All patients are required to have pre admission testing (PAT) before surgery to assess if you are medically fit to tolerate the surgical procedure. This will be scheduled with General Medical Consultants physicians located in the same building as the Joint Implant Surgeons main ofiice. In some cases your insurance may require pre admission testing be done by your primary care physician. Pre admission testing will include a history and physical, routine blood work, EKG and 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.

What about my daily medications before surgery?

At the time of your preadmission testing the doctor will review the medications you take routinely. You will be advised of any need to stop a medication 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?

For joint replacement surgery, the average length of stay is between 1 and 2 days. Length of stay is determined by activity progress, medical progress, and wound condition. Insurance authorizations are frequently required and your and your surgeons' office will take care of this for you. If additional days are needed a hospital representative will contact the insurance company to provide medical information to obtain additional authorized days.

Will I need a blood transfusion?

The need for a transfusion is based on several points. In the case of a first time hip or knee surgery when joint is being replaced, it is unlikely that you will require a blood transfusion. The decision is largely based on postoperative hemoglobin and hematocrit levels. Other considerations include whether there are associated symptoms such as lightheadedness, fast heart rate, and low blood pressure. For patients over 80 years of age having a hip or knee replacement, it is more likely a blood transfusion will be needed. For patients over 80 years having both knees or both hips replaced there is higher likelihood a transfusion will be needed. Options for blood transfusion include: Red Cross Blood Bank, Autologous (you donate for yourself) and Directed Donor (someone you choose with your same blood type donates for you). Blood can be donated at any Red Cross Donor Center; it will then be transported to the hospital. Our office can provide you with Red Cross forms for donation. Blood may be donated up to 4s in advance of your surgery, and should be donated as far ahead as possible. We respect patient rights regarding blood transfusion.

What should I bring to the hospital?

Suggested items include personal toiletries, shaving items, non-skid shoes or slippers, a copy of your living will and/or advanced directive. Bring comfortable clothing to wear home such as loose “one size too big” sweat pants. If you have purchased your walker or assistive device prior to surgery, be certain that it is available so that your family can bring it to your room after your surgery. The hospital therapist will check for proper size, and adjust for proper height. A hospital gown, slipper socks, and a small toiletries supply will be provided to you at the hospital. DO NOT BRING large amounts of cash, valuable items, or large suitcases of clothing.

When should I arrive at the hospital for my surgery?

Notification of your arrival time will depend on where you are having your surgery. For New Albany Surgical Hospital, the hospital will call you on the afternoon before your surgery and tell you what time to arrive. For University Hospital East, you will need to contact the Joint Implant Surgeons Office at (614) 221-6331 on the Thursday or Friday before your surgery to obtain your arrival time to the hospital. Once you arrive to the hospital you will go through the admission process, change into hospital clothing, see the anesthesiologist, and meet hospital 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. At the time of your pre-admission testing, diet before surgery will be discussed. You are to have nothing by mouth (NPO) from midnight on the day of your surgery. In cases where you have been instructed to take medications the morning of surgery, you should do so with the least amount of water necessary. 

Will I have an opportunity to ask questions?

Questions and concerns will be addressed at the time of your visit with the surgeon. Other opportunities include time of your pre-admission testing when you will meet with an internal medicine physician and a licensed physical therapist.

How long will my joint replacement last?

The “life time” of your hip or knee replacement is likely to be between 13 and 15 years. Lifestyle, age, vocation, and weight impact the life of your implant. Work types involving intense activities such as heavy lifting or hip impact such as involved in sports like running may accelerate the wear of you joint replacement and should be avoided.

Should I have cemented or non-cemented (bio-ingrowth) implants?

For hip replacement non-cemented (bio-ingrowth) implants are recommended when the underlying bone quality is of good quality. In situations of bone loss, revision surgeries, or poor bone quality (such as osteoporosis), cement may be needed for fixation of the implant to your bone.

For knee replacement cemented implants are recommended. Past review reveals higher level of success and longevity when cement is utilized.

When arthritis or other debilitating condition has affected both hips or both knees with equal severity, both joints may be replaced at the same surgery setting. This decision is based on several points of consideration including: your preference, medical risk and the medical physician opinion, surgeon recommendations, x-ray findings, and your preference.

What nature of anesthesia will I have?

Surgeries are performed under general, epidural, 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. At that time feel free to voice any questions.

How long will surgery take?

Knee and hip replacement surgeries require 40 minutes to 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 phone the waiting area to speak with your family members

Your will be taken to the Recovery room (PACU) where your will be monitored closely for one to three hours. You will then be transferred to your hospital room. Your nurse will perform a total body assessment; your pulse, blood pressure and oxygen levels will be checked frequently for twenty-four hours. You will probably be a little groggy from the anesthesia. Pain medication will be administered. You will have a urinary catheter, intravenous lines (IV), oxygen, a “bootie” on both feet that will intermittently pump - keeping blood circulating and preventing blood clots, some will have a heart monitor. You will be instructed to perform several exercises every hour including: deep breathing, ankle pumps, quad sets, and a buttock squeeze.

The day after surgery the knee dressing will be removed, and either a light dressing or gauze and support stockings will be put on. The hip incision dressing is removed the second day after surgery. It is important for both knee and hip replacement patients (where size permits) to use support stockings for approximately two weeks after surgery. They should be removed at night.

Your incision may be closed several ways depending on factors that include if the surgery was a primary or revision. The incision may be closed with absorbable suture under the skin covered with either skin adhesive (glue) or “steri-strips” which are strips of tape that fall off or can be removed two weeks after your surgery. Otherwise, your incision may be closed with the more traditional method of skin staples, which will be removed three weeks after your surgery.

Either the day of or the day after surgery you will begin therapy sessions. These are scheduled for twice a day, each day during your hospital stay. Therapists are a very important part of your rehab and will be instructing you on exercises, walking, stairs, getting in/out of car, using the bathroom, and reviewing “DO and Don’t” precautions

When will I see my Surgeon?

The surgeon and orthopedic team make rounds each morning whenever possible. Your surgeon will see you on his surgery days and by associates on office days. 

Will I be discharged home or somewhere else for Rehab?

For joint replacement surgery, the average length of stay is between 1 and 2 days. Activity progress, medical progress, and wound condition determine length of stay. Insurance authorizations are usually for three to four days in the hospital. If additional days are needed a hospital representative will contact the insurance company to provide medical information to obtain additional authorized days. The RN Case Manager and Social Worker will meet with you (and family members if indicated) to review progress, and assist in discharge plans. Preparations, if needed, for transfer to a rehabilitation unit, or other nursing facility will be evaluated and overseen by you, the case manager and social worker.

Discharge / Recovery

Top

Can I go up and down stairs?

Before you are discharged to home the physical therapist will instruct you on stair climbing. We discourage more than one flight up/down a day for several weeks. In home settings with no sleeping accommodation on the main living level, necessitating several trips up/down stairs, a hospital bed may be needed.

What about pain management at home?

You will likely need pain medication for several weeks or more. You will be provided with a prescription when you leave the hospital. This prescription usually has one refill. 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. The refill can usually be phoned in to your pharmacy.

NOTE: We are not able to respond to pain medication refills after hours or on the weekend.

How long will I need to use my walker or crutches?

You may need to use an assistive device for walking such as a walker, crutches or cane for up to 4 to 6 weeks after surgery. The choice of the aid depends upon the type and extent of your surgery, as well as your general physical condition.

When may I drive?

Driving is deferred for up to 4-6 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.

When can I go back to work?

Usually patients are away from work for anywhere from 6 to 12 weeks. Decisions to return to work are based on patient progress, unique situation, work type, and patient choice issues.

When can I resume sports activities?

Individual ability and endurance will differ between patients. Activities such as swimming, bike riding, golf, hiking, and low impact sport activities can be resumed somewhere between 6 and 12 weeks. We strongly discourage routine high impact activities such as singles tennis, basketball, high impact aerobics etc. High impact activities performed regularly will accelerate the polyethylene wear and decrease the life of the joint replacement.

When can I resume intercourse after surgery?

Sexual intimacy may be resumed when you feel comfortable to do so. Bear in mind postoperative fatigue, pain levels, and postoperative restrictions will play a part, particularly in the hip replacement patient. Hip precautions (limiting flexion to less than 90 degrees, no crossing the surgical leg, and no twisting or turning at the waist) will need to be maintained during sexual activities. Hip restrictions are generally lifted at six weeks from surgery.

Are there any special concerns when going to the dentist or another doctor?

Antibiotics are recommended for patients who have had a joint replacement when you are undergoing a dental cleaning, extraction, root canal or filling. We recommended 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 antibiotics for dental appointments can be obtained by calling our office. It is recommended reporting your joint replacement procedure to any physician you may see.

Will my joint set off a metal detector?

It is unlikely that your hip or knee replacement will set off a metal detector, such as those found in airports. However you will be provided with a card identifying you as a joint replacement patient in the event a metal detector would be activated.

Conservative Treatment

Top

What about other conservative treatment for osteoarthritis?

• Modifications in lifestyle, weight loss, diet changes, controlled exercise can benefit the arthritic patient.
• Non-steroidal anti-inflammatory (NSAIDs) medications have been long used. Unfortunately side effects are also well known which have included gastrointestinal ulcers. This medication is also limited to those with normal liver and kidney function.
• Cortisone Injections directly into the joint space in some cases can provide temporary relief of arthritis symptoms.
• Chondroprotective Agents have been brought to public attention by recent research. Newer research is focused on slowing the progression of osteoarthritis. Examples of such agents include: hyaluronic acid injections, glucosamine, and chondroitin sulfate supplements.
• Hyaluronic acid serves as a lubricant and shock absorber in the synovial fluid. Injections of this substance provide additional lubrication of the synovial membrane. Hyaluronic acid is injected directly into the joint and is usually tolerated well. It is administered weekly in series of 3 or 5 injections.
• Glucosamine is a substance normally found in our bodies. In laboratory studies glucosamine was demonstrated to be a stimulator of the process that builds new cartilage cells. It is felt that supplementation of one gram of glucosamine daily may offer protection of cartilage. Glucosamine is generally well tolerated without toxic effects.
• Chondroitin sulfate is also a substance normally found in our body. It is found in cartilage, tendon, bone, disks, the cornea and heart valves. Among many things, chondroitin is known to inhibit enzymes that break down cartilage. A daily dose of 1200mg has been shown in clinical studies to reduce pain associated with arthritis and was tolerated without side effect.
• Glucosamine and Chondroitin Sulfate together is more beneficial than taking either separately. Glucosamine and chondroitin sulfate are considered dietary supplements, and are not regulated by the Food and Drug Administration.