Hip arthroscopy - the Melbourne procedure

[injuryupdate]

Confirming my suspicions, I just went to the HIC website Medicare item number statistics and just checked the RAW numbers of hip arthroscopies performed in each state for the period July 2000-June 2005:

To do this go to www.hic.gov.au : HOME > HEALTH STATISTICS > STATISTICAL REPORTING > MEDICARE > REPORTS

Here are the RAW numbers of hip arthroscopies (Item 49366) which were done in each state over that 5-year period:

State Total
NSW VIC QLD SA WA TAS ACT NT Total
306 1,723 241 129 201 62 27 17 2,706

Sorry to ignore the smaller states for the time being, but WHAT ABOUT THE DIFFERENCE BETWEEN NSW and VICTORIA? There were more than five times as many hip arthroscopies performed in Victoria than in NSW over the last five years, despite, of course, NSW having a significantly higher population.

You can only make one of two conclusions to the above information:

(1) Victorian orthopaedic surgeons are massively over-servicing in the number of hip arthroscopies getting done.
(2) NSW orthopaedic surgeons are massively under-servicing and should be doing more.

This is a situation I have suspected for a long time - as a Sydney practitioner I have sent quite a few patients down to Melbourne for hip arthroscopies because the Sydney surgeons don't like to do hip scopes.

How does the College of Surgeons rationalise this discrepency? What is best practice for deciding when to do a hip scope, or don't they care? Is it a matter of surgeons being allowed to make their money whatever way they can?

Surely someone should be doing a controlled trial between Melbourne and Sydney - i.e. follow 200 patients treated in Melbourne with hip arthroscopy along with 200 matched patients treated conservatively in Sydney and see who does better.

It does suggest that if you live in Sydney and want a hip scope by a surgeon with substantial experience in the procedure then you should seriously considered going to Melbourne.

[Unregistered]

My experience may interest you - I used to live in Sydney, now in Victoria. I saw a sports physician in Sydney who correctly diagnosed me with a labrum tear. I tried conservative treatment but no luck. He referred me to a Melbourne specialist on the basis that there wasn't really anyone in Sydney that specialised in labral debridement. I saw him and he recommended surgery. Then living in Victoria, I sought a second opinion from another Melbourne surgeon who came highly recommended by another Melbourne doctor. To my surprise, this surgeon recommended conservative management and prolonged rest/reduced activitiy - for the moment this appears to have worked. As an aside - if I hadn't moved to Vic I would have flown to Melbourne to see the right doctor.
Damian

[Jean M]

Very interesting posts (albeit rather old now).

I am yet another statistic. I live in Sydney but flew to Melbourne to have a labral repair done and femoral osteotomy. The reason? I went to 2 highly recommended hip/knee surgeons here in Sydney who admitted they'd only done a handful of arthroscopies of the hip. So, the orthos recommended Dr. O'Donnell in Melbourne, cos they said he operated on a lot of AFL players and ballet dancers.

I'm glad I went to the trouble (stayed with my sister who lives in Melb.) cos I truly believe I got the best possible result. My hip isn't 100%, but my level of pain has reduced substantially. Interestingly, my body doesn't like much exercise - if I engage in it I pay for it (usually that night or the next few days).

[gaydownunder]

I was interested to read your post as I, too, have had hip arthroscopy, chondroplasty and debridement under John O'Donnell in Melbourne. I have to agree with you he is well worth the trip interstate! My procedure was 6 weeks ago and I am very happy with the way things have progressed. I found the frozen peas and ani-inflammatories to be invaluable in the 1st week, continued to take things pretty easy in the 2nd, moved around a bit more in the 3rd, tossed the crutches at the end of the 4th and started walking my dogs again in the 5th. I had hoped to be relatively pain-free after 6 weeks and am OK on the flat but do get very sore in the groin on inclines and when I bend in a certain way. I am no spring chicken either, which could be a disadvantage. However, I was told there could be discomfort for some weeks or even months so perhaps I am expecting too much too soon. You say you are still not 100% pain free. I would be interested to know how many weeks/months it is since your surgery.

[Jean M]

Hi Gaydownunder: Yeah, isn't John great? I spoke to him earlier this week, and was sooo impressed that he gave me his time (unpaid). To answer your question: I had the labral repair and osteochrondroplasty done in April. The first pain to go was buttock, followed by thigh/leg pain. Oh yeah, somewhere in there was the groin pain too (but not too close in, more in the mid section. I've since found out this is the quadriceps muscle). Anyway, I was in a bad bad state, basically flippiing out with all those mucsle spasms, nerve pains etc. So I'm very grateful to John. During the phone conversation we talked about how some surgeons don't think FAI can be fixed. Well, John agreed that the results (for many, not all patients) speak for themselves. But he DID say they (the docs) don't know yet about the long term prognosis. But let's stay positive!! Anyway, if I eventually need further surgery I know who to go to!!
By the way, I agree with the comment about some discomfort. I'm not entirely out of the woods yet. But John thinks I'll continue to get better. When you read all the posts on this site you start to get a clearer picture of things. I truly believe (as others have suggested) that FAI doesn't spring up overnite, and your body (post surgerical correction) needs TIME to re-adjust. I'm talking about the muscles, tendons, nerves - the whole kit and caboodle.
So..............keep checking in and reading the posts. This site has done wonders for my psyche. Let me know how you track further along. Don't hesitate to ask more questions - I often check in.
Regards,
Jean

[steven hadley]

Hi,i have been diagnosed with femoro acetabular impingement (i think,cartilege tear)in my left hip and im simply wondering how much hip arthroscopy would cost (AU$)

cheers

[Jean M]

Steven
Best to speak to Dr. O'Donnell's office about costs when you call them (that is, if you take my advice and ring that particular surgeon). Jus explain your situation and hopefully they can advise you appropriately.

[steven hadley]

ok,im looking at the number infront of me right now,thankyou for your help jean
cheers

[Omega3]

Confirming my suspicions, I just went to the HIC website Medicare item number statistics and just checked the RAW numbers of hip arthroscopies performed in each state for the period July 2000-June 2005:

To do this go to www.hic.gov.au : HOME > HEALTH STATISTICS > STATISTICAL REPORTING > MEDICARE > REPORTS

Here are the RAW numbers of hip arthroscopies (Item 49366) which were done in each state over that 5-year period:

State Total
NSW VIC QLD SA WA TAS ACT NT Total
306 1,723 241 129 201 62 27 17 2,706

Sorry to ignore the smaller states for the time being, but WHAT ABOUT THE DIFFERENCE BETWEEN NSW and VICTORIA? There were more than five times as many hip arthroscopies performed in Victoria than in NSW over the last five years, despite, of course, NSW having a significantly higher population.

You can only make one of two conclusions to the above information:

(1) Victorian orthopaedic surgeons are massively over-servicing in the number of hip arthroscopies getting done.
(2) NSW orthopaedic surgeons are massively under-servicing and should be doing more.

This is a situation I have suspected for a long time - as a Sydney practitioner I have sent quite a few patients down to Melbourne for hip arthroscopies because the Sydney surgeons don't like to do hip scopes.

How does the College of Surgeons rationalise this discrepency? What is best practice for deciding when to do a hip scope, or don't they care? Is it a matter of surgeons being allowed to make their money whatever way they can?

Surely someone should be doing a controlled trial between Melbourne and Sydney - i.e. follow 200 patients treated in Melbourne with hip arthroscopy along with 200 matched patients treated conservatively in Sydney and see who does better.

It does suggest that if you live in Sydney and want a hip scope by a surgeon with substantial experience in the procedure then you should seriously considered going to Melbourne.


Hmm, here's my 2 cents worth
1) Melbourne is the sporting capital of australia and hence surgeons experience more hip related injuries.
2) From what I've heard, Melbourne University is the most difficult uni to get into to study medicine....

[soccer girl]

Would love to hear from anyone from NSW who has travelled to Melbourne to get a hip arthroscopy done by John O'Donnell. I play soccer at an elite level and after 4 months out of the game have been told that my osteitis pubis is actually a labral tear and a femoral acetabular impingement in my left hip.

My sports doctor has recommended that I go to Melbourne for the surgery if I want the best people to do it. I'm willing to do this, but have no family or friends in Melbourne. The logistics of coming out of hospital and either getting a plane back straight away or looking after myself for a few days are a bit daunting. Can someone who has travelled to get this procedure done tell me how they managed the stay and the travel back? Did you stay in hospital overnight or did you have to stay somewhere else? Is the pain sitting down the day after surgery too unbearable to stay seated for 2 hours on a plane back to Sydney?

[Maryw]

Hi.

I had a Hip Arthroscopy in Sydney a few years ago. I was in hospital overnight, and it was quite painful. I wouldn't have been able to sit for 2 hours on a plane until about 3/4 days post op. I needed crutches for at least 2 days.
I guess every -one is different, and I have since had that hip replaced.

[gaydownunder]

I hope Jean M reads your post as she is probably better qualified to reply than me, having had surgery in Melbourne for a labral tear with FAI. I had a labral tear only and flew from Hobart to Melbourne to see John O'Donnell. Following recommendation by my sports physician I had a consultation on the day of arrival, stayed overnight in local accommodation, and had arthroscopy the following morning, to avoid two separate visits interstate. I was advised in advance to spend the post-surgery night in hospital (a) because I did not have anybody with me in Melbourne and (b) for pain-management . One important thing to remember - the hospital insists that you MUST have somebody to pick you up from hospital on discharge. They are very particular about this for obvious reasons. Fortunately I had a friend there who was able to pick me up in the morning and take me to the airport for an afternoon flight. I paid to go into the Guest Lounge which was well worth it as I was then on my own and had a few of hours to kill before my flight. As I had pre-booked as a Special Needs client the airline staff were very good and wheeled me to the plane. The only upset was that on boarding they asked for the 'clearance to fly' papers from my doctor which I had not previously been advised I would need. Apparently this is an airline requirement following surgery. I told them when I booked that I was having arthroscopy but nobody had told me about the release paper because (apparently) the staff member didn't know arthroscopy constituted surgery. I don't know if anybody else has experienced this problem but it was very upsetting at the time as they wanted to send me back! It was all sorted out eventually and I did fly, but be aware! It was only about 1.5 hours to Hobart but I had no problems and could have gone further. I was, of course, on pain-killers prescribed by the hospital. I had a lift to get me off the plane (you have to walk down the stairs at Hobart) and again, transport to the terminal. The airline staff were very efficient in this regard. I emphasise that I did NOT have FAI. It is important you keep this in mind as the after-effects might well be different . I hope this helps.

[soccer girl]

Thanks for info guys. I half decided today to have it done in Sydney to avoid the logistical nightmare of going to Melbourne, but I'll still look into the Melbourne option. I would really like to get the best possible surgeon, I'm 22 and like to think that I have a lot of competitive sport still ahead of me.

Oh, another thing, was it difficult to book the appointment and surgery on consecutive days? How long did you have to wait before you could get a booking?

[Vixen]

[quote=soccer girl;29720] I would really like to get the best possible surgeon, quote]Smart choice, the best surgeon is JO in Melb, given you are only an hour flight away in my opinion you would be mad not to use him given people are flying in from OS to be treated by John