You have questions and we have answers. Working to eradicate your pain is a collaborative effort, and we want to arm you with the knowledge
necessary to feel comfortable with the recommended treatment.
Our team has the knowledge and expertise to help give you confidence on your path to a pain-free lifestyle. Let’s start this journey together.
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, an electrocardiogram (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. 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, 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.
Depending upon the procedure, your insurance coverage, and your health status, there is a good chance your procedure can done as an outpatient, allowing you to come in and go home the same day. Some patients will 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. 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. 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? 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 revision rate of approximately 25% at 20 years.
Surgeries are performed using 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 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.
Following your procedure, the surgeon will visit the waiting area to speak with your family members.
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. 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. The incision may 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 three weeks after your surgery. Some incisions are closed with a surface closure called “Zipline,” which the patient should remove two weeks after surgery.
You will begin physical therapy sessions the day of or the day after surgery. These are scheduled for twice a day each day during your hospital stay. 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 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 or the administrator of the surgery center 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.
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.
You have signed a controlled substance agreement that 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 when performed regularly, this high level of activity may accelerate polyethylene wear and may decrease the life of the joint replacement. 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 use of antibiotics for infection prophylaxis in joint replacement patients is a controversial subject. At JIS Orthopedics, we recommend antibiotic prophylaxis for all patients who have had a joint replacement who are undergoing a dental cleaning, extraction, root canal, or filling. We recommend a dose of Amoxicillin before and after the dental procedure, or Clindamycin if allergic to Penicillin. In situations of procedures involving skin penetration, or testing involving the gastrointestinal and genitourinary tract, we also recommend preventative antibiotic administration. Prescriptions for prophylactic antibiotics for these procedures can be obtained from your dentist, your physician performing the procedure, or our office before your procedure is performed. It is recommended that you report your joint replacement to any physician you may see.
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.
If you have heard of stem cell injections then you have heard of
regenerative medicine. See how it works…
Most people assume that stem cell injects are in a class of their own but realistically there are several different categories of what we call Biologic Injections aka Regenerative Medicine. Regenerative Medicine utilizes cellular therapy to repair and/or replace damaged tissue resulting from trauma and age related wear. Osteoarthritis, for example, is a degenerative process of cartilage destruction eventually leading to bone on bone arthritis. Current non-biologic injection treatments, such as corticosteroids and gel injections, do not alter the course of the disease, but rather manage symptoms. The goals of Regenerative Medicine in arthritis is to slow, stop and possibly reverse the degenerative cascade. These treatments may allow patients to avoid the need for surgery. Below are the various forms of regenerative biologic injections that JIS offers inlcluding what seems to be the most news friendly, stem cell injections.
Platelet Rich Plasma (PRP): PRP is obtained by drawing the patient’s blood, which is then highly concentrated into a solution of healing proteins. These proteins help combat the inflammation of arthritis as well as promote cell growth and increase blood flow.
Autologous Mesenchymal Stem Cells (MS Cs): Autologous MS Cs are obtained from drawing stem cell fluid from the patient’s pelvic bone. This fluid is then concentrated to isolate cells with the potential to differentiate into many different types of tissue including cartilage. MSCs also exhibit anti-inflammatory properties that can help reduce pain associated with arthrritis.
Amniotic Fluid: Amniotic fluid is obtained from donated tissue at the time of full term c-section deliveries. Amniotic fluid is rich in proteins, hyaluronic acid, cytokines, and growth factors which have similar properties to synovial fluid in joints. Amniotic fluid has lubrication and anti-inflammatory properties.
Joint preservation is a concept of restoring normal and pain-free function to the knee, hip, and shoulder joint. Learn how we do it…
Arthroscopic preservation surgery of the knee and shoulder has been around since the mid-20th century. However, it wasn’t until the past few decades that techniques advanced for arthroscopic surgery of the hip. Hip arthroscopy is a specialized skill, which many surgeons do not perform. We are fortunately at JIS to have one of the few hip arthroscopy surgeons around. Hip arthroscopy is used to treat conditions such as labral tears, hip impingement and cartilage injury.
Arthroscopic treatment of Femoroacetabular Impingement (FAI)
Femoroacetabular Impingement (FAI) is a condition that results from a mismatch in shape between the ball and socket of the hip. This abnormal shape leads to damage of the cartilage, labrum and often seen in patients who develop arthritis at an early age. The goals of arthroscopic FAI surgery are to reshape the abnormal portions of the bone to reduce pain and future damage to the cartilage and labrum.
Hip labral repair
The hip labrum is a soft structure that surrounds most of the hip socket (acetabulum). This labrum forms a suction seal in the hip and when damaged, can be a source of significant hip pain. Hip labral tears are often caused the abnormal bone shape seen in femoroacetabular impingement. The labrum is vital to normal hip function and should be repaired whenever possible. Sometimes labral tears are so bad that a reconstruction of the labrum needs to be performed with tissue from another source.
Hip tendon repair/bursectomy
There are some causes of “hip” pain that really aren’t from a problem within the hip joint itself. One of the most common of these being trochanteric bursitis and associated abductor tendon injury. These tendons are outside the hip joint and have fluid filled bursal tissue next to them that can become inflamed. Patients will often have pain on the outside of their hip, and if the abductor tendons are torn they can have a limp. When conservative treatments have failed, an endoscopic surgery can be performed to repair the tendon if needed as well as clean out the bursal tissue.
Whether from a recent tennis injury, an old football battle wound or simply walking down the street, we put a lot of stress on our knees that can lead to damage. Many times, these injuries do not require a joint replacement surgery and the injured portion of the knee can be repaired and preserved. When choosing a knee surgeon, ensure they have the expertise to take care of any knee problem you have like we do at JIS.
Anterior Cruciate Ligament Reconstruction
The anterior cruciate ligament (ACL) is the most commonly torn knee ligament. Most everyone knows someone or heard of an athlete that has had an ACL tear. The good new though is that JIS can help. Reconstruction of the ACL is a very successful surgery, allowing athletes to get back to action. A new ACL is created with either tissue from your own body or donated tissue, which restores stability to the knee. If you have torn your ACL, get back before the next season with an ACL reconstruction.
Meniscus Repair or clean-up
The meniscus is a “C” shaped structure that cushions the knee joint. There is a medial (inside) and lateral (outside) meniscus. Tears can occur from acute injuries or develop over time. With large tears from acute injuries, the meniscus can often be repaired. This is essential for normal function and health of the knee. Certain times though, the meniscus is not repairable and must be debrided or “cleaned-up”. If a meniscus tear occurs along with arthritis, surgery for the meniscus is not typically recommended.
Cartilage is the smooth gliding surfaces that covers our joints. When cartilage wears out over the entire surface of a joint, we refer to this as arthritis. However, sometimes there is isolated damage to cartilage that can be repaired. You can think of this like a pothole on an otherwise smooth road. Our goal with cartilage preservation surgery is to fill in that “pothole” to decrease pain and prolong the health of the knee. There are many different types of procedures to treat cartilage damage, and the experts at JIS can guide you through this discussion.
The shoulder is a complex joint comprised of bones, ligaments and tendons, and shoulder pain can result from injury to any of these structures. Determining the exact source of shoulder pain is much more difficult than other joints, and requires a skilled surgeon such as those at JIS. Most shoulder injuries that require surgery can be treated with arthroscopic preservation without the need for replacement.
Rotator Cuff Repair
The rotator cuff is comprised of 4 muscles that are essential for normal function. Tears of the rotator cuff can arise from discrete injuries or slowly tear over time. Not all rotator cuff tears need repaired, but if the tear is large and/or not improving with other treatments, then surgery is typically recommended. Repair of the rotator cuff can typically be performed through a few arthroscopic incisions, leading to a faster recovery. Special implants with suture allow JIS surgeons to re-attach the rotator cuff tendons back to the bone.
Many patients are not aware that a one portion of the bicep tendons attaches inside the shoulder joint. This “long head” of the bicep tendon can be a source of shoulder pain from a tear of its attachment, tears of the tendon or inflammation of the tendon. Bicep tendon problems are often seen along with rotator cuff tear and can cause pain in the front portion of the shoulder. A bicep tenodesis re-anchors the tendon outside the shoulder joint, which alleviates this source of pain. Sometime the tendon can simply be cut from within the shoulder, known as a bicep tenotomy.
Shoulder labral repair
The bony socket of the shoulder joint (glenoid) is a shallow structure, which lends to the inherent instability of the shoulder. Surround the glenoid is a structure called the labrum, which deepens the socket as well as being an attachment site for the shoulder capsule. When a shoulder dislocation or near dislocation (subluxation) occurs, the labrum can tear. This labral tear and loosening of the shoulder capsule can lead to shoulder instability. An arthroscopic surgery can be performed through a few small incisions to repair the torn labrum and restore stability to the shoulder joint.