Mr. Eden Raleigh
FRACS (Orth) M.B. B.S. FAOA
Surgery Information
Consultation
To book the initial and further consultations, please ring the Richmond office on 9421 1900 and bookings at all premises can be booked through this phone number.
The office is open 9 AM to 5 PM Monday to Friday.
We request that all relevant information including referrals, any radiology or pathology reports, physiotherapy and allied health letters and any other relevant information is provided prior to the appointment for review. This can be sent to dredenraleigh@gmail.com
The initial consultation fee is payable on the first visit. We use the Eclipse System allowing Medicare refunds immediately.
Surgery
Surgery Fees
Mr Raleigh works in the private system exclusively and gaps are payable with most Insurance Companies. Mr Raleigh provides a discount to the recommended AMA fees for services.
Assistant and Anaesthetist Fees
All procedures require an Assistant Surgeon and Anaesthetist, and they will provide an invoice separately with information provided prior to surgery to assist in identifying the exact fees payable.
Estimation of Surgical Fees
All patients will be provided with the amount payable for the surgery prior to the surgical date. As most Private Insurance Agencies in Australia provide little or no remuneration for the Surgeon, Assistant Surgeon and Anaesthetist, which with most being paid via Medicare, there are out-of-pocket expenses for all procedures.
Medications
Surgery Times
We do our best to provide the most effective surgical times and discharge times but are limited by procedure type and the operated side. We are happy to accommodate specific requests if possible.
Postoperative Care
Patients will be seen by a Physiotherapist at discharge and provided with a programme. Most patients will follow the programme doing the exercises as described and once the postoperative appointment is completed, will be directed to a Physiotherapist. We usually use the Physiotherapist previously used but if the patient doesn’t have a specific Physiotherapist in mind, we can suggest a qualified Physiotherapist known to Mr Raleigh.
Use of Sling or Brace
Patients undergoing shoulder procedures such as rotator cuff repair and reconstructions will require a sling which is commonly used for a period of six weeks in most situations. These slings can be removed for activities of daily living including, but not limited to, eating, washing, sleeping, writing and use of computer.
Dressings
Dressing information will be provided on the postoperative sheet.
Postoperative Issues
If there are any significant issues which needs to be addressed out of office hours, please email dredenraleigh@gmail.com for assistance.
Driving after Surgery
We suggest patients don’t drive until six weeks after rotator cuff and instability surgery and when the patient can then lift the arm more than 90º without pain. 1-2 weeks after impingement surgery
Knee arthroscopy patients/ACL surgery patients can usually drive the same week. Knee replacements patients are asked to wait at least 4 weeks.
This is a general guide only.
Shoulder Conditions
Rotator cuff partial and full tears
Rotator cuff injuries are the most common injury in the shoulder and one of the most common injuries in the general population. There is usually a causal relationship between the acromion bone above and the tear itself. Younger patients often have morphological changes in the acromion which lead to rotator cuff tearing. Older patients most likely have a spur forming an impingement process to occur, resulting in cuff tearing.
When tears are partial thickness, they are usually treated conservatively which includes a physiotherapist and other and other Allied Health Professionals, injectables and conservative measures. If these measures fail, commonly a decompression procedure is performed.
Shoulder decompression involves removal of the underlying pathology which is commonly performed arthroscopically.
This can be performed as a day procedure or an overnight stay whereby a sling is used for the first one or two weeks and a physiotherapy programme afterwards.
When the tear reaches full thickness, in that there is a hole in the tendon itself, commonly these are fixed with a decompression procedure and rotator cuff repair.
Rotator cuff repair includes repairing the tendon back to the original base of the humerus bone involving plastic anchors. These anchors remain permanently and do not need to be removed.
A sling is used for a six-week period and a physiotherapy programme initiated.
Shoulder dislocations
Shoulder dislocations are a common injury in Australia. Most patients are in the younger age groups and shoulder dislocation usually results in a labral tear for which without treatment, can result in further dislocations.
In most cases a labral repair can be performed involving an arthroscopic procedure whereby multiple anchors are placed in the glenoid socket and the labrum is repaired back to its original base. Approximately 50% of patients undergo a Remplissage procedure at the same time whereby bone defects in the humeral head can be treated by a tendon transfer which results in a lower dislocation rate.
Occasionally patients with bone loss which occurs usually after multiple dislocations require a Latarjet procedure whereby a bone graft is performed to the glenoid socket.
Most patients undergo a period of rehabilitation including six weeks in a sling.
AC joint dislocation
AC joint dislocations occur whereby the clavicle bone dislocates out of its socket and results in pain and recurrent instability. Low grade dislocations can be treated conservatively in a sling and with physiotherapy whereby high-grade dislocations may require surgical treatment. In most situations a dislocation plate is used and then removed at the four-month mark. This allows patients to rapidly get back the range of motion, requires a sling for a period of approximately two weeks and a physiotherapy programme.
Shoulder arthritis and replacement
Arthritis of the shoulder joint is a common ailment in the older population. Conservative management includes physiotherapy and injections but if this fails, they commonly require shoulder replacement.
Total shoulder replacement and reverse shoulder replacement are the mainstays of treatment. The former involves replacing the ball and socket with titanium (with plastic inserts) and the latter involves a similar procedure whereby the ball and socket are placed in a reverse position.
Approximately 70% of replacements in Australia are reverse replacements.
Mr Raleigh uses patient specific instrumentation for all patients. This requires a CT scan to be performed, and CT modelling done to provide the best positioning. Following this plastic 3D models are made by Zimmer-Biomet in the USA. This is then sent to Australia for the procedure. This process takes approximately four weeks to arrange. This allows better instrumentation and placement of the prosthesis.
The Australian Joint Registry has ongoing data which shows revision rates of approximately 3% at the seven-year mark with this prosthesis.
Frozen shoulder
Frozen shoulder occurs either primarily which may or may not be related to risk factors such as diabetes, thyroid disease or alcoholism, possibly trauma or other conditions related, or secondarily, from other pathologies.
Commonly hydrodilatation is performed which is done by a Radiology Centre whereby salt water and cortisone are injected under guidance. This is in conjunction with a physiotherapy programme which can be arranged.
Only when patients fail this procedure, or this procedure performed multiple times will an arthroscopic procedure be suggested.
The arthroscopic procedure involves releasing all the tissues providing the constriction in movement and is commonly performed with an overnight hospital stay.
Knee Replacement
Osteoarthritis of the knee is a common predicament in the older population. Conservative therapy is usually undertaken at the outset including a physiotherapy programme, cortisone or gel injections and other therapies.
Failing these therapies, knee replacement is commonly performed.
Patients usually undergo a spinal anaesthetic and immediate weight bearing. Patients usually stay three nights in hospital and physiotherapy is provided afterwards for a period of some months.
Postoperative Care
Patients are seen in the Clinic on a regular basis from usually the two-week mark post-surgery.
Physiotherapists are used mostly after the initial two-week period.
Wound care is provided from the hospital and most dressings are removed at the two-week mark.
Pre-Surgery Health Optimisation
Physical therapy
Patients may need to attend the Physiotherapist prior to surgery for prehab. This will be discussed at the initial consultation.
Dietary recommendations
Advice on healthy eating and foods to be avoided pre and post surgery will be provided.
Medication management
Instructions on medications will be provided at the initial consultation. Blood thinners (excluding Aspirin) will need to be stopped between three and five days before surgery depending on the type of tablet which is taken.
Preoperative testing
Blood tests, ECG and other necessary tests will be required for any joint replacement and medium to high-risk patients having other procedures. This will be initiated prior to surgery.
Smoking cessation
All patients are encouraged to stop smoking prior to surgery and continue smoking cessation.
Clothing
Patients are encouraged to wear loose, comfortable clothing for surgery and have one change of clothing for discharge.