Patient Education & FAQ
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.
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.
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.
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.
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.
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.
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.
Families may stay with patients until the patient is taken to the operating room.
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. However, if you still have any questions please do not hesitate to
to call our office at 517.487.3717
Day of Surgery
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.
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.
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.
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.
Day After Surgery
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 arevital to your progress and are arranged for 2-3
sessions each day, each session lasting 45 minutesto 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.
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.
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.
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.
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.
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.
Stairclimbing will be practiced in the physical therapy program before you
eave 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.
Most 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
Walkers 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 for walking.
From 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.
Driving 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.
If you feel you will need to drive earlier than the 6 week routine
prescribed, you should discuss this with your surgeon and obtain his
This 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.
Depending upon what activity you want to participate in will determine
when you can start these again. Swimming, walking distances (hiking),
icycle 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 your surgeon.
In 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.
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