Before Surgery

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It is important that you know before surgery what is covered by your insurance. Please refer to the Office Information: Insurance tab on the website. You will want to ensure that the approvals include the surgery, the anesthesiologist, even the procedure itself. We have the people in the office to help answer those questions. It often begins with an authorization or approval prior to surgery.

A lot of patients want to bring their medications from home for surgery. I think it is important that we have an accurate list of your medications, but we ask that you allow us to dispense the medications at the hospital or surgery center. The reason for this is that I may have recommended medications that may interact with your home medications. Please allow us to monitor your medications while you are in the hospital and make recommendations after your surgery.

Please do not drink alcohol the night before your surgery. This can interfere with your anesthetic on the day of surgery.

Many patients ask about donating their own blood prior to surgery or a family member donating blood for them. Typically, we do not require this before surgery. New techniques in preserving blood or even getting your own blood back have prevented the need for you donating prior to surgery.

We may ask you to pre-register at the hospital or the surgery center. This may involve you having to go to the center before the surgery and fill out paperwork. All of this makes the day of surgery much smoother.

I recommend that all of our patients do their best to quit smoking. We know that smoking has been related to delayed healing, so I recommend that everyone consider quitting smoking. Is it absolutely necessary for your surgery? Of course not. We are not trying to change your life; we are just trying to return you to the highest function, as soon as possible.

After knee or hip replacement surgery, typically you will be in the hospital for two to three days. If you have you have your surgery done at the Surgery Center, your stay may be shortened. The important thing is to go home when you feel safe and your pain is well controlled. We will do our best at the hospital to prepare you for home and if that is not possible, a rehabilitation hospital may be necessary. Regardless, you will be home when you are ready. In appropriate candidates, outpatient or a 23-hour stay may be achieved.

Typical recovery after hip replacement surgery goes something like this: Initially when you go home, our goal is to get you walking and moving as quickly as possible. You will be caring for yourself, getting in and out of bed by yourself and certainly using the bathroom on your own. Two to Three weeks after surgery when you return to the office, I expect you to be walking well with minimal pain. It may require the assistance of a cane or walker, but simply for balance. Six weeks after hip replacement, we will allow you to return to activities that you enjoy such as golf, simple walking or even bicycling. Three months after hip replacement surgery, I expect at that point you will be returning to most activities that you enjoy. You have been back to work for a couple of months and now you are starting to participate in a full round of golf, a full game of tennis or any other activity that you enjoy.

Following knee arthroscopy, a typical recovery goes like this: we encourage you to walk right away. Specifically, if we did not repair or reconstruct tissue in your knee, it is important to get it moving right away and return to your activities as soon as possible. This could be as early as two, three or even four days. Typically, by seeing you back in the office nine or ten days after surgery, you are walking well, your swelling is controlled and you can already see the light at the end of the tunnel. Six weeks after surgery we will allow you to return to all of your activities. This may include running, jogging and it may include football, softball, and tennis or even simply golf. It is important to understand-recovery time may vary depending on the severity of the injury and/or the extent of surgery and may take several months to achieve maximal improvement. For example, if a meniscus repair or micro fracture surgery has been done, you will be instructed NOT to put full weight on your leg for up to eight weeks.

Recovery after knee replacement surgery will go something like this: Once you are home and you are safe walking in your home, getting in and out of bed and even using the bathroom on your own. Within the first three weeks, you are doing physical therapy at home but again, working on bending and straightening the knee but walking more independently every day. At three weeks after surgery, most patients return to the office on a cane, walker or maybe no assistive device. An assistive device will be used usually for balance and not for pain control. At six weeks after knee replacement, typically patients are returning to activities they enjoy like golfing, biking and maybe even starting to hit the tennis ball. At three months after knee replacement surgery, I expect you to return to most of the activities that you enjoy with the exception of high impact activities such as running, singles tennis or anything that requires pounding of your knee. Our goal is to have it last as long as possible. Within that year, you will get better every month. At your one year follow-up, you will start to forget about this knee replacement.

Following shoulder arthroscopy, it is important that we/you get your shoulder moving right away. If you have had a repair of your rotator cuff or other tissue in the shoulder, this may require you to be in a sling. Typical recovery following this procedure may take up to four to six weeks in the sling and then an additional six to eight weeks in aggressive physical therapy to reach your goals. In the entire year, you will continue to get better every month. If no repair of tissue is performed in your shoulder; such as a subacromial decompression-optimal is to move it right away. A sling will be there for your comfort, but we encourage you to move the arm as quickly as possible. Typically, six weeks after surgery, you may return to the activities that you enjoy such as throwing a ball, hitting the courts and maybe even playing a little golf. However, if a rotator cuff or labral repair has been done, it may be 4-6 weeks before tennis or golf can be attempted safely.

Recovery after shoulder replacement goes something like this: Typically after you leave the hospital in 24-48 hours, the important thing is to move your shoulder with the assistance of a motion machine or a physical therapist. In the first four weeks, someone else will move your shoulder in what we call passive range of motion. In the second four weeks, you will start participating in the movement of the shoulder, and finally in the last four weeks you will begin to strengthen the arm. It is important to remember that our goal is to control your pain and improve your function every month.

Following arthroscopy of the Knee, Shoulder, Ankle or Hip we hope to get you back to work when your pain is controlled. Depending on your job description, this could be as early as two to three or even four days if you are allowed to wear a sling at work. If you are not permitted to wear a sling and are required to lift items during the day or repetitive use of your arm, this could take as long as six or eight weeks. What is important is returning to work when you feel you can do your job safely and your pain is controlled. Arthroscopy that involves weight-bearing joints may require additional time off work depending on the extent of the surgery and the physical demands that are required for the patient to function at his or her job.

Following hip replacement surgery, we try to return you to work as soon as possible. This may be as early as two weeks, depending on your job description. Obviously, if you are able to sit at a desk or do minimal walking in a day, two to three weeks is certainly very reasonable. However, if you are required to be on your feet all day or walk extensively, this could take six or eight weeks. Our goal is to get you back to work when you are safe and your pain is controlled.

Following knee replacement surgery, it may be necessary to take three to six weeks off work, depending of course on your job. If you are required to go to work and sit at a desk, typically we can get you back to work as early as two to three weeks. However, if you are required to stand on your feet all day or do an extensive amount of walking, this could take six or eight weeks. Every patient, of course, is not the same but we will certainly monitor your progress in physical therapy and encourage you to return to work when your pain is controlled and you and your doctor feel it is safe.

A lot of people ask me how much surgery will cost. I do not know. Most importantly, we have the folks in this office to help answer all of your financial questions and assist you with insurance approvals, etc.

Many patients ask who will be performing the surgery. I am the only one who will be performing your surgery. For some surgeries, I do use assistants to hold and retract tissue and sometimes hand me surgical instruments, but I am always the one performing the surgery. In addition, I close all of my own incisions and apply all postoperative dressings and splints to ensure that they are done properly.

Surgery of the hip, knee and shoulder can certainly be painful. In fact, we expect pain after surgery. Most importantly, we expect to control it. Pain medication will be provided and sometimes changed and sometimes used longer or shorter by different patients following surgery. What you must do it take the medication even if you are feeling ok. We expect that you will feel well following the surgery. Some patients don’t take their pain pills because of this-and then wake four hours later in extreme pain. It is better to maintain your medication schedule for the first 72 hours and re-evaluate after that with your Dr.

It is important not to eat after midnight the night before surgery. A full stomach or frankly any food or water in your stomach, can lead to a problem with anesthesia. Please be sure not to have any food or drink unless directed by myself or anesthesia prior to surgery. Generally, medications that are recommended to be taken prior to surgery and/or pain pills can be taken with a small sip of water on the morning of surgery, but please ask someone in the office, or the person taking your pre-operative information.

A lot of patients ask us “what time will I have surgery?” Let’s face it; nobody wants to wait until the afternoon. A lot of times you have not eaten since midnight or drank since midnight so everybody wants their surgery early. We try to operate on the older and sicker patients in the morning. For example, diabetics. It is important that they have their medication and that their diet is followed more closely. Please try and understand that when we schedule your surgery.

There are several different types of anesthesia for your surgery. The most common is given through a tube in your throat or in your mouth. The other kind of anesthetic is called a spinal anesthetic where the legs are numb from the waist down. Prior to your surgery in the pre-op holding area, you will meet the anesthesiologist. It is important to discuss the type of anesthetic you will receive at that time. Occasionally local anesthetic can be injected into the surgical site, sometimes combined with IV sedation to make you relax during the procedure.

When you come to the hospital prior to surgery, please bring comfortable clothing, please bring a list of your medications and certainly instructions for your ride home. Most importantly, please bring a great attitude.

It is very important that you have an accurate list of your medications prior to surgery. We will be able to tell you what medications we would like you to stop. This typically includes medications that will cause your blood to be thinner. Please bring that list with you prior to surgery.

Following surgery, you will be given pain medication. It is important that you take the medication when you need it. Our goal is to minimize or have no side effects while controlling your pain. Often, we may need to change that medication it if is just not working. Please be patient with us and we will find the right medication for you.

Some vitamins and supplements have been linked to thinning your blood. If you are going to have a surgery, we certainly do not want your blood to be thin, so sometimes we ask you to stop your vitamins and supplements. We will get them started just as soon as it is safe.

Preoperative clearance is very important. There is no one that knows you better than the doctor who has been taking care of you. I want to make sure your lungs, your heart and your kidneys are all working as best as they can be before we start surgery.

Most often, we know if you will need a brace or crutches after surgery. However, there are times and circumstances where we may find something different at surgery requiring a brace on your knee or a sling on your shoulder.

Following outpatient surgery of the hip, knee or shoulder, I ask that you have help at home over the first 24 to 48 hours to ensure a safe recovery.

Home health care will involve a registered nurse coming out to your home the following day after you are discharged from the hospital. The registered nurse will work to evaluate your wound, assess your vitals, teach your medication, remove the staples when needed and you will approximately see the nurse for three to four visits before being discharged. The home health physical therapy will start the following day you are discharged from the hospital. The physical therapist will work to instruct proper technique, reduce your swelling, regaining your range of motion and restoring your normal gait with the use of assistive equipment like a front wheeled walker or a cane. They will also answer any and all questions in regard to home physical therapy.