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What kinds of tests will I need before surgery?

All 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.

Most 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.

PLEASE 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 standard procedure.

Will I need to donate blood before surgery?

Some 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.

If 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 use.

If 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.

Are there any medicines I need to take before surgery?

It 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.

Are there medications I need to stop taking before surgery?

Most 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 discontinuing them.

Blood 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 this.

How long will I be in the hospital?

For 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.

PLEASE BE ADVISED 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.

What should I bring to the hospital?

All 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.

PLEASE BE ADVISED 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.

In 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.

DO NOT BRING radios, TV's, or large amounts of cash.

When should I arrive at the hospital for my surgery?

Patients 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.

PLEASE BE ADVISED 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.

Can my family stay with me during this time?

Families may stay with patients until the patient is taken to the operating room.

Will anyone contact me before surgery to discuss any concerns I may have?

The 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.

What type of anesthesia will I have?

Most 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 addressed.

How long will the surgery take?

Depending 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.

Will the surgeon see my family immediately after surgery is completed?

Whenever 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.

What will my hospital stay be like?

The 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.

Starting 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 be discussed.

Will I see my doctor regularly while in the hospital?

The 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.

When will I be ready for discharge?

Depending 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.

How will I know whether to go home or to another facility for further rehab?

In 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 as warranted.

What can I expect the first few days after discharge?

Expect 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.

During 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.

Do I need someone to stay full-time with me when I go home?

It 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 situation.

When can I go up and down stairs?

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