1 I apply a plaster of paris cast - backslab in theatre

2 Then fibreglass cast from the Cairns Hand Clinic - which can be waterproof if applied after 2 weeks when the wound is fully healed. This will incur additional costs.

3 Watch out for infection - any fever or increase in pain please notify your surgeon. 

4 You can have scar prevention - using a Hypafix dressing for 6 weeks and then a silicone dressing for another 6 weeks - this will be provided by the Cairns Hand Clinic.

5 You may require grafting of your torn ligament from another site - this is generally in the crease of the wrist joint, and wont affect your recovery time. This will be decided while you are asleep.

6 Delays to surgery may increase the complexity of the surgery, or increase the risk of developing early onset arthritis.

7 Driving after surgery is not legally prohibited, but insurance may be an issue.

8 I do not participate in a no-gap scheme, as I don’t believe surgery should be rushed.

9 You would require 3-4 days resting at home, and may not be able to work for the 4 weeks while wearing the cast. If you have a desk based job, you may be able to work at day 10 - once in the fibreglass cast.

10 We can discuss your return to work at your day 7 check as patients are very variable in their responses to surgery.

11 You need to plan whether you want to stay overnight in hospital. This is dependent on your pain levels and the capacity of your support person to assist you with showering, eating, meal preparation.

12 You may get a throbbing

13 If your hand is puffy then you should elevate it and move your fingers. If it is not swollen, you can use your hand as able.

1. Pain - is useful, it tells you if you have done too much. Pain killers will mask this. It is not useful to be in constant severe pain, or allow your pain to get out of control between taking your medication, but a background mild pain can be tolerated.

2. Swelling - also useful, but later in your recovery - if your knee is swelling up and down, then you are doing too much. Early on in the recovery, your knee will be swollen all the time, but once this is under control, then keep an eye on it, so that you know if the joint is struggling with your activity level, as it is having to make extra lubricating fluid for the joint.

3. Endorphins - you are used to getting endorphin (happy hormone) release every time you exercise - if you push your pain barrier! A lack of exercise will stop this. You can replace it with narcotic pain killers, but they lose their effectiveness after 10 days. You can replace them by getting out into the sunshine, relaxing with friends or doing anything that generally makes you ‘feel good’.

4. Returning to sport - this should be more gradual than you hope it is going to be. You can make a schedule - try and match it to your usual training regime. So, if you normally get up at 6 and go for a run, get up at 6 and do your physiotherapy exercises and some stretches. You can make it take the full hour, if you do exercises, stretch then repeat your exercises. 

5. Exercises - there is a whole group of exercises available to strengthen your knee. Some will hurt you, and some will not. Your physiotherapist needs feedback about which exercises are working for you. Sometimes it is easier to do the exercise for a length of time (30 seconds) than a number of repetitions. 

6. The rest of you - you are able to exercise your upper body immediately after your surgery. You will find that your knee can throb if you put your blood pressure up by exercising, so you may have to slow it down. The throb will settle with time, but you need to work out what your knee will let you do.

Swimming is great - you can just do upper body, and put a board between your legs, but wait until your wound is checked by your surgeon, before submerging it in a public pool.

"Arthritis" to doctors is any cartilage injury, but to patients they think about pain and loss of function.
Cartilage injury can be managed effectively, with surgical and non-surgical treatment.

Knee arthritis progresses more rapidly than other joints, because the knee takes so much of the body's weight during activity. As such, research and intervention is very aggressive because the loss of function can be dramatic.

What can I do?
1. Lose weight - a BMI in the lower end of the normal range, will help your pain
2. Exercise - ideally non-weight bearing repetitive exercise such as cycling or swimming is ideal, however any exercise can be beneficial
3. Strengthen the thigh muscles - this doesn't happen with walking, which strengthens the hip muscles. This requires cycling or swimming, or gym programmes. It is easy to injury yourself in any sport, so it is helpful to get some advice from a registered provider such as a physiotherapist.
4. Modify your activities / expectations - some people may have trouble with hill-climbing activities, while others may have trouble with running. As such, it is important to continue to have goals, but you should work around your knee's function.
5. Supplements - it is difficult to find good science around nutritional supplements, as they are regulated like a food product, and not like a drug so the companies supplying these products have not had to undergo rigorous studies of effectiveness in order to gain a PBS listing.

Innovations

1. Medial patellofemoral ligament - surgery can be done to stabilise a knee which has a tendency to dislocate - this can occur at the top of a flight of stairs, or when the weight is on the leg, and you twist your knee.
2. ACL / Knee reconstruction - the technology behind this has stabilised, and the biggest advance has been in requirement to return to sport - the single leg box jump test is likely to be the best predictor of ACL rupture. Trainers can also use a FIFA prescribed warm up which prevents ACL ruptures.
3. Medial meniscal tear - the most common site of tear, the medial meniscus can cause the meniscus to 'fall out' of the joint and thus render the knee 'bone on bone'. This can lead to rapid arthritis in young patients