Revision Total Knee Replacement

Most knee replacements provide very good long term function for many years after implantation. The most recent figures from The AOANJRR (Australian Orthopaedic Association National Joint Replacement  Registry) reveal that the revision rate for Primary Total Knee Arthroplasty at 15 years is 7%. Most of these replacements have failed either as a result of infection or premature wear.

After a long period of time, a knee replacement can wear out. Sometimes the procedure to correct this problem is as simple as changing the polyethylene bearing insert in the knee – much like a retread on a car tyre. Other times a much more extensive procedure is required where all the major components of the knee are exchanged. Each of these procedures can renew the life of knee replacement for another 10-15 years.

Below is an example of a worn out polyethylene bearing which was able to be swapped out for a new one.

Another example of a much more extensive procedure appears below.


The decision as to whether to do the more minor operation or the larger one is best left to your specialist total knee replacement surgeon who will consider the pros and cons of each operation.


Knee Replacement surgeons, Sydney

For those who suffer severe and debilitating pain from osteoarthritis or injury of the knee, there is always the option to consult the expertise of orthopaedic or knee replacement surgeons. Sydney has a number of knee replacement Orthopaedic surgeons though few capable of safely completing the simultaneous replacement of both knees.


One knee replacement surgeon in Sydney with experience in replacing both knees in one procedure is Dr. Simon Coffey. He is practicing in both Penrith and Macquarie University, Sydney.

Patients eligible for bilateral simultaneous knee replacement most often suffer from the osteoarthritic degeneration of both knees. Both knees are required to be equally dysfunctional and painful for the procedure to be considered. This is due to the fact that the progress of the disease can stabilise once strength is restored to the knee operated on. This post-operative improvement can often delay the need for a second knee replacement by several years.

If a patient meets the criteria for simultaneous bilateral  knee replacement, the benefits are twofold in comparison to having two separate operations.

The first is that the recovery time of the rehabilitation process is reduced. The advantage of a single recovery period also lessens the work-related burdens of asking for two extended blocks of sick leave. Asking for two lots of sick leave can lead to secondary financial issues as well.

The second benefit is the reduced cost of undergoing one procedure as opposed to having to pay for two.

However, due to the longer duration, higher potential for blood loss and cardiovascular complications of the surgery, the overall health of the patient needs to be robust in order for the operation to go ahead.

The preconditions a patient must meet to be eligible for a bilateral simultaneous knee replacement are:

  • Under 80 years of age
  • No history of systemic cardiovascular disease
  • No history of Kidney disease
  • No history of Diabetes
  • Presently experiencing bilateral debilitating knee pain

To be certain patients meet these criteria, thorough preoperative tests need to be undertaken. Other personal considerations like the impact on your work commitments and support network are also an important part of making your decision.

If you experience severe and debilitating pain in both knees, then there is a knee replacement surgeon in Sydney who can help you investigate your options. With a successful record for knowing and picking the right candidates to receive this life-changing operation, Dr. Simon Coffey is one of the very few Sydney based surgeons able to help.

Hip Replacement Surgery Has Come a Long Way

In the 100 plus years, hip replacement has been practiced, the surgery has come a long way. This is due to rigorous testing and research into the prosthetic materials used, as well as, technological developments in diagnostic tools like the arthroscope. This single instrument has come to change industry practice and improve results worldwide. It offers highly-magnified imagery of inside the body, in real-time, so doctors can make their decisions quickly based on detailed evidence.

hip replacement simon coffey

The most common candidates for hip replacement are people with the degenerative form of arthritis called osteoarthritis. There are many other treatments designed to treat and manage osteoarthritis, but in some cases these treatments don’t properly restore the quality of life expected. So, when a limit to the amount of pain relief you get from other medications has been reached, hip replacement is one option that addresses your pain and immobility at its source.

Below is a short list of experiences worth consulting your doctor or specialist over:

    • Persistent pain despite pain relief medication
    • Pain increases with walking, even with a cane or walker
    • Discomfort interferes with your sleep
    • Stiffness and tenderness affects your ability to go up or down stairs
    • Immobility makes it difficult to rise from a seated position

There are also numerous other conditions that can require a range of treatments. Here is a list of other potential treatments for a range of hip conditions:

  • Arthritis in general;

Educational and exercise programs designed to improve general health, flexibility and self-management. Some regimes are more tailored and adapted uniquely to the different forms of the disease.

Assistive Devices: walking frames, canes etc.

Natural and Alternative therapies:  nutritional supplements, acupuncture or acupressure, massage, relaxation techniques and hydrotherapy are examples.

Analgesics for pain relief and include Acetaminophen, Opioids, (narcotics), and an atypical opioid called Tramadol. These pain-killers are commonly prescribed and can be effective for maintenance.

Nonsteroidal anti-inflammatory drugs (NSAID’s), are the most commonly used drugs to ease inflammation and related pain. NSAIDs include Aspirin, Ibuprofen, Ketoprofen and Naproxen sodium.

Corticosteroids to reduce inflammation like Prednisone, Prednisolone and Methyprednisolone, which are potent and quick-acting.

Hyaluronic acid. Hyaluronic acid acts as a shock absorber and lubricant in the joint naturally but breaks down in people with osteoarthritis.

Surgery: Arthroscopy, Total Hip Replacement or partial Hip Replacement.

  • Rheumatoid Arthritis and Ankylosing Spondylitis:

Nonsteroidal anti-inflammatory drugs, (NSAID’s), such as Ibuprofen, Ketoprofen and Naproxen sodium can be taken or for those with a vulnerability to ulcers a COX-2 inhibitor version called celecobix is an alternative.

Corticosteroids to reduce inflammation like Prednisone, Prednisolone and Methyprednisolone, which are potent and quick-acting.

Disease-modifying anti-rheumatic drugs, (DMARD’s), are drugs that work to modify the course of the disease and include Methotrexate, Hydroxycholorquine, Sulfasalazine, Leflunomide, Cyclophosphamide and Azathioprine.

Biologics are a sub-category of DMARD’s which target specific phases in the inflammatory process.

Another sub-category is the JAK inhibitor class which block the Janus Kinase pathways involved in the body’s immune response. Tofacitinib is a JAK inhibitor.

Surgery: Arthroscopy, Total Hip Replacement or partial Hip Replacement.

  • Fracture:

Treatment such as hospital admission, rest, braces, some forms of cast and surgery.

  • Dysplasia:

With developmental dysplasia of the hip a special harness is worn for 6 to 12 weeks to hold the joint in place while the baby’s skeleton matures.

  • Perthes’ disease:

Bed rest, pain-killers and a brace or splint. This is worn for up to 1 and 2 years for regrowth of femoral head. Possible surgery to treat deformities.

  • Slipped capital femoral epiphysis:

Surgery to reposition femoral head to fix into place.

  • Irritable hip syndrome:

Bed rest, pain-killers and NSAID’s.

  • Soft tissue pain:

Exercise program, Anti-inflammatory creams and pain-relieving medications for soft tissue pain.

When other treatments prove ineffective, hip replacement is one option with the potential to increase the scope of your active lifestyle and turn things around. It is even possible after recovery that when asked – ‘What are you capable of doing without pain?’ – you’ll be in a position to list a whole lot of activities you wouldn’t dream of doing today.

Hip Replacement is only ever undertaken on the advice of your specialist surgeon.


Arthroscopy is a common procedure used to treat joints when injury or osteoarthritis is complicating movement and creating pain. The instrument used is the arthroscope. This is a thin-headed fiber-optic telescope which functions as a camera. The visual information is then relayed to a large monitor in the surgical theatre for doctors to work from. Doctors consult the image in real time to evaluate their movements during surgery and make valuable diagnostic observations.


Arthroscopy is a non-invasive form of surgery with usually Day Only hospital stays necessary. This is due to arthroscopy requiring only small incisions near the affected joint and minimal surgical disruption to the surrounding areas. The incisions made are an example of what have come to be known as the ‘keyholes’, of ‘keyhole surgery’. Arthroscopy is one of the most common forms of joint surgery, with 100,000 operations occurring annually throughout Australia.

The form of anaesthetic administered for arthroscopy is the ‘general anaesthetic’. Though due to the relatively short time these operations take, the affects of taking a ‘general anaesthetic’ rarely extend a patient’s hospital stay beyond a day. Regional anaesthetics are also used in combination with mild sedatives.

Understanding Total Hip Replacement Surgery


A procedure in which the damaged or broken hip parts or areas are replaced with synthetic and artificial materials with durable and smooth substance to help make joints work properly is called hip replacement. To know what type of surgery is needed, the person that will undergo replacement should be examined by orthopedic surgeon. Nowadays, one of the most effective solutions to recuperate damaged hip due to arthritis or injury is hip replacement surgery.

Understanding Partial and Total Hip Replacement

Understanding hip replacement is important to be able to prepare for the surgery. First, we need to understand the difference between partial and total hip replacement. Now, both partial and total replacement will need a replacement in certain or all areas of the hip. In partial hip replacement, only half of the hip joint needs replacement. This occurs once the ball of the femur gets worn-out hence limiting movement and motion of the leg and creating ache and discomfort while walking. Total hip replacement, however, uses a synthetic joint in order to replace whole damaged hip framework. The process is similar to the partial replacement surgery, just this point the socket is replaced as well with synthetic.

Some Preparations You Can Do Before Undergoing Hip Replacement Surgery

Oftentimes, when you have made a decision to go for hip replacement surgery, you’ll be given a full physical examination by the GP to make sure you are generally in good health and sufficient to undergo the surgery and find out regardless of whether you have conditions or problems which may affect the procedure or even your healing. Other tests you need to go through like a chest x-ray, cardiogram, and urine and blood samples. If you are taking any medicine, it is important that you let your GP know about this so that they can give you advice prior to the surgery.

It’s good to donate blood prior to surgery.  You may need blood while in or following the surgery. Moreover, overweight may increase risks of surgery and will put more force on your artificial joint which could affect to your recovery. Have a dental check-up prior to the surgery. Even regular teeth’s cleaning isn’t recommended for a few months following the surgery. Finally, your skin must not have problems or bacterial infections when you go through surgery. Consult your GP to get a treatment if you are experiencing any of these.

In conclusion, it is important to understand what the hip replacement surgery can affect you. Hip replacement surgery won’t allow you to perform greater than was doable before. After the surgery, it is strongly recommended that you refrain from certain actions and high-impact sports such as jogging, basketball or cycling. You should also need to avoid particular posture of hip joint that could result in dislocation.

Hip replacement surgery has become an excellent and efficient treatment to repair hip injury. It is important to consider your alternatives by consulting with your GP so that you could be sure if this procedure suits your current condition.

Knee Surgery: A Solution To Avoid Knee Arthritis

Painful knees are a common problem in middle-aged people and elders, and the most common cause of knee pain in this population is Knee Arthritis. There are few treatments for knee arthritis early can help alleviate pain and return people to their daily activities. As some point, arthritis of the knee begins to interfere with the quality of life to the point that something has to change. When treatments such as Anti-inflammatory medications, cortisone injections and physical therapy, do not improve the situation total knee replacement may be an option. The most general reason of chronic knee pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis and traumatic arthritis are the most common. Osteoarthritis generally occurs after age 50 and often in an individual with a family history of arthritis. The cartilage that cushions the bones of the knee softens and wears away. The bones rub together, causing pain and stiffness in the knee. Rheumatoid arthritis is a disease in which the synovial membrane becomes thickened and inflamed, producing too much synovial fluid over-fills the joint space. This chronic inflammation can damage cartilage and eventually cause cartilage loss, pain and stiffness. Traumatic arthritis can follow a serious knee injury. A knee fracture or severe tears in the ligaments of the knee can damage the articular cartilage over time, causing knee pain and limited function of the knee.

Recent Advances in Knee Joint Replacement Surgery: Minimally invasive surgery (MIS) has developed knee replacement surgery, and many fields of medicine. Its key feature is that it uses specific methods and instrumentation to let surgeons execute major surgery without any large cut. MIS requires a much smaller incision, three inches to five years, compared to standard approach and the incision, which is usually eight to twelve inches. The smaller, less invasive approaches result in less tissue trauma, allowing the surgeon to work between the quadriceps muscle fibers rather than requiring an incision through the tendon. It may lead to less pain, shorter recovery time and better motion due to reduced formation of scar tissue. When a full knee surgery is performed, the bone and cartilage at the end of the thighbone (femur) and upper shin bone (tibia) are removed. This is done with accuracy to craft accurate surfaces to accommodate the implant. A metal and plastic implant knee replacement are put to work as a new knee joint. Depending on the condition of the cartilage on the under surface of the kneecap, this may also be replaced.

The knee prosthesis implants can wear out over time. The implant is made of metal and plastic, and while these implants are designed to last many years, all of which take time. Studies have shown knee replacement implants are functioning well in 90-95% of patients between 10 and 15 years after the knee surgery. Most full knee replacements last 20 years and many of them last longer. However, it is important to understand that there are possible complications of knee replacement surgery may reduce the life of the implant. Because of this, total knee replacement should be reserved for elderly patients with significant symptoms of arthritis.

When to Consider Hip Replacement Surgery?


Hip Replacement SurgeryIf you suffer from osteoarthritis, rheumatoid or septic arthritis, or you have Paget’s disease or hip dysplasia, you may experience significant hip pain and reduced movement, which is often significant enough to affect your day-to-day life. While non-surgical treatments, such as medications, physiotherapy and lifestyle changes, are available and can offer some success, these are not always sufficiently effective to relieve pain and improve your functional ability. In these instances, a hip replacement also termed a hip arthroplasty is usually recommended to restore your mobility and quality of life. With a variety of centers in the capital offering surgery to replace a damaged hip joint with an artificial prosthesis, it is important that you do your research before choosing a clinic for your surgery. Choosing a surgeon with expertise in hip arthroplasty makes sure that you will receive the best possible result from your joint replacement surgery so that your expectations of treatment are fully met.

Most doctors have more than 20 years of experience in performing surgical hip replacements. As they keep abreast of developments within the field of orthopedics, they work with the most up-to-date techniques and prostheses, all of which are backed by evidence from clinical studies to guarantee their effectiveness. Besides their commitment to the latest advances in hip arthroplasty, He or She also makes sure he delivers patient-centered care. This means that he involves you in decision-making and tailors your treatment to your individual needs. With his level of expertise and commitment to best practice you can trust that you will receive a complete hip replacement recovery.

Surgery Options:
Before you have your surgery you will meet with an orthopaedic surgeon for an initial assessment. This not only allows him to check your suitability for a hip replacement, but also enables him to advice on the most appropriate prosthesis for your circumstances. In cases where your hip damage is not sufficiently advanced to justify surgery, he will discuss more conservative treatment options with you and may suggest hip resurfacing as an alternative. Certain health problems are sometimes a contraindication to joint replacement surgery, the surgeon will also review your medical history before making a decision. When it comes to the type of procedure he recommends, a complete clinical assessment to decide whether a partial or total hip replacement is more suitable, and whether you would benefit most from a metal-on-plastic, ceramic-on-plastic or a metal-on-metal artificial hip joint. Where necessary he may also advise weight loss or recommend other lifestyle changes to aid your recovery following hip replacement surgery.