general Australian population (mean score of 64.0 compared to 77.6). This research demonstrates the detrimental impact that arthritis has on the quality of life of Australians.

Arthritis becomes more common the older you get, at 75 yrs of age you have a 50% chance of suffering from the symptoms of arthritis. Because of this fact it is a common misconception that arthritis is a natural part of the ageing process.

However, this is not the case. While arthritis researchers still debate the underlying causes of osteoarthritis, what they all agree on, is that arthritis is not a natural part of ageing.

If arthritis isn’t a natural part of ageing then it shouldn’t be simply accepted with all the pain and disability that accompanies it.

But what can you do to reduce arthritic symptoms or minimise the impact of this disease on everyday life? How can you take action?

Dr. Benjamin Hewitt is an Orthopaedic Surgeon in Perth who specialises in treating arthritis of the knee, hip and shoulder. He uses state of the art treatments to return his patients to the best function their body can provide.

Dr Benjamin Hewitt works in concert with a variety of medical and non medical specialists to formulate an individual treatment programme that aims to alleviate the symptoms of arthritis and improve your quality of life .

Often if caught early symptoms may be alleviated with a structured exercise programme, cartilage preserving agents or inflammation reducing injections.

In some cases surgery may be the answer. This may be key hole arthroscopy to reconstruct or clean up an arthritic joint. In other situations major joint replacement surgery may be an option to create a whole new customised pain free joint.

People are now living and better, why suffer the pain of arthritis and orthopaedic conditions any longer?

Hip Replacement Surgery – The FAQs

Hip replacement surgery is one of the most common and successful orthopedic operations performed worldwide. It is usually performed when the hip joint wears out, resulting in pain and dysfunction. Such deterioration in your joint can dramatically affect and reduce your quality of life.

Last year in Australia there were over 34 thousand hip replacements performed, with this number steadily increasing every year. The following section hopefully answers some of the commonly asked questions about hip replacement and hip revision surgery.

Why would I need a hip replacement?

The hip joint is one of the most important joints in your body. We rely on it to stand, walk, and do all our usual daily activities. It consists of a ball and socket joint with a smooth hard bearing cartilage. This cartilage is the key to the joint functioning well, if it becomes damaged the joint will become painful and stiff. The most common cause of damage to hip joint cartilage is osteoarthritis, but the cartilage can also be damaged by infection or trauma. If the cartilage is damaged the joint usually becomes painful and progressively more stiff. In some patients, this can be very severe.

Normally, the hip is replaced when you are getting severe pain on a daily basis and it is stopping you doing the activities you want or need to do. For some people this might be the inability to sleep without pain, others might no longer be able to walk the dog or play golf. The aim of any hip replacement is to remove your pain and stiffness and get you back to the activities you enjoy.

Are there any alternatives to hip replacements?

Absolutely! A hip replacement is the last resort.

For some patients, painkillers, injections, and exercises can provide temporary relief. If the hip joint is worn out and the symptoms become debilitating, then the only long term solution is a hip replacement.

How long will my hip replacement last?

As is the case with all mechanical devices, hip replacements can fail – this usually occurs when the bearing surface wears out and the components become loose.

The details of all hip replacements performed in Australia are recorded and analysed by the Australian National Joint Replacement Registry. This means that Dr. Hewitt (and thus you) have access to exactly how long most joint replacements last.

On average, at the 10-year mark, 94% of joint replacements are functioning well, and come 15-years this has dropped to 90%. That means, should you have undergone a hip replacement, you have a 90% chance of it still fully functioning 15 years after your original operation. Try getting that from the next motor vehicle you buy!

What is the difference between hip replacement and hip revision?

If a hip replacement fails or comes loose, a new hip replacement needs to be inserted. The operation to remove the old joint (also called the primary joint) and insert a new joint is called a revision hip replacement. This is usually a bigger procedure than the first operation and requires very careful planning.

What are the different types of artificial hips? What type will I get?

Most hip replacements are very similar and consist of a cup, bearing surface (that sits within the cup) and a stem.

The stem and cup are metal and Dr. Hewitt uses an uncemented system. This means the components are pressed into the bone, which then (in time) grow onto them, hopefully holding them in place forever.

The ideal bearing surface is hotly debated amongst hip surgeons. Metal on highly cross linked plastic performs the best on the Australian Joint Registry, which is why Dr. Hewitt uses this in most of his patients.

How do I prepare for a hip operation?

Once you and Dr. Hewitt have decided that hip replacement is your best option the rest is easy. His experienced staff will assist you in selecting a surgery date and booking in to the hospital.

Dr. Hewitt performs his hip replacements exclusively at Hollywood Private Hospital. In most situations, Hollywood Private Hospital will contact you prior to your operation for a pre-admission assessment. This may involve a short appointment at Hollywood where the nursing staff will answer any queries you may have and ensure you’re fit and ready to proceed.

How long will I need to be in hospital?

Most patients will stay in hospital for 4-5 nights. This time is spent optimising your recovery and beginning your rehabilitation. Dr. Hewitt and yourself will decide when you are safe and comfortable to go home.

If you have any further questions, or believe you require hip replacement surgery, please contact Dr. Benjamin Hewitt’s office to arrange a consultation.