Musculoskeletal



Director: Mr Andrew Tang

Associate Director, Audit: Mr Robert Steele

Associate Director, Education: Dr Camdon Fary

Associate Director, Research: A/Prof Martin Richardson


Services


The Musculoskeletal Clinical Institute brings together the craft groups of orthopaedics, sports and exercise medicine and rheumatology. These are complemented by Epworth Richmond’s emergency department and rehabilitation services’ treatment of orthopaedic conditions and sports injuries.


Orthopaedics

 

Epworth specialises in the treatment of a wide range of elective orthopaedic conditions including joint replacement surgery for patients with arthritis, foot and ankle disorders, and sporting injuries with particular emphasis on knee ligament and reconstruction procedures.


Epworth also treats a large number of patients presenting with orthopaedic trauma involving fractures, dislocations and soft tissue injuries.


Orthopaedic surgeons and neurosurgeons cooperate closely in all problems and conditions associated with the cervical, thoracic and lumbar spine.


In 2014 there were 1168 primary hip replacements and 1358 primary knee replacements performed at Epworth HealthCare. Patients are encouraged to attend a dedicated Pre Admission run by experienced staff. The clinic outlines the process of joint replacement, discusses the journey through the hospital and gives patients the opportunity to view a multimedia education module showing the operation, the potential risks and what to expect during the recovery period.

 

Sports and Exercise Medicine

 

Epworth has a new specialised medical centre offering a complete medical service for all sports related injuries, as well as exercise and fitness advice and health screening prior to exercise.

 

Rheumatology

 

Epworth has considerable expertise in the diagnosis and therapy of rheumatic diseases. Many of the conditions we treat, including osteoporosis, polymyositis, rheumatoid arthritis, SLE and many other inflammatory joint conditions, are chronic rather than acute, in addition to healing, our focus is on returning quality of life to patients, many of whom have to deal with a considerable burden of pain. In this, we are assisted by the expertise of our pain management colleagues.

 

Activity


​  FY 2014 ​       FY 2015
       FY 2016

Services Admissions
Bed
days
Admissions Bed
days
Admissions Bed days​

​Orthopaedic surgery ​14,750 50,160 14,935 47,268 14,586​ 48,795​
Rheumatology 299 2,292 382 3,030 333​ 2,272​
 

Highlights

 

  • Epworth is one of the largest providers of joint replacement surgery in Australia performing more than 2,500 knee and hip replacement operations each year.[a1]
  • Epworth is also one of the largest providers of anterior cruciate ligament (ACL) reconstruction surgery in Australia. Surgeons at Epworth were the leading participants in an Australian-wide pilot study of the feasibility of creating a registry of ACL reconstructions to assess patient outcome data. 
  • The Musculoskeletal unit admits over 1100 patients per year with orthopaedic trauma including fractures, dislocations and soft tissue injuries.  There is a roster of specialists available on call 24 hours a day to deal with these injuries in a timely manner.
  • Epworth was successful in attracting an NHMRC project grant for 2015 to 2017. This grant combines a cross institutional and multidisciplinary collaboration between Professor Richard de Steiger, Professor John Hamilton and Dr Andrew Cook of the University of Melbourne. The grant is awarded for research into a rational strategy for treatment of osteoarthritis of the knee. Patients undergoing knee arthroscopy and knee replacement surgery will be recruited from Epworth Healthcare. Synovial tissue will be collected to examine for the presence of GM-CFS molecules within the tissue.  Previous collaborations between the Chief Investigators have established a mechanism for analysing​ synovial tissue samples and the work will be carried out at the Epworth Musculoskeletal Institute and the Department of Medicine, University of Melbourne.
  • Standardised approach for the management of hip fracture. Aligns with British Orthopaedic Association Standards for Trauma (BOASTs)
  • Orthopaedic and reconstructive surgery has benefited enormously over the last few years from the rapid advances in 3D printing. Epworth is leading the way at Epworth in the use of 3D printed orthopaedic parts. The use of 3D printed custom parts provides safer surgical solutions for very complex problems than what is otherwise available. Prior to this technique, surgery would require the use of off-the-shelf screws and plates that have to be bent to conform to the patient’s altered anatomy. With 3D printing the implant is manufactured to suit the existing anatomy which makes surgery safer, quicker and less complicated.

 

Our performance

 

In 2014/15 there were over 85,000 hip and knee joint procedures performed in Australia.

 

Epworth HealthCare benchmarks its performance using data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). This is a clinical quality registry which collects information on all joint replacement procedures performed in Australia and has achieved national coverage since 2002 with almost 100% accuracy.

 

Compared to all other hospitals in Australia, Epworth HealthCare has a significantly lower rate of revision for primary conventional hip replacement, total resurfacing hip replacement and primary unicompartmental knee replacement.

 

Revision is when your initial joint replacement fails and your doctor recommends that you have a second surgery. In a revision procedure, your doctor removes some or all of the parts of the original prosthesis and replaces them with new ones. Revision surgery is a more complex procedure.


Epworth Healthcare data up to December 2013


Cumulative Percent Revision (CPR) of Primary Total Conventional Hip Replacement by Hospital (All Diagnoses)
Cumulative Percent Revision (CPR) of Primary Total Conventional Hip Replacement by Hospital (All Diagnoses).png
Compared to all other hospitals in Australia, Epworth HealthCare has a lower rate of revision for primary total resurfacing hip replacement.



Cumulative Percent Revision (CPR) of Primary Unicompartmental Knee Replacement by Hospital (All Diagnoses)
Cumulative Percent Revision (CPR) of Primary Unicompartmental Knee Replacement by Hospital (All Diagnoses).png
Compared to all other hospitals in Australia, Epworth HealthCare has a lower rate of revision for primary unicompartmental knee replacement.  



Cumulative Percent Revision (CPR) of Primary Total Knee Replacement by Hospital (All Diagnoses)


Cumulative Percent Revision (CPR) of Primary Total Knee Replacement by Hospital (All Diagnoses).png

At the regular Epworth musculoskeletal audit meeting, the trend for higher rate of revisions for primary total knee replacement was identified. This was due to the use of implants with a higher rate of revision. As a result of our audit process these implants are no longer used.


Queries

If you have any queries regarding the data on this page, please email ClinicalProfile@epworth.org.au



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