Birmingham Hip Resurfacing

For twenty years we’ve been doing Birmingham Hip Resurfacing – and in perfectly selected patients they have done extremely well! Going forward though – the company is probably ceasing supply in 2027.

Hip resurfacing was a great idea of Derrick McMinn in the 1990’s – at that time – hip replacements used to wear out, or not really allow normal function. Birmingham’s basically solved that problem, so by 2010, represented about 10% of all joint replacements done in Australia. Ordinary hip replacements though have improved – the plastic is better, longer lasting, anterior hip replacement has reduced the dislocation rate, and maybe the shorter stems of modern hip replacements have removed thigh pain as a complication.

The number of Birminghams done in Australia in 2022 was down to 93. Ceramic on ceramic resurfacing has become more popular, at 231 in 2022. Again though, a hundred less than the previous year. I’ll be attending the AOA Annual Scientific Meeting in October, and working out my plan going forward.

Mr. David Mitchell
Orthopedic Surgeon

Metal Allergy & Knee Replacement

It is claimed 16% of knee replacements patients aren’t that impressed with their outcome – I’d be devastated if that’s what we saw at Ballarat Orthopaedics & Sports Medicine. Metal allergy probably contributes to this percentage.

Maybe 5% of people can’t tolerate nickel – be it in cheap earrings, or stainless steel watches. Nickel turns out to be a common impurity in chrome-cobalt alloys used for the femoral component of knee replacements. To its credit – that alloy is hard to scratch, easy to coat the surface rubbing against the femur with titanium which helps bone ongrowth.

Titanium is a rare allergy – used in the tibial component of most knee replacements, but is too soft to use as a bearing surface for the femoral component, it scratches too easily. Most low allergy knee replacements – for example the Persona Titanium/Niobium coated implant (Zimmer-Biomet), or the Oxiniuim coated Journey knee (Smith & Nephew) both have titanium tibial baseplates. Whilst all polyethylene tibial components exist – most surgeons are avoiding them in younger patients.

B.Braun Columbus offers a multiply coated implant – both femur and tibia components. Admittedly there is still the question of cement allergy. At the end of the day – we have a case by case solution. Routine testing for allergies has not been demonstrated to improve outcomes, but where someone seems to be at risk, we’re keen to have a solution.

A New Physiotherapist Is Joining The Team At Ballarat Sports Medicine

The Ballarat Sports Medicine clinical team is very excited to be welcoming Shalin Patel to the physiotherapy team. Shalin is an APA titled Musculoskeletal Physiotherapist and APA titled Sports and Exercise Physiotherapist. Shalin has 17 years experience working in musculoskeletal private practice physiotherapy. Shalin has previously worked with various organisations providing care for general musculoskeletal ailments, occupational health and work-related injuries, post-operative rehabilitation but equally enjoys the challenge of rehabilitation of high-performance & sporting individuals.

Shalin is also involved in regular supervision of physiotherapy students and mentoring of graduate physiotherapists. He is a regular course presenter for Australian Physiotherapy Association, presenting Spinal Physiotherapy courses. Shalin has special interest in musculoskeletal conditions including persistent pain and complex spinal issues. Shalin delivers high value care with his wealth of knowledge and experience in diagnostic skills. Patients will receive a tailored treatment plan based on specific needs, backed with up-to-date scientific evidence.

Qualifications:
Bachelor of Physiotherapy (RGUHS, 2005)
Master of Manual & Sports Physiotherapy (University of South Australia, 2008)

Shalin has affiliations with the Australian Physiotherapy Association and is on the committee of the Victorian Musculoskeletal Physiotherapy Association.

Shalin has specific interest in treating the following conditions

• Back pain & nerve related pain
• Neck pain & whiplash
• Headaches & Jaw pain
• Tendon related issues – shoulders, hips & achilles
• Post-operative rehabilitation
• Chronic & persistent pain

Shalin will work collaboratively with the other Physiotherapists, Sports Medicine Specialists and Exercise Physiologists practicing at Ballarat Sports Medicine and with Orthopaedic Surgeons practicing at BallaratOSM to achieve holistic patient care.

Shalin will be consulting at NOVAR, 109 Webster Street Lake Wendouree, Tuesday and Thursday afternoon/evenings commencing 03/09/2024. Bookings can be made on-line at BOOKINGS or call 5332 2969.

Appointments are now available for Shalin at: 

Book Appointment

Surgeons without medical degrees

Recently, The Age and Sydney Morning Herald carried headline articles on foot surgery being performed by podiatric “surgeons” without medical training.  Channel Nine’s 60 Minutes programme also recently aired a story on this topic.

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Australian Doctors for Africa

After a prolonged break due to the Covid 19 pandemic, we returned to Madagascar. Australian Doctors for Africa organise missions to provide medical services to the local people in Toliara, a town on the west coast of Madagascar, where services and infrastructure are lacking.

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FIFA Women’s World Cup Series – Calf Strain

FIFA Women's World Cup - Sam Kerr injury

In the final training session before our first match, star Sam Kerr has injured her calf.  We will all be hoping the team medical physicians and allied health practitioners can rehabilitate Sam quickly, particularly now as we have a critical must win game against Canada.

A strained calf muscle is a common injury in sports, and especially in ball sports. Proper rehabilitation following this type of injury is important to avoid re-injury. This blog focuses on the calf strain and how physicians working at Ballarat Sports Medicine can assist athletes with calf strains.

Calf strains

The muscles gastrocnemius and soleus, commonly referred to as the calf muscles, are located on the back of the lower leg. These muscles are particularly vulnerable to strains injuries. In football, they usually happen when a player quickly tries to reach the ball.

The middle part of the gastrocnemius muscle is most often injured. The strain is often in the superficial part of the muscle, i.e. towards the skin, just below the knee. Strain injuries in the soleus muscle are also quite common.

Signs and symptoms

The athlete will feel an acute “stabbing” or “cutting” pain and local tenderness. In addition, there is often swelling and visible bruising. The pain may cause the althlete to limp.

Diagnosis

The diagnosis is made by a doctor or physiotherapist following a clinical examination. MRI or ultrasound are not always necessary, but can be helpful in confirming the diagnosis.

Treatment and rehabilitation

In the acute phase (right after the injury occurs) it is important to start treatment according to the RICE principle (Rest, Ice, Compression, Elevation). This will help to reduce pain, minimize swelling, and prevent further damage.

Pain relieving medication is rarely necessary, but paracetamol can be taken if it is very painful. Pain killers can be effective in the first few days, but anti-inflammatories (NSAIDs) such as Nurofen, Voltaren and Naprosyn should be avoided for the first 24 hours. The reason for this is that they can have a blood thinning effect that can increase the amount of bleeding, resulting in more pain.  In the beginning it can be a good idea to take some weight off the leg by using crutches. Following this, it is important to  increase weight-bearing gradually. This will speed up recovery.

Exercises with a low load should be introduced early in the rehabilitation process. This will strengthen the new muscle tissue. Strengthening exercises can usually be started after 7-10 days. They should be done in consultation with a physiotherapist. Some passive treatment techniques (e.g. massage) can be helpful, but it is nevertheless systematic training that will have the best effect and greatest impact on the final result.

Later on, in the rehabilitation process, it is important for athletes planning on returning to sport to train maximum strength and jumping ability.

Skilled physiotherapists can assist with sport-specific rehabilitation at this point.  Luke Blunden, Peta Johnston and Simon Lewis are all highly experienced clinicians who can direct your return to sport.

Prognosis

It is very difficult to predict how long it takes for a strained calf muscle to heal completely. This is often affected by the extent of the injury.

A study on professional football players showed an average time away from sport to be 13 days. In about 90% of cases, the athlete is back in full training within 28 days. Recovery from the most severe injuries can take up to several months.

There is a high risk of re-injury following this injury, especially for those who haven’t been through a comprehensive rehabilitation program.

https://fittoplay.org/body-parts/lower-leg/strained-calf-muscle/?p=4750

Australian orthopaedic surgeons – ANZ Journal of Surgery

Recent Research

Excellence in healthcare is frequently driven by developments in research. This is no different in the fields of orthopaedic surgery and Sport & Exercise Medicine. Recently Mr David Mitchell and Mr Luke Spencer were co-authors of an article titled “Australian orthopaedic surgeons’ knowledge and practice of medial collateral ligament release in knee arthroscopy” published in ANZ Journal of Surgery. Additionally, Mr David Mitchell, Dr Greg Harris and Mr Like Spencer co-authored an article titled “The use of intra-articular platelet rich plasma for the symptomatic management of osteoarthritis of the knee: a pilot study” also published in ANZ Journal of Surgery. You can read this research at


https://onlinelibrary.wiley.com/doi/10.1111/ans.18001
https://onlinelibrary.wiley.com/doi/10.1111/ans.17565

FIFA Women’s World Cup Blog – ACL Injury

FIFA Women's World Cup – Underway!

The FIFA Women’s World Cup is under way.  Australia have had success in the first game versus Ireland 1:0 albeit with the unfortunate loss of captain Sam Kerr to injury.

The injury that many sports persons dread and is relatively common in many sports is a rupture to the anterior cruciate ligament (ACL).  This blog focuses on the ACL and how physicians working at Ballarat Sports Medicine and BallaratOSM can assist athletes with ACL injuries.

ACL Injuries

Anterior cruciate ligament (ACL) injuries are unpredictable. Most of them happen in harmless situations the athlete has been in hundreds of times before without it resulting in injury.

What many people do not know is, that we have two cruciate ligaments: An anterior and a posterior. Both are essential for stabilizing the knee. The anterior cruciate ligament is the one we hear most about. Unfortunately, usually after an injury has occurred.

This type of injury leads to a lengthy time away from sport (often up to 12 months) and increases the risk of osteoarthritis. Therefore, it is important that prevention of this type injury is a priority and if it does occur, that the right treatment is followed.

The knee’s safety belt

The ACL is a ligament in the centre of the knee that functions as a safety belt to prevent unwanted movements. A tear in the ACL is far more common than in the posterior cruciate ligament (PCL) and injuries to the former usually have a greater impact on knee function.

ACL injuries are especially common in sports that involve sudden changes in direction such as soccer. Female athletes have up to 3 times higher risk of an ACL injury than men and they are often injured at a young age.

Characteristics of a torn cruciate ligament

A typical characteristic of a cruciate ligament injury is swelling, which occurs soon after a twisting movement, and a sensation of giving way. It can also be difficult to straighten out the leg or bend the knee more than 80 to 90 degrees. You should have a medical examination if you show any of these signs.  This can be arranged quickly with Sport & Exercise Medicine physician, Dr Greg Harris, or Sport & Exercise Medicine Registrar, Dr Jai Sharma at Ballarat Sports Medicine.

Additional injuries

Often, other structures such as the meniscus, cartilage, bone, and collateral ligaments, are also affected following a cruciate ligament injury. These additional injuries can often account for many of the symptoms following a torn cruciate ligament, and they can affect treatment options and the long-term prognosis. As such, it is important to have an MRI examination and get a specialist’s opinion soon after the incident.

Treatment

Surgery following an ACL injury is not a given. On the contrary, about 50% of ACL injuries are treated conservatively (rehabilitation without surgery). Many of these show good results.

An orthopaedic surgeon will evaluate whether or not knee surgery is required following an ACL injury. The decision is based on symptoms and the athlete’s requirements for knee function in the future. That means that surgery is more common for an elite soccer player.  Independent surgeons, Mr David Mitchell and Mr Luke Spencer have subspeciality interest in knee injuries and can be seen quickly at BallaratOSM for ACL injuries.

It is recommended that athletes who don’t have any serious additional injuries try intensive training in conjunction with a physiotherapist for up to 3 months before surgery is considered. This will make it easier to predict whether the operation will have a good outcome, and rehabilitation will be more efficient.  Luke Blunden, Peta Johnston and Simon Lewis are all highly skilled at assisting athletes at Ballarat Sports Medicine pre-operatively and post operatively with ACL injuries.

Surgery

The surgery involves replacing the injured ligament with tissue graft taken from the anterior or posterior thigh muscles. The surgery is done with an arthroscope using small incisions, which means that it is not necessary for the surgeon to completely open the knee.

Rehabilitation

Rehabilitation with a physiotherapist is tough following an ACL injury whether or not surgery is involved. Close monitoring of the training program is, therefore, important to manage all aspects of rehabilitation and a follow-up period of at least 6 to 12 months is recommended.

Rehabilitation focuses on regaining strength, mobility, balance, and control. The exercises are gradually made more difficult, and as function improves, more geared towards a functional return to the athlete’s sport.

For each extra month of post-surgery rehabilitation, the risk of re-injury is reduced by 50%.  The athlete should pass a variety of sport-specific tests to check whether their knee is ready for returning to sport. But this in itself is not enough; the athlete should also feel that they are ready. It is important that the athlete is not overly worried about re-injury and that they can trust their knee.

The decision to return to sport should be made in consultation with the doctor, physiotherapist, trainer, and the athlete. Often, it is the trainer who knows the athlete best and sees how they move and behave in a sport-specific setting. Participation should also start slowly and be increased gradually.

Athletes with cruciate ligaments injuries have an increased risk of sustaining a new cruciate ligament injury, both in their injured and their uninjured knee. Ongoing preventative training is therefore especially important for this group.

Return to sport

Even though there are examples of elite athletes returning to competitive sport in less than 6 months, such an aggressive rehabilitation training program is not recommended. The risk of another injury to the knee is increased after a cruciate ligament injury but can be reduced by taking the time for proper rehabilitation.

References: https://fittoplay.org/sports/football/