PATIENT SURGERY INFORMATION
Patient guide
Professor Peter Choong
MBBS MD FRACS FAOrthA FAAHMS MAICD.
Orthopaedic Surgeon
Pre and post operative care and advice from
Central Melbourne Orthopaedics
This information is to help patients prepare for their surgery and know what to expect after their operation and transition from hospital care to home care. To help you access any specific information on this page, please use the buttons below:
Pre-admission – Booking your surgery
Surgical Consent – Once your Surgical Consent has been signed our rooms will forward you all necessary information for your procedure.
This will include:
- Admission details
- Hospital Registration
- Out of Pocket Cost
- Any additional appointments.
Central Melbourne Orthopaedics – You will be contacted by our rooms the day prior to surgery, to confirm admission and fasting times.
Surgery Location – Professor Choong operates at St Vincent’s Private Hospital, Victoria Parade, Fitzroy. Melbourne VIC 3002.
Fees
Private health cover – It is a requirement of our Practice that you have appropriate Private Health cover in order to plan an appointment and any subsequent surgery.
Financial consent – You will receive an informed financial consent form regarding out of pocket expenses for Professor Choong’s fee when you make your booking for surgery. This out of pocket is payable after surgery. The surgical fee includes initial follow up visits. However, later consultations (generally those more than three months after surgery) usually attract a separate charge.
Out of pocket – There is an out of pocket to the patient for Professor Choong’s services. This is determined by the MBS Item No. All other procedures are billed at AMA (Australian Medical Association) rates and will incur an out of pocket to the patient.
The anticipated MBS item no will be advised at the time of your surgical booking. It is strongly advised that you contact your Private Health Fund to confirm your eligibility and any excess or out of pocket payable to the Hospital
Surgical assistant | Anaesthetist | Surgical team – It is routine for Professor Choong to use a Surgical Assistant. Assistants’ fees are calculated at a maximum of 20% of the surgeon’s fee. There is also a separate fee for the Anaesthetist, for which there may be an out of pocket expense. The Surgical Team will be confirmed at the time of booking and you will be contacted separately by their respective rooms in regard to cost.
Peri Operative Physician – Prior to surgery you will be reviewed by Professor Choong’s Perioperative Physician. He will discuss your medical history, medical conditions and any medications currently taken, advising when and if these need to cease prior to surgery.
You will require routine blood tests and he may also send you for any other investigations required prior to your surgery.
You will be invoiced separately by the Perioperative Physician for their services.
Pre admission classes
Joint replacement patients
St Vincent’s Private Hospital conduct classes for Professor Choong’s Joint Replacement patients. They are held once a month and are specific to either knee or hip.
Class size – Usually 6 participants and in attendance will be a Nurse, Physiotherapist and Occupational Therapist.
Patient plans – Information provided relates to:
- Inpatient care
- Discharge plan (whether to Home or a Rehab facility)
- Recovery ie: post operative exercises.
This is a service offered by St Vincent’s Private as part of their and Professor Choong’s services. Professor Choong strongly encourages patients to attend.
Before surgery advice
Surgery is an important event in your life. It is very important that you and your family understand the reasons for your surgery and feel comfortable with your knowledge and explanations of your care prior to undergoing treatment. A successful outcome more often occurs when your expectations of surgery matches the surgeon’s. Fully understanding your care is vital for providing informed consent. It is important that you take the time to ask your surgeon any query that you may have and even get a second opinion if you are not comfortable with the information that you have been given.
Involvement – Be actively involved in your own care.
Ask – Speak to your surgeon or their staff if you have any concerns or questions.
Educate yourself – Learn more about:
- Your condition
- Treatment options
- Length of hospital stay
- Be aware of your admission and fasting times.
Central Melbourne Orthopaedics staff are happy to provide you with further information if you require it.
Medications – Make sure you have a list of all the medications that you take, and you understand why you are taking these.
Agreement – Make sure you, your GP and your surgeon are all agreed to what surgery is being proposed.
Medical conditions and allergies – Let your surgeon know if you have an allergy or a medical condition that may affect your surgery.
Documentation – Ensure your admission documentation and operation consent have been completed.
X-rays and scans – Bring all x-rays and scans with you to hospital.
Carer – Ensure that you have someone to bring you to hospital and drive you home. If you are having day only surgery it is advisable that you have someone that can stay with you for a couple of hours after returning home on the day of surgery.
What to bring – Ensure to:
- Bring comfortable clothes
- Appropriate footwear
- Toiletries
- Change of bedclothes if you are staying in the hospital overnight.
During your hospital stay
Surgical approach – Most patients are healthy other than the specific problem that they are being treated for. It is important to understand that most orthopaedic surgery is wellness surgery and so you should aim to be as active and normal as possible while in hospital.
Fasting – Most patients will fast for at least 6 hours before surgery. You will be told a specific fasting time on your hospital paperwork.
Post surgery meals – Most patients will be able to take a light meal or fluids about 6 hours after surgery, although it is normal to lose your appetite for a number of days after major surgery.
Pain management – It is normal to feel some discomfort or pain after surgery. It is important that you ask for pain killing medication as soon as you start to feel discomfort. The nursing staff is there to make your stay comfortable, so please ask if there is anything they can do to help you. A comfortable and pain free patient is able to do more and return to normal more quickly than one who is in pain.
Drips and tubes – Do not be afraid of drips in your arm or neck, or tubes coming out from near your incision. These are normally in place for about 48 hours after your surgery. Drips are to provide you with antibiotics, pain killers, fluid and blood if this is needed. Drains are placed in the area of operation to help remove any excessive amounts of blood that may collect after surgery.
Swelling – Usually the limb that is operated on will be swollen. Do not worry. The sooner it is used normally, the quicker it will return to its normal size and shape. You will be given appropriate precautions about the use of your limbs after surgery.
Contact with your doctor post surgery – While you are in hospital you will be seen by your surgeon almost everyday following your surgery. The time at which you will be seen may vary depending on your surgeon’s schedule. You may also be seen by a physician each day to ensure that your general health remains good during your stay after surgery if required.
Routine tests – There may be blood tests and x-rays performed routinely after your surgery.
Movement post surgery – Walking if you can, or moving your feet and legs if you are confined to bed are important exercises to reduce the risk of deep vein thrombosis (DVT). Many patients will also receive daily injections and special calf massaging appliances to minimize the risk of DVT.
Rehabilitation – A plan will be made soon after surgery as to whether you will return straight home or to a rehabilitation centre. Almost all patients are well enough to go home, and only a few will require a short stay at a rehabilitation centre. Most patients find that they sleep, move around and eat much better in their own homes because of the familiarity of their surroundings. Patient’s families or carers are vital team members in a successful return to home programme.
Going home
Most patients will return home by car.
Medication – Make sure that you have your medication supplied to you before you go home. This will include painkillers, but may also include other medications that you usually take or have been given following your surgery.
Wound care – Make sure you understand who will look after your wound, and follow the post operative dressing instructions given to you at your discharge.
Restrictions and exercises – Make sure that you understand from your physiotherapist or surgeon what your restrictions are after you leave hospital. At the same time, ensure that you understand what exercises you have to do each day to maintain your strength and mobility.
Wound or swelling concerns – If you are worried about your wound, swelling of a limb or pain do not hesitate to let your surgeon know by ringing (03) 9639 1300. If you cannot get through to your surgeon then contact the ward where you were before discharge and they will be able to advise you.
Follow up appointment – A postoperative appointment has been made for you at the time of booking your procedure. Please refer to your Surgery Booking Letter or please call our rooms during office hours on (03) 9639 1300.
Getting home from surgery advice
Hip replacement
Sleeping position – You must sleep on your back for the first 6 weeks. After that you may start to lie on your side. It will be a little uncomfortable initially, because the weight of your body will be resting on the wound.
Bathroom visits – You must use a special elevated seat over the toilet for the first 3 months after surgery. This will be required until the strength of your quads and buttock muscles improve. The physiotherapist will give you instructions on how to strengthen your muscles.
Use of crutches – You may need to use a set of crutches for the first 6 weeks after surgery as these help to support your weight and allow your bone, muscle and tendons to improve after the surgery.
Seating position – You must not sit on a low seat (bean bag, low couch, soft sofa chair, floor) for the first 6 months after surgery to protect you from unexpected dislocation of the hip.
Bending – You must not bend right over to pick things from the ground or do your shoes laces up or care for your feet for the first 6 months after hip surgery. This is to avoid hip dislocation.
Leg exercises – You must avoid exercises that take your leg away from your side for the first 6 weeks after surgery. This is to protect the repair of the wound.
Walking and exercise – You are allowed to increase your walking around the block as you recover. Do not push yourself too hard for the first 6 weeks. Exercise and other activities can be picked up after that time.
Knee replacement
To avoid stiffness – To avoid stiffness, continue knee bending and straightening exercises everyday, several times a day.
Tip – Use a skateboard to help you rock your knee backwards and forwards while you are sitting in a chair.
Exercise and knee position – During your exercises, make sure you get your knee as straight as possible when straightening, and bend it so that it is underneath your seat (more than 90 degrees) when you are sitting down.
Pain management – Ice your knee and take your simple pain killers (Panadol, Neurofen) to help you with any discomfort so that you can continue to do your exercises. It will feel uncomfortable and sometimes painful to do your exercises up to 3-6 months after surgery.
Walking – Walk around as much as possible, as this will help you regain your balance.
Climbing stairs – Climbing stairs will take time as you will need to regain strength, balance and confidence. At the start go up one step at a time. Climbing one step after another can be difficult so be patient.
Knee arthroscopy
Wound dressing – Leave the dressing alone until it falls off on its own. This will usually occur about 7-10 days after surgery.
- If you are concerned about the wound or dressing, take a picture and send it to the office and wait for advice.
Exercise and movement (first 3 weeks) – Do not do any exercise for the first 3 weeks after arthroscopy. This will help to protect the wound and stop any sweating under the dressing which may lead to infection and wound problems.
- For the first 3 weeks after surgery do not squat down or kneel on the knee as this will irritate the wound as well as irritate the area within the knee that has been operated on.
After 3 weeks – You can start returning gradually to your sporting activity. There may still be some remaining discomfort so do not push too hard with activity at the start.
Shoulder surgery
Exercise (first 6 weeks after surgery) – Do not exercise for the first 6 weeks after surgery. When you are reviewed you will be provided with instructions as to what you may do after this time.
- By reducing activity during your recovery, you will be protecting your wound from infection or injury.
Wound care – The dressing will need to be changed at 12-14 days after surgery, which would give time for the wound to be inspected as well. Your general practitioner may be able to help you with this.
Abductor pillow – If you have left hospital with a special abductor pillow/splint on to keep your arm away from your side, it is important that you keep this on at all times including when in bed. This may be taken off to shower, but during your shower, there must be a waterproof splint to help keep your arm away from your side. You will receive instructions about this before you are discharged.
Shoulder activity – Do not take any risks or do any activity with your arm unless you have been instructed to do so.
Tumour surgery
After surgery care – You will receive specific instructions regarding your care after tumour surgery. This may mean advice from different surgeons who have been involved in your surgery. If you are not sure, please contact this office.
Tumour surgery complications – Tumour surgery is often complex and can be associated with a higher risk of complications than other non-cancer surgery.
If you are concerned about any aspect of your recovery, please contact this office for advice.
Please note – After ANY surgery:
Pain management – If you are in pain that is not responding to the pain tablets that you have been discharged with, please contact this office.
Wound monitoring – If your wound is oozing, please take a photograph and send it to this office for advice. Always contact this office if you have concerns about your wound.
Swelling (pain) – If you have calf pain or unexplained leg swelling after discharge from hospital, please contact this office for advice. We may do some tests to make sure that you do not have a deep vein thrombosis.
Symptoms to look out for – If you have shortness of breath, a temperature or chest pain, please contact your general practitioner immediately.
Concerns or questions – If you require attention for any concerns please contact Central Melbourne Orthopaedics. After hours, please direct your call to the ward at St. Vincent’s Private Hospital where you recovered after surgery.
Research
As an academic surgeon, I am constantly researching ways of improving the care of my patients. To do this, I collect information from my patients and also the outcomes of my care to inform strategies of how these may be improved in the future.
The information that I collect include patient medical history, surgical treatment, outcome information including patient related outcome measures. My staff may contact you from time to time to update your information.
I am involved in ongoing studies around joint replacement and tumour surgery. I shall ask you if you wish for your data not to be included in any future studies. If you wish for these not to be included, I will ask you to sign an opt-out document.
Disclosure
I declare that I provide paid consultancy services as a private practitioner to Stryker corporation for the design and research into tumour related implants. I am not reimbursed by Stryker Corporation for the use of any of their implants in my patients.
I declare that I provide paid consultancy services as a private practitioner, am a co-inventor and receive royalties for my contribution to the design of prostheses and surgical instruments for the Johnson & Johnson Company. I am not reimbursed by the Johnson and Johnson Company for the use of any of their implants in my patients.