BEFORE SURGERY
WHAT TESTING WILL I NEED BEFORE SURGERY?
You are required to have pre-admission testing before surgery to assess if you are medically fit to tolerate the surgical procedure. This will be scheduled with your primary care physician. Pre-admission testing will include a history and physical, routine blood work, EKG, and a chest x-ray. In some instances, other testing may be ordered. For example, if you have a history of heart disease, a stress test may be ordered. Your physician may also coordinate any other consultations with medical specialists if they believe it is necessary for appropriate surgical optimization.
WHAT ABOUT MY DAILY MEDICATIONS BEFORE SURGERY?
At the time of your pre-admission testing, your doctor should review the medications you take routinely. You will be advised of any medications that you need to stop before surgery, such as anti-inflammatory pills. You will also be told which medications you may take the morning of surgery. Specific instructions will be given regarding blood thinning medications, and how far before surgery to discontinue.
HOW LONG WILL I BE IN THE HOSPITAL OR SURGERY CENTER?
Depending upon the procedure, your insurance coverage, and your health status, there is a good chance your procedure can be done as an outpatient, allowing you to come in and go home the same day. Some patients will require a hospital stay, and the average length of that stay is 1 – 2 days. Length of stay is determined by activity progress, medical progress, and wound condition. Insurance authorizations are frequently required, and my office will take care of this for you. If additional hospital inpatient days are needed, a hospital representative will contact your insurance company to provide medical information and obtain additional authorized days.
WHEN SHOULD I ARRIVE AT THE HOSPITAL OR SURGERY CENTER FOR MY SURGERY?
The hospital or surgery center will call you the afternoon (1 business day) before your surgery and tell you what time to arrive. Once you arrive to the hospital or surgery center you will go through the admission process, change into hospital/surgery center clothing, meet the anesthesiologist, and meet hospital or surgery center staff who will be caring for you. Specific surgery times are not given. Typically, you can expect to undergo your surgery within a few hours of the arrival time. Occasionally situations occur which may result in a delay. You are to eat nothing by mouth (NPO) from midnight until after your surgery. In cases where you have been instructed to take medications the morning of surgery, you should do so with a sip of water if necessary.
WILL I HAVE AN OPPORTUNITY TO ASK QUESTIONS?
Questions and concerns will be addressed at the time of your pre-operative office visit. Another opportunity to ask questions is during the time of your pre-admission testing with your internal medicine physician. If you have any additional questions, please feel free to call our office at (954) 747-1221.
HOW LONG WILL MY JOINT REPLACEMENT LAST?
What you are really asking is: what is the chance I will need another procedure or when will I need another procedure on my new joint? Overall, only about 10% of joint replacements will fail or need to be redone. Each individual patient’s chance of needing another procedure is about 1% per year, so 20 years from surgery, you have a better than 80% chance the joint is doing fine. This is true of hip, knee, and partial knee replacements.
CAN I REPLACE BOTH SIDES AT THE SAME TIME?
Although it is common to have arthritis in more than one joint, there is more risk with doing two surgeries at once. There’s increased risk with longer anesthetic times, increased blood loss, increased risk of blood clots, and increased chance of hospital re-admission. Typically, we recommend operating on the more painful joint first, and then staging the other joint for 6 weeks later to avoid these risks.
SURGERY
WHAT NATURE OF ANESTHESIA WILL I HAVE?
Surgeries are performed using general, spinal or nerve block anesthesia, or a combination of these. In some cases, the medical physician or anesthesiologist will have specific recommendations. The anesthesiologist will meet with you the day of surgery to discuss these options. At that time, feel free to voice any questions.
HOW LONG WILL SURGERY TAKE?
Knee and hip replacement surgeries require approximately one hour. If the surgery is a revision or a difficult case, the procedure may take several hours.
HOW WILL MY FAMILY KNOW WHEN THE SURGERY HAS BEEN COMPLETED?
Following your procedure, the surgeon will visit the waiting area to speak with your family members.
AFTER SURGERY
WHAT HAPPENS AFTER SURGERY?
After surgery, you will be taken to the post-anesthesia care unit (PACU) where you will be monitored closely for one to three hours. You will then be taken to your private recovery room or hospital room where you will be reunited with your family. Your nurse will perform assessments frequently until you are ready to leave the hospital or surgery center. Pain medication will be administered. You will have an intravenous line (IV) and pumps on both calves that will intermittently pump – keeping blood circulating and helping prevent blood clots. Some patients will have a heart monitor. Your surgeon strongly recommends that you take the portable calf pumps home with you as they are the safest and most effective way of preventing blood clots. You will be instructed to perform several exercises every hour including: deep breathing, ankle pumps, quad sets, and buttock squeezes.
If your procedure requires a hospital stay, wound dressings for the knee will be removed the day after surgery and a light dressing will be placed. Most hip replacements will have a clear dressing that is left in place for 5 days; however, some hip dressings will be changed the day after surgery as well.
Support stockings are used for all surgeries and are helpful in reducing leg swelling after surgery. These stockings are also helpful in keeping knee dressings in place and acting as a skin barrier for icing and the leg pumps. However, these stockings are NOT mandatory and can be removed or used as needed after the second post-operative day.
HOW WILL MY INCISION BE CLOSED?
Your incision may be closed one of several ways depending on multiple factors including the type of surgery and health of the skin. Most incisions are closed with an absorbable suture underneath the skin, and then a skin adhesive (skin glue or Dermabond) above. You may have a clear dressing over a hip wound that should be removed in five days. Otherwise, your incision may be closed with the more traditional method of skin staples, which will be removed three weeks after your surgery. Some incisions are closed with a surface closure called “ZipLine,” and this should be removed 10 – 14 days after surgery.
WHEN WILL I START PHYSICAL THERAPY?
You will begin physical therapy sessions the day of or the day after surgery. These are scheduled for twice a day, each day during your hospital stay. Therapists are a very important part of your rehabilitation and will be instructing you on exercises, walking, stairs, getting in and out of a car, using the bathroom, and reviewing “Do and Don’t” precautions. If you are discharged to home the same day as your surgery, you will be provided with instructions for participating in the “MyMobility” home exercise program and a prescription for outpatient physical therapy 3 times per week (as needed if not meeting the home exercise program goals). Exercises should start within 24-48 hours of surgery.
WHEN WILL I SEE MY SURGEON?
At the surgery center, the surgeon will be present throughout the day and monitoring your progress towards going home. At the hospital, the surgeon and the orthopedic team make rounds each morning whenever possible. If your surgeon is not available you will be seen by his associate.
WILL I BE DISCHARGED HOME OR SOMEWHERE ELSE FOR REHABILITATION?
As an outpatient, you will be able to return home the same day as your procedure. We do have the ability to keep you overnight, should the need arise. From the hospital, you will usually be discharged to home once your physician determines that therapy goals of independence and safety have been met. It is important for most people that you have family or friends with you for several days to two weeks.
In situations where goals have not been met, or if you live alone and there are problems with independence and safety, additional physical therapy and inpatient rehabilitation may be needed before you can go home. Case managers from the hospital or the administrator of the surgery center will help arrange for rehabilitation if this is necessary.
DISCHARGE/RECOVERY
CAN I GO UP AND DOWN STAIRS?
Following release from the center or before you are discharged to home, the physical therapist will instruct you on stair climbing. We discourage more than one flight up and down a day until your strength and stamina allow it. This may be several days or weeks. In home settings with no sleeping accommodation on the main living level, necessitating several trips up and down stairs, a hospital bed may be needed.
WHAT ABOUT PAIN MANAGEMENT AT HOME?
You have signed a controlled substance agreement that helps guide you on what to expect following surgery. You will be given a specific set of pain prescriptions and very specific instructions guiding their use. You will likely need pain medication for several weeks or more. You will be provided with a narcotic prescription when you leave the surgery center or hospital. It is helpful to coordinate medication doses before exercises and bedtime. Should you need additional medication beyond this prescription you will need to contact our office during regular business hours for a refill.
HOW LONG WILL I NEED TO USE MY WALKER OR CRUTCHES?
Patients typically require a walker or crutches for 1 – 2 weeks and then a cane for an additional 1 – 2 weeks. The choice of assistive device and duration of use varies widely and depends upon the type and extent of your surgery, as well as your general physical condition.
WHEN MAY I DRIVE?
Driving is usually deferred for 3 – 6 weeks after surgery, particularly if surgery was performed on the right leg. Driving is discouraged not only because of the surgery to your hip or knee, but also because of the possible side effects of your pain medication. However, if you feel safe and capable to handle the vehicle, and you have stopped taking narcotic pain medications, you may resume driving at your own discretion.
WHEN CAN I GO BACK TO WORK?
Usually patients are away from work for about 6 to 12 weeks after surgery. Decisions to return to work are based on patient progress, unique situation, work type, and patient choice issues.
WHEN CAN I RESUME SPORTING ACTIVITIES?
Individual ability and endurance will differ between patients. Activities such as swimming, bike riding, golf, hiking, and low impact sporting activities can be resumed somewhere between 6 and 12 weeks after surgery. You may resume high impact activities, but when performed regularly, this high level of activity may accelerate polyethylene wear and may decrease the life of the joint replacement. Discuss any specific activity questions with your surgeon directly.
ARE THERE ANY SPECIAL CONCERNS WHEN GOING TO THE DENTIST OR ANOTHER DOCTOR?
The use of antibiotics for infection prophylaxis in joint replacement patient is a controversial subject. We recommend lifelong antibiotic prophylaxis for all patients who have had a joint replacement who are undergoing a dental cleaning, extraction, root canal, or filling. We recommend a dose of Amoxicillin before and after the dental procedure. In situations of procedures involving skin penetration, or testing involving the gastrointestinal and genitourinary tract, we also recommend preventative antibiotic administration. Prescriptions for prophylactic antibiotics for these procedures can be obtained by your dentist, your physician performing the procedure, or our office before your procedure is performed. It is recommended that you report your joint replacement to any physician you may see.
WHAT IS AN EXPLANATION OF BENEFITS (EOB)? IS IT A “BILL”?
An EOB is a document provided to you by your insurance company that explains how your insurance claim and charges were processed from the multiple providers that cared for you. It is NOT a bill, but the EOB may be a preview of what you owe the providers that cared for you during the surgery.
WILL I RECEIVE DIFFERENT BILLS FROM DIFFERENT PROVIDERS OF CARE?
It is very common to receive a bill from each of the providers that participated in your care including your surgeon, the facility, the pre-admission testing physician, and the anesthesiologist. How much you will owe is determined by your insurance plan and other factors like your deductible, co-pay amounts, and co-insurance responsibilities.
