Dray Orthopaedics Ltd

03/05/2025

Recovery from hip and knee replacement surgery..

Hip and knee replacements give most people excellent pain relief for decades and although expensive upfront (approx costs $25-30,000), are two of the best-value health spends in terms of quality of life gained.

Typically, recovery from these 2 hour operations involves 2-3 days in hospital, crutches for about 6 weeks.
Physiotherapy is very important, and at https://royston.co.nz and https://roystonds.co.nz, we work closely with our in-house physiotherapists https://www.focushealth.co.nz. Ongoing physiotherapy is important after you go home, too, for the first 6 weeks.

People are 80-90% recovered from hip and knee replacement surgery by about 2-3 months, but improvement continues for 12-18 months.

Knees are warm and swollen for up to 12 months - this is normal, not a concern.
A small percentage (3-5%) of people get stiff and may need a manipulation under anaesthetic at around 3-4 months if their knees are not bending (flexing) enough.

Hip replacement has a small risk of dislocation (2-3% of people), so physiotherapy is important to rehabilitate the protective muscle function and learn techniques to avoid this problem.

95% of hip and knee replacements last at least 15 years without needing further surgery, and many will last decades.

NZ-trained orthopaedic surgeon at Royston Hosp. Hip, Knee, Ankle Replacement, foot & ankle surgery

03/05/2025

Ankle replacement update ….

For 18 months now, I’ve been using a new ankle replacement (Infinity) which comes with two advantages:

Firstly, it has a porous metal backing where the two metal components attach to the bones. During the healing process, this allows the bone to grow onto, then into, the metal backing, essentially ‘welding’ it in. This has proven to be an important advance in hip replacements, and is now available with ankles too. Longterm, this should reduce the need for revision, or ‘re-do’ further surgery.

Secondly, positioning of the ankle replacement components is enhanced by having a planning CT scan, then custom cutting blocks made from the CT scan . This ensures optimal positioning of the metal components. I have found this very useful and I do think it is improving function for ankle replacement patients.

07/09/2024

Heel Pain...

heel pain is unpleasant, and there are 4 main causes - bursitis, plantar fasciitis, and insertional and non-insertional Achilles tendonitis.
I will go through each cause in detail...

1. Non-insertional Achilles tendonitis.

This often starts without an injury, and in most people it will settle within a year. It is typically worse on start-up (eg: when you get up each morning).
The first treatments to try are

- gentle calf stretches (Alfredson's protocol - Physiotherapy can help with this),
- weight loss,
- wear a Strassburg sock in bed at night to hold the calf and tendon gently out to length (available on internet for about $40),
anti-inflammatory medications if you can take these,
- shockwave therapy (in Hawkes Bay Boyce Podiatry and Hawkes Bay Sports Medicine can provide this).

If it hasn't settled after trying these measures and giving it plenty of time, surgery to strip the paratenon and fenestrate the tendon can help.

2. Retrocalcaneal bursitis.

In my experience this rarely occurs on its own, and is usually present with insertional tendonitis. However if you have retrocalcaneal bursitis, it will be tender if you pinch each side and just in front of the Achilles tendon where it meets the heel bone.
It can respond to a cortisone injection into the bursa, best done under ultrasound for accuracy. I would not recommend more than two injections for this problem as it may predispose you to an Achilles rupture.

3. Insertional Achilles tendonitis.

this is when the heel is sore at the back where the Achilles joins it, and there is often a bony spur that has built up over many years within the substance of the tendon.
It may settle with time and stretches, shockwave, shoes that don't rub, etc.
If it isn't settling, surgery to detach the Achilles insertion, remove the spur, then reattach the tendon to the heel bone, is very successful at treating both the bursitis and the Achilles pain.
Aterwards, you need a cast then a moonboot for a total of 6 weeks, then rehab.
Results are very good with this surgery, and almost everyone gets complete relief of their pain.

4. Plantar fasciitis.

this is pain under the heel, and is often worst on start-up.
It will usually settle within a year and measures that can help are stretches, weight loss, gel heel pads in your footwear, a Strassburg sock, shockwave therapy, a cortisone injection.
If the pain hasn't settled after a year with these treatment measures, an operation to release a tight calf muscle sinew (called PMGR - Proximal Medial Gastrocs Release) works well in 80-90% of people.
Rarely, release of the plantar fascia itself may be needed, but it is preferable to try the PMGR first.
the spur seen on Xray under the heel isn't usually the source of the pain.

25/08/2024

I’ve written some printable information sheets for surgery, available in the drop-down menu of my homepage

24/08/2024

Hip and Knee Arthritis …

Hip and knee replacement surgery is very successful at relieving pain, with modern designs of replacements lasting decades in most people - 95% of replacements still functioning well 15 years later, and many will last much longer. If you are 60 or older, a hip or knee replacement has a 90% chance of lasting the rest of your life.

Risks are broadly similar - small risk of serious complications such as infection (

01/06/2024

Sports Ankle Injuries...

Rolled ankles are very common injuries.
Most will settle with time and physiotherapy, and can take up to a year to recover.
Don't focus on swelling - if you are getting better, swelling will be the last thing to settle, and can also take up to a year to resolve.

But pain and instability can persist, and sometimes surgery is necessary to restore stability and relieve pain.

Reasonable early treatment includes a short period of rest in a cast or moonboot, but then early functional physiotherapy.
An X-ray if there is suspicion of a fracture, or ultrasound to look at tendons/ligaments, can be useful if pain is not settling.

From my point of view, the worst thing is to stay in a moon boot without early movement and physio, for prolonged periods - this can lead to delayed recovery, worse pain and stiffness.

Pain from bone bruising and sprained, thickened ligaments will slowly settle with time, upto a year in some people.
However, sometimes surgery may be necessary for the following problems -
(1)ongoing instability,
(2) deep ankle pain or clicking/catching,
(3) interstitial tendon tears than are remaining painful...

Instability:
most people roll their ankles into inversion, which can tear the lateral ligaments (outer side of the ankle). two of these ligaments are called the ATFL and CFL. In 90-95% of people, these will heal over time and immediate surgical repair is not needed. a small number of people will develop ongoing instability where the ankle keeps rolling easily or feels untrustworthy: the ligaments can be reconstructed if this is the case. Only 5-10% of people will need this.

Deep ankle pain/clicking:
when the ankle rolls, the edge of the talus (ankle bone) can get chipped in its socket. this is called an osteochondral lesion. It can heal, but some cause ongoing deep pain and/or clicking/catching. These can be addressed arthroscopically (keyhole surgery) and 90-95% heal after this surgery. These can show up on Xray, but often don't - they can be detected on MRI scan.

Interstitial tendon tears:
the sudden unexpected force through a tendon when the ankle rolls can rupture the tendon, but more commonly causes it to split longitudinally - the tendon remains intact and strong, but can hurt. Some settle with time, but some need to repaired with surgery - the split is stitched up along its length.

A common operation for an ankle that is not settling is to do a combination of arthroscopy, ligament reconstruction and tendon repair. this can usually be done as day surgery, and you need 3 weeks of rest in a cast or moon boot while wounds heal, then physiotherapy and weaning out of the moon boot over 4-6 weeks. It takes at least 2-3 months to recover from this.

(pictures: MRIs showing torn ATFL ligament, and talus osteochondral injury)

27/01/2024

Bunions…..

Bunions can cause different problems - they can rub on footwear, cause overload of the ball of the foot (under 2nd and 3rd metatarsal heads), which can eventually lead to clawing of the lesser toes.
Less commonly, the overload of the ball of the foot can lead to midfoot arthritis.

Modern surgery for bunions is much less painful than 20-30 years ago, and most patients report they had much less pain than they were expecting, and they wish they’d had the surgery years before. The ‘old days’ of casts, agony, and long recoveries are gone - but stories of how painful this surgery used to be, still puts people off.
Once the bones have been realigned, they are held in place, and this, plus local anaesthetic injected around the ankle, usually means there is no pain when you wake up from the anaesthetic.

Most of the time, both feet can be done together if necessary, you can walk ‘flat-footed’ in bandages and post-op shoes afterwards, and we take X-rays at 6 weeks to check the bones have healed.

If it’s your right foot, you shouldn’t drive for 6 weeks.

Hawke’s Bay Orthopaedic - Dray Orthopaedics specialises in hip, knee, ankle replacement, bunion, foot and ankle surgery.

21/01/2024

Ankle Arthritis Replacement versus Fusion

Ankle arthritis is much less common than in hips and knees, and is usually from old injuries. The younger, heavier, working patient is best treated with an ankle fusion, which gives reliable pain relief but the ankle is stiff - the other joints in the hind foot still move to compensate for this to some extent.

Ankle replacement is an option for lighter patients (eg: less than 85-90kg), and ideally retired, or lower-demand. The advantage is the joint still moves so feels more natural than a fusion. It has an 85% survival over 10 years.

18/01/2024

Knee Joint Replacement

Knee replacement is a well-proven operation for arthritis pain. It gives years of relief - 95% of replacements lasting 15 or more years, and many lasting 20-30 years. If you are 60 or older, a knee replacement has a 90% chance of lasting the rest of your life.

Surgery takes about 2 hours, you need 3 nights in hospital, and crutches for the first 6 weeks. Attending Royston Joint School before surgery means you will know what to expect after your operation, and have a better recovery. There are small risks of blood clots, infection, stiffness, and temporary numbness beside the scar. But the most likely outcome is a good result with years of benefit.

Hawke’s Bay Orthopaedic - Dray Orthopaedics specialises in hip, knee, ankle replacement, bunion, foot and ankle surgery.

18/01/2024

Hip Replacement

Hip replacement is a well-proven operation for arthritis pain. It gives years of relief - 95% of replacements lasting 15 or more years, and many lasting 20-30 years. If you are 60 or older, a hip replacement has a 90% chance of lasting the rest of your life.

Surgery takes about 2 hours, you need 3 nights in hospital, and crutches for the first 6 weeks. Attending Royston Joint School before surgery means you will know what to expect after your operation, and have a better recovery. There are small risks of blood clots, infection, dislocation. But the most likely outcome is a good result with years of benefit.

18/01/2024

I am a NZ-trained orthopaedic surgeon, practising at Royston Hospital here in Hastings, Hawkes Bay since 2010. I specialise in Hip, Knee and Ankle replacements, and all aspects of foot & ankle surgery. I welcome your referral - please contact us if you have any queries about the referral process.