Frequently Asked Questions

 

What are your business hours?


Our practice hours are from 8:00am to 5:00pm, Monday through Friday.




What is your contact phone number?


(02) 4229 9116




What is your practice location?


Practice Location 54 Princes Hwy West Wollongong NSW 2500 Current Appointments Wollongong Hospital
Loftus St (main entrance)
Wollongong 2521 02 4222 5000 Shellharbour Hospital 15-17 Madigan Boulevarde Mt Warrigal 2528 02 4295 2500




Who do I call for appointments?


For all appointments and enquiries, please contact us on (02) 4229 9116.

Our practice hours are from 8am to 5pm Monday to Friday (excepting public holidays). Or request an appointment here




Where do I park for appointments?


Free parking is available onsite via the practice driveway off London Drive.




What if I need to cancel an appointment?


Telephone the office during business hours and allow at least 1 days’ notice so that we can offer your appointment time to patients on our waiting list.




What should I bring with me when I come for an appointment?


When you come for your appointment remember to bring the following:

  • Driver’s License or a valid ID
  • Insurance information
  • Referral Letter (if required)
  • Reports, X-Rays, MRI’s, CT scans and any other relevant medical information
  • List of medications (if any)




Does Dr Bhimani usually run on time?


We recognise that your time is valuable, and we make every effort to run on time. Occasionally emergencies or patients require a little more time, and these cause scheduling delays beyond our control. We apologise if we keep you waiting.




Should I make an appointment?


  • Do you have pain in your knees, hip or groin?
  • Is the pain restricting your daily activities?
  • Is the pain not relieved on taking medications?
  • Do you have swollen knee?
  • Do you limp while walking?
  • Does pain makes you stop when you walk more than a few blocks?
  • Are you having pain when lying or sitting down?
  • Are you getting pain for about 3 to 4 days per week?
  • Do your knees hurt when climbing or descending stairs?
  • Do you feel pain when walking for long time?
  • Does pain disturbs your sleep?
  • Do you find difficult to put your socks and shoes?
  • Do you have a sensation of instability or the knee is going to give out when you are physically active?
  • Do you need crutches, cranes or walkers to help you while walking?
  • Do you have tightness or limited range of hip motion?
If your answer is yes to the any of these questions, you might be suffering from arthritis - a degenerative joint disease, and you should contact us to arrange a consultation.




What if I need imaging?


During your initial consultation Dr Bhimani may write you a referral letter for additional imaging. Please ask at the time of your image referral letter for an image centre which is located near you.




What can I do if am happy with the service I have received?


If you like the service we provide please spread the word! Like Us on Facebook or take a minute to provide an online review for Dr Bhimani via Google Reviews, Rate MD or Doctoralia.




Am I likely to require surgery?


Surgery is the right decision when patients have tried non-surgical options first but are still not coping. Dr Bhimani encourages patients to make the decision to have surgery based on how their condition is upsetting their quality of life, their level of pain and their loss of normal function.
As a dedicated orthopedic surgeon Dr Bhimani always make sure his patients fully understand their condition, the treatment options available to them, as well as any risks or potential complications of a particular treatment. However it is crucial that patients understand that the decision to have any kind of orthopedic surgery is always theirs to make.
Once Dr Bhimani understands your diagnosis, you can both plan and agree on a sensible and holistic approach to treatment and rehabilitation for your best long-term results. If you decide that surgery is necessary, then not only is our objective to reduce your pain and increase your mobility, but to also facilitate the earliest possible return to normal activity post-surgery.
To accomplish these objectives for patients Dr Bhimani is extremely dedicated to ensuring he is at the forefront of developments in hip and knee surgery to provide patients with the best possible orthopaedic care.




Will physical therapy be required after surgery?


Getting a full range of motion, strength and flexibility back after surgery usually takes time. That’s where pre-operative exercise and education and post-operative physical therapy programs help to ensure you're physically and emotionally prepared for surgery and to maximise your recovery after surgery.

Dr Bhimani will choose the least invasive surgical procedure suited to your condition to minimise your recovery period. Dr Bhimani will ensure you understand what procedure you are having, how to prepare for surgery and what recovery program you need to follow. Physiotherapy is an essential part of this education, preparation and recovery process and will help you obtain a better surgical outcome.




Does Dr Bhimani see public and private patients?


Yes, Dr Bhimani sees both private and public patients.




What are Dr Bhimani's fees?


The following is a guide to the fees charged by Dr Aziz Bhimani. Please do not hesitate to contact our staff on 02 4229 9116 if you require further information or assistance. Consultation Fees Each consultation attracts a fee which is reimbursed in part from Medicare. The consultation fee will be advised to you at the time of booking your appointment. Operation Fees If you require a surgical procedure a detailed itemised quote of Dr Bhimani & his surgical team’s fees will be provided up front as well as an estimate of out-of-pocket expenses. You will meet with your anaesthetist before your operation so that you can obtain an estimate of his/her fees also. Procedures vary in complexity, difficulty and duration and these are all factors that determine out-of- pocket expenses. Please check with your Private Health Insurer regarding whether an excess is payable to the hospital under your level of cover. Pensioners Dr Bhimani is a no-gap surgeon for pensioners. Worker Compensation​ If you have your claim number, your consultation and operation fees will be charged directly to your workers compensation insurer with no personal charge to you. Veteran's Affairs (DVA) If you have a valid DVA number, your consultation and operation fees will be charged directly to the Department of Veterans’ Affairs with no personal charge to you.





General

 

Acute Knee Clinic

What are your business hours?


Our practice hours are from 8:00am to 5:00pm, Monday through Friday.




What is your contact phone number?


(02) 4229 9116




What is your practice location?


Practice Location 54 Princes Hwy West Wollongong NSW 2500 Current Appointments Wollongong Hospital
Loftus St (main entrance)
Wollongong 2521 02 4222 5000 Shellharbour Hospital 15-17 Madigan Boulevarde Mt Warrigal 2528 02 4295 2500




Who do I call for appointments?


For all appointments and enquiries, please contact us on (02) 4229 9116.

Our practice hours are from 8am to 5pm Monday to Friday (excepting public holidays). Or request an appointment here




Where do I park for appointments?


Free parking is available onsite via the practice driveway off London Drive.




What if I need to cancel an appointment?


Telephone the office during business hours and allow at least 1 days’ notice so that we can offer your appointment time to patients on our waiting list.




What should I bring with me when I come for an appointment?


When you come for your appointment remember to bring the following:

  • Driver’s License or a valid ID
  • Insurance information
  • Referral Letter (if required)
  • Reports, X-Rays, MRI’s, CT scans and any other relevant medical information
  • List of medications (if any)




Does Dr Bhimani usually run on time?


We recognise that your time is valuable, and we make every effort to run on time. Occasionally emergencies or patients require a little more time, and these cause scheduling delays beyond our control. We apologise if we keep you waiting.




Should I make an appointment?


  • Do you have pain in your knees, hip or groin?
  • Is the pain restricting your daily activities?
  • Is the pain not relieved on taking medications?
  • Do you have swollen knee?
  • Do you limp while walking?
  • Does pain makes you stop when you walk more than a few blocks?
  • Are you having pain when lying or sitting down?
  • Are you getting pain for about 3 to 4 days per week?
  • Do your knees hurt when climbing or descending stairs?
  • Do you feel pain when walking for long time?
  • Does pain disturbs your sleep?
  • Do you find difficult to put your socks and shoes?
  • Do you have a sensation of instability or the knee is going to give out when you are physically active?
  • Do you need crutches, cranes or walkers to help you while walking?
  • Do you have tightness or limited range of hip motion?
If your answer is yes to the any of these questions, you might be suffering from arthritis - a degenerative joint disease, and you should contact us to arrange a consultation.




What if I need imaging?


During your initial consultation Dr Bhimani may write you a referral letter for additional imaging. Please ask at the time of your image referral letter for an image centre which is located near you.




What can I do if am happy with the service I have received?


If you like the service we provide please spread the word! Like Us on Facebook or take a minute to provide an online review for Dr Bhimani via Google Reviews, Rate MD or Doctoralia.




Am I likely to require surgery?


Surgery is the right decision when patients have tried non-surgical options first but are still not coping. Dr Bhimani encourages patients to make the decision to have surgery based on how their condition is upsetting their quality of life, their level of pain and their loss of normal function.
As a dedicated orthopedic surgeon Dr Bhimani always make sure his patients fully understand their condition, the treatment options available to them, as well as any risks or potential complications of a particular treatment. However it is crucial that patients understand that the decision to have any kind of orthopedic surgery is always theirs to make.
Once Dr Bhimani understands your diagnosis, you can both plan and agree on a sensible and holistic approach to treatment and rehabilitation for your best long-term results. If you decide that surgery is necessary, then not only is our objective to reduce your pain and increase your mobility, but to also facilitate the earliest possible return to normal activity post-surgery.
To accomplish these objectives for patients Dr Bhimani is extremely dedicated to ensuring he is at the forefront of developments in hip and knee surgery to provide patients with the best possible orthopaedic care.




Will physical therapy be required after surgery?


Getting a full range of motion, strength and flexibility back after surgery usually takes time. That’s where pre-operative exercise and education and post-operative physical therapy programs help to ensure you're physically and emotionally prepared for surgery and to maximise your recovery after surgery.

Dr Bhimani will choose the least invasive surgical procedure suited to your condition to minimise your recovery period. Dr Bhimani will ensure you understand what procedure you are having, how to prepare for surgery and what recovery program you need to follow. Physiotherapy is an essential part of this education, preparation and recovery process and will help you obtain a better surgical outcome.




Does Dr Bhimani see public and private patients?


Yes, Dr Bhimani sees both private and public patients.




What are Dr Bhimani's fees?


The following is a guide to the fees charged by Dr Aziz Bhimani. Please do not hesitate to contact our staff on 02 4229 9116 if you require further information or assistance. Consultation Fees Each consultation attracts a fee which is reimbursed in part from Medicare. The consultation fee will be advised to you at the time of booking your appointment. Operation Fees If you require a surgical procedure a detailed itemised quote of Dr Bhimani & his surgical team’s fees will be provided up front as well as an estimate of out-of-pocket expenses. You will meet with your anaesthetist before your operation so that you can obtain an estimate of his/her fees also. Procedures vary in complexity, difficulty and duration and these are all factors that determine out-of- pocket expenses. Please check with your Private Health Insurer regarding whether an excess is payable to the hospital under your level of cover. Pensioners Dr Bhimani is a no-gap surgeon for pensioners. Worker Compensation​ If you have your claim number, your consultation and operation fees will be charged directly to your workers compensation insurer with no personal charge to you. Veteran's Affairs (DVA) If you have a valid DVA number, your consultation and operation fees will be charged directly to the Department of Veterans’ Affairs with no personal charge to you.





 

Non-surgical treatment

What are non-surgical orthpaedic treatments?


Many orthopaedic conditions have many non-surgical treatment options. And to the patient’s benefit, rehabilitation times with these conservative methods are typically shorter and carry less risk than undergoing a surgical procedure.

Dr Bhimani will explore all the possible options to avoid surgery, but sometimes it becomes the only option for effectively treating the injury and managing pain. We also consider if avoiding surgery could result in long-term impairment, pain or dysfunction.

Non- pharmacological Treatments

Physical and Occupational Therapy

Through a range of motion exercises, strengthening techniques and patient education, physical and occupational therapy can help patients with orthopaedic injuries, diseases or changes in physical conditions.

Weight reduction and physical exercise

The lifestyle changes resulting in weight loss in obese individuals and doing appropriate physical exercises plays an important role in prevention and management of knee and hip conditions.

Thermotherapy

Thermotherapy involves application of hot or cold packs to the affected area. It is contraindicated in individuals with thermoregulatory impairments. Individuals having peripheral vascular disease, diabetes, cardiovascular disease and hypertension, or who are pregnant should use it with caution.

Orthotics

Orthotics involves the use of devices such as splints or braces to correct an injury. These devices need to be properly designed by a qualified orthotist to fit the patient’s body and their specific injury.

Pharmacological Treatments

Platelet-rich plasma therapy (PRP)

This procedure uses the patient’s own blood chemistry to heal tendon and ligament injuries, as well as osteoarthritis.

Steroid injections

These injections of steroids are given directly into the affected joint for severe pain when use of Non-steroidal anti-inflammatory drugs does not bring much relief. Steroids are very strong anti-inflammatory drugs and if used orally cause various side effects on other body systems. Local analgesics that prevent the sensation of pain are sometimes given along with steroids in the same shot to bring relief quickly.

Medications

To manage pain throughout recovery, we often prescribe patients with anti-inflammatories, acetaminophen, muscle relaxants, topical medications and other types pain relievers. Prescription of medication is most often used in combination with other non-surgical orthopaedic treatments.

Non-steroidal anti-inflammatory drugs are found to be effective in reducing pain and inflammation . Caution must be taken while using NSAIDs for overdosing as they are known to cause hepatotoxicity. Patients with liver diseases must take extreme care while using them.

They can cause a range of side effects, chances of which increase with the concomitant use of diuretics, angiotensin converting enzyme inhibitors, angiotensin 2 receptor blockers, anticoagulants or oral corticosteroids.

Stem cells These are special cells in your body that can turn into other types of cells. During the healing process, stem cells are called to the area of your body that needs repair. Factors in the area influence the stem cells to become repair cells. Note that the same stem cell that repairs bone can also repair a tendon or ligament. Of all the types of cells, stem cells have the greatest potential for promoting healing. As discussed above, stem cells are immature cells that are influenced by their surroundings. When brought to an injury site, a stem cell can develop into the kind of cell needed to help in healing - bone, muscle, ligament, and cartilage. Because of the healing capabilities of stem cells, doctors have developed ways to bring stem cells to an injury site faster and in greater numbers. The first step in this process is to retrieve the stem cells. This can be done by harvesting them from the patient, or through a stem cell donor program. Stem Cell Harvesting: There are many sources of stem cells in the human body. The most important source is bone marrow. Bone marrow is located in the centers of long bones, such as the bones in your arms, forearms, thighs, and legs. The pelvic bone contains the highest concentration of stem cells. Therefore, the bone marrow in your pelvic bone is the most common source for harvesting stem cells. The doctor draws the stem cells out of the bone marrow with a needle, in a similar way that blood is drawn from your arm for tests. An orthopaedic surgeon then inserts this large supply of stem cells into the injury site. This eliminates the time it would take for the stem cells to reach the injury on their own and delivers them in a higher concentration, which speeds the healing process. Stem Cell Donation: Orthopaedic surgeons can also use donor stem cells to promote healing. In much the same way that blood transfusions help millions of patients each year, stem cells taken from donors after they pass away help millions of orthopaedic patients. When these cells are harvested, they are treated so that they will not create an immune or allergic reaction in the patient.





 

Preparing For Surgery

What are non-surgical orthpaedic treatments?


Many orthopaedic conditions have many non-surgical treatment options. And to the patient’s benefit, rehabilitation times with these conservative methods are typically shorter and carry less risk than undergoing a surgical procedure.

Dr Bhimani will explore all the possible options to avoid surgery, but sometimes it becomes the only option for effectively treating the injury and managing pain. We also consider if avoiding surgery could result in long-term impairment, pain or dysfunction.

Non- pharmacological Treatments

Physical and Occupational Therapy

Through a range of motion exercises, strengthening techniques and patient education, physical and occupational therapy can help patients with orthopaedic injuries, diseases or changes in physical conditions.

Weight reduction and physical exercise

The lifestyle changes resulting in weight loss in obese individuals and doing appropriate physical exercises plays an important role in prevention and management of knee and hip conditions.

Thermotherapy

Thermotherapy involves application of hot or cold packs to the affected area. It is contraindicated in individuals with thermoregulatory impairments. Individuals having peripheral vascular disease, diabetes, cardiovascular disease and hypertension, or who are pregnant should use it with caution.

Orthotics

Orthotics involves the use of devices such as splints or braces to correct an injury. These devices need to be properly designed by a qualified orthotist to fit the patient’s body and their specific injury.

Pharmacological Treatments

Platelet-rich plasma therapy (PRP)

This procedure uses the patient’s own blood chemistry to heal tendon and ligament injuries, as well as osteoarthritis.

Steroid injections

These injections of steroids are given directly into the affected joint for severe pain when use of Non-steroidal anti-inflammatory drugs does not bring much relief. Steroids are very strong anti-inflammatory drugs and if used orally cause various side effects on other body systems. Local analgesics that prevent the sensation of pain are sometimes given along with steroids in the same shot to bring relief quickly.

Medications

To manage pain throughout recovery, we often prescribe patients with anti-inflammatories, acetaminophen, muscle relaxants, topical medications and other types pain relievers. Prescription of medication is most often used in combination with other non-surgical orthopaedic treatments.

Non-steroidal anti-inflammatory drugs are found to be effective in reducing pain and inflammation . Caution must be taken while using NSAIDs for overdosing as they are known to cause hepatotoxicity. Patients with liver diseases must take extreme care while using them.

They can cause a range of side effects, chances of which increase with the concomitant use of diuretics, angiotensin converting enzyme inhibitors, angiotensin 2 receptor blockers, anticoagulants or oral corticosteroids.

Stem cells These are special cells in your body that can turn into other types of cells. During the healing process, stem cells are called to the area of your body that needs repair. Factors in the area influence the stem cells to become repair cells. Note that the same stem cell that repairs bone can also repair a tendon or ligament. Of all the types of cells, stem cells have the greatest potential for promoting healing. As discussed above, stem cells are immature cells that are influenced by their surroundings. When brought to an injury site, a stem cell can develop into the kind of cell needed to help in healing - bone, muscle, ligament, and cartilage. Because of the healing capabilities of stem cells, doctors have developed ways to bring stem cells to an injury site faster and in greater numbers. The first step in this process is to retrieve the stem cells. This can be done by harvesting them from the patient, or through a stem cell donor program. Stem Cell Harvesting: There are many sources of stem cells in the human body. The most important source is bone marrow. Bone marrow is located in the centers of long bones, such as the bones in your arms, forearms, thighs, and legs. The pelvic bone contains the highest concentration of stem cells. Therefore, the bone marrow in your pelvic bone is the most common source for harvesting stem cells. The doctor draws the stem cells out of the bone marrow with a needle, in a similar way that blood is drawn from your arm for tests. An orthopaedic surgeon then inserts this large supply of stem cells into the injury site. This eliminates the time it would take for the stem cells to reach the injury on their own and delivers them in a higher concentration, which speeds the healing process. Stem Cell Donation: Orthopaedic surgeons can also use donor stem cells to promote healing. In much the same way that blood transfusions help millions of patients each year, stem cells taken from donors after they pass away help millions of orthopaedic patients. When these cells are harvested, they are treated so that they will not create an immune or allergic reaction in the patient.





 

Anaesthesia

What types of anaesthesia are there?


The type of anaesthesia used will depend on the nature and duration of the procedure, your general medical condition, and your preference, your and those of your anaesthetist and surgeon or other doctor performing the procedure. General anaesthesia You are put into a state of unconsciousness for the duration of the operation. This is usually achieved by injecting drugs through a cannula placed in a vein and maintained with intravenous drugs or a mixture of gases which you will breathe. While you remain unaware of what is happening around you, the anaesthetist monitors your condition closely and constantly adjusts the level of anaesthesia. You will often be asked to breathe oxygen through a mask just before your anaesthesia starts. Regional anaesthesia A nerve block numbs the part of the body where the surgeon operates and this avoids the need for general anaesthesia. You may be awake or sedated (see below). Examples of regional anaesthesia include epidurals for labour, spinal anaesthesia for caesarean section and ‘eye blocks’ for cataracts. Local anaesthesia A local anaesthetic drug is injected at the site of the surgery to cause numbness. You will be awake but feel no pain. An obvious example of local anaesthesia is numbing an area of skin before having a cut stitched. Sedation The anaesthetist administers drugs to make you relaxed and drowsy. This is sometimes called ‘twilight sleep’ or ‘intravenous sedation’ and may be used for some eye surgery, some plastic surgery and for some gastroenterological procedures. Recall of events is possible with ‘sedation’. Most patients prefer to have little or no recall of events. Please discuss your preference with your anaesthetist.




What is an anaesthetist?


A specialist anaesthetist is a fully qualified medical doctor who, after obtaining their medical degree, has spent at least two years working in the hospital system before completing a further five years of training in anaesthesia. Clinical anaesthesia is built on the knowledge of physiology (how the body works) and pharmacology (how medications work in the body). Anaesthetists have an extensive knowledge of medicine and surgery and understanding of the basic sciences. They know how the body responds to anaesthesia and surgery, and how a patient’s health affects these responses. In Australia and New Zealand, anaesthesia training is supervised and accredited by the Australian and New Zealand College of Anaesthetists (ANZCA). The training to become a specialist anaesthetist is equal in length to that of other medical specialists, such as surgeons, and includes intensive assessments, both at the hospitals where trainees work, and by written and verbal examinations. Doctors in the training program are called registrars. When a registrar completes their training and passes all examinations, they are awarded a diploma of fellowship of ANZCA, become Fellows of the College and may use the initials FANZCA after their name. They can then practise as a specialist anaesthetist in Australia and New Zealand. Anaesthetists are perioperative physicians trained in all forms of anaesthesia and are members of multidisciplinary teams providing healthcare to patients. They assess patients before their procedures and play an important role in caring for the patient before, during and after surgery. They also provide anaesthetic care for patients undergoing non-surgical procedures, particularly if the procedures are long, complex or painful. Anaesthetists play a pivotal role in resuscitating acutely unwell patients, including trauma victims, and help to manage patients suffering from acute or chronic pain. They also provide pain relief for women during labour and delivery. Throughout their practice, anaesthetists must continue to update their skills by regularly attending professional development sessions. Anaesthetists must participate in a continuing professional development (CPD) program that complies with ANZCA’s CPD standard in order for them to practise. Many anaesthetists are active in research, studying how the body works, and developing new drugs and equipment to minimise error and patient harm. They teach a range of healthcare workers, including medical and nursing students, interns, residents, anaesthesia trainees and other medical specialists. In some remote or rural communities where the workload is not sufficient to support a fulltime specialist, non-specialist doctors may give anaesthetics. These doctors undergo limited training sufficient to provide anaesthesia for healthy patients undergoing less complex operations. Non-specialist anaesthetists often also work as family or general practitioners and undertake training to meet the requirements of the Joint Consultative Committee on Anaesthesia. This is a tripartite committee with representatives from ANZCA, the Royal Australian College of General Practice (National Rural Faculty) and the Australian College of Rural and Remote Medicine.




What is anaesthesia?


Relieving pain and suffering is central to the practice of anaesthesia, which involves administering medications to eliminate sensations, including pain. This allows doctors to perform medical and surgical procedures without causing undue distress or discomfort to the patient. Most people undergo anaesthesia at some stage in their lives, such as during the birth of a baby or during surgery. They may be anaesthetised for a short, simple day surgery or for major surgery requiring complex, rapid decisions. Modern anaesthesia is relatively safe due to high standards of training that emphasise quality and safety. There also have been improvements in drugs and equipment. Advances in anaesthesia have also resulted in patients being able to have more complex surgery as a day stay procedure because of more rapid recovery with modern anaesthesia; and they have facilitated many of the advances in surgery. Australia and New Zealand have one of the best patient safety records in the world, thanks to increased support for research to improve anaesthesia. Specialist anaesthetists become involved in the patient’s care prior to surgery with assessment of their medical condition and planning their care as part of the surgical team. They closely monitor the patient’s health and wellbeing throughout the procedure and help to ensure a smooth and comfortable recovery.




How do I prepare for anaesthesia?


‘Day of surgery admission’ and ‘day surgery’ Almost all patients are now admitted to hospital on the same day as their operation. Depending on the hospital’s requirements, you may be waiting for some hours. There will normally only be limited time available for you to talk to your anaesthetist before your procedure. If you are having a major procedure, or have concerns about your health or anaesthesia, it is beneficial to consult with your anaesthetist at a separate visit before the day of your surgery.

Make sure that you leave plenty of time to get to the hospital and the admissions area prior to your designated arrival time. There can often be a considerable waiting period at hospitals, so bring something to read or listen to and try to remain relaxed – as difficult as this may be! Your anaesthetist and the hospital staff are there to look after you.

Remember, if you have any concerns or questions please contact your anaesthetist prior to coming to hospital. What should I tell the anaesthetist? Your anaesthetist will meet with you before your operation to discuss your health, general medical condition, any previous anaesthesia and will perform a relevant examination.
Depending on the type of operation, hospital or facility, this may not occur until immediately before your procedure. The anaesthetist will want to know:
1. How healthy you are and whether you have had any recent illnesses, with a particular focus on heart or respiratory problems.
2. What previous operations you have had and whether there were any problems with anaesthesia.
3. If you have had any abnormal reactions to any medications and whether you have any allergies.
4. Whether you have a history of reflux or heartburn, asthma, bronchitis, heart problems or any other medical conditions. 5. Whether you are currently taking any drugs, prescribed or otherwise – including cigarettes and alcohol – and whether you are taking ‘blood thinners’, otherwise known as ‘antiplatelet drugs’ or ‘anticoagulants’. These include aspirin, clopidogrel [Plavix], warfarin, Pradaxa and Xarelto. Please bring all your current medications in their original packaging. 6. If you have any loose, capped or crowned teeth or implants, have ‘veneers’ or ‘bonding’, or wear dentures or plates.
You may be given questionnaires to complete, or be asked questions by nurses, before seeing your anaesthetist. Your anaesthetist needs to have the best possible picture of you and your present condition so that the most suitable anaesthesia can be planned. Answer all questions honestly – it is really all about minimising risk to you. Your role There are some things you can do which will make your anaesthesia safer.
1. Get a little fitter – regular walks will work wonders.
2. Don’t smoke – ideally, you need to stop six weeks before surgery. However, stopping for even 24 hours can help. Your GP may be able to assist.
3. If you are overweight, make a serious attempt to reduce your weight before your procedure. 4. Minimise alcohol consumption.
5. Continue to take any medications which have been prescribed but remember to let your anaesthetist and surgeon know what they are. 6. If you are taking aspirin, non-steroidal anti-inflammatory agents or other blood thinning drugs, consult your surgeon or anaesthetist about whether you should stop taking them prior to surgery. 7. If you have any kind of health problem or have had problems with previous anaesthesia, tell your anaesthetist and surgeon so that they are fully informed. 8. If you are concerned about your anaesthesia, make an appointment to see or talk your anaesthetist before admission to hospital and get the answers you need. 9. For children, many hospitals can arrange a preoperative visit. 10. Discuss any herbal products you might be taking with your anaesthetist. It may be necessary to cease taking them two to three weeks prior to surgery. 11. Inform your anaesthetist if you use ‘so called’ recreational drugs as these may interact with the anaesthesia. 12. Inform your surgeon/anaesthetist if you have any issues with blood transfusions. Is fasting really necessary? You will usually be advised to avoid food for six hours and fluids (including water) for three hours before your operation. Food or fluid in the stomach may be vomited and could enter your lungs while you are unconscious.

If you don’t follow this rule of fasting, the operation may be postponed in the interests of your safety. Your surgeon, anaesthetist or the hospital will advise you how long to fast.




What about anaesthesia for joint replacement surgery?


The anaesthetist will consider several factors when planning your anaesthesia, including: • Past experience with surgery. • Health and physical condition. • Reactions or allergies to medicines. • Risks of each type of anaesthesia. • Preferences of your surgical team. • Your preferences. Regional anaesthesia is the most common form of anaesthesia used during joint-replacement surgery because it aims to provide optimal pain relief while minimising side effects such as sedation, postoperative nausea and vomiting, and leg weakness. It may be used on its own or combined with sedation or general anaesthesia. Regional anaesthesia numbs the part of the body where the surgery will happen. It involves the injection of local anaesthetic around major nerve bundles supplying body areas, such as the thigh, ankle, forearm, hand, shoulder or abdomen. This is sometimes done using a nerve-locating device, such as a nerve stimulator, or ultrasound, so that the anaesthetic can be delivered with greater accuracy. Once local anaesthetic is injected, you may experience numbness and tingling in the area supplied by the nerves and it may become difficult or impossible to move that part of the body. BEFORE THE OPERATION It is important that you speak to your doctor about when you should stop eating and drinking before your anaesthetic. The anaesthetist will also need information such as: • Any recent coughs, colds or fevers. • Any previous anaesthetics or family problems with anaesthesia. • Abnormal reactions or allergies to drugs. • Any history of asthma, bronchitis, heart problems or other medical problems. • Any medications you may be taking. WHAT TO EXPECT Each surgery is different. How long an operation takes depends on how badly the joint is damaged and how the surgery is done. The duration of the anaesthesia depends on which anaesthetic is used, the region into which it is injected, and whether it is maintained by continual doses or repeated injections. After surgery, you will be moved to a recovery room for a period of time until you are ready to be returned to the ward. Typically, numbness can last several hours but may last several days. Generally, the “heaviness” wears off within a few hours but the numbness and tingling may persist much longer. As the local anaesthetic effect wears off, numbness will diminish and surgical pain may return, in which case your doctor will prescribe alternative methods of pain relief, including injections or tablets. Because osteoarthritis is often found in hips and knees, and patients undergoing hip or knee replacements are often elderly, there may be complications. Many joint-replacement patients have other medical conditions – diagnosed and undiagnosed – such as high blood pressure and heart problems, which require assessment and investigation. Most patients undergoing joint replacement tend to accept the risks involved because of the potential improvement in their quality of life.




What are the risks and complications of anaesthesia?


There is no safer place in the world to be anaesthetised than in Australia.

Nevertheless, some patients are at an increased risk of complications because of health problems e.g. heart or respiratory disease, diabetes or obesity, age, and/ or because of the type of surgery which they are undergoing.

Infrequent complications include: bruising, pain or injury at the site of injections, temporary breathing difficulties, temporary nerve damage, muscle pain, asthmatic reactions, headaches, the possibility of some sensation or awareness during the operation (especially with caesarean section and some emergency procedures), damage to teeth and dental prostheses, lip and tongue injuries, and temporary difficulty in speaking.

Nausea and vomiting are quite common after certain types of surgery, and rare after other types. The type of anaesthesia used may also be a factor. Even with the use of modern medications, a small percentage of patients may experience nausea and vomiting that is difficult to control. If you have had difficulties in the past, please let your anaesthetist know.

There are also some very rare, but serious complications including: heart attack, stroke, seizure, severe allergic or sensitivity reactions, brain damage, kidney or liver failure, lung damage, paraplegia or quadriplegia, permanent nerve or blood vessel damage, eye injury, damage to the larynx (voice box) and vocal cords, pneumonia and infection from blood transfusion. Remember that these more serious complications, including death, are quite remote but do exist.

We urge you to ask questions. Your anaesthetist will be happy to answer them and to discuss the best way to work with you for the best possible outcome. Risk of infections Needles, syringes and intravenous lines are all used only once. They are new in the packet before your surgery commences and they are disposed of immediately afterwards. Cross infection from one patient to another is therefore not possible.
Blood transfusion With modern surgery the requirements for blood transfusion are less common. All blood collected today from donors is carefully screened and tested but a very small risk of cross infection still remains.

Your anaesthetist is aware of these risks and only uses blood transfusions when absolutely necessary. For major surgery, your anaesthetist may supervise a system of collecting your blood during or after your operation, processing it and returning it to you. This is called blood salvage and sometimes this can avoid the need for a transfusion.





 

Post-operative CARE

What is Osteoarthritis?


Osteoarthritis, also known as "wear and tear" arthritis, occurs when the cartilage that cushions and protects the ends of your bones gradually wears away. This leads to pain and stiffness that worsens over time, making it difficult to do daily activities.
Osteoarthritis is the most common form of arthritis. It develops slowly and most often occurs during middle age.
Although there is no cure for osteoarthritis, there are many treatment options available to help manage pain and keep people staying active.




What causes Osteoarthritis?


With osteoarthritis, the articular cartilage that covers the ends of bones in the joints gradually wears away. Where there was once smooth articular cartilage that allowed the bones to glide easily against each other when the joint bent and straightened, there is now a frayed, rough surface. Joint motion along this exposed surface is painful.
Osteoarthritis usually develops after many years of use. It affects people who are middle-aged or older. Other risk factors for osteoarthritis include obesity, previous injury to the affected joint, and family history of osteoarthritis.




What are the symptoms of Osteoarthritis?


Osteoarthritis can affect any joint in the body including the joints of the spine. Symptoms may range from mild to disabling.
A joint affected by osteoarthritis may be painful and inflamed. Without cartilage, bones rub directly against each other as the joint moves. This causes the pain and inflammation. Pain or a dull ache develops gradually over time. Pain may be worse in the morning and feel better with activity. Vigorous activity may cause pain to flare up.
The joint may stiffen and look swollen, enlarged or "out of joint." A bump may develop over the joint. Joint movements such as bending, straightening and rotation may become more difficult and loss of motion may follow.
Loose fragments of cartilage can interfere with the smooth motion of a joint. The joint may lock or "stick." It may creak, click, snap, or make a grinding noise (crepitus). An arthritic joint may weaken and weight bearing joints such as a knee or ankle may buckle and give way.

Although osteoarthritis cannot be cured, early diagnosis and treatment can help maintain joint mobility, relieve pain and improve function.




How is Osteoarthritis diagnosed?


Although osteoarthritis cannot be cured, early diagnosis and treatment can help maintain joint mobility, relieve pain and improve function.
When you visit Dr Bhimani, a complete medical history, physical examination, x-rays, and possibly laboratory tests will be done.
Medical History
Dr Bhimani will want to know if the joint has ever been injured. Dr Bhimani will want to know when the joint pain began and the nature of the pain. Is the pain continuous, or does it come and go? Does it occur in other parts of the body? Is it worse at night? Does it occur only with activity or at rest as well?
Physical Examination
Dr Bhimani will then examine the affected joint in various positions to see if there is pain or
restricted motion. Dr Bhimani will look for creaking or grinding noises (crepitus) that indicate bone-on-bone friction. muscle loss (atrophy), and signs that other joints are involved. Dr Bhimani will look for signs of injury to muscles, tendons, and ligaments.

X-rays
X-rays can show the extent of joint deterioration, including narrowing of joint space, thinning or erosion of bone, excess fluid in the joint, and bone spurs or other abnormalities. They can help Dr Bhimani distinguish various forms of arthritis.
Laboratory Tests
Sometimes laboratory tests, such as blood tests, can help rule out other diseases that cause
symptoms similar to osteoarthritis.




What are non-surgical treatments?


Early, nonsurgical treatment can help maintain joint mobility, improve strength, and relieve pain. Most treatment programs combine lifestyle modifications, medication, and physical therapy.
Lifestyle Changes
Dr Bhimani may recommend rest or a change in activities to avoid provoking osteoarthritis pain. This may include modifications in work or sports activities. It may mean switching from high-impact activities (such as aerobics, running, jumping, or competitive sports) to low-impact exercises (such as stretching, walking, swimming, or cycling). A weight loss program may be recommended, if needed, particularly if osteoarthritis affects weight-bearing joints (such as the knee, hip, spine, or ankle)
Medications
Non-steroidal anti-inflammatory drugs can help reduce inflammation. Sometimes, Dr Bhimani may recommend strong anti-inflammatory agents called corticosteroids, which are injected directly into the joint. Corticosteroids provide short term relief of pain and swelling.
Dietary supplements called glucosamine and chondroitin sulfate may help relieve pain from
osteoarthritis.

Physical Therapy
A balanced fitness program, physical therapy, and/or occupational therapy may improve flexibility, increase range of motion, reduce pain, and strengthen the joint. Supportive or assistive devices (such as a brace, splint, elastic bandage, cane, crutches, or walker) may be needed. Ice or heat may need to be applied to the affected joint for short periods, several times a day.




What are surgical treatments?


If early treatments do not stop the pain or if they lose their effectiveness, surgery may be
considered. The decision to treat surgically depends upon the age and activity level of the patient, he condition of the affected joint, and the extent to which osteoarthritis has progressed. Surgical options for osteoarthritis include arthroscopy, osteotomy, joint fusion, and joint replacement.

Arthroscopy
Dr Bhimani uses a pencil-sized, flexible, fiberoptic instrument (arthroscope) to make two or three small incisions to remove bone spurs, cysts, damaged lining, or loose fragments in the joint.
Osteotomy
The long bones of the arm or leg are realigned to take pressure off of the joint.
Joint replacement
Dr Bhimani removes parts of the bones and creates an artificial joint with metal or plastic
components (total joint replacement or arthroplasty).





 

Joint Replacement Surgery

What types of anaesthesia are there?


The type of anaesthesia used will depend on the nature and duration of the procedure, your general medical condition, and your preference, your and those of your anaesthetist and surgeon or other doctor performing the procedure. General anaesthesia You are put into a state of unconsciousness for the duration of the operation. This is usually achieved by injecting drugs through a cannula placed in a vein and maintained with intravenous drugs or a mixture of gases which you will breathe. While you remain unaware of what is happening around you, the anaesthetist monitors your condition closely and constantly adjusts the level of anaesthesia. You will often be asked to breathe oxygen through a mask just before your anaesthesia starts. Regional anaesthesia A nerve block numbs the part of the body where the surgeon operates and this avoids the need for general anaesthesia. You may be awake or sedated (see below). Examples of regional anaesthesia include epidurals for labour, spinal anaesthesia for caesarean section and ‘eye blocks’ for cataracts. Local anaesthesia A local anaesthetic drug is injected at the site of the surgery to cause numbness. You will be awake but feel no pain. An obvious example of local anaesthesia is numbing an area of skin before having a cut stitched. Sedation The anaesthetist administers drugs to make you relaxed and drowsy. This is sometimes called ‘twilight sleep’ or ‘intravenous sedation’ and may be used for some eye surgery, some plastic surgery and for some gastroenterological procedures. Recall of events is possible with ‘sedation’. Most patients prefer to have little or no recall of events. Please discuss your preference with your anaesthetist.




What is an anaesthetist?


A specialist anaesthetist is a fully qualified medical doctor who, after obtaining their medical degree, has spent at least two years working in the hospital system before completing a further five years of training in anaesthesia. Clinical anaesthesia is built on the knowledge of physiology (how the body works) and pharmacology (how medications work in the body). Anaesthetists have an extensive knowledge of medicine and surgery and understanding of the basic sciences. They know how the body responds to anaesthesia and surgery, and how a patient’s health affects these responses. In Australia and New Zealand, anaesthesia training is supervised and accredited by the Australian and New Zealand College of Anaesthetists (ANZCA). The training to become a specialist anaesthetist is equal in length to that of other medical specialists, such as surgeons, and includes intensive assessments, both at the hospitals where trainees work, and by written and verbal examinations. Doctors in the training program are called registrars. When a registrar completes their training and passes all examinations, they are awarded a diploma of fellowship of ANZCA, become Fellows of the College and may use the initials FANZCA after their name. They can then practise as a specialist anaesthetist in Australia and New Zealand. Anaesthetists are perioperative physicians trained in all forms of anaesthesia and are members of multidisciplinary teams providing healthcare to patients. They assess patients before their procedures and play an important role in caring for the patient before, during and after surgery. They also provide anaesthetic care for patients undergoing non-surgical procedures, particularly if the procedures are long, complex or painful. Anaesthetists play a pivotal role in resuscitating acutely unwell patients, including trauma victims, and help to manage patients suffering from acute or chronic pain. They also provide pain relief for women during labour and delivery. Throughout their practice, anaesthetists must continue to update their skills by regularly attending professional development sessions. Anaesthetists must participate in a continuing professional development (CPD) program that complies with ANZCA’s CPD standard in order for them to practise. Many anaesthetists are active in research, studying how the body works, and developing new drugs and equipment to minimise error and patient harm. They teach a range of healthcare workers, including medical and nursing students, interns, residents, anaesthesia trainees and other medical specialists. In some remote or rural communities where the workload is not sufficient to support a fulltime specialist, non-specialist doctors may give anaesthetics. These doctors undergo limited training sufficient to provide anaesthesia for healthy patients undergoing less complex operations. Non-specialist anaesthetists often also work as family or general practitioners and undertake training to meet the requirements of the Joint Consultative Committee on Anaesthesia. This is a tripartite committee with representatives from ANZCA, the Royal Australian College of General Practice (National Rural Faculty) and the Australian College of Rural and Remote Medicine.




What is anaesthesia?


Relieving pain and suffering is central to the practice of anaesthesia, which involves administering medications to eliminate sensations, including pain. This allows doctors to perform medical and surgical procedures without causing undue distress or discomfort to the patient. Most people undergo anaesthesia at some stage in their lives, such as during the birth of a baby or during surgery. They may be anaesthetised for a short, simple day surgery or for major surgery requiring complex, rapid decisions. Modern anaesthesia is relatively safe due to high standards of training that emphasise quality and safety. There also have been improvements in drugs and equipment. Advances in anaesthesia have also resulted in patients being able to have more complex surgery as a day stay procedure because of more rapid recovery with modern anaesthesia; and they have facilitated many of the advances in surgery. Australia and New Zealand have one of the best patient safety records in the world, thanks to increased support for research to improve anaesthesia. Specialist anaesthetists become involved in the patient’s care prior to surgery with assessment of their medical condition and planning their care as part of the surgical team. They closely monitor the patient’s health and wellbeing throughout the procedure and help to ensure a smooth and comfortable recovery.




How do I prepare for anaesthesia?


‘Day of surgery admission’ and ‘day surgery’ Almost all patients are now admitted to hospital on the same day as their operation. Depending on the hospital’s requirements, you may be waiting for some hours. There will normally only be limited time available for you to talk to your anaesthetist before your procedure. If you are having a major procedure, or have concerns about your health or anaesthesia, it is beneficial to consult with your anaesthetist at a separate visit before the day of your surgery.

Make sure that you leave plenty of time to get to the hospital and the admissions area prior to your designated arrival time. There can often be a considerable waiting period at hospitals, so bring something to read or listen to and try to remain relaxed – as difficult as this may be! Your anaesthetist and the hospital staff are there to look after you.

Remember, if you have any concerns or questions please contact your anaesthetist prior to coming to hospital. What should I tell the anaesthetist? Your anaesthetist will meet with you before your operation to discuss your health, general medical condition, any previous anaesthesia and will perform a relevant examination.
Depending on the type of operation, hospital or facility, this may not occur until immediately before your procedure. The anaesthetist will want to know:
1. How healthy you are and whether you have had any recent illnesses, with a particular focus on heart or respiratory problems.
2. What previous operations you have had and whether there were any problems with anaesthesia.
3. If you have had any abnormal reactions to any medications and whether you have any allergies.
4. Whether you have a history of reflux or heartburn, asthma, bronchitis, heart problems or any other medical conditions. 5. Whether you are currently taking any drugs, prescribed or otherwise – including cigarettes and alcohol – and whether you are taking ‘blood thinners’, otherwise known as ‘antiplatelet drugs’ or ‘anticoagulants’. These include aspirin, clopidogrel [Plavix], warfarin, Pradaxa and Xarelto. Please bring all your current medications in their original packaging. 6. If you have any loose, capped or crowned teeth or implants, have ‘veneers’ or ‘bonding’, or wear dentures or plates.
You may be given questionnaires to complete, or be asked questions by nurses, before seeing your anaesthetist. Your anaesthetist needs to have the best possible picture of you and your present condition so that the most suitable anaesthesia can be planned. Answer all questions honestly – it is really all about minimising risk to you. Your role There are some things you can do which will make your anaesthesia safer.
1. Get a little fitter – regular walks will work wonders.
2. Don’t smoke – ideally, you need to stop six weeks before surgery. However, stopping for even 24 hours can help. Your GP may be able to assist.
3. If you are overweight, make a serious attempt to reduce your weight before your procedure. 4. Minimise alcohol consumption.
5. Continue to take any medications which have been prescribed but remember to let your anaesthetist and surgeon know what they are. 6. If you are taking aspirin, non-steroidal anti-inflammatory agents or other blood thinning drugs, consult your surgeon or anaesthetist about whether you should stop taking them prior to surgery. 7. If you have any kind of health problem or have had problems with previous anaesthesia, tell your anaesthetist and surgeon so that they are fully informed. 8. If you are concerned about your anaesthesia, make an appointment to see or talk your anaesthetist before admission to hospital and get the answers you need. 9. For children, many hospitals can arrange a preoperative visit. 10. Discuss any herbal products you might be taking with your anaesthetist. It may be necessary to cease taking them two to three weeks prior to surgery. 11. Inform your anaesthetist if you use ‘so called’ recreational drugs as these may interact with the anaesthesia. 12. Inform your surgeon/anaesthetist if you have any issues with blood transfusions. Is fasting really necessary? You will usually be advised to avoid food for six hours and fluids (including water) for three hours before your operation. Food or fluid in the stomach may be vomited and could enter your lungs while you are unconscious.

If you don’t follow this rule of fasting, the operation may be postponed in the interests of your safety. Your surgeon, anaesthetist or the hospital will advise you how long to fast.




What about anaesthesia for joint replacement surgery?


The anaesthetist will consider several factors when planning your anaesthesia, including: • Past experience with surgery. • Health and physical condition. • Reactions or allergies to medicines. • Risks of each type of anaesthesia. • Preferences of your surgical team. • Your preferences. Regional anaesthesia is the most common form of anaesthesia used during joint-replacement surgery because it aims to provide optimal pain relief while minimising side effects such as sedation, postoperative nausea and vomiting, and leg weakness. It may be used on its own or combined with sedation or general anaesthesia. Regional anaesthesia numbs the part of the body where the surgery will happen. It involves the injection of local anaesthetic around major nerve bundles supplying body areas, such as the thigh, ankle, forearm, hand, shoulder or abdomen. This is sometimes done using a nerve-locating device, such as a nerve stimulator, or ultrasound, so that the anaesthetic can be delivered with greater accuracy. Once local anaesthetic is injected, you may experience numbness and tingling in the area supplied by the nerves and it may become difficult or impossible to move that part of the body. BEFORE THE OPERATION It is important that you speak to your doctor about when you should stop eating and drinking before your anaesthetic. The anaesthetist will also need information such as: • Any recent coughs, colds or fevers. • Any previous anaesthetics or family problems with anaesthesia. • Abnormal reactions or allergies to drugs. • Any history of asthma, bronchitis, heart problems or other medical problems. • Any medications you may be taking. WHAT TO EXPECT Each surgery is different. How long an operation takes depends on how badly the joint is damaged and how the surgery is done. The duration of the anaesthesia depends on which anaesthetic is used, the region into which it is injected, and whether it is maintained by continual doses or repeated injections. After surgery, you will be moved to a recovery room for a period of time until you are ready to be returned to the ward. Typically, numbness can last several hours but may last several days. Generally, the “heaviness” wears off within a few hours but the numbness and tingling may persist much longer. As the local anaesthetic effect wears off, numbness will diminish and surgical pain may return, in which case your doctor will prescribe alternative methods of pain relief, including injections or tablets. Because osteoarthritis is often found in hips and knees, and patients undergoing hip or knee replacements are often elderly, there may be complications. Many joint-replacement patients have other medical conditions – diagnosed and undiagnosed – such as high blood pressure and heart problems, which require assessment and investigation. Most patients undergoing joint replacement tend to accept the risks involved because of the potential improvement in their quality of life.




What are the risks and complications of anaesthesia?


There is no safer place in the world to be anaesthetised than in Australia.

Nevertheless, some patients are at an increased risk of complications because of health problems e.g. heart or respiratory disease, diabetes or obesity, age, and/ or because of the type of surgery which they are undergoing.

Infrequent complications include: bruising, pain or injury at the site of injections, temporary breathing difficulties, temporary nerve damage, muscle pain, asthmatic reactions, headaches, the possibility of some sensation or awareness during the operation (especially with caesarean section and some emergency procedures), damage to teeth and dental prostheses, lip and tongue injuries, and temporary difficulty in speaking.

Nausea and vomiting are quite common after certain types of surgery, and rare after other types. The type of anaesthesia used may also be a factor. Even with the use of modern medications, a small percentage of patients may experience nausea and vomiting that is difficult to control. If you have had difficulties in the past, please let your anaesthetist know.

There are also some very rare, but serious complications including: heart attack, stroke, seizure, severe allergic or sensitivity reactions, brain damage, kidney or liver failure, lung damage, paraplegia or quadriplegia, permanent nerve or blood vessel damage, eye injury, damage to the larynx (voice box) and vocal cords, pneumonia and infection from blood transfusion. Remember that these more serious complications, including death, are quite remote but do exist.

We urge you to ask questions. Your anaesthetist will be happy to answer them and to discuss the best way to work with you for the best possible outcome. Risk of infections Needles, syringes and intravenous lines are all used only once. They are new in the packet before your surgery commences and they are disposed of immediately afterwards. Cross infection from one patient to another is therefore not possible.
Blood transfusion With modern surgery the requirements for blood transfusion are less common. All blood collected today from donors is carefully screened and tested but a very small risk of cross infection still remains.

Your anaesthetist is aware of these risks and only uses blood transfusions when absolutely necessary. For major surgery, your anaesthetist may supervise a system of collecting your blood during or after your operation, processing it and returning it to you. This is called blood salvage and sometimes this can avoid the need for a transfusion.





 

Arthroscopic Surgery

What are your business hours?


Our practice hours are from 8:00am to 5:00pm, Monday through Friday.




What is your contact phone number?


(02) 4229 9116




What is your practice location?


Practice Location 54 Princes Hwy West Wollongong NSW 2500 Current Appointments Wollongong Hospital
Loftus St (main entrance)
Wollongong 2521 02 4222 5000 Shellharbour Hospital 15-17 Madigan Boulevarde Mt Warrigal 2528 02 4295 2500




Who do I call for appointments?


For all appointments and enquiries, please contact us on (02) 4229 9116.

Our practice hours are from 8am to 5pm Monday to Friday (excepting public holidays). Or request an appointment here




Where do I park for appointments?


Free parking is available onsite via the practice driveway off London Drive.




What if I need to cancel an appointment?


Telephone the office during business hours and allow at least 1 days’ notice so that we can offer your appointment time to patients on our waiting list.




What should I bring with me when I come for an appointment?


When you come for your appointment remember to bring the following:

  • Driver’s License or a valid ID
  • Insurance information
  • Referral Letter (if required)
  • Reports, X-Rays, MRI’s, CT scans and any other relevant medical information
  • List of medications (if any)




Does Dr Bhimani usually run on time?


We recognise that your time is valuable, and we make every effort to run on time. Occasionally emergencies or patients require a little more time, and these cause scheduling delays beyond our control. We apologise if we keep you waiting.




Should I make an appointment?


  • Do you have pain in your knees, hip or groin?
  • Is the pain restricting your daily activities?
  • Is the pain not relieved on taking medications?
  • Do you have swollen knee?
  • Do you limp while walking?
  • Does pain makes you stop when you walk more than a few blocks?
  • Are you having pain when lying or sitting down?
  • Are you getting pain for about 3 to 4 days per week?
  • Do your knees hurt when climbing or descending stairs?
  • Do you feel pain when walking for long time?
  • Does pain disturbs your sleep?
  • Do you find difficult to put your socks and shoes?
  • Do you have a sensation of instability or the knee is going to give out when you are physically active?
  • Do you need crutches, cranes or walkers to help you while walking?
  • Do you have tightness or limited range of hip motion?
If your answer is yes to the any of these questions, you might be suffering from arthritis - a degenerative joint disease, and you should contact us to arrange a consultation.




What if I need imaging?


During your initial consultation Dr Bhimani may write you a referral letter for additional imaging. Please ask at the time of your image referral letter for an image centre which is located near you.




What can I do if am happy with the service I have received?


If you like the service we provide please spread the word! Like Us on Facebook or take a minute to provide an online review for Dr Bhimani via Google Reviews, Rate MD or Doctoralia.




Am I likely to require surgery?


Surgery is the right decision when patients have tried non-surgical options first but are still not coping. Dr Bhimani encourages patients to make the decision to have surgery based on how their condition is upsetting their quality of life, their level of pain and their loss of normal function.
As a dedicated orthopedic surgeon Dr Bhimani always make sure his patients fully understand their condition, the treatment options available to them, as well as any risks or potential complications of a particular treatment. However it is crucial that patients understand that the decision to have any kind of orthopedic surgery is always theirs to make.
Once Dr Bhimani understands your diagnosis, you can both plan and agree on a sensible and holistic approach to treatment and rehabilitation for your best long-term results. If you decide that surgery is necessary, then not only is our objective to reduce your pain and increase your mobility, but to also facilitate the earliest possible return to normal activity post-surgery.
To accomplish these objectives for patients Dr Bhimani is extremely dedicated to ensuring he is at the forefront of developments in hip and knee surgery to provide patients with the best possible orthopaedic care.




Will physical therapy be required after surgery?


Getting a full range of motion, strength and flexibility back after surgery usually takes time. That’s where pre-operative exercise and education and post-operative physical therapy programs help to ensure you're physically and emotionally prepared for surgery and to maximise your recovery after surgery.

Dr Bhimani will choose the least invasive surgical procedure suited to your condition to minimise your recovery period. Dr Bhimani will ensure you understand what procedure you are having, how to prepare for surgery and what recovery program you need to follow. Physiotherapy is an essential part of this education, preparation and recovery process and will help you obtain a better surgical outcome.




Does Dr Bhimani see public and private patients?


Yes, Dr Bhimani sees both private and public patients.




What are Dr Bhimani's fees?


The following is a guide to the fees charged by Dr Aziz Bhimani. Please do not hesitate to contact our staff on 02 4229 9116 if you require further information or assistance. Consultation Fees Each consultation attracts a fee which is reimbursed in part from Medicare. The consultation fee will be advised to you at the time of booking your appointment. Operation Fees If you require a surgical procedure a detailed itemised quote of Dr Bhimani & his surgical team’s fees will be provided up front as well as an estimate of out-of-pocket expenses. You will meet with your anaesthetist before your operation so that you can obtain an estimate of his/her fees also. Procedures vary in complexity, difficulty and duration and these are all factors that determine out-of- pocket expenses. Please check with your Private Health Insurer regarding whether an excess is payable to the hospital under your level of cover. Pensioners Dr Bhimani is a no-gap surgeon for pensioners. Worker Compensation​ If you have your claim number, your consultation and operation fees will be charged directly to your workers compensation insurer with no personal charge to you. Veteran's Affairs (DVA) If you have a valid DVA number, your consultation and operation fees will be charged directly to the Department of Veterans’ Affairs with no personal charge to you.





 

Anterior Cruciate Ligament (ACL) Injuries

What types of anaesthesia are there?


The type of anaesthesia used will depend on the nature and duration of the procedure, your general medical condition, and your preference, your and those of your anaesthetist and surgeon or other doctor performing the procedure. General anaesthesia You are put into a state of unconsciousness for the duration of the operation. This is usually achieved by injecting drugs through a cannula placed in a vein and maintained with intravenous drugs or a mixture of gases which you will breathe. While you remain unaware of what is happening around you, the anaesthetist monitors your condition closely and constantly adjusts the level of anaesthesia. You will often be asked to breathe oxygen through a mask just before your anaesthesia starts. Regional anaesthesia A nerve block numbs the part of the body where the surgeon operates and this avoids the need for general anaesthesia. You may be awake or sedated (see below). Examples of regional anaesthesia include epidurals for labour, spinal anaesthesia for caesarean section and ‘eye blocks’ for cataracts. Local anaesthesia A local anaesthetic drug is injected at the site of the surgery to cause numbness. You will be awake but feel no pain. An obvious example of local anaesthesia is numbing an area of skin before having a cut stitched. Sedation The anaesthetist administers drugs to make you relaxed and drowsy. This is sometimes called ‘twilight sleep’ or ‘intravenous sedation’ and may be used for some eye surgery, some plastic surgery and for some gastroenterological procedures. Recall of events is possible with ‘sedation’. Most patients prefer to have little or no recall of events. Please discuss your preference with your anaesthetist.




What is an anaesthetist?


A specialist anaesthetist is a fully qualified medical doctor who, after obtaining their medical degree, has spent at least two years working in the hospital system before completing a further five years of training in anaesthesia. Clinical anaesthesia is built on the knowledge of physiology (how the body works) and pharmacology (how medications work in the body). Anaesthetists have an extensive knowledge of medicine and surgery and understanding of the basic sciences. They know how the body responds to anaesthesia and surgery, and how a patient’s health affects these responses. In Australia and New Zealand, anaesthesia training is supervised and accredited by the Australian and New Zealand College of Anaesthetists (ANZCA). The training to become a specialist anaesthetist is equal in length to that of other medical specialists, such as surgeons, and includes intensive assessments, both at the hospitals where trainees work, and by written and verbal examinations. Doctors in the training program are called registrars. When a registrar completes their training and passes all examinations, they are awarded a diploma of fellowship of ANZCA, become Fellows of the College and may use the initials FANZCA after their name. They can then practise as a specialist anaesthetist in Australia and New Zealand. Anaesthetists are perioperative physicians trained in all forms of anaesthesia and are members of multidisciplinary teams providing healthcare to patients. They assess patients before their procedures and play an important role in caring for the patient before, during and after surgery. They also provide anaesthetic care for patients undergoing non-surgical procedures, particularly if the procedures are long, complex or painful. Anaesthetists play a pivotal role in resuscitating acutely unwell patients, including trauma victims, and help to manage patients suffering from acute or chronic pain. They also provide pain relief for women during labour and delivery. Throughout their practice, anaesthetists must continue to update their skills by regularly attending professional development sessions. Anaesthetists must participate in a continuing professional development (CPD) program that complies with ANZCA’s CPD standard in order for them to practise. Many anaesthetists are active in research, studying how the body works, and developing new drugs and equipment to minimise error and patient harm. They teach a range of healthcare workers, including medical and nursing students, interns, residents, anaesthesia trainees and other medical specialists. In some remote or rural communities where the workload is not sufficient to support a fulltime specialist, non-specialist doctors may give anaesthetics. These doctors undergo limited training sufficient to provide anaesthesia for healthy patients undergoing less complex operations. Non-specialist anaesthetists often also work as family or general practitioners and undertake training to meet the requirements of the Joint Consultative Committee on Anaesthesia. This is a tripartite committee with representatives from ANZCA, the Royal Australian College of General Practice (National Rural Faculty) and the Australian College of Rural and Remote Medicine.




What is anaesthesia?


Relieving pain and suffering is central to the practice of anaesthesia, which involves administering medications to eliminate sensations, including pain. This allows doctors to perform medical and surgical procedures without causing undue distress or discomfort to the patient. Most people undergo anaesthesia at some stage in their lives, such as during the birth of a baby or during surgery. They may be anaesthetised for a short, simple day surgery or for major surgery requiring complex, rapid decisions. Modern anaesthesia is relatively safe due to high standards of training that emphasise quality and safety. There also have been improvements in drugs and equipment. Advances in anaesthesia have also resulted in patients being able to have more complex surgery as a day stay procedure because of more rapid recovery with modern anaesthesia; and they have facilitated many of the advances in surgery. Australia and New Zealand have one of the best patient safety records in the world, thanks to increased support for research to improve anaesthesia. Specialist anaesthetists become involved in the patient’s care prior to surgery with assessment of their medical condition and planning their care as part of the surgical team. They closely monitor the patient’s health and wellbeing throughout the procedure and help to ensure a smooth and comfortable recovery.




How do I prepare for anaesthesia?


‘Day of surgery admission’ and ‘day surgery’ Almost all patients are now admitted to hospital on the same day as their operation. Depending on the hospital’s requirements, you may be waiting for some hours. There will normally only be limited time available for you to talk to your anaesthetist before your procedure. If you are having a major procedure, or have concerns about your health or anaesthesia, it is beneficial to consult with your anaesthetist at a separate visit before the day of your surgery.

Make sure that you leave plenty of time to get to the hospital and the admissions area prior to your designated arrival time. There can often be a considerable waiting period at hospitals, so bring something to read or listen to and try to remain relaxed – as difficult as this may be! Your anaesthetist and the hospital staff are there to look after you.

Remember, if you have any concerns or questions please contact your anaesthetist prior to coming to hospital. What should I tell the anaesthetist? Your anaesthetist will meet with you before your operation to discuss your health, general medical condition, any previous anaesthesia and will perform a relevant examination.
Depending on the type of operation, hospital or facility, this may not occur until immediately before your procedure. The anaesthetist will want to know:
1. How healthy you are and whether you have had any recent illnesses, with a particular focus on heart or respiratory problems.
2. What previous operations you have had and whether there were any problems with anaesthesia.
3. If you have had any abnormal reactions to any medications and whether you have any allergies.
4. Whether you have a history of reflux or heartburn, asthma, bronchitis, heart problems or any other medical conditions. 5. Whether you are currently taking any drugs, prescribed or otherwise – including cigarettes and alcohol – and whether you are taking ‘blood thinners’, otherwise known as ‘antiplatelet drugs’ or ‘anticoagulants’. These include aspirin, clopidogrel [Plavix], warfarin, Pradaxa and Xarelto. Please bring all your current medications in their original packaging. 6. If you have any loose, capped or crowned teeth or implants, have ‘veneers’ or ‘bonding’, or wear dentures or plates.
You may be given questionnaires to complete, or be asked questions by nurses, before seeing your anaesthetist. Your anaesthetist needs to have the best possible picture of you and your present condition so that the most suitable anaesthesia can be planned. Answer all questions honestly – it is really all about minimising risk to you. Your role There are some things you can do which will make your anaesthesia safer.
1. Get a little fitter – regular walks will work wonders.
2. Don’t smoke – ideally, you need to stop six weeks before surgery. However, stopping for even 24 hours can help. Your GP may be able to assist.
3. If you are overweight, make a serious attempt to reduce your weight before your procedure. 4. Minimise alcohol consumption.
5. Continue to take any medications which have been prescribed but remember to let your anaesthetist and surgeon know what they are. 6. If you are taking aspirin, non-steroidal anti-inflammatory agents or other blood thinning drugs, consult your surgeon or anaesthetist about whether you should stop taking them prior to surgery. 7. If you have any kind of health problem or have had problems with previous anaesthesia, tell your anaesthetist and surgeon so that they are fully informed. 8. If you are concerned about your anaesthesia, make an appointment to see or talk your anaesthetist before admission to hospital and get the answers you need. 9. For children, many hospitals can arrange a preoperative visit. 10. Discuss any herbal products you might be taking with your anaesthetist. It may be necessary to cease taking them two to three weeks prior to surgery. 11. Inform your anaesthetist if you use ‘so called’ recreational drugs as these may interact with the anaesthesia. 12. Inform your surgeon/anaesthetist if you have any issues with blood transfusions. Is fasting really necessary? You will usually be advised to avoid food for six hours and fluids (including water) for three hours before your operation. Food or fluid in the stomach may be vomited and could enter your lungs while you are unconscious.

If you don’t follow this rule of fasting, the operation may be postponed in the interests of your safety. Your surgeon, anaesthetist or the hospital will advise you how long to fast.




What about anaesthesia for joint replacement surgery?


The anaesthetist will consider several factors when planning your anaesthesia, including: • Past experience with surgery. • Health and physical condition. • Reactions or allergies to medicines. • Risks of each type of anaesthesia. • Preferences of your surgical team. • Your preferences. Regional anaesthesia is the most common form of anaesthesia used during joint-replacement surgery because it aims to provide optimal pain relief while minimising side effects such as sedation, postoperative nausea and vomiting, and leg weakness. It may be used on its own or combined with sedation or general anaesthesia. Regional anaesthesia numbs the part of the body where the surgery will happen. It involves the injection of local anaesthetic around major nerve bundles supplying body areas, such as the thigh, ankle, forearm, hand, shoulder or abdomen. This is sometimes done using a nerve-locating device, such as a nerve stimulator, or ultrasound, so that the anaesthetic can be delivered with greater accuracy. Once local anaesthetic is injected, you may experience numbness and tingling in the area supplied by the nerves and it may become difficult or impossible to move that part of the body. BEFORE THE OPERATION It is important that you speak to your doctor about when you should stop eating and drinking before your anaesthetic. The anaesthetist will also need information such as: • Any recent coughs, colds or fevers. • Any previous anaesthetics or family problems with anaesthesia. • Abnormal reactions or allergies to drugs. • Any history of asthma, bronchitis, heart problems or other medical problems. • Any medications you may be taking. WHAT TO EXPECT Each surgery is different. How long an operation takes depends on how badly the joint is damaged and how the surgery is done. The duration of the anaesthesia depends on which anaesthetic is used, the region into which it is injected, and whether it is maintained by continual doses or repeated injections. After surgery, you will be moved to a recovery room for a period of time until you are ready to be returned to the ward. Typically, numbness can last several hours but may last several days. Generally, the “heaviness” wears off within a few hours but the numbness and tingling may persist much longer. As the local anaesthetic effect wears off, numbness will diminish and surgical pain may return, in which case your doctor will prescribe alternative methods of pain relief, including injections or tablets. Because osteoarthritis is often found in hips and knees, and patients undergoing hip or knee replacements are often elderly, there may be complications. Many joint-replacement patients have other medical conditions – diagnosed and undiagnosed – such as high blood pressure and heart problems, which require assessment and investigation. Most patients undergoing joint replacement tend to accept the risks involved because of the potential improvement in their quality of life.




What are the risks and complications of anaesthesia?


There is no safer place in the world to be anaesthetised than in Australia.

Nevertheless, some patients are at an increased risk of complications because of health problems e.g. heart or respiratory disease, diabetes or obesity, age, and/ or because of the type of surgery which they are undergoing.

Infrequent complications include: bruising, pain or injury at the site of injections, temporary breathing difficulties, temporary nerve damage, muscle pain, asthmatic reactions, headaches, the possibility of some sensation or awareness during the operation (especially with caesarean section and some emergency procedures), damage to teeth and dental prostheses, lip and tongue injuries, and temporary difficulty in speaking.

Nausea and vomiting are quite common after certain types of surgery, and rare after other types. The type of anaesthesia used may also be a factor. Even with the use of modern medications, a small percentage of patients may experience nausea and vomiting that is difficult to control. If you have had difficulties in the past, please let your anaesthetist know.

There are also some very rare, but serious complications including: heart attack, stroke, seizure, severe allergic or sensitivity reactions, brain damage, kidney or liver failure, lung damage, paraplegia or quadriplegia, permanent nerve or blood vessel damage, eye injury, damage to the larynx (voice box) and vocal cords, pneumonia and infection from blood transfusion. Remember that these more serious complications, including death, are quite remote but do exist.

We urge you to ask questions. Your anaesthetist will be happy to answer them and to discuss the best way to work with you for the best possible outcome. Risk of infections Needles, syringes and intravenous lines are all used only once. They are new in the packet before your surgery commences and they are disposed of immediately afterwards. Cross infection from one patient to another is therefore not possible.
Blood transfusion With modern surgery the requirements for blood transfusion are less common. All blood collected today from donors is carefully screened and tested but a very small risk of cross infection still remains.

Your anaesthetist is aware of these risks and only uses blood transfusions when absolutely necessary. For major surgery, your anaesthetist may supervise a system of collecting your blood during or after your operation, processing it and returning it to you. This is called blood salvage and sometimes this can avoid the need for a transfusion.





 

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 Osteoarthritis?


Osteoarthritis, also known as "wear and tear" arthritis, occurs when the cartilage that cushions and protects the ends of your bones gradually wears away. This leads to pain and stiffness that worsens over time, making it difficult to do daily activities.
Osteoarthritis is the most common form of arthritis. It develops slowly and most often occurs during middle age.
Although there is no cure for osteoarthritis, there are many treatment options available to help manage pain and keep people staying active.




What causes Osteoarthritis?


With osteoarthritis, the articular cartilage that covers the ends of bones in the joints gradually wears away. Where there was once smooth articular cartilage that allowed the bones to glide easily against each other when the joint bent and straightened, there is now a frayed, rough surface. Joint motion along this exposed surface is painful.
Osteoarthritis usually develops after many years of use. It affects people who are middle-aged or older. Other risk factors for osteoarthritis include obesity, previous injury to the affected joint, and family history of osteoarthritis.




What are the symptoms of Osteoarthritis?


Osteoarthritis can affect any joint in the body including the joints of the spine. Symptoms may range from mild to disabling.
A joint affected by osteoarthritis may be painful and inflamed. Without cartilage, bones rub directly against each other as the joint moves. This causes the pain and inflammation. Pain or a dull ache develops gradually over time. Pain may be worse in the morning and feel better with activity. Vigorous activity may cause pain to flare up.
The joint may stiffen and look swollen, enlarged or "out of joint." A bump may develop over the joint. Joint movements such as bending, straightening and rotation may become more difficult and loss of motion may follow.
Loose fragments of cartilage can interfere with the smooth motion of a joint. The joint may lock or "stick." It may creak, click, snap, or make a grinding noise (crepitus). An arthritic joint may weaken and weight bearing joints such as a knee or ankle may buckle and give way.

Although osteoarthritis cannot be cured, early diagnosis and treatment can help maintain joint mobility, relieve pain and improve function.




How is Osteoarthritis diagnosed?


Although osteoarthritis cannot be cured, early diagnosis and treatment can help maintain joint mobility, relieve pain and improve function.
When you visit Dr Bhimani, a complete medical history, physical examination, x-rays, and possibly laboratory tests will be done.
Medical History
Dr Bhimani will want to know if the joint has ever been injured. Dr Bhimani will want to know when the joint pain began and the nature of the pain. Is the pain continuous, or does it come and go? Does it occur in other parts of the body? Is it worse at night? Does it occur only with activity or at rest as well?
Physical Examination
Dr Bhimani will then examine the affected joint in various positions to see if there is pain or
restricted motion. Dr Bhimani will look for creaking or grinding noises (crepitus) that indicate bone-on-bone friction. muscle loss (atrophy), and signs that other joints are involved. Dr Bhimani will look for signs of injury to muscles, tendons, and ligaments.

X-rays
X-rays can show the extent of joint deterioration, including narrowing of joint space, thinning or erosion of bone, excess fluid in the joint, and bone spurs or other abnormalities. They can help Dr Bhimani distinguish various forms of arthritis.
Laboratory Tests
Sometimes laboratory tests, such as blood tests, can help rule out other diseases that cause
symptoms similar to osteoarthritis.




What are non-surgical treatments?


Early, nonsurgical treatment can help maintain joint mobility, improve strength, and relieve pain. Most treatment programs combine lifestyle modifications, medication, and physical therapy.
Lifestyle Changes
Dr Bhimani may recommend rest or a change in activities to avoid provoking osteoarthritis pain. This may include modifications in work or sports activities. It may mean switching from high-impact activities (such as aerobics, running, jumping, or competitive sports) to low-impact exercises (such as stretching, walking, swimming, or cycling). A weight loss program may be recommended, if needed, particularly if osteoarthritis affects weight-bearing joints (such as the knee, hip, spine, or ankle)
Medications
Non-steroidal anti-inflammatory drugs can help reduce inflammation. Sometimes, Dr Bhimani may recommend strong anti-inflammatory agents called corticosteroids, which are injected directly into the joint. Corticosteroids provide short term relief of pain and swelling.
Dietary supplements called glucosamine and chondroitin sulfate may help relieve pain from
osteoarthritis.

Physical Therapy
A balanced fitness program, physical therapy, and/or occupational therapy may improve flexibility, increase range of motion, reduce pain, and strengthen the joint. Supportive or assistive devices (such as a brace, splint, elastic bandage, cane, crutches, or walker) may be needed. Ice or heat may need to be applied to the affected joint for short periods, several times a day.




What are surgical treatments?


If early treatments do not stop the pain or if they lose their effectiveness, surgery may be
considered. The decision to treat surgically depends upon the age and activity level of the patient, he condition of the affected joint, and the extent to which osteoarthritis has progressed. Surgical options for osteoarthritis include arthroscopy, osteotomy, joint fusion, and joint replacement.

Arthroscopy
Dr Bhimani uses a pencil-sized, flexible, fiberoptic instrument (arthroscope) to make two or three small incisions to remove bone spurs, cysts, damaged lining, or loose fragments in the joint.
Osteotomy
The long bones of the arm or leg are realigned to take pressure off of the joint.
Joint replacement
Dr Bhimani removes parts of the bones and creates an artificial joint with metal or plastic
components (total joint replacement or arthroplasty).





 

Rheumatoid Arthritis

What types of anaesthesia are there?


The type of anaesthesia used will depend on the nature and duration of the procedure, your general medical condition, and your preference, your and those of your anaesthetist and surgeon or other doctor performing the procedure. General anaesthesia You are put into a state of unconsciousness for the duration of the operation. This is usually achieved by injecting drugs through a cannula placed in a vein and maintained with intravenous drugs or a mixture of gases which you will breathe. While you remain unaware of what is happening around you, the anaesthetist monitors your condition closely and constantly adjusts the level of anaesthesia. You will often be asked to breathe oxygen through a mask just before your anaesthesia starts. Regional anaesthesia A nerve block numbs the part of the body where the surgeon operates and this avoids the need for general anaesthesia. You may be awake or sedated (see below). Examples of regional anaesthesia include epidurals for labour, spinal anaesthesia for caesarean section and ‘eye blocks’ for cataracts. Local anaesthesia A local anaesthetic drug is injected at the site of the surgery to cause numbness. You will be awake but feel no pain. An obvious example of local anaesthesia is numbing an area of skin before having a cut stitched. Sedation The anaesthetist administers drugs to make you relaxed and drowsy. This is sometimes called ‘twilight sleep’ or ‘intravenous sedation’ and may be used for some eye surgery, some plastic surgery and for some gastroenterological procedures. Recall of events is possible with ‘sedation’. Most patients prefer to have little or no recall of events. Please discuss your preference with your anaesthetist.




What is an anaesthetist?


A specialist anaesthetist is a fully qualified medical doctor who, after obtaining their medical degree, has spent at least two years working in the hospital system before completing a further five years of training in anaesthesia. Clinical anaesthesia is built on the knowledge of physiology (how the body works) and pharmacology (how medications work in the body). Anaesthetists have an extensive knowledge of medicine and surgery and understanding of the basic sciences. They know how the body responds to anaesthesia and surgery, and how a patient’s health affects these responses. In Australia and New Zealand, anaesthesia training is supervised and accredited by the Australian and New Zealand College of Anaesthetists (ANZCA). The training to become a specialist anaesthetist is equal in length to that of other medical specialists, such as surgeons, and includes intensive assessments, both at the hospitals where trainees work, and by written and verbal examinations. Doctors in the training program are called registrars. When a registrar completes their training and passes all examinations, they are awarded a diploma of fellowship of ANZCA, become Fellows of the College and may use the initials FANZCA after their name. They can then practise as a specialist anaesthetist in Australia and New Zealand. Anaesthetists are perioperative physicians trained in all forms of anaesthesia and are members of multidisciplinary teams providing healthcare to patients. They assess patients before their procedures and play an important role in caring for the patient before, during and after surgery. They also provide anaesthetic care for patients undergoing non-surgical procedures, particularly if the procedures are long, complex or painful. Anaesthetists play a pivotal role in resuscitating acutely unwell patients, including trauma victims, and help to manage patients suffering from acute or chronic pain. They also provide pain relief for women during labour and delivery. Throughout their practice, anaesthetists must continue to update their skills by regularly attending professional development sessions. Anaesthetists must participate in a continuing professional development (CPD) program that complies with ANZCA’s CPD standard in order for them to practise. Many anaesthetists are active in research, studying how the body works, and developing new drugs and equipment to minimise error and patient harm. They teach a range of healthcare workers, including medical and nursing students, interns, residents, anaesthesia trainees and other medical specialists. In some remote or rural communities where the workload is not sufficient to support a fulltime specialist, non-specialist doctors may give anaesthetics. These doctors undergo limited training sufficient to provide anaesthesia for healthy patients undergoing less complex operations. Non-specialist anaesthetists often also work as family or general practitioners and undertake training to meet the requirements of the Joint Consultative Committee on Anaesthesia. This is a tripartite committee with representatives from ANZCA, the Royal Australian College of General Practice (National Rural Faculty) and the Australian College of Rural and Remote Medicine.




What is anaesthesia?


Relieving pain and suffering is central to the practice of anaesthesia, which involves administering medications to eliminate sensations, including pain. This allows doctors to perform medical and surgical procedures without causing undue distress or discomfort to the patient. Most people undergo anaesthesia at some stage in their lives, such as during the birth of a baby or during surgery. They may be anaesthetised for a short, simple day surgery or for major surgery requiring complex, rapid decisions. Modern anaesthesia is relatively safe due to high standards of training that emphasise quality and safety. There also have been improvements in drugs and equipment. Advances in anaesthesia have also resulted in patients being able to have more complex surgery as a day stay procedure because of more rapid recovery with modern anaesthesia; and they have facilitated many of the advances in surgery. Australia and New Zealand have one of the best patient safety records in the world, thanks to increased support for research to improve anaesthesia. Specialist anaesthetists become involved in the patient’s care prior to surgery with assessment of their medical condition and planning their care as part of the surgical team. They closely monitor the patient’s health and wellbeing throughout the procedure and help to ensure a smooth and comfortable recovery.




How do I prepare for anaesthesia?


‘Day of surgery admission’ and ‘day surgery’ Almost all patients are now admitted to hospital on the same day as their operation. Depending on the hospital’s requirements, you may be waiting for some hours. There will normally only be limited time available for you to talk to your anaesthetist before your procedure. If you are having a major procedure, or have concerns about your health or anaesthesia, it is beneficial to consult with your anaesthetist at a separate visit before the day of your surgery.

Make sure that you leave plenty of time to get to the hospital and the admissions area prior to your designated arrival time. There can often be a considerable waiting period at hospitals, so bring something to read or listen to and try to remain relaxed – as difficult as this may be! Your anaesthetist and the hospital staff are there to look after you.

Remember, if you have any concerns or questions please contact your anaesthetist prior to coming to hospital. What should I tell the anaesthetist? Your anaesthetist will meet with you before your operation to discuss your health, general medical condition, any previous anaesthesia and will perform a relevant examination.
Depending on the type of operation, hospital or facility, this may not occur until immediately before your procedure. The anaesthetist will want to know:
1. How healthy you are and whether you have had any recent illnesses, with a particular focus on heart or respiratory problems.
2. What previous operations you have had and whether there were any problems with anaesthesia.
3. If you have had any abnormal reactions to any medications and whether you have any allergies.
4. Whether you have a history of reflux or heartburn, asthma, bronchitis, heart problems or any other medical conditions. 5. Whether you are currently taking any drugs, prescribed or otherwise – including cigarettes and alcohol – and whether you are taking ‘blood thinners’, otherwise known as ‘antiplatelet drugs’ or ‘anticoagulants’. These include aspirin, clopidogrel [Plavix], warfarin, Pradaxa and Xarelto. Please bring all your current medications in their original packaging. 6. If you have any loose, capped or crowned teeth or implants, have ‘veneers’ or ‘bonding’, or wear dentures or plates.
You may be given questionnaires to complete, or be asked questions by nurses, before seeing your anaesthetist. Your anaesthetist needs to have the best possible picture of you and your present condition so that the most suitable anaesthesia can be planned. Answer all questions honestly – it is really all about minimising risk to you. Your role There are some things you can do which will make your anaesthesia safer.
1. Get a little fitter – regular walks will work wonders.
2. Don’t smoke – ideally, you need to stop six weeks before surgery. However, stopping for even 24 hours can help. Your GP may be able to assist.
3. If you are overweight, make a serious attempt to reduce your weight before your procedure. 4. Minimise alcohol consumption.
5. Continue to take any medications which have been prescribed but remember to let your anaesthetist and surgeon know what they are. 6. If you are taking aspirin, non-steroidal anti-inflammatory agents or other blood thinning drugs, consult your surgeon or anaesthetist about whether you should stop taking them prior to surgery. 7. If you have any kind of health problem or have had problems with previous anaesthesia, tell your anaesthetist and surgeon so that they are fully informed. 8. If you are concerned about your anaesthesia, make an appointment to see or talk your anaesthetist before admission to hospital and get the answers you need. 9. For children, many hospitals can arrange a preoperative visit. 10. Discuss any herbal products you might be taking with your anaesthetist. It may be necessary to cease taking them two to three weeks prior to surgery. 11. Inform your anaesthetist if you use ‘so called’ recreational drugs as these may interact with the anaesthesia. 12. Inform your surgeon/anaesthetist if you have any issues with blood transfusions. Is fasting really necessary? You will usually be advised to avoid food for six hours and fluids (including water) for three hours before your operation. Food or fluid in the stomach may be vomited and could enter your lungs while you are unconscious.

If you don’t follow this rule of fasting, the operation may be postponed in the interests of your safety. Your surgeon, anaesthetist or the hospital will advise you how long to fast.




What about anaesthesia for joint replacement surgery?


The anaesthetist will consider several factors when planning your anaesthesia, including: • Past experience with surgery. • Health and physical condition. • Reactions or allergies to medicines. • Risks of each type of anaesthesia. • Preferences of your surgical team. • Your preferences. Regional anaesthesia is the most common form of anaesthesia used during joint-replacement surgery because it aims to provide optimal pain relief while minimising side effects such as sedation, postoperative nausea and vomiting, and leg weakness. It may be used on its own or combined with sedation or general anaesthesia. Regional anaesthesia numbs the part of the body where the surgery will happen. It involves the injection of local anaesthetic around major nerve bundles supplying body areas, such as the thigh, ankle, forearm, hand, shoulder or abdomen. This is sometimes done using a nerve-locating device, such as a nerve stimulator, or ultrasound, so that the anaesthetic can be delivered with greater accuracy. Once local anaesthetic is injected, you may experience numbness and tingling in the area supplied by the nerves and it may become difficult or impossible to move that part of the body. BEFORE THE OPERATION It is important that you speak to your doctor about when you should stop eating and drinking before your anaesthetic. The anaesthetist will also need information such as: • Any recent coughs, colds or fevers. • Any previous anaesthetics or family problems with anaesthesia. • Abnormal reactions or allergies to drugs. • Any history of asthma, bronchitis, heart problems or other medical problems. • Any medications you may be taking. WHAT TO EXPECT Each surgery is different. How long an operation takes depends on how badly the joint is damaged and how the surgery is done. The duration of the anaesthesia depends on which anaesthetic is used, the region into which it is injected, and whether it is maintained by continual doses or repeated injections. After surgery, you will be moved to a recovery room for a period of time until you are ready to be returned to the ward. Typically, numbness can last several hours but may last several days. Generally, the “heaviness” wears off within a few hours but the numbness and tingling may persist much longer. As the local anaesthetic effect wears off, numbness will diminish and surgical pain may return, in which case your doctor will prescribe alternative methods of pain relief, including injections or tablets. Because osteoarthritis is often found in hips and knees, and patients undergoing hip or knee replacements are often elderly, there may be complications. Many joint-replacement patients have other medical conditions – diagnosed and undiagnosed – such as high blood pressure and heart problems, which require assessment and investigation. Most patients undergoing joint replacement tend to accept the risks involved because of the potential improvement in their quality of life.




What are the risks and complications of anaesthesia?


There is no safer place in the world to be anaesthetised than in Australia.

Nevertheless, some patients are at an increased risk of complications because of health problems e.g. heart or respiratory disease, diabetes or obesity, age, and/ or because of the type of surgery which they are undergoing.

Infrequent complications include: bruising, pain or injury at the site of injections, temporary breathing difficulties, temporary nerve damage, muscle pain, asthmatic reactions, headaches, the possibility of some sensation or awareness during the operation (especially with caesarean section and some emergency procedures), damage to teeth and dental prostheses, lip and tongue injuries, and temporary difficulty in speaking.

Nausea and vomiting are quite common after certain types of surgery, and rare after other types. The type of anaesthesia used may also be a factor. Even with the use of modern medications, a small percentage of patients may experience nausea and vomiting that is difficult to control. If you have had difficulties in the past, please let your anaesthetist know.

There are also some very rare, but serious complications including: heart attack, stroke, seizure, severe allergic or sensitivity reactions, brain damage, kidney or liver failure, lung damage, paraplegia or quadriplegia, permanent nerve or blood vessel damage, eye injury, damage to the larynx (voice box) and vocal cords, pneumonia and infection from blood transfusion. Remember that these more serious complications, including death, are quite remote but do exist.

We urge you to ask questions. Your anaesthetist will be happy to answer them and to discuss the best way to work with you for the best possible outcome. Risk of infections Needles, syringes and intravenous lines are all used only once. They are new in the packet before your surgery commences and they are disposed of immediately afterwards. Cross infection from one patient to another is therefore not possible.
Blood transfusion With modern surgery the requirements for blood transfusion are less common. All blood collected today from donors is carefully screened and tested but a very small risk of cross infection still remains.

Your anaesthetist is aware of these risks and only uses blood transfusions when absolutely necessary. For major surgery, your anaesthetist may supervise a system of collecting your blood during or after your operation, processing it and returning it to you. This is called blood salvage and sometimes this can avoid the need for a transfusion.