Orthopaedics 360

22/06/2026

Pain after joint replacement is one of the things patients worry about most before surgery. The reality tends to be much better than expected.

Modern pain management uses a multimodal approach - combining several methods to control pain rather than relying on a single strong opioid.

During surgery, I inject a long-acting local anaesthetic mixture around the joint before closing in a knee replacement. We find we don't need this for a hip replacement. This provides several hours of relief while the spinal block wears off.

After surgery, the plan typically includes paracetamol taken regularly around the clock, possibly an anti-inflammatory (celecoxib), and sometimes a nerve pain modifier (pregabalin). Opioids are available but are used as a supplement, not a foundation. We use Palexia and Endone when we need to use Opioids.

Most patients are genuinely surprised by how manageable it is. The most common feedback I hear is "I expected it to be much worse."

A few things patients can do: take medications on schedule rather than waiting until pain is severe, do your physio exercises even when the joint is uncomfortable, and keep the leg elevated when resting.

Pain that is well-controlled in the first two weeks makes rehabilitation significantly more effective.

drchienwenliew.com.au

19/06/2026

A little preparation before surgery makes the first two weeks at home significantly easier.

Medications: get your prescriptions filled before admission. You will not want to manage a pharmacy trip on day one at home.

Your chair: you need a firm chair with armrests you can push off from easily. Low sofas and soft lounges are hard to get out of in the early weeks. A chair that lets you get to standing without struggling is worth setting up before you go in.

Bathroom: a shower stool or shower chair is helpful, particularly after knee replacement. For hip replacement via the direct anterior approach, there are no toilet height restrictions - no raised toilet seat is required.

Trip hazards: remove rugs, secure loose cords, and clear a clear path between your bedroom, bathroom, and kitchen.

Food: stock the fridge before surgery. You will be mobile, but elaborate cooking in the first week is more effort than it needs to be. Prepare a few days of simple meals.

Transport: organise who is collecting you from hospital and who is staying the first night. Do not plan to be alone for the first 24 hours at home.

The patients who prepare well have a smoother first week. It is worth the half hour.

drchienwenliew.com.au

17/06/2026

Surgeons, physios, and a robot walk into a room… 🤖
A brilliant education night with the PhysioXtra and Eastwood Physiotherapy Clinic teams — a tour of our new rooms, shared learning, and a live, hands-on demo of the Mako 4 Robotic System we use at Eastwood Private Hospital.
Surgery is only half the story — recovery is the other. When both teams work this closely, patients get the best of both.👏
Our surgeons: Dr Luke Mooney, Dr Raymond Yu, Dr Mike Smith and Dr Chien Wen Liew.
.raymondyu Dr. Luke Mooney Eastwood Physio and Rehab Clinic

16/06/2026

Swelling after joint replacement is normal - and it can look alarming if you are not expecting it.

Here is what is happening. Surgery causes local tissue trauma and an inflammatory response. Your body sends fluid to the area as part of healing, not as a sign that something is wrong.

After hip replacement, swelling tends to be mild and settles within 2 to 3 weeks for most patients. After knee replacement, it is more significant and can persist for 3 to 6 months. The knee has a tight soft tissue envelope and takes longer to settle - this is normal.

What helps: elevate the leg above heart level when resting, particularly in the first few weeks. Use an ice pack wrapped in a cloth for 20 minutes several times a day. Walk regularly - movement pumps fluid out of the limb. Wear your compression stockings for the first 2 weeks.

What does not help: sitting with the leg down for long periods, standing still, or missing physio exercises.

One thing to watch for: sudden swelling that is hot, one-sided, and particularly in the calf warrants a call to us. That is a different situation and needs review.

drchienwenliew.com.au

13/06/2026

Surgery day can feel daunting. Most patients tell me afterward that it was much calmer than they expected.

Here is how the day typically unfolds.

You arrive at Eastwood Private or Calvary Adelaide Hospital (The two newest ones in Adelaide) and get settled into the pre-op gowned wait area. The anaesthesia team comes by to introduce themselves and go over the plan in holding bay. We always check things multiple times - Name, DOB and side for surgery - it's just part of the routine. We never make mistakes because we follow set protocols. I visit before you go to theatre to answer any last-minute questions.

The operation itself takes around 60 to 90 minutes for a primary joint replacement. You spend a short time in recovery, then return to your room.

Within a few hours - or the morning after at the latest - the physiotherapist gets you up and walking. That first walk is usually the moment patients realise the joint already feels different.

Hospital stay is typically 2 -3 nights for a single hip replacement, and up to 3 nights for a knee replacement or bilateral hip.

A few things to prepare: have your prescriptions filled before admission, have someone stay the first night at home, and set up a firm chair with armrests you can push off from easily. Make sure you have a good supply of food at home, and queue up some movies to watch, or books to read. The first few weeks are just short walks, regularly, icing and elevation.

drchienwenliew.com.au

04/06/2026

A question that comes up regularly in clinic, especially for patients planning travel or interstate visits after surgery: when is it safe to fly after hip replacement?

The main concern with flying is deep vein thrombosis (DVT). Surgery increases the risk of blood clots, and prolonged immobility in a plane cabin compounds that risk. This is why timing matters.

For most patients, I advise:

DOMESTIC FLIGHTS (under 4 hours): typically safe anytime after surgery. We have many patients who fly in from all over Australia, who decide to stay in Adelaide a few days after discharge, and then fly home. This is absolutely fine. You will have blood thinners on board, compression stockings, and you should be walking reasonably well.

LONG-HAUL FLIGHTS (over 4 hours): I recommend waiting a minimum of 4 weeks. At this stage, you are walking well, and the blood clot risk has reduced significantly. It's not quite normal as yet, but the risk is far lower.

Even so, there are sensible precautions:

Book an aisle seat so you can stand and walk every hour without disturbing others. Wear compression stockings for the full duration of the flight. Stay well hydrated and avoid alcohol. Perform the exercises that you were given - especially toe wriggling, ankle pumps etc, regularly, whilst on the flight. And it is recommended to take an Aspirin 100mg before take off, and one on landing as well after longer flights. It will thin the blood slightly, and reduce your risks.

If you have had a blood clot before, avoid long flights for 10-12 weeks post op.

The same principles apply to long car trips and cruises. It is the prolonged sitting, not the altitude, that creates the risk.

If you have a specific trip planned, let me know at your pre-operative or post-operative visit and we can plan around it.

drchienwenliew.com.au/learn-hip

04/06/2026

For most of my career, the prevailing view was that doctors don't do social media. I think that's changing, and here's why I changed my mind.

During a consultation, research suggests patients absorb as little as 20 to 30% of what they're told. It's not a reflection on the patient. It's just how the human brain works under stress and information load. That's why we've always tried to deliver information in multiple ways: printed material, videos, follow-up calls.

I actually love instagram - Social media is how I personally consume information. I use Instagram to research new workouts, nutrition advice, ideas for crafts to do with my kids and to be inspired. It's where I go when I want to learn something quickly and visually. It's the medium of this generation, and it's not going away.

So we launched our Instagram page a couple of weeks ago. Its what our patients seem to respond to - What I think we will find is that short, focused posts - a clip about what to expect in week one of recovery, or what goes into a hip implant - will land in a way that a five-page information booklet often doesn't. People will watch them before their appointment. They will share them with family members. It will help us focus attention during the consultation on what specifically matters to each patient.

The feedback has been more positive than I expected. We've been producing educational videos for several years on youtube, and the engagement on the new formats on instagram has reinforced that patients genuinely want this kind of access.

If clear communication matters to you - and I'd argue it should matter to all of us - this is worth considering.

Dr Chien-Wen Liew

Want to see how we approach it? Follow Dr Liew on Instagram.
https://www.instagram.com/drliewhipknee

196 Followers, 51 Following, 32 Posts - See Instagram photos and videos from Dr Chien-Wen Liew Hip Knee Replacement ()

26/05/2026

Something I wish more patients knew before they came to see me: what you do in the weeks before surgery affects your result just as much as what happens in the theatre.

This is what I focus on with every patient before we operate.

NUTRITION

Your body needs protein to rebuild muscle and soft tissue, vitamin C for wound healing, iron to avoid anaemia, and vitamin D for bone health. Many patients arrive nutritionally depleted and do not realise it. A high-protein diet in the 4 to 6 weeks before surgery makes a measurable difference.

WEIGHT

Even a modest reduction in BMI before surgery reduces operative risk, reduces implant stress, and improves functional outcomes. It is not about a number on the scale. It is about giving your body the best possible conditions to heal.

FITNESS AND STRENGTH

Patients who are stronger before surgery recover faster. Simple home exercises, walking, and hydrotherapy in the weeks leading up to the procedure build the muscle reserve that carries you through early rehabilitation.

STOPPING SMOKING

Smoking significantly increases the risk of wound complications, infection, and delayed healing. I ask all patients to stop at least 6 weeks before surgery.

MANAGING MEDICAL CONDITIONS

Blood pressure, blood sugar, and anticoagulation all need to be optimised before we operate. Your GP and I work together on this.

Surgery is a partnership. The outcome belongs to both of us.

drchienwenliew.com.au/learn-hip
drchienwenliew.com.au/learn-knee

23/05/2026

One question I get asked in clinic almost every week: "Is recovering from a hip replacement the same as a knee?"

The short answer is no. Here's what Ive found.:

HIP REPLACEMENT

Hip replacement recovery is generally faster than most patients expect. I perform a direct anterior approach with minimal soft tissue damage, which allows most patients to be up and walking on the day of surgery. Pain is usually well managed with simple medications. Most patients are off their walking aids within 2 weeks and drive within 2-3 weeks. With hips, it's often me holding patients back - stopping them from overdoing it. The bone needs to grow into the implant which takes about 6 weeks for a meaningful attachment so we don't do anything heavy until then.

The early focus is on allowing the swelling to decrease, the internal inflammation to settle, and allowing the bone to grow into the implant. Whilst you won't feel that happening, and everything will feel good, it still takes time and there is nothing patients can really do to speed up the biology of it all.

KNEE REPLACEMENT

Knee replacement takes a little more time and more work. The knee is a more complex joint to rehabilitate. You need to regain range of motion, manage swelling, and retrain the surrounding muscles, all at the same time.

In my practice, I use a kinematic alignment approach for knee replacement. Rather than placing the implant in a fixed mechanical position, I align it to restore the natural anatomy of your knee. This means the joint moves and feels more like your own knee, and patients tend to recover better range of motion compared with conventional techniques.

The key to a good knee outcome is early, consistent physiotherapy. The first 6 weeks are critical. Patients who do the work in that window consistently do better at 3 and 6 months.

WHAT I FOCUS ON FOR BOTH

Regardless of which joint we are replacing, I focus on a few things for every patient:

Getting you ready before surgery. Nutrition matters: protein, iron, and vitamin D all affect how well you heal. Some people find zinc helpful for the wound. I actually really like Creatine and Glutamine for recovery. Optimising any medical conditions beforehand. Making sure you know exactly what to expect, so there are no surprises. Setting a realistic timeframe. Most patients are doing what they want to do by 3 months, but full recovery takes closer to 9.

If you are thinking about either procedure and want to understand your options in more detail, I have dedicated information on both on my website.

Hip replacement: drchienwenliew.com.au/learn-hip
Knee replacement: drchienwenliew.com.au/learn-knee

I am happy to give you an honest assessment of where you are and what makes sense for your situation.

14/05/2026

Wow- what a team at Eastwood! Love this fam. Thanks for making me feel 20, and letting me live out my hoop dreams! Feeling lucky to work and have fun with such legends