Working with you to educate and determine the best course of action for your unique situation.

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 a General Medical Consultants physician. General Medical Consultants is located directly across from the JIS Orthopedics New Albany office. 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, and an electrocardiogram (EKG). In some instances, other testing may be ordered. For example, a chest x-ray, or if you have a history of heart disease, a stress test may be ordered. These physicians may also coordinate any other consultations with medical specialists if they believe it is necessary for appropriate surgical optimization.

At the time of your preadmission testing the doctor will review the medications you take routinely. You will be advised of any medications that you need to stop before surgery. 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. You should continue to take or will be rescheduled. Celebrex or Meloxicam should also be taken before and after surgery.

Most procedures can be done as an outpatient, allowing you to come in and go home the same day. Depending upon the procedure, your insurance coverage, and your health status, there is a possibility you may require a hospital stay, and the average length of that stay is 1-2 days. Length of stay is determined by activity progress, medical progress, and wound condition. Insurance authorizations are frequently required and your surgeon’s office will take care of this for you. If additional days are needed, a hospital representative will contact your insurance company to provide medical information to obtain additional authorized days.

The hospital or center will call you the afternoon (1 business day) before your surgery and tell you what time to arrive. Once you arrive to the hospital or surgery center you will go through the admission process, change into hospital/surgery center clothing, meet the anesthesiologist, and meet hospital or center 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. You are to eat nothing by mouth (NPO) from midnight on the day of your surgery. You will be provided with a carbohydrate drink to consume on your way to the facility. In cases where you have been instructed to take medications the morning of surgery, you should do so with a sip of water as necessary.

On the day of your surgery, please be sure to bring your photo identification and insurance card. Also, you should not bring any valuable items.

Questions and concerns will be addressed at the time of your visit with the surgeon. Other opportunities to ask questions include at the time of your pre-admission testing when you will meet with an internal medicine physician and a licensed physical therapist. If you have any additional questions, please feel free to call the JIS Orthopedics office.

What you are really asking is: what is the chance I will need another procedure or when will I need another procedure on my new joint? The vast majority of joint replacements will last a lifetime. Overall, only about 10% of joint replacements will fail or need to be redone. Each individual patient’s chance of needing another procedure is about 1% per year, so 20 years from surgery you have a better than 80% chance the joint is doing fine. This is true of hip, knee, and partial knee replacements. Shoulder replacements have a chance of revision at approximately 25% at 20 years.

Surgeries are performed using general, 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 to discuss these options. At that time, feel free to voice any questions.

Knee and hip replacement surgeries require approximately one hour. If the surgery is a revision or a difficult case the procedure may take several hours. Shoulder replacements typically require 60 to 90 minutes of operative time. Arthroscopic surgeries typically take 30-60 minutes.

Following your procedure, the surgeon will call your family or contact or visit the waiting area to speak with your family or contact.

After surgery, you will be taken to the post-anesthesia care unit (PACU) where you will be monitored closely for one to three hours. You will then be taken to your private recovery room or hospital room where you will be reunited with your family or caregiver. Your nurse will perform assessments frequently until you are ready to leave the hospital or surgery center. Pain medication will be administered. You will have an intravenous line (IV) and pumps on both calves that will intermittently pump – keeping blood circulating and helping prevent blood clots. Some patients will have a heart monitor. Your surgeon strongly recommends that you take the portable calf pumps home with you as they are the safest and most effective way of preventing blood clots. You will be instructed to perform several exercises every hour including: deep breathing, ankle pumps, quad sets, and a buttock squeeze.

If your procedure requires a hospital stay, wound dressings for knee and shoulder replacements will be removed the day after surgery and a light dressing will be placed. Most hip replacements will have a clear dressing that is left in place for 5 days; however, some hip dressings will be changed the day after surgery as well.

Support stockings are used for all surgeries and are helpful in reducing leg swelling after surgery. These stockings are also helpful in keeping knee dressings in place and acting as a skin barrier for icing and the leg pumps. However, these stockings are NOT mandatory and can be removed or used as needed after the second postoperative day.

Your incision may be closed several ways depending on multiple factors including the type of surgery and health of the skin. Most incisions will be closed with absorbable suture under the skin covered with a skin adhesive (skin glue or Dermabond). You may have a clear dressing over a hip wound that you should remove after five days. Otherwise, your incision may be closed with the more traditional method of skin staples, which will be removed at JIS Orthopedics two – three weeks after your surgery.

You will begin physical therapy sessions the day of or the day after surgery. Therapists are a very important part of your rehabilitation and will be instructing you on exercises, walking, stairs, getting in and out of a car, using the bathroom, and reviewing “Do and Don’t” precautions. If you are discharged to home the same day as your surgery, you will be provided with a prescription for outpatient physical therapy, and this should start within 24-48 hours of surgery.

At the surgery center, the surgeon will be present throughout the day and monitoring your progress towards going home. At the hospital, the surgeon and orthopedic team make rounds each morning whenever possible. If your surgeon is not available, you will be seen by his or her associate.

As an outpatient, you will be able to return home the same day as your procedure. We do have the ability to keep you overnight at the surgery center, should the need arise. From the hospital, you will usually be discharged to home once your physician determines that therapy goals of independence and safety have been met. It is important for most people that you have family or friends with you for several days to two weeks. It is important to arrange for outpatient physical therapy approximately 3 times per week after your hip, knee, or shoulder replacement surgery.

In situations where goals have not been met, or if you live alone and there are problems with independence and safety, additional physical therapy and rehabilitation may be needed before you can go home. Case managers from the hospital will help arrange for rehabilitation if this is necessary. Patient choice, availability, and insurance criteria impact approval for these rehabilitation centers and transfer issues if needed. Patients are not able to be transferred to a nursing home or rehabilitation facility after a procedure at the surgery center.

Following release from the surgery center or before you are discharged to home, the physical therapist will instruct you on stair climbing. We discourage more than one flight up and down a day until your strength and stamina allow it. This may be several days or weeks. In home settings with no sleeping accommodation on the main living level, necessitating several trips up and down stairs, a hospital bed may be needed.

The controlled substance agreement that you signed helps guide you on what to expect following surgery. You will be given a specific set of pain prescriptions and very specific instructions guiding their use. You will likely need pain medication for several weeks or more. You will be provided with a prescription when you leave the hospital or surgery center. 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. NOTE: We are not able to respond to pain medication refills after hours or on the weekend.

Patients typically require a walker or crutches for 1-2 weeks and a cane for an additional 1-2 weeks. The choice of assistive devices and duration of use varies widely and depends upon the type and extent of your surgery, as well as your general physical condition.

Driving is usually deferred for 3-6 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. However, if you feel safe and capable to handle the vehicle, and you have stopped taking narcotic pain medications, you may resume driving at your own discretion. If you had a shoulder replacement, you should not drive until the sling is removed after postoperative week 5, and you have stopped taking narcotic pain medications.

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.

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. You may resume high impact activities, but only after you are completely pain free and strength has returned. Shoulder replacement patients typically return to cardio exercise after 6 weeks and upper extremity sports after 4-5 months depending on the sport and extremity dominance. Discuss any specific activity questions with your surgeon directly.

The American Dental Association and the American Academy of Orthopedic Surgeons are no longer recommending the routine use of antibiotics for prophylaxis prior to and after a routine dental procedure. There are exceptions to this including patients with immunocompromised status such as aids/HIV, chemotherapy, solid organ transplant, and other immunocompromised conditions. Additionally, more invasive dental procedures may require antibiotics. Lastly, patients with significant diabetes and difficult blood sugar control may also benefit from prophylactic antibiotics.

If you are concerned and believe you may be an exception as indicated above, please discuss antibiotic prophylaxis with your dentist.

An EOB is a document provided to you by your insurance company that explains how your insurance claim and charges were processed from the multiple providers that cared for you. It is NOT a bill, but the EOB may be a preview of what you owe to the providers who cared for you during the surgery.

It is very common to receive a bill from each of the providers that participated in your care including your surgeon, the facility, the pre-admission testing medical physician, and the anesthesiologist. How much you owe is determined by your insurance plan and other factors like your deductible, co-pay amounts, and co-insurance responsibilities.