Unless a patient has a fracture, dislocation, tumour or rapidly progressive deformity, orthopaedic surgery is always a choice. These exceptions generally require surgery to prevent deterioration or irreversible change. For everything else, the decision is made jointly between the patient and Mr Balakumar, based on a clear understanding of the diagnosis, the available options and the patient’s own goals.
No one is pressured towards surgery. If non-surgical management is appropriate and the patient is managing well, that is the recommended course.
(03) 9573 9659
For most hip and knee conditions, non-surgical management is the appropriate starting point. Depending on the diagnosis, this may include physiotherapy, activity modification, weight management, anti-inflammatory medication, bracing, orthotics, and injections such as cortisone or PRP.
It is worth noting that taking pain medication long-term is generally safe for most patients and is not, by itself, a reason to have surgery. The decision to operate should be based on the impact the condition has on the patient’s life, not on a desire to avoid medication.
Symptoms that have not responded adequately to a sustained course of non-surgical treatment. Conditions that are progressive, where delay is likely to result in worse long-term outcomes, such as untreated impingement or dysplasia in a younger patient with preserved cartilage. Significant functional limitation affecting work, daily activities or quality of life. Imaging findings that clearly confirm the diagnosis and are consistent with the clinical picture.
The appropriate timing of surgery varies by condition. For some joint preservation procedures, early intervention produces better long-term outcomes than waiting until cartilage damage is more advanced. Mr Balakumar discusses timing honestly at the consultation.
At the first consultation, Mr Balakumar reviews the history, examines the joint and discusses imaging. He explains his findings clearly, outlines the available options and makes a recommendation based on the clinical picture. If surgery is discussed, patients are given time to consider the information and ask further questions before deciding. Informed consent is a process, not a single conversation.
The answer to the question of whether to have surgery ultimately depends on the patient’s symptoms and how much those symptoms are limiting their life. For an active athlete with an impinging hip, early surgery may be the right choice to return to sport. For someone with a less active lifestyle, lifestyle modification and non-surgical management may be entirely appropriate.
There are many orthopaedic surgeons in Melbourne. What sets Mr Balakumar apart is the breadth of his training and his ability to treat the same patient across their entire lifetime, from a hip condition detected at birth through to joint replacement in later life.
His fellowship at Harvard’s Children’s Hospital in Boston is one of the most competitive surgical training programmes in the world, and one that rarely accepts foreign-trained surgeons.
The mentors he trained under, including Dr Mike Millis and Dr Young Jo Kim, are among the surgeons who defined modern hip preservation surgery. That training, combined with his adult hip and knee practice, gives Mr Balakumar a clinical perspective that very few surgeons in Australia can offer.
He has run a fellowship programme in Melbourne for over 10 years, training surgeons who now work at leading institutions around the world. He publishes research, presents at international conferences and collaborates with radiologists at the Royal Children’s Hospital on advanced cartilage imaging techniques that inform his surgical decision-making.
None of that changes the way he approaches a consultation. Every patient gets a thorough assessment, an honest account of their options and enough time to ask the questions that matter to them. Surgery is recommended when the clinical picture supports it, and not before.
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.
(03) 9573 9659
