Written by Dr. Richard Forster, MD
Before Surgery
Now that my surgery is scheduled, what do I have to do?
Our office will call your insurance company for pre certification, if required. Dr. Forster will notify your primary care physician in writing of the upcoming surgery. If you have a cardiologist, then normally a cardiac clearance evaluation is required prior to surgery. Please call your cardiologist as soon as possible to schedule this consult.The hospital will call you to schedule a preoperative evaluation. This usually is scheduled 2 weeks prior to surgery.
Pre admission testing and evaluation
This is done at the hospital and takes several hours. You will attend a class which is run by nurses and therapists so that you will be familiar with what to expect when in hospital. Routine blood tests, as well as EKGs and chest x-rays will be done as deemed necessary. You will see an internal medicine sub specialist, who will review your medical history and labs to make sure that you are medically stable to have this operation. It is always a good idea to bring in a complete list of the medications and dosages that you routinely take as well.
Some medications, herbal preparations, and nutritional supplements can interfere with anesthesia and the surgical process. You will be counseled in stopping these substances prior to surgery.
Smoking interferes with wound healing and is not allowed in the hospital setting. Please let us know if you smoke and we can offer treatment while you are recovering from surgery.
Surgery
Time to report to Hospital for surgery
Patients are asked to report 3 hours prior to their scheduled surgery time. Surgery opens at 6 am, so do not come in earlier if you have an early morning surgery. If you are having your surgery at Kettering Mecial Center and live far from the hospital, consider coming in as a guest admit the night prior to surgery. Please let us know if you would like to do this so we can make the appropriate arrangements.
Duration of Surgery
Generally, most knee surgeries take about an hour and 15 minutes, while most hip surgeries take about 2 hours. This will vary from patient to patient.
Patients will usually spend 2 hours in the post anesthesia recovery room. The time can also vary depending on how fast a patient wakes up after surgery and how busy the nurses are. Families are not permitted in this area, but staff at the surgery reception desk are available to answer any questions you may have, and Dr. Forster will talk to the family after the surgery.
Total Joint Nursing Unit
Patients are seen later on the day of surgery by nurses, therapists, and by the internal medicine sub specialist. Our goal is to have you out of bed that afternoon, if possible.
A long acting anesthetic is placed in the joint, but pain medications are available if needed. A special dressing is placed on the joint which is waterproof and has infection fighting properties.
Physical therapists work with the patient on recovering joint function, while occupational therapists work on recovering the ability to perform activities of daily living. Patients are seen each morning and afternoon. Patients use a walker for ambulation because muscles can be weak after surgery.
Social Workers assess each patient’s home situation and needs. Most patients are able to go home two (2) days following a single joint replacement.
Going Home
Patients go home when they have met their therapy goals and are medically stable. Patients who live alone or may need additional therapy may benefit from a stay at a skilled nursing facility. It is important to note that studies show no difference in the ultimate recovery whether or not one chooses to go to a skilled nursing facility.
Pain Medications
You will be given a prescription for a pain medication with instructions as you leave the hospital. Follow the instructions and monitor the number of pills you take daily. Try to take as few pills as possible (take one instead of two pills and take them less frequently). You should contact Dr. Forster’s office for a refill prescription if needed, but you should plan to do so 4 or 5 days in advance of needing this refill, as the prescription will have to be mailed to you. The Federal Drug Administration (FDA) has very specific rules and restrictions on the control of narcotics. Pharmacies cannot always accept phone based prescriptions.
Constipation
Constipation is a common complaint after surgery. This is related to the use of narcotic medication and aggravated by the fact that most patients are less active than normal following surgery. Be sure to drink plenty of fluids and try to decrease the use of pain medications. Increasing activity and taking a fiber laxative can also be of benefit.
Dressing
The dressing is waterproof, so you can shower anytime after surgery. You cannot submerge the joint in a bath or swimming pool until 6 weeks after surgery. Please take the dressing off 1 week after surgery. Leave the wound open, no dressing is necessary once the original dressing is removed. You can continue to shower, drying the wound by patting it with a clean towel. If the dressing becomes loose before 1 week, just pull it off and follow the above directions.
Exercises
For knee surgeries, concentrate on stretching the knee straight, and on bending the knee (page 20 of your joint book from the hospital). Add other exercises only when comfortable.
Exercises after hip surgery should be only done as tolerated. It is important to remember your hip dislocation precautions. Do not turn your knee inward when bending. Be careful when picking up objects off of the floor. It is safe to pick up objects by reaching between your legs. Avoid twisting when bending, or reaching under beds and tables.
Swelling
Post- operative swelling is to be expected at the operative site and the affected leg. The application of cold has been shown to reduce swelling and pain at the surgical site. Ice can be applied at 15 minute intervals every 3 to 4 hours on a daily basis for the first several weeks following surgery.
For the first month after surgery, the amount of time sitting should be limited to 30 to 45 minutes at a time, since this will increase swelling. You should alternate periods of walking with periods of elevating the leg to reduce swelling. When elevating the leg, the ankle should be above the level of your heart. This usually requires 4 to 5 pillows under your leg and foot.
Blood thinners
Blood clots can occur after surgery, so most doctors prescribe blood thinners. A blood clot that dislodges from the leg and travels to the lungs is called an embolus. This can be fatal, however you should know that the chance of having a lethal embolus is about one in one thousand. To minimize this risk, blood thinners are prescribed after surgery and you will get detailed information about this from your nurse prior to discharge.
Driving
You can only drive when off all narcotic medication and you are in control of your car. To be safe, go to an empty parking lot with a friend or family prior to driving in public so you can be sure that you are in control of your vehicle. Driving after surgeries on the right leg can typically be considered after 3 weeks, while driving after surgeries on the left leg can be considered after 2 weeks.
Numbness
It is normal to experience numbness or decreased sensation to the skin near the scar that likely will improve over time.
Leg lengths after hip surgery
It is normal to feel like the operated leg is longer after hip surgery. Patients have had years of tightened muscles and loss of joint space and perceive the new hip to be longer. The body may take up to 6 months after surgery to adjust to the new hip.
Follow up Appointment schedule
Most patients are seen 2 weeks after surgery, unless discharged to a skilled nursing facility, in which case patients are seen once discharged home from the skilled facility.
Subsequent follow up appointments occur at 6 weeks, 6 months, 18 months and then every 5 years to monitor the implant.
Any patient who has a concern after surgery can call my secretary, Kim, who will then schedule an appointment as soon as possible.
Other insights and comments
When the wound turns from a pinkish color to white, healing is complete. Full recovery takes a year, but patients generally feel much improved after 6 weeks. From 6 weeks to 52 weeks, the swelling improves, the joint feels less warm, the scar fades, and muscle strength improves. Exercises are beneficial up to 1 year or more from the date of surgery.
Delay routine dental procedures, including cleanings for 3 months following surgery. Use of antibiotics prior to dental work or surgery has been recommended, but exact indications for their use continues to evolve. We’ll be happy to advise you in this regard.
Useful phone numbers
Dr. Forster’s secretary Kim
937-531-6703
Dr. Forster’s medical assistant Chelsea
937-298-4417 ext 235
Kettering Joint Center
937-395-8971
Kettering Joint Nursing Unit
937-395-8915