What do I bring along for my first appointment?
- Your referral letter from your GP (without this referral you will not be able to claim through Medicare)
- X-rays, scans and any other information that you have from your GP
- Medication history
- Health insurance details
- Workcover claim details, if applicable
- Any family members or friends you may want to have present to help in the discussion and decision making process
- A written list of questions you may have
Major surgery on a joint may take some hours in the operating room. Getting a full range of motion, strength and flexibility back in that joint after surgery usually takes months. That’s where pre-operative exercise and education and post-operative physiotherapy programs come in – to ensure you’re physically and emotionally prepared for surgery, and to maximise your recovery after surgery. Together, such programs are among the most important determinants in the success of your surgery.
What is a hip replacement?
A hip replacement involves a surgical procedure to replace part or all of a diseased or damaged hip joint with an artificial substitute—a prosthetic hip joint. The operation to replace or mend a joint is known as ‘arthroplasty’. The aim of a hip replacement is to alleviate pain and restore function in the hip joint.
When is a hip replacement necessary?
A hip replacement may become necessary to prevent pain and increase mobility if your hip joint is damaged as a result of disease or injury. The most common cause of hip replacements is osteoarthritis, but the procedure may also be necessary for people with rheumatoid arthritis, osteonecrosis, bone tumours or a fracture or dislocation affecting the hip joint.
Hip replacements may not be recommended for people who have a high likelihood of injury, such as people with Parkinson’s disease or a significant weakness of the muscles.
How is my new hip different?
You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending. These differences often diminish with time and most patients find these are minor compared to the pain and limited function they experienced prior to surgery.
Your new hip may activate metal detectors required for security in airports and some buildings. Tell the security agent about your hip replacement if the alarm is activated.
What causes arthritis in the knee?
Osteoarthritis or Degenerative Joint Disease – the most common type of arthritis. Osteoarthritis is also known as “wear and tear arthritis” since the cartilage simply wears out. When cartilage wears away, bone rubs on bone causing severe pain and disability. The most frequent reason for osteoarthritis is genetic, since the durability of each individual’s cartilage is based on genetics.
Trauma – can also lead to osteoarthritis. A bad fall or blow to the knee can injure the joint. If the injury does not heal properly, extra force may be placed on the joint, which over time can cause the cartilage to wear away.
Inflammatory Arthritis – swelling and heat (inflammation) of the joint lining causes a release of enzymes which soften and eventually destroy the cartilage. Rheumatoid arthritis, Lupus and Psoriatic arthritis are inflammatory in nature.
What is the difference between total knee replacement and unicompartmental knee resurfacing?
Knee replacement is removing the edges of the joint that have been diseased by degeneration or trauma. Knee resurfacing is like a retread. The only part of the joint that is resurfaced is the side of the joint that is diseased.
What is revision knee surgery? How is it different to the knee replacement?
Revision surgery is different in that the original components are removed and new components are implanted. The technical aspects of the surgery are more complex than the original total knee replacement. However, the preparation for surgery and hospital experience tend to be very similar to the primary knee replacement.
What happens if my knee gets infected?
If a knee is infected the patient is first given antibiotics. If the infection does not clear up, the implant will have to be taken out and the patient is scheduled for revision surgery. The original components are removed and a block of polyethylene cement treated with antibiotics (known as a “spacer block”) is inserted into the knee joint for six weeks. During this time the patient is also treated with intravenous (I.V.) antibiotics. After a minimum of six weeks, new knee components are implanted.
How is my new knee different?
You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities. Improvement of knee motion is a goal of total knee replacement, but restoration of full motion is uncommon. The motion of your knee replacement after surgery is predicted by the motion of your knee prior to surgery. Most patients can expect to nearly fully straighten the replaced knee and to bend the knee sufficiently to go up and down stairs and get in and out of a car. Kneeling is usually uncomfortable, but it is not harmful. Occasionally, you may feel some soft clicking of the metal and plastic with knee bending or walking. These differences often diminish with time and most patients find these are minor, compared to the pain and limited function they experienced prior to surgery.
Your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated. Find out more from your doctor on special precautions and special exercise programs.
Fee Structure Information
Dr Cooke has set his own private fee which sits in between the Medicare Schedule fee and the AMA fee. Dr Cooke does take special circumstances into consideration, so if you feel it necessary, it is important that you speak to Dr Cooke about your fees.
Dr Cooke does see patients from Workcover, DVA and those who require medico-legal assessments. Separate fees schedules are used for these patients and are typically billed directly to the appropriate organization.
Dr Cooke does not offer discounts for Health Care Card holders. He attends Princess Alexandra Hospital Public Out-patients for those in financial need.
First consultation: When you visit Dr Cooke for the first time, you will be charged a long consultation fee as Dr Cooke needs to spend extra time with you gathering your medical history. You will receive a portion of this visit’s fee back through the Medicare rebate.
Subsequent consultation: A lower fee is charged when you see the doctor again. This is because less time is usually needed once the doctor has become familiar with your condition. Post operative Consultation Depending upon the operation the cost of some of your post operative appointments are included in the surgical fee.
Payment of Fees: Our staff will outline the exact costs to you when you ring for an appointment. We ask for full payment at the time of the appointment accepting cash, cheques, EFTPOS and most credit cards (not American Express or Diners Card). You will receive an receipt from these consultations. Our practice can submit your claim to work cover for you.
If you are a Work Cover patient you must bring with you your claim number so we can make a claim on your behalf. If you do not provide this then you will be responsible for payment. If you are a DVA patient you must bring with you your appropriate cards for verification and claiming purposes.
Extra costs: If a procedure is performed at the time of the consultation (for example a joint injection) you will be charged for this.
Surgical Fees: Once Dr Cooke has informed you of the need for an operation, our staff will give you an estimate of the costs for your particular surgery. Each operation has a different item number and fee. As well, each health fund has a different policy for payments to both patients and doctors. This makes the estimate and billing process all that much harder to navigate. (It would be wise to talk to your health fund to ensure your level of cover prior to your surgery).
The estimate we provide to you, will include the costs for Dr Cooke, his surgical assistant, your rebate and any out of pocket costs. Generally speaking, there will be a gap to pay that is not covered by the Medicare Rebate or your Health Fund. You will need to pay the gap or the co-payment before proceeding with surgery.
We will also provide you with the Anaesthetist’s name and practice contact details and it is important that you make contact with this Anaesthetist to determine his costs. The fees charged by the Anaesthetist are separate from the fees charged by the hospital or by Dr Cooke. The anaesthestic fees vary dependent upon the complexity and duration of the anaesthesia. It is your responsibility to pay the Anaesthetist for the services they provide. You may be able to claim a rebate from Medicare as well as from your private health fund (assuming you have private health insurance).
Depending on the surgical procedure and your medical health, Dr Cooke may require you to have a consultation with a General Physician prior to your surgery. We can make this appointment for you. You will be responsible for the fee charged by this Physician.
Depending upon your level of Private Health Insurance you may also receive an account from the Hospital, Radiology, Pharmacy, or Physiotherapy. There may also be costs for rehabilitation devices such as knee braces or crutches. These accounts generally arrive after your surgery, and are separate and independent of Dr Cooke’s cost. Our Secretary will be able to advise you in relation to gaining quotes for such items.
Please remember that this is a quotation only, and Dr Cooke may have to do more or in some cases, less than initially expected which could cause a difference in costs to those originally quoted.
Trauma Procedures: By its very nature, Orthopaedic Trauma work can be quite difficult, often is not timed conveniently and can be distressing for the patient. Despite this Dr Cooke has a particular interest in the management of trauma and has spent considerable time gaining additional expertise in this area. The Medicare recommended fees are not commensurate with equivalent elective procedures. Added to this is the after hours nature of this work and follow-up care. It is for this reason that Dr Cooke charges (for trauma procedures only) the AMA recommended fees.
Summary: Estimating the costs for surgical procedures does appear quite complicated and our staff will do their best to help you understand the costs within the private health care framework. It is very important that you understand and are well informed regarding your financial commitment to Dr Cooke prior to your surgery. Please do not hesitate to call us any time to discuss any financial concerns you may have.