kinds of tests will I need before surgery?
patients are required to have routine blood work and urinalysis
performed. These tests cannot be performed prior to 14 days before
the scheduled surgery in order to be acceptable. In addition
all patients are required to have a physical examination which
can be performed at any time within 30 days of the surgical date. Patients
over the age of 50 are required to have an EKG and chest x-ray
performed within 30 days of the surgical date. Patients below
the age of 50 with any cardiac or respiratory history may also
be required to have these tests performed.
pre-admission testing and physical evaluations can be performed
either by the patient's personal physician or at the hospital
where the procedure will be performed.
BE ADVISED that if an abnormal exam or test result is reported,
you may need a further evaluation or repeat testing performed.
This does not necessarily mean surgery is canceled, but for your
own safety, further investigation of any abnormalities is the
I need to donate blood before surgery?
surgeries do require the patient to donate blood if possible.
If your physician requests blood donation, this can be done any
time within 35 days of the surgical date. The number of units
that can be donated prior to surgery will be discussed with the
patient by their physician. When units of blood are donated, the
patient's blood levels are monitored prior to each donation in
order to assure the patient's safety.
the patient cannot donate his or her own blood, a designated donor,
usually a family member or relative, may donate blood for the
patient. This is done through the Red Cross Blood Donor Centers
and the units then transported to the hospital for the patient's
a patient is unable to donate blood and there is no designated
donor, the patient will receive blood from the hospital Blood
Bank if necessary. The hospital follows universal guidelines in
screening blood and blood products to ensure the patient's safety
as much as possible in this situation.
there any medicines I need to take before surgery?
is recommended that patients take an iron supplement prior to
surgery particularly if you will be donating your own blood. These
supplements may be purchased at any drugstore or recommended by
your family physician.
there medications I need to stop taking before surgery?
medications may be taken up to the day of surgery. If you are
currently taking an anti-inflammatory medication containing aspirin,
this should be discontinued two weeks prior to surgery unless
you are instructed otherwise by your physician. These medications
tend to act as blood thinners and this is the reason for recommending
thinning medications such as Coumadin or aspirin are also discontinued
prior to surgery. However, the exact times of discontinuing these
medications are made on an individualized basis and should be
checked with your personal physician for the correct method regarding
long will I be in the hospital?
joint replacement surgery, most patients are hospitalized 4 days,
including the day of surgery. This may vary if the patient is
either going to a rehabilitation center, a sub-acute facility,
or not cleared medically or surgically for discharge home.
Most insurance covers 3-4 days of acute
care in the hospital for total knee replacement surgery. Some
insurances do provide for further care in several other types
of facilities. It is advisable for each patient to contact their
health insurance provider for specific programs covered and to
obtain these provisions in writing.
should I bring to the hospital?
patients should bring with them personal toiletries and shaving
gear, loose fitting COMFORTABLE clothing; non-skid shoes or slippers
(slip-on type with closed back preferred), a list of their current
medications (including dosages), and any paperwork the hospital
may have requested.
The hospital provides pajamas, gowns, robes, slipper socks, and
a small toiletries supply. Most patients, however, do supplement
these with the articles outlined above, at least in terms of toiletries.
addition, if you have an assistive device that you plan to use
after discharge (i.e. walker, cane, crutches) but are not currently
using, you should have someone bring this in prior to discharge
so the physical therapist can check to assure that it is the adequate
size for you.
NOT BRING radios, TV's, or large amounts of cash.
should I arrive at the hospital for my surgery?
are requested to arrive at the hospital 2 HOURS prior to the scheduled
surgery time. This allows time for you to go through the admission
process, change into hospital clothing, meet the anesthesiologist
and nursing personnel who will be with you during your surgery,
and get any questions pertaining to this process answered.
You should have nothing by mouth from midnight
on the day of your surgery. In some cases you may be allowed to
take a medication the morning of surgery. If this is the case,
you should take the medication with the least amount of water
necessary. Report to the admitting nurse any medications (and
dosage) you may have taken.
my family stay with me during this time?
may stay with patients until the patient is taken to the operating
anyone contact me before surgery to discuss any concerns I may
orthopaedic surgery patients are followed throughout their experience
by a case manager. This is an R.N. who is familiar with our routines
and procedures. The case manager's role is to assist the patient
in planning for discharge, answer any questions the patient may
have in terms of their case, and provide a supportive link throughout
the patient's surgical experience. You will be contacted by the
case manager prior to your surgery and assisted in planning for
your individualized case management. The case manager also will
schedule you to attend a pre-operative class in which you and
your family members will receive instruction for each phase of
your surgical experience. The classes are held on a rotating weekly
schedule for total hip and total knee patients and are highly
recommended. By attending class, both you and your case manager
are better able to plan for your upcoming surgical experience.
type of anesthesia will I have?
of our cases are performed under spinal anesthesia. We feel this
is the safest anesthesia for you and unless there is a recommendation
from the anesthesiologist, this is the method preferred. You will
be meeting with the anesthesiologist on the day of surgery and
at that time any questions or concerns regarding this will be
long will the surgery take?
upon the difficulty of your case, the surgery may take several
hours. In general, you should expect 2-3 hours in surgery and
2-3 hours in the recovery room.
the surgeon see my family immediately after surgery is completed?
possible, the surgeon or one of his assisting surgeons will meet
with family members immediately after surgery. If for any reason
the family misses seeing the surgeon, they should contact his
office the next day and all efforts will be made to arrange a
time for the surgeon and family to discuss the patient's surgery.
will my hospital stay be like?
first night of your stay, you will more than likely be somewhat
"groggy" from the medications you receive in surgery.
You will be taken to your hospital room directly from the recovery
room in your hospital bed to avoid transferring you from stretcher
to bed. Once you are fully awake, you will be able to eat and
drink as tolerated. Your vital signs, urinary output, and any
drainage will be monitored closely by the nurses on the orthopaedic
surgery floor. Pain medicine for the first 24 hours may be administered
by intravenous method (the PCA pump-) and you will be shown how
to use this device to assist in controlling your pain level.
on day one post-operatively, you will be getting out of bed and
attending physical and occupational therapy sessions. These sessions
are vital to your progress and are arranged for 2-3 sessions each
day, each session lasting 45 minutes to 1 hour. The physical therapists
attending you will teach you the exercises needed for your optimal
recuperation and instruct you on your weight bearing technique
using a walker or crutches. The occupational therapist is trained
to assist you in adapting your activities of daily living to your
post-operative limitations. Activities such as bathing, dressing,
using the bathroom, transfers from bed to chair, ambulation, and
stair climbing will all be addressed during these sessions. Instructions
for traveling by car or in some cases car and plane will also
I see my doctor regularly while in the hospital?
attending doctors make rounds daily on their patients whenever
possible. In addition, the orthopaedic resident doctors make rounds
twice daily to monitor your progress and make any changes required
for your care. The case manager will also meet with you (and family
members if necessary) in order to assure the proper discharge
plan for your particular case. Arrangements for transfer to a
rehabilitation floor or sub-acute floor either at the hospital
or elsewhere will be evaluated by you and the case manager if
this becomes an option.
will I be ready for discharge?
on whether you go home or to another facility to recuperate will
play a role in when discharge occurs. In general, a patient can
be transferred to the rehabilitation floor on the 2nd post-operative
day. Transfer to the sub-acute floor may occur on the 2nd or 3rd
post-operative day. If you are being transferred to another facility,
transfers usually occur on the 2nd or 3rd post-operative day as
well. Discharges to home occur on the 3rd to 4th post-operative
day in general.
will I know whether to go home or to another facility for further
general, if you live with someone who will be assisting you, discharge
home is the usual procedure. Arrangements for further home or
out-patient P.T. will be made by the case manager. Most patients
can go directly home if they are deemed safe by the physician
and therapists. While not required, it is highly recommended to
have someone to assist you the first 48-72 hours after discharge
on a full-time basis and perhaps part-time the 1st WEEK or two
after this. If you live alone or are in an environment at home
where your safety is in question (i.e. PT/OT goals not met), you
may be recommended for placement in a rehabilitation center. These
facilities are usually available to a patient for a 3-5 day stay,
with emphasis on returning the patient home in a short period
after aggressively addressing any problems with patient independence.
If you live alone or are not progressing rapidly enough in therapy
sessions and it is unlikely you will be able to do so in a rehab
setting, a sub-acute facility may be recommended for a longer
period of recuperation. The choices available are influenced by
insurances in some aspects and, therefore, will need to be discussed
by the patient, the case manager, and the insurance companies
can I expect the first few days after discharge?
a time of transition. You may feel overwhelmed the 1st day or
two after discharge and may even feel you've made a mistake coming
home so soon. This may occur even after discharge from a rehab
or sub-acute floor. Be patient, and give yourself some time to
adjust. Many patients report that after the 1st day or two of
practical problem solving and establishing a routine, they experience
a change in their progress and notice a definite upward trend
to their recuperation.
this phase of discharge, usually within the 1st 24-72 hours after
discharge, you will receive a telephone check-up from your case
manager. You will be asked several questions to establish your
progress and whether your post-discharge home or out patient therapies
have been started. This phone call also allows you to ask any
questions or voice concerns regarding your home situation so they
can be addressed.
I need someone to stay full-time with me when I go home?
is our recommendation that someone be with you the first 24-72
hours after discharge. Many patients do live alone and we realize
this is not always possible. But if you have a relative or a friend
who offers to stay with you, take this offer for your own ease
of mind. Many times patients have family members or friends who
stay with them all day in the hospital. While this is certainly
welcomed, it is often more helpful that this person be available
after you leave the hospital. If you do live alone and either
are discharged from rehab or from the orthopaedic floor with no
help available at home, perhaps a friend or neighbor can call
you daily to check on your progress. In addition, if home care
has been arranged, these visits usually can be arranged so that
someone is checking on you daily. The case manager will be discussing
options available for your particular circumstances, and together
you will develop a discharge plan which addresses your particular
can I go up and down stairs?
will be practiced in the physical therapy program before you
leave the hospital. Most patients can climb stairs before leaving
the hospital. If you live in a 2 story home and have practiced
stairclimbing, stairs can be done one to two times a day after
discharge depending upon your needs and your comfort level.
I need pain medicine after I'm discharged from the hospital?
patients do require a short term course of pain medicine. Renewals
on these prescriptions can be obtained by calling our offices.
Expect to be on some type of pain medication for several weeks
after discharge. Most patients take these medications especially
at night or before therapy sessions.
long will I need to use my walker or crutches?
and/or crutches are used the 1st 6 weeks after surgery. You
then will be allowed to use a cane which again will be for 6
weeks. After that time, most patients do not need any support
can I go outside?
the physician's aspect, you may go outside at any time. Comfort
and safety should be the primary guidelines for doing this.
We suggest starting with short trips at first, perhaps to therapy
or church. Gradually increase the number and length of outside
activities as you feel more comfortable.
can I drive?
routinely is not permitted before 6 weeks from the time of your
surgery. However, some physicians will allow the patient to
drive earlier if they feel the patient can do so safely. The
type of surgery, side of surgery (left vs. right leg), and the
patients overall general condition plays a part in this decision.
you feel you will need to drive earlier than the 6 week routine
prescribed, you should discuss this with your surgeon and
obtain his approval.
will I be able to return to work?
varies with each patient. In general, patients usually do not
return to work until after their first check-up at 6 weeks from
surgery. Some patients do return to work earlier if they can
do so safely. This should be discussed with your physician so
that the best decision for your individual situation is made.
will I be able to participate in sports activities?
upon what activity you want to participate in will determine
when you can start these again. Swimming, walking distances
(hiking), bicycle riding, golfing, and other low impact sports
activities can likely be tried after a few weeks. Returning
to high impact activities such as jogging, tennis, or aerobics
exercises will probably not be recommended for quite some time.
Your return to any of these activities should be discussed with
will I be able to have sexual intercourse after my surgery?
most cases, sexual activities can be resumed when the patient
feels comfortable enough to do so. If the patient has been cautioned
to maintain certain position restrictions, these restrictions
will need to be followed in this instance also. In general,
most patients resume their normal sexual activities between
4-6 weeks following surgery.