Dr Tong will take your medical history, physically examine you and check any x-rays / imaging at the time of your consultation. Treatment options will then be discussed. Further tests or investigations may be ordered to help form a diagnosis. You would most likely need to return at a later date for the results of these investigations and to plan your further treatment, which may be surgical or non-surgical.
Dr Tong will have a discussion with you about the potential risks and benefits of your surgery. You will then complete a hospital consent form, along with an admission form. Most patients are able to complete this paperwork, in some cases attend a pre-admission clinic, and then go ahead with the surgery. However, depending on your medical condition, it may prove necessary to have pre-operative consultations with other specialists e.g., to assess cardiac or vascular status. This will be discussed with Dr Tong at the time you consent to the surgery.
It may be necessary for you to cease certain medications prior to your surgery, and this will also be discussed.
If you are having your surgery privately at John Flynn Hospital you will be advised by Dr Tong’s receptionists regarding any pre-admission clinic appointments, admission times for surgery, when to cease any medications and fasting times. You will also be advised if any pre-operative blood tests, etc are required and when to have these performed. You must take any relevant x-rays with you to the hospital at the time of admission.
It is usually the case that you will be admitted to hospital on the day of your surgery. You should present to the front desk in the foyer of the relevant hospital, from where you will be guided through the admission process.
If you are having your surgery in the public system at either the Tweed or Murwillumbah hospitals, then your pre-admission clinic appointment, date for surgery and admission time will be advised by the hospital.
If you are having day surgery you will need someone to drive you home and to stay with you overnight. Hospital policy does not allow that you go home by taxi, public transport or drive yourself.
For those patients having more major surgery, such as joint replacement, it is sometimes necessary or preferred by the patient to go to a rehabilitation centre following surgery. Whether public or private, this will be organised at the time of surgery when you are still an in-patient on the ward. Rehabilitation facilities are available at John Flynn Hospital for private and DVA patients and at the Murwillumbah hospital publicly.
Dr Tong operates privately (for those patients with private health insurance) at John Flynn Hospital in Tugun.
Both private and public postoperative appointments are at Dr Tong’s rooms in Palm Beach.
Your joint replacement surgery should last a lifetime in about 90% of people. Therefore, choosing your surgeon is an important decision. You should not let marketing, fashion trends (such as anterior approach or new implants with no long term results) or other such things influence your decision. Talking to your GP is a good place to start, but if you are looking at this website then you are probably searching around on the net to get the best hip or best knee replacement. The National Joint Replacement Registry of Australia (NJRR) is an independent body so you can ask your particular surgeon for their revision rate. This statistic is less meaningful if they do not have results for 10 years as 95% of joint replacements should be lasting this long. Therefore, it is not difficult to achieve good results with follow up less than 10 years.
You may be discharged from hospital 1 day earlier with an anterior approach, however results show no difference in function at 2 weeks (*Ref 2) and 2 months (*Ref 3) compared to posterior approach.
It is important to note that if there is a higher failure rate using the anterior approach, you will require further surgery and your 1 day earlier discharge from hospital would look a little irrelevant.
Dr Tong believes the NJRR will be soon releasing data regarding approaches and revision rates. He is of the opinion it will confirm what most orthopaedic surgeons already suspect - that anterior approach is associated with a higher failure rate.
Different orthopaedic fashions come and go and we have seen a number of these over the years. Most orthopaedic surgeons pursue the anterior hip approach for marketing reasons or if they have an increased dislocation rate. Most patients having an anterior approach do so believing they are getting a superior product, but unfortunately the reverse is probably true.
The Australian NJRR is a world recognised independent body which records all joint replacements in Australia and reports annually. This helps identify poorly performing prostheses (which tends to decrease surgeons’ use of that particular prosthesis), but it also confirms well performing prostheses.
The NJRR has made available individual surgeon revision rates for about the last 10 years. This data is presently only available privately to the individual surgeons and can only be compared to the national average. Hopefully this data will be made public in the not too distant future as it will then allow patients to obtain factual data rather than exaggerated claims, flash websites or marketing to help them make important decisions about their joint replacement, which should be a decision for a lifetime in most instances.
*Ref 2: IA Maler et al JBJS, Vol 98-B, No 6, June 2016
*Ref 3: Kirsten L Poehling-Monaghan et al. Clin Orthop Relat Res 2015 Feb; 473(2): 623-631