Frequently Asked Questions

 

What is Arthritis?


Arthritis is inflammation of one or more of your joints that causes pain and stiffness. While arthritis is mainly an adult disease, some forms affect children.
There are many types of arthritis. Some of these include osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, septic arthritis, and psoriatic arthritis.
While each of these conditions has different causes, the symptoms and treatment are often thesame. Pain, swelling, and stiffness are the primary symptoms of arthritis. Any joint in the body may be affected by the disease, but it is particularly common in weight-bearing joints such as the knee and hip.
Although there is no cure for arthritis, there are many treatment options available to help manage pain and keep patients staying active.




What causes arthritis?


Arthritis may be caused by wear and tear on the articular cartilage through the natural aging process (osteoarthritis), or may develop following an injury (post-traumatic arthritis).
Other types of arthritis, such as crystalline arthritis, may come from an inflammatory process.
Still others, such as rheumatoid arthritis or lupus arthritis, are the result of a systemic disease
throughout the body.

Regardless of whether the cause is from injury, normal wear and tear, or disease, the joint becomes inflamed, causing swelling, pain and stiffness. Inflammation is one of the body's normal reactions to injury or disease. In arthritic joints, however, inflammation may cause long-lasting or permanent disability.




What is osteoarthritis?


The most common type of arthritis is osteoarthritis. Also known as "wear and tear" arthritis,
osteoarthritis occurs when the cartilage that cushions and protects the ends of your bones gradually wears away.

It results from overuse, trauma, or the natural degeneration of cartilage that occurs with aging.
Osteoarthritis is often more painful in joints that bear weight, such as the knee, hip, and spine. However, joints that are used extensively in work or sports, or joints that have been damaged by injury may show signs of osteoarthritis.
In many cases, bone growths called "spurs" develop at the edges of osteoarthritic joints. The bone can become hard and firm (sclerosis). The joint becomes inflamed, causing pain and swelling meaning continued use of the joint is painful.




What is rheumatoid arthritis?


Rheumatoid arthritis is a long-lasting disease. Rheumatoid arthritis affects many parts of the body, but mainly the joints. The body's immune system, which normally protects the body, begins to produce substances that attack the body. In rheumatoid arthritis, the joint lining swells, invade surrounding tissues. Chemical substances are produced that attack and destroy the joint surface.
Rheumatoid arthritis may affect both large and small joints in the body and also the spine. Swelling, pain, and stiffness usually develop, even when the joint is not used. In some circumstances, juvenile arthritis may cause similar symptoms in children.




What is post-traumatic arthritis?


Post-traumatic arthritis results from an injury to the joint. If a broken bone or fracture extends into a joint it will damage the smooth cartilage that covers the joint surfaces. The surface becomes uneven and causes friction as the joint moves. Over time, the joint breaks down and becomes arthritic.




What is septic arthritis?


Septic arthritis is an infection of the joint. Most often bacteria reach the joint through the
bloodstream from an infection in another part of the body, such as the urinary tract. Infected joints are typically warm, red, and acutely tender. They are often swollen due to pus in the joint. An infected joint often needs surgical drainage in addition to antibiotics.




What is psoriatic arthritis?


Psoriatic arthritis is associated with the skin disease psoriasis. While it may involve larger joints such as the knees it often presents with symptoms in smaller areas such as the distal joints at the tips of the fingers and toes.




What is gouty arthritis?


Gouty arthritis develops as the result of uric acid build up in the bloodstream. The uric acid forms crystals which cause acute inflammation in a joint. The big toe, ankle, knee, and elbow are the most common joints affected. A gout attack can be acutely painful. The inflamed joint becomes red and very sensitive to touch. Gout attacks are most often treated with medicine rather than surgery. Long term, many patients develop soft tissue masses (tophi) over the affected joints.




What is Lyme arthritis?


Lyme arthritis can be one of the side effects of Lyme disease, a systemic infection caused by a tick bite. Lyme arthritis can present acutely as pain and swelling in early stages of the disease. Lyme disease is treated with antibiotics. Left untreated, Lyme disease can lead to chronic arthritis.




What is Lupus arthritis?


Lupus is an autoimmune disease that affects multiple organs including the kidneys, skin, blood, and the heart. Lupus arthritis can be systemic and cause chronic pain in multiple joints.




What is Juvenile arthritis?


Juvenile arthritis is the most common type of arthritis in children. There are several types of the disease and most are different from rheumatoid arthritis in adults.




How is arthritis diagnosed?


Arthritis is diagnosed through a careful evaluation of symptoms and a physical examination. X-rays are important to show the extent of any damage to the joint. Blood tests and other laboratory tests may help to determine the type of arthritis. Some of the findings of arthritis include:

  • Weakness (atrophy) in the muscles
  • Tenderness to touch
  • Limited ability to move the joint passively (with assistance) and actively (without assistance)
  • Signs that multiple joints are painful or swollen (an indication of rheumatoid arthritis)
  • A grating feeling or sound (crepitus) with movement
  • Pain when pressure is placed on the joint or the joint is moved




How is arthritis treated?


There is no cure for arthritis, but there are many treatments to help relieve the pain and disability that it can cause.




What are the non-surgical treatments of arthritis?


Medications Over-the- counter medications can be used to control pain and inflammation in the joints. These medications, called anti-inflammatory drugs, include aspirin, ibuprofen, and naproxen. Acetaminophen can be effective in controlling pain.
Prescription medications also are available. Dr Bhimani will choose a medication by taking into account the type of arthritis, its severity, and your general physical health. Patients with ulcers, asthma, kidney, or liver disease, for example, may not be able to safely take anti-inflammatory medications.
Injections of cortisone into the joint may temporarily help to relieve pain and swelling. It is
important to know that repeated, frequent injections into the same joint can cause damage and undesirable side effects.
Viscosupplementation or injection of hyaluronic acid preparations can also be helpful in lubricating the joint. This is typically performed in the knee. Exercise and therapy Canes, crutches, walkers, or splints may help relieve the stress and strain on arthritic joints. Learningmethods of performing daily activities that are the less stressful to painful joints also may be helpful. Certain exercises and physical therapy may be used to decrease stiffness and to strengthen the weakened muscles around the joint.




What are the surgical treatments of arthritis?


In general, Dr Bhimani will perform surgery for arthritis when other methods of nonsurgical
treatment have failed to relieve pain and other symptoms. When deciding on the type of surgery, Dr Bhimani will take into account the type of arthritis, its severity, and your loss of normal function.

There are a number of surgical procedures. These include:

  • Removing the diseased or damaged joint lining
  • Realignment of the joints
  • Fusing the ends of the bones in the joint together, to prevent joint motion and relieve joint pain
  • Replacing the entire joint (total joint replacement)




How is arthritis managed long-term?


In most cases, persons with arthritis can continue to perform normal activities of daily living.
Exercise programs, anti-inflammatory drugs, and weight reduction for obese persons are common measures to reduce pain, stiffness, and improve function.

In persons with severe cases of arthritis, orthopaedic surgery can often provide dramatic pain relief and restore lost joint function.
Some types of arthritis, such as rheumatoid arthritis, are often treated by a team of health care professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.





General

 

Acute Knee Clinic

What is the ‘Acute Knee Clinic’?


I run a clinic specifically for patients with an acute knee injury. The aim of the clinic is to see you as promptly as possible following an injury to initiate appropriate management in order to facilitate an early return to activity.




Why is the clinic exclusively for acute knee injuries?


It is important due to the nature of the knee joint that all acute cases of knee injury are promptly assessed, diagnosed and treated in order to obtain the best long term outcomes for patients, both athletes and non-athletes.




Who are the appropriate candidates to attend the acute knee clinic?


Appropriate candidates include any patients who have recently injured their knee, for example, due to a weekend sports injury, a fall or similar.




What are the advantages of acute knee injury clinic?


Our acute knee trauma clinic offers you an early and expert assessment to determine if a significant knee injury has occurred.

Radiological tests such as X-rays, MRI scans, ultrasound, and Doppler study are all easily organized to provide a timely diagnosis.




How do I get an appointment with the acute knee trauma clinic?


To make an appointment contact us at (02) 4229 9116 and request an appoint with Dr Bhimani.




Do I need a referral?


No. You can attend without a referral from a GP. However, without a referral from another doctor you will receive no rebate from Medicare for your consultation.




Who treats me at the acute knee trauma clinic?


Dr Aziz Bhimani, an expert knee surgeon, sees patients at the knee clinic.




Where is the acute knee trauma clinic located?


54 Princes Hwy
West Wollongong NSW 2500





 

Non-surgical treatment

What is Rheumatoid Arthritis?


Aching joints are common in arthritis. In rheumatoid arthritis, the joint lining swells, invades
surrounding tissues, and produces chemical substances that attack and destroy the joint surface.

People of all ages may be affected. The disease usually begins in middle age.
Rheumatoid arthritis usually affects joints on both sides of the body in the hands and feet, as well as the hips, knees, and elbows. Without proper treatment, rheumatoid arthritis can become a chronic, disabling condition.




What causes Rheumatoid Arthritis?


Rheumatoid arthritis is not an inherited disease. Researchers believe that some people have genes that make them susceptible to the disease. People with these genes will not automatically develop rheumatoid arthritis. There is usually a "trigger", such as an infection or environmental factor, which activates the genes. When the body is exposed to this trigger, the immune system responds inappropriately. Instead of protecting the joint, the immune system begins to produce substances that attack the joint. This is what may lead to the development of rheumatoid arthritis.
Ligaments and joint capsules become less effective supporting structures. Erosion of the articular cartilage, together with ligamentous changes, result in deformity and contractures. As the disease progresses, pain and deformity increase.




What are the symptoms of Rheumatoid Arthritis?


Pain, morning stiffness, swelling, and systemic symptoms are common. Other rheumatoid symptoms include:

  • Swelling, pain, and stiffness in the joint, even when it is not being used
  • A feeling of warmth around the joint
  • Deformities and contractures of the joint
  • Symptoms throughout the body, such as fever, loss of appetite and decreased energy
  • Weakness due to a low red blood cell count (anemia)
  • Nodules, or lumps, particularly around the elbow
  • Foot pain, bunions, and hammer toes with long-standing disease
Patients with severe rheumatoid arthritis typically have multiple affected joints in the hands, arms, legs, and feet. Joints of the cervical spine may be involved as well.




How Is Rheumatoid Arthritis Diagnosed?


Rheumatoid arthritis is diagnosed using a medical history and a physical examination. Some of the conditions Dr Bhimani looks for include swelling and warmth around the joint, painful motion, lumps under the skin, joint deformities, and joint contractures (inability to fully stretch or bend the joint).
A blood test may reveal an antibody called rheumatoid factor. This is an indicator of rheumatoid arthritis. X-rays can help show the progression of the disease. The American College of Rheumatology requires at least four of the following seven criteria to confirm the diagnosis:

  • Morning stiffness around the joint that lasts at least 1 hour
  • Arthritis of three or more joints for at least 6 weeks
  • Arthritis of hand joints for at least 6 weeks
  • Arthritis on both sides of the body for at least 6 weeks
  • Rheumatoid nodules under the skin
  • Rheumatoid factor present in blood testing
  • Evidence of rheumatoid arthritis on X-rays




How Is Rheumatoid Arthritis Treated?


Although there is no cure for rheumatoid arthritis, there are a number of treatment options that can help relieve joint pain and improve functioning. The treatment plan is tailored to the patient's needs and lifestyle. Rheumatoid arthritis is often treated by a team of health care professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.
Medication
Medications used to control rheumatoid arthritis fall into two categories: those that relieve
symptoms and those that have the potential to modify the course of the disease. Often, they are used together. Aspirin and ibuprofen can help reduce the pain and inflammation of rheumatoid arthritis. Disease-modifying drugs include methotrexate and sulfasalazine and gold injections.

Researchers are also working on biologic agents that can interrupt the progress of the disease. These agents target specific chemicals in the body to prevent them from acting on the joints.
Exercise and Therapy
Exercise is an important part of a treatment program. The physician and physical therapist may work with patients to develop an exercise program that helps strengthen the joints without stressing them. In some cases, a splint or corrective footwear may be required.

Surgery
Joint replacement surgery is also an option and is often effective in restoring function.





 

Preparing For Surgery

What is the ‘Acute Knee Clinic’?


I run a clinic specifically for patients with an acute knee injury. The aim of the clinic is to see you as promptly as possible following an injury to initiate appropriate management in order to facilitate an early return to activity.




Why is the clinic exclusively for acute knee injuries?


It is important due to the nature of the knee joint that all acute cases of knee injury are promptly assessed, diagnosed and treated in order to obtain the best long term outcomes for patients, both athletes and non-athletes.




Who are the appropriate candidates to attend the acute knee clinic?


Appropriate candidates include any patients who have recently injured their knee, for example, due to a weekend sports injury, a fall or similar.




What are the advantages of acute knee injury clinic?


Our acute knee trauma clinic offers you an early and expert assessment to determine if a significant knee injury has occurred.

Radiological tests such as X-rays, MRI scans, ultrasound, and Doppler study are all easily organized to provide a timely diagnosis.




How do I get an appointment with the acute knee trauma clinic?


To make an appointment contact us at (02) 4229 9116 and request an appoint with Dr Bhimani.




Do I need a referral?


No. You can attend without a referral from a GP. However, without a referral from another doctor you will receive no rebate from Medicare for your consultation.




Who treats me at the acute knee trauma clinic?


Dr Aziz Bhimani, an expert knee surgeon, sees patients at the knee clinic.




Where is the acute knee trauma clinic located?


54 Princes Hwy
West Wollongong NSW 2500





 

Anaesthesia

What is Arthritis?


Arthritis is inflammation of one or more of your joints that causes pain and stiffness. While arthritis is mainly an adult disease, some forms affect children.
There are many types of arthritis. Some of these include osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, septic arthritis, and psoriatic arthritis.
While each of these conditions has different causes, the symptoms and treatment are often thesame. Pain, swelling, and stiffness are the primary symptoms of arthritis. Any joint in the body may be affected by the disease, but it is particularly common in weight-bearing joints such as the knee and hip.
Although there is no cure for arthritis, there are many treatment options available to help manage pain and keep patients staying active.




What causes arthritis?


Arthritis may be caused by wear and tear on the articular cartilage through the natural aging process (osteoarthritis), or may develop following an injury (post-traumatic arthritis).
Other types of arthritis, such as crystalline arthritis, may come from an inflammatory process.
Still others, such as rheumatoid arthritis or lupus arthritis, are the result of a systemic disease
throughout the body.

Regardless of whether the cause is from injury, normal wear and tear, or disease, the joint becomes inflamed, causing swelling, pain and stiffness. Inflammation is one of the body's normal reactions to injury or disease. In arthritic joints, however, inflammation may cause long-lasting or permanent disability.




What is osteoarthritis?


The most common type of arthritis is osteoarthritis. Also known as "wear and tear" arthritis,
osteoarthritis occurs when the cartilage that cushions and protects the ends of your bones gradually wears away.

It results from overuse, trauma, or the natural degeneration of cartilage that occurs with aging.
Osteoarthritis is often more painful in joints that bear weight, such as the knee, hip, and spine. However, joints that are used extensively in work or sports, or joints that have been damaged by injury may show signs of osteoarthritis.
In many cases, bone growths called "spurs" develop at the edges of osteoarthritic joints. The bone can become hard and firm (sclerosis). The joint becomes inflamed, causing pain and swelling meaning continued use of the joint is painful.




What is rheumatoid arthritis?


Rheumatoid arthritis is a long-lasting disease. Rheumatoid arthritis affects many parts of the body, but mainly the joints. The body's immune system, which normally protects the body, begins to produce substances that attack the body. In rheumatoid arthritis, the joint lining swells, invade surrounding tissues. Chemical substances are produced that attack and destroy the joint surface.
Rheumatoid arthritis may affect both large and small joints in the body and also the spine. Swelling, pain, and stiffness usually develop, even when the joint is not used. In some circumstances, juvenile arthritis may cause similar symptoms in children.




What is post-traumatic arthritis?


Post-traumatic arthritis results from an injury to the joint. If a broken bone or fracture extends into a joint it will damage the smooth cartilage that covers the joint surfaces. The surface becomes uneven and causes friction as the joint moves. Over time, the joint breaks down and becomes arthritic.




What is septic arthritis?


Septic arthritis is an infection of the joint. Most often bacteria reach the joint through the
bloodstream from an infection in another part of the body, such as the urinary tract. Infected joints are typically warm, red, and acutely tender. They are often swollen due to pus in the joint. An infected joint often needs surgical drainage in addition to antibiotics.




What is psoriatic arthritis?


Psoriatic arthritis is associated with the skin disease psoriasis. While it may involve larger joints such as the knees it often presents with symptoms in smaller areas such as the distal joints at the tips of the fingers and toes.




What is gouty arthritis?


Gouty arthritis develops as the result of uric acid build up in the bloodstream. The uric acid forms crystals which cause acute inflammation in a joint. The big toe, ankle, knee, and elbow are the most common joints affected. A gout attack can be acutely painful. The inflamed joint becomes red and very sensitive to touch. Gout attacks are most often treated with medicine rather than surgery. Long term, many patients develop soft tissue masses (tophi) over the affected joints.




What is Lyme arthritis?


Lyme arthritis can be one of the side effects of Lyme disease, a systemic infection caused by a tick bite. Lyme arthritis can present acutely as pain and swelling in early stages of the disease. Lyme disease is treated with antibiotics. Left untreated, Lyme disease can lead to chronic arthritis.




What is Lupus arthritis?


Lupus is an autoimmune disease that affects multiple organs including the kidneys, skin, blood, and the heart. Lupus arthritis can be systemic and cause chronic pain in multiple joints.




What is Juvenile arthritis?


Juvenile arthritis is the most common type of arthritis in children. There are several types of the disease and most are different from rheumatoid arthritis in adults.




How is arthritis diagnosed?


Arthritis is diagnosed through a careful evaluation of symptoms and a physical examination. X-rays are important to show the extent of any damage to the joint. Blood tests and other laboratory tests may help to determine the type of arthritis. Some of the findings of arthritis include:

  • Weakness (atrophy) in the muscles
  • Tenderness to touch
  • Limited ability to move the joint passively (with assistance) and actively (without assistance)
  • Signs that multiple joints are painful or swollen (an indication of rheumatoid arthritis)
  • A grating feeling or sound (crepitus) with movement
  • Pain when pressure is placed on the joint or the joint is moved




How is arthritis treated?


There is no cure for arthritis, but there are many treatments to help relieve the pain and disability that it can cause.




What are the non-surgical treatments of arthritis?


Medications Over-the- counter medications can be used to control pain and inflammation in the joints. These medications, called anti-inflammatory drugs, include aspirin, ibuprofen, and naproxen. Acetaminophen can be effective in controlling pain.
Prescription medications also are available. Dr Bhimani will choose a medication by taking into account the type of arthritis, its severity, and your general physical health. Patients with ulcers, asthma, kidney, or liver disease, for example, may not be able to safely take anti-inflammatory medications.
Injections of cortisone into the joint may temporarily help to relieve pain and swelling. It is
important to know that repeated, frequent injections into the same joint can cause damage and undesirable side effects.
Viscosupplementation or injection of hyaluronic acid preparations can also be helpful in lubricating the joint. This is typically performed in the knee. Exercise and therapy Canes, crutches, walkers, or splints may help relieve the stress and strain on arthritic joints. Learningmethods of performing daily activities that are the less stressful to painful joints also may be helpful. Certain exercises and physical therapy may be used to decrease stiffness and to strengthen the weakened muscles around the joint.




What are the surgical treatments of arthritis?


In general, Dr Bhimani will perform surgery for arthritis when other methods of nonsurgical
treatment have failed to relieve pain and other symptoms. When deciding on the type of surgery, Dr Bhimani will take into account the type of arthritis, its severity, and your loss of normal function.

There are a number of surgical procedures. These include:

  • Removing the diseased or damaged joint lining
  • Realignment of the joints
  • Fusing the ends of the bones in the joint together, to prevent joint motion and relieve joint pain
  • Replacing the entire joint (total joint replacement)




How is arthritis managed long-term?


In most cases, persons with arthritis can continue to perform normal activities of daily living.
Exercise programs, anti-inflammatory drugs, and weight reduction for obese persons are common measures to reduce pain, stiffness, and improve function.

In persons with severe cases of arthritis, orthopaedic surgery can often provide dramatic pain relief and restore lost joint function.
Some types of arthritis, such as rheumatoid arthritis, are often treated by a team of health care professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.





 

Post-operative CARE

What is Rheumatoid Arthritis?


Aching joints are common in arthritis. In rheumatoid arthritis, the joint lining swells, invades
surrounding tissues, and produces chemical substances that attack and destroy the joint surface.

People of all ages may be affected. The disease usually begins in middle age.
Rheumatoid arthritis usually affects joints on both sides of the body in the hands and feet, as well as the hips, knees, and elbows. Without proper treatment, rheumatoid arthritis can become a chronic, disabling condition.




What causes Rheumatoid Arthritis?


Rheumatoid arthritis is not an inherited disease. Researchers believe that some people have genes that make them susceptible to the disease. People with these genes will not automatically develop rheumatoid arthritis. There is usually a "trigger", such as an infection or environmental factor, which activates the genes. When the body is exposed to this trigger, the immune system responds inappropriately. Instead of protecting the joint, the immune system begins to produce substances that attack the joint. This is what may lead to the development of rheumatoid arthritis.
Ligaments and joint capsules become less effective supporting structures. Erosion of the articular cartilage, together with ligamentous changes, result in deformity and contractures. As the disease progresses, pain and deformity increase.




What are the symptoms of Rheumatoid Arthritis?


Pain, morning stiffness, swelling, and systemic symptoms are common. Other rheumatoid symptoms include:

  • Swelling, pain, and stiffness in the joint, even when it is not being used
  • A feeling of warmth around the joint
  • Deformities and contractures of the joint
  • Symptoms throughout the body, such as fever, loss of appetite and decreased energy
  • Weakness due to a low red blood cell count (anemia)
  • Nodules, or lumps, particularly around the elbow
  • Foot pain, bunions, and hammer toes with long-standing disease
Patients with severe rheumatoid arthritis typically have multiple affected joints in the hands, arms, legs, and feet. Joints of the cervical spine may be involved as well.




How Is Rheumatoid Arthritis Diagnosed?


Rheumatoid arthritis is diagnosed using a medical history and a physical examination. Some of the conditions Dr Bhimani looks for include swelling and warmth around the joint, painful motion, lumps under the skin, joint deformities, and joint contractures (inability to fully stretch or bend the joint).
A blood test may reveal an antibody called rheumatoid factor. This is an indicator of rheumatoid arthritis. X-rays can help show the progression of the disease. The American College of Rheumatology requires at least four of the following seven criteria to confirm the diagnosis:

  • Morning stiffness around the joint that lasts at least 1 hour
  • Arthritis of three or more joints for at least 6 weeks
  • Arthritis of hand joints for at least 6 weeks
  • Arthritis on both sides of the body for at least 6 weeks
  • Rheumatoid nodules under the skin
  • Rheumatoid factor present in blood testing
  • Evidence of rheumatoid arthritis on X-rays




How Is Rheumatoid Arthritis Treated?


Although there is no cure for rheumatoid arthritis, there are a number of treatment options that can help relieve joint pain and improve functioning. The treatment plan is tailored to the patient's needs and lifestyle. Rheumatoid arthritis is often treated by a team of health care professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.
Medication
Medications used to control rheumatoid arthritis fall into two categories: those that relieve
symptoms and those that have the potential to modify the course of the disease. Often, they are used together. Aspirin and ibuprofen can help reduce the pain and inflammation of rheumatoid arthritis. Disease-modifying drugs include methotrexate and sulfasalazine and gold injections.

Researchers are also working on biologic agents that can interrupt the progress of the disease. These agents target specific chemicals in the body to prevent them from acting on the joints.
Exercise and Therapy
Exercise is an important part of a treatment program. The physician and physical therapist may work with patients to develop an exercise program that helps strengthen the joints without stressing them. In some cases, a splint or corrective footwear may be required.

Surgery
Joint replacement surgery is also an option and is often effective in restoring function.





 

Joint Replacement Surgery

What is the ‘Acute Knee Clinic’?


I run a clinic specifically for patients with an acute knee injury. The aim of the clinic is to see you as promptly as possible following an injury to initiate appropriate management in order to facilitate an early return to activity.




Why is the clinic exclusively for acute knee injuries?


It is important due to the nature of the knee joint that all acute cases of knee injury are promptly assessed, diagnosed and treated in order to obtain the best long term outcomes for patients, both athletes and non-athletes.




Who are the appropriate candidates to attend the acute knee clinic?


Appropriate candidates include any patients who have recently injured their knee, for example, due to a weekend sports injury, a fall or similar.




What are the advantages of acute knee injury clinic?


Our acute knee trauma clinic offers you an early and expert assessment to determine if a significant knee injury has occurred.

Radiological tests such as X-rays, MRI scans, ultrasound, and Doppler study are all easily organized to provide a timely diagnosis.




How do I get an appointment with the acute knee trauma clinic?


To make an appointment contact us at (02) 4229 9116 and request an appoint with Dr Bhimani.




Do I need a referral?


No. You can attend without a referral from a GP. However, without a referral from another doctor you will receive no rebate from Medicare for your consultation.




Who treats me at the acute knee trauma clinic?


Dr Aziz Bhimani, an expert knee surgeon, sees patients at the knee clinic.




Where is the acute knee trauma clinic located?


54 Princes Hwy
West Wollongong NSW 2500





 

Arthroscopic Surgery

What is Arthroscopic Surgery?


Arthroscopic Surgery is a procedure Dr Bhimani can use on a patient by patient basis depending upon the patient’s medical circumstances, to visualize, diagnose, and treat problems inside a joint.
Arthroscopic surgical procedures are usually performed on an outpatient basis and the patient is able to return home on the same day as the procedure. If a procedure can be done arthroscopically instead of by traditional surgical methods, it can cause less trauma, may result in less pain, and may promote a quicker recovery for the patient.
In an arthroscopic examination, Dr Bhimani makes a small incision in the patient's skin and then inserts a small tube that contains optical fibers and lenses. Light is transmitted through fiber optics to the end of the arthroscope that is inserted into the joint.
By attaching the arthroscope to a miniature television camera, Dr Bhimani is able to see the interior of the joint through this very small incision rather than a large incision needed for traditional surgical methods.
The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing Dr Bhimani to look, for example, throughout the knee or hip. Dr Bhimani can then see the cartilage, ligaments, and under the kneecap to determine the amount or type of injury and can sometimes repair or correct the problem.
However there are many instances when arthroscopic surgery would be insufficient to treat the problems a patient is experiencing and more traditional surgical options such as a joint replacement may be required.
Dr Bhimani will always discuss the non-surgical and surgical options available to you, and which option he believes is most suitable in order to obtain the best long term result given your diagnosis, pain and loss of normal function.




Why is Arthroscopy necessary?


An arthroscope may be recommended even if the condition causing you pain has already been diagnosed or to help find a diagnosis. Diagnosing joint injuries and disease begins with a thorough medical history, physical examination, and usually X-rays. Additional tests such as an MRI or CT scan also may be required. A final diagnosis may be more accurate following an arthroscope to assist your surgeon to treat the issue, whether during an arthroscope or more traditional surgical options.




What are the conditions that can be treated by Arthroscopy?


On a case by case basis, as determined by Dr Bhimani, arthroscopy can be helpful in the diagnosis and treatment of many non-inflammatory, inflammatory, and infectious types of arthritis as well as various injuries within the joint.
Non-inflammatory degenerative arthritis, or osteoarthritis, can be seen using the arthroscope as frayed and irregular cartilage. In inflammatory arthritis, such as rheumatoid arthritis, some patients with isolated chronic joint swelling can sometimes benefit by arthroscopic removal of the inflamed joint tissue (synovectomy).
Arthroscopy is commonly used in the evaluation of knees but can also be used to examine and treat conditions of the hips.
Common knee joint injuries for which arthroscopy is considered include cartilage tears (meniscus tears), ligament strains and tears, and cartilage deterioration underneath the kneecap (patella). Lastly, loose tissues, such as chips of bone or cartilage, or foreign objects, such as plant thorns or needles, which become lodged within the joint, can be removed via arthroscopy.




What are the possible complications?


While uncommon, complications do occasionally occur during or following arthroscopy. Infection, phlebitis (blood clots of a vein), excessive swelling or bleeding, damage to blood vessels or nerves, and instrument breakage are the most common complications, but occur in far less than 1 percent of all arthroscopic procedures.




How is arthroscopy performed?


Arthroscopic surgery, although much easier in terms of recovery than ‘open’ surgery, still requires the use of anaesthetics and the special equipment in a hospital operating room or outpatient surgical suite. You will be given a general, spinal, or a local anaesthetic, depending on the joint or suspected problem.
A small incision (about the size of a buttonhole) will be made to insert the arthroscope while other incisions may be made to see other parts of the joint or insert other instruments.
Corrective surgery is performed with specially designed instruments that are inserted into the joint through accessory incisions. Initially, arthroscopy was simply a diagnostic tool for planning standard open surgery. With development of better instrumentation and surgical techniques, many conditions can be treated arthroscopically.
For instance, many meniscal tears in the knee can be treated successfully with arthroscopic surgery. The surgeon inserts miniature scissors to trim a torn meniscus .
After arthroscopic surgery, the small incisions will be covered with a dressing. You will be moved from the operating room to a recovery room. Many patients need little or no pain medications.

Before being discharged, you will be given instructions about care for your incisions, what activities you should avoid, and which exercises you should do to aid your recovery. During the follow-up visit, Dr Bhimani will inspect your incisions; remove sutures, if present; and discuss your rehabilitation program.
The amount of surgery required and recovery time will depend on the complexity of your problem. Occasionally, during arthroscopy, Dr Bhimani may discover that the injury or disease cannot be treated adequately with arthroscopy alone.




What are the advantages of arthroscopy?


Most patients have their arthroscopic surgery as outpatients and are home several hours after the surgery as it usually causes less trauma, may result in less pain, and may promote a quicker recovery for the patient than traditional surgical methods.





 

Anterior Cruciate Ligament (ACL) Injuries

What is Rheumatoid Arthritis?


Aching joints are common in arthritis. In rheumatoid arthritis, the joint lining swells, invades
surrounding tissues, and produces chemical substances that attack and destroy the joint surface.

People of all ages may be affected. The disease usually begins in middle age.
Rheumatoid arthritis usually affects joints on both sides of the body in the hands and feet, as well as the hips, knees, and elbows. Without proper treatment, rheumatoid arthritis can become a chronic, disabling condition.




What causes Rheumatoid Arthritis?


Rheumatoid arthritis is not an inherited disease. Researchers believe that some people have genes that make them susceptible to the disease. People with these genes will not automatically develop rheumatoid arthritis. There is usually a "trigger", such as an infection or environmental factor, which activates the genes. When the body is exposed to this trigger, the immune system responds inappropriately. Instead of protecting the joint, the immune system begins to produce substances that attack the joint. This is what may lead to the development of rheumatoid arthritis.
Ligaments and joint capsules become less effective supporting structures. Erosion of the articular cartilage, together with ligamentous changes, result in deformity and contractures. As the disease progresses, pain and deformity increase.




What are the symptoms of Rheumatoid Arthritis?


Pain, morning stiffness, swelling, and systemic symptoms are common. Other rheumatoid symptoms include:

  • Swelling, pain, and stiffness in the joint, even when it is not being used
  • A feeling of warmth around the joint
  • Deformities and contractures of the joint
  • Symptoms throughout the body, such as fever, loss of appetite and decreased energy
  • Weakness due to a low red blood cell count (anemia)
  • Nodules, or lumps, particularly around the elbow
  • Foot pain, bunions, and hammer toes with long-standing disease
Patients with severe rheumatoid arthritis typically have multiple affected joints in the hands, arms, legs, and feet. Joints of the cervical spine may be involved as well.




How Is Rheumatoid Arthritis Diagnosed?


Rheumatoid arthritis is diagnosed using a medical history and a physical examination. Some of the conditions Dr Bhimani looks for include swelling and warmth around the joint, painful motion, lumps under the skin, joint deformities, and joint contractures (inability to fully stretch or bend the joint).
A blood test may reveal an antibody called rheumatoid factor. This is an indicator of rheumatoid arthritis. X-rays can help show the progression of the disease. The American College of Rheumatology requires at least four of the following seven criteria to confirm the diagnosis:

  • Morning stiffness around the joint that lasts at least 1 hour
  • Arthritis of three or more joints for at least 6 weeks
  • Arthritis of hand joints for at least 6 weeks
  • Arthritis on both sides of the body for at least 6 weeks
  • Rheumatoid nodules under the skin
  • Rheumatoid factor present in blood testing
  • Evidence of rheumatoid arthritis on X-rays




How Is Rheumatoid Arthritis Treated?


Although there is no cure for rheumatoid arthritis, there are a number of treatment options that can help relieve joint pain and improve functioning. The treatment plan is tailored to the patient's needs and lifestyle. Rheumatoid arthritis is often treated by a team of health care professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.
Medication
Medications used to control rheumatoid arthritis fall into two categories: those that relieve
symptoms and those that have the potential to modify the course of the disease. Often, they are used together. Aspirin and ibuprofen can help reduce the pain and inflammation of rheumatoid arthritis. Disease-modifying drugs include methotrexate and sulfasalazine and gold injections.

Researchers are also working on biologic agents that can interrupt the progress of the disease. These agents target specific chemicals in the body to prevent them from acting on the joints.
Exercise and Therapy
Exercise is an important part of a treatment program. The physician and physical therapist may work with patients to develop an exercise program that helps strengthen the joints without stressing them. In some cases, a splint or corrective footwear may be required.

Surgery
Joint replacement surgery is also an option and is often effective in restoring function.





 

What is Arthritis?


Arthritis is inflammation of one or more of your joints that causes pain and stiffness. While arthritis is mainly an adult disease, some forms affect children.
There are many types of arthritis. Some of these include osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, septic arthritis, and psoriatic arthritis.
While each of these conditions has different causes, the symptoms and treatment are often thesame. Pain, swelling, and stiffness are the primary symptoms of arthritis. Any joint in the body may be affected by the disease, but it is particularly common in weight-bearing joints such as the knee and hip.
Although there is no cure for arthritis, there are many treatment options available to help manage pain and keep patients staying active.




What causes arthritis?


Arthritis may be caused by wear and tear on the articular cartilage through the natural aging process (osteoarthritis), or may develop following an injury (post-traumatic arthritis).
Other types of arthritis, such as crystalline arthritis, may come from an inflammatory process.
Still others, such as rheumatoid arthritis or lupus arthritis, are the result of a systemic disease
throughout the body.

Regardless of whether the cause is from injury, normal wear and tear, or disease, the joint becomes inflamed, causing swelling, pain and stiffness. Inflammation is one of the body's normal reactions to injury or disease. In arthritic joints, however, inflammation may cause long-lasting or permanent disability.




What is osteoarthritis?


The most common type of arthritis is osteoarthritis. Also known as "wear and tear" arthritis,
osteoarthritis occurs when the cartilage that cushions and protects the ends of your bones gradually wears away.

It results from overuse, trauma, or the natural degeneration of cartilage that occurs with aging.
Osteoarthritis is often more painful in joints that bear weight, such as the knee, hip, and spine. However, joints that are used extensively in work or sports, or joints that have been damaged by injury may show signs of osteoarthritis.
In many cases, bone growths called "spurs" develop at the edges of osteoarthritic joints. The bone can become hard and firm (sclerosis). The joint becomes inflamed, causing pain and swelling meaning continued use of the joint is painful.




What is rheumatoid arthritis?


Rheumatoid arthritis is a long-lasting disease. Rheumatoid arthritis affects many parts of the body, but mainly the joints. The body's immune system, which normally protects the body, begins to produce substances that attack the body. In rheumatoid arthritis, the joint lining swells, invade surrounding tissues. Chemical substances are produced that attack and destroy the joint surface.
Rheumatoid arthritis may affect both large and small joints in the body and also the spine. Swelling, pain, and stiffness usually develop, even when the joint is not used. In some circumstances, juvenile arthritis may cause similar symptoms in children.




What is post-traumatic arthritis?


Post-traumatic arthritis results from an injury to the joint. If a broken bone or fracture extends into a joint it will damage the smooth cartilage that covers the joint surfaces. The surface becomes uneven and causes friction as the joint moves. Over time, the joint breaks down and becomes arthritic.




What is septic arthritis?


Septic arthritis is an infection of the joint. Most often bacteria reach the joint through the
bloodstream from an infection in another part of the body, such as the urinary tract. Infected joints are typically warm, red, and acutely tender. They are often swollen due to pus in the joint. An infected joint often needs surgical drainage in addition to antibiotics.




What is psoriatic arthritis?


Psoriatic arthritis is associated with the skin disease psoriasis. While it may involve larger joints such as the knees it often presents with symptoms in smaller areas such as the distal joints at the tips of the fingers and toes.




What is gouty arthritis?


Gouty arthritis develops as the result of uric acid build up in the bloodstream. The uric acid forms crystals which cause acute inflammation in a joint. The big toe, ankle, knee, and elbow are the most common joints affected. A gout attack can be acutely painful. The inflamed joint becomes red and very sensitive to touch. Gout attacks are most often treated with medicine rather than surgery. Long term, many patients develop soft tissue masses (tophi) over the affected joints.




What is Lyme arthritis?


Lyme arthritis can be one of the side effects of Lyme disease, a systemic infection caused by a tick bite. Lyme arthritis can present acutely as pain and swelling in early stages of the disease. Lyme disease is treated with antibiotics. Left untreated, Lyme disease can lead to chronic arthritis.




What is Lupus arthritis?


Lupus is an autoimmune disease that affects multiple organs including the kidneys, skin, blood, and the heart. Lupus arthritis can be systemic and cause chronic pain in multiple joints.




What is Juvenile arthritis?


Juvenile arthritis is the most common type of arthritis in children. There are several types of the disease and most are different from rheumatoid arthritis in adults.




How is arthritis diagnosed?


Arthritis is diagnosed through a careful evaluation of symptoms and a physical examination. X-rays are important to show the extent of any damage to the joint. Blood tests and other laboratory tests may help to determine the type of arthritis. Some of the findings of arthritis include:

  • Weakness (atrophy) in the muscles
  • Tenderness to touch
  • Limited ability to move the joint passively (with assistance) and actively (without assistance)
  • Signs that multiple joints are painful or swollen (an indication of rheumatoid arthritis)
  • A grating feeling or sound (crepitus) with movement
  • Pain when pressure is placed on the joint or the joint is moved




How is arthritis treated?


There is no cure for arthritis, but there are many treatments to help relieve the pain and disability that it can cause.




What are the non-surgical treatments of arthritis?


Medications Over-the- counter medications can be used to control pain and inflammation in the joints. These medications, called anti-inflammatory drugs, include aspirin, ibuprofen, and naproxen. Acetaminophen can be effective in controlling pain.
Prescription medications also are available. Dr Bhimani will choose a medication by taking into account the type of arthritis, its severity, and your general physical health. Patients with ulcers, asthma, kidney, or liver disease, for example, may not be able to safely take anti-inflammatory medications.
Injections of cortisone into the joint may temporarily help to relieve pain and swelling. It is
important to know that repeated, frequent injections into the same joint can cause damage and undesirable side effects.
Viscosupplementation or injection of hyaluronic acid preparations can also be helpful in lubricating the joint. This is typically performed in the knee. Exercise and therapy Canes, crutches, walkers, or splints may help relieve the stress and strain on arthritic joints. Learningmethods of performing daily activities that are the less stressful to painful joints also may be helpful. Certain exercises and physical therapy may be used to decrease stiffness and to strengthen the weakened muscles around the joint.




What are the surgical treatments of arthritis?


In general, Dr Bhimani will perform surgery for arthritis when other methods of nonsurgical
treatment have failed to relieve pain and other symptoms. When deciding on the type of surgery, Dr Bhimani will take into account the type of arthritis, its severity, and your loss of normal function.

There are a number of surgical procedures. These include:

  • Removing the diseased or damaged joint lining
  • Realignment of the joints
  • Fusing the ends of the bones in the joint together, to prevent joint motion and relieve joint pain
  • Replacing the entire joint (total joint replacement)




How is arthritis managed long-term?


In most cases, persons with arthritis can continue to perform normal activities of daily living.
Exercise programs, anti-inflammatory drugs, and weight reduction for obese persons are common measures to reduce pain, stiffness, and improve function.

In persons with severe cases of arthritis, orthopaedic surgery can often provide dramatic pain relief and restore lost joint function.
Some types of arthritis, such as rheumatoid arthritis, are often treated by a team of health care professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.





Arthritis

 

Osteoarthritis

What is Rheumatoid Arthritis?


Aching joints are common in arthritis. In rheumatoid arthritis, the joint lining swells, invades
surrounding tissues, and produces chemical substances that attack and destroy the joint surface.

People of all ages may be affected. The disease usually begins in middle age.
Rheumatoid arthritis usually affects joints on both sides of the body in the hands and feet, as well as the hips, knees, and elbows. Without proper treatment, rheumatoid arthritis can become a chronic, disabling condition.




What causes Rheumatoid Arthritis?


Rheumatoid arthritis is not an inherited disease. Researchers believe that some people have genes that make them susceptible to the disease. People with these genes will not automatically develop rheumatoid arthritis. There is usually a "trigger", such as an infection or environmental factor, which activates the genes. When the body is exposed to this trigger, the immune system responds inappropriately. Instead of protecting the joint, the immune system begins to produce substances that attack the joint. This is what may lead to the development of rheumatoid arthritis.
Ligaments and joint capsules become less effective supporting structures. Erosion of the articular cartilage, together with ligamentous changes, result in deformity and contractures. As the disease progresses, pain and deformity increase.




What are the symptoms of Rheumatoid Arthritis?


Pain, morning stiffness, swelling, and systemic symptoms are common. Other rheumatoid symptoms include:

  • Swelling, pain, and stiffness in the joint, even when it is not being used
  • A feeling of warmth around the joint
  • Deformities and contractures of the joint
  • Symptoms throughout the body, such as fever, loss of appetite and decreased energy
  • Weakness due to a low red blood cell count (anemia)
  • Nodules, or lumps, particularly around the elbow
  • Foot pain, bunions, and hammer toes with long-standing disease
Patients with severe rheumatoid arthritis typically have multiple affected joints in the hands, arms, legs, and feet. Joints of the cervical spine may be involved as well.




How Is Rheumatoid Arthritis Diagnosed?


Rheumatoid arthritis is diagnosed using a medical history and a physical examination. Some of the conditions Dr Bhimani looks for include swelling and warmth around the joint, painful motion, lumps under the skin, joint deformities, and joint contractures (inability to fully stretch or bend the joint).
A blood test may reveal an antibody called rheumatoid factor. This is an indicator of rheumatoid arthritis. X-rays can help show the progression of the disease. The American College of Rheumatology requires at least four of the following seven criteria to confirm the diagnosis:

  • Morning stiffness around the joint that lasts at least 1 hour
  • Arthritis of three or more joints for at least 6 weeks
  • Arthritis of hand joints for at least 6 weeks
  • Arthritis on both sides of the body for at least 6 weeks
  • Rheumatoid nodules under the skin
  • Rheumatoid factor present in blood testing
  • Evidence of rheumatoid arthritis on X-rays




How Is Rheumatoid Arthritis Treated?


Although there is no cure for rheumatoid arthritis, there are a number of treatment options that can help relieve joint pain and improve functioning. The treatment plan is tailored to the patient's needs and lifestyle. Rheumatoid arthritis is often treated by a team of health care professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.
Medication
Medications used to control rheumatoid arthritis fall into two categories: those that relieve
symptoms and those that have the potential to modify the course of the disease. Often, they are used together. Aspirin and ibuprofen can help reduce the pain and inflammation of rheumatoid arthritis. Disease-modifying drugs include methotrexate and sulfasalazine and gold injections.

Researchers are also working on biologic agents that can interrupt the progress of the disease. These agents target specific chemicals in the body to prevent them from acting on the joints.
Exercise and Therapy
Exercise is an important part of a treatment program. The physician and physical therapist may work with patients to develop an exercise program that helps strengthen the joints without stressing them. In some cases, a splint or corrective footwear may be required.

Surgery
Joint replacement surgery is also an option and is often effective in restoring function.





 

Rheumatoid Arthritis

What is Rheumatoid Arthritis?


Aching joints are common in arthritis. In rheumatoid arthritis, the joint lining swells, invades
surrounding tissues, and produces chemical substances that attack and destroy the joint surface.

People of all ages may be affected. The disease usually begins in middle age.
Rheumatoid arthritis usually affects joints on both sides of the body in the hands and feet, as well as the hips, knees, and elbows. Without proper treatment, rheumatoid arthritis can become a chronic, disabling condition.




What causes Rheumatoid Arthritis?


Rheumatoid arthritis is not an inherited disease. Researchers believe that some people have genes that make them susceptible to the disease. People with these genes will not automatically develop rheumatoid arthritis. There is usually a "trigger", such as an infection or environmental factor, which activates the genes. When the body is exposed to this trigger, the immune system responds inappropriately. Instead of protecting the joint, the immune system begins to produce substances that attack the joint. This is what may lead to the development of rheumatoid arthritis.
Ligaments and joint capsules become less effective supporting structures. Erosion of the articular cartilage, together with ligamentous changes, result in deformity and contractures. As the disease progresses, pain and deformity increase.




What are the symptoms of Rheumatoid Arthritis?


Pain, morning stiffness, swelling, and systemic symptoms are common. Other rheumatoid symptoms include:

  • Swelling, pain, and stiffness in the joint, even when it is not being used
  • A feeling of warmth around the joint
  • Deformities and contractures of the joint
  • Symptoms throughout the body, such as fever, loss of appetite and decreased energy
  • Weakness due to a low red blood cell count (anemia)
  • Nodules, or lumps, particularly around the elbow
  • Foot pain, bunions, and hammer toes with long-standing disease
Patients with severe rheumatoid arthritis typically have multiple affected joints in the hands, arms, legs, and feet. Joints of the cervical spine may be involved as well.




How Is Rheumatoid Arthritis Diagnosed?


Rheumatoid arthritis is diagnosed using a medical history and a physical examination. Some of the conditions Dr Bhimani looks for include swelling and warmth around the joint, painful motion, lumps under the skin, joint deformities, and joint contractures (inability to fully stretch or bend the joint).
A blood test may reveal an antibody called rheumatoid factor. This is an indicator of rheumatoid arthritis. X-rays can help show the progression of the disease. The American College of Rheumatology requires at least four of the following seven criteria to confirm the diagnosis:

  • Morning stiffness around the joint that lasts at least 1 hour
  • Arthritis of three or more joints for at least 6 weeks
  • Arthritis of hand joints for at least 6 weeks
  • Arthritis on both sides of the body for at least 6 weeks
  • Rheumatoid nodules under the skin
  • Rheumatoid factor present in blood testing
  • Evidence of rheumatoid arthritis on X-rays




How Is Rheumatoid Arthritis Treated?


Although there is no cure for rheumatoid arthritis, there are a number of treatment options that can help relieve joint pain and improve functioning. The treatment plan is tailored to the patient's needs and lifestyle. Rheumatoid arthritis is often treated by a team of health care professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.
Medication
Medications used to control rheumatoid arthritis fall into two categories: those that relieve
symptoms and those that have the potential to modify the course of the disease. Often, they are used together. Aspirin and ibuprofen can help reduce the pain and inflammation of rheumatoid arthritis. Disease-modifying drugs include methotrexate and sulfasalazine and gold injections.

Researchers are also working on biologic agents that can interrupt the progress of the disease. These agents target specific chemicals in the body to prevent them from acting on the joints.
Exercise and Therapy
Exercise is an important part of a treatment program. The physician and physical therapist may work with patients to develop an exercise program that helps strengthen the joints without stressing them. In some cases, a splint or corrective footwear may be required.

Surgery
Joint replacement surgery is also an option and is often effective in restoring function.