Accurate imaging is central to how Mr Balakumar assesses knee conditions. A knee X-ray taken lying down tells a very different story to one taken standing under full load, and the difference matters when making decisions about treatment. Mr Balakumar requests weight-bearing X-rays as standard because they more accurately reflect what is actually happening inside the joint during normal daily activity.
Imaging is always reviewed alongside the clinical history and examination. A finding on a scan does not automatically mean it is the source of a patient’s symptoms, and Mr Balakumar takes care to ensure that treatment recommendations are based on the full clinical picture rather than imaging findings alone.
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Weight-bearing X-rays of the knee are the standard starting point for most knee assessments. Taking X-rays with the patient standing applies load to the joint, which more accurately reflects the true degree of joint space narrowing compared to non-weight-bearing views.
Mr Balakumar typically requests standing views of both knees plus a skyline view to assess the patellofemoral joint. In patients with suspected leg mal-alignment, a full-length standing leg X-ray is requested to measure the mechanical axis of the limb accurately. The radiation dose from plain X-rays is small and equivalent to background radiation from a short-haul flight.
MRI is the most detailed imaging modality for soft tissue structures in the knee. It provides clear images of the menisci, cruciate and collateral ligaments, articular cartilage and surrounding soft tissues. MRI does not involve radiation. MRI is used when there is clinical suspicion of a meniscal tear, ligament injury, cartilage lesion, or when the diagnosis remains unclear after clinical assessment and X-rays.
It takes 30 to 45 minutes and requires lying still in a narrow tunnel. Patients with pacemakers or certain metal implants may not be suitable.
A bone scan may be used in selected knee cases, particularly when assessing the stability of a knee replacement or investigating an unusual cause of knee pain.
It involves less radiation than CT and provides functional rather than anatomical information.
Mr Balakumar is one of a small number of surgeons in Australia with formal training in both paediatric and adult hip surgery. His fellowship at Harvard’s Children’s Hospital in Boston, under some of the world’s leading specialists in hip preservation, gives him a depth of expertise that is difficult to find in a single practice.
His approach is the same whether the patient is 6 months or 65 years old – thorough assessment, honest options, and no pressure toward surgery until the clinical picture clearly supports it.
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