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When conservative management of
orthopedic conditions fails, your physician may recommend surgery.
If this is the case, the more informed you are about the surgical
process and your specific procedure the more comfortable you will
feel on the day of your surgery. When having surgery, there are
important things to be aware of prior to your procedure
(pre-operatively), during your procedure (intra-operatively), and
after your procedure (post-operatively). Your surgeon’s nurse will
discuss many of these things at the time of scheduling your surgery.
Pre-operatively, there are a
“checklist” of things for which you are responsible:
1. You are required to have a
current history and physical examination by your
primary physician. If you have not established care with a
provider, discuss this with your surgeon’s nurse so she can
recommend someone near you or coordinate a physician assistant to
complete this. It is important to get any long-standing or critical
medical problems under optimal control and monitoring prior to
undergoing any orthopedic procedure. Also, if you are having a
procedure for which you have decided to donate blood, this should be
completed at least one week prior to your planned procedure.
2. Financially, you are responsible
for understanding your own insurance’s coverage of the
procedure and other costs incurred during your hospital stay.
A customer service representative from your insurance company or a
workman’s comp or third party liability insurance representative
should address these coverage questions. If you still have
questions or concerns, contact our billing office at 952-931-9718,
3. It is wise to arrange any
post-operative care needs prior to having your
surgery. This includes any physical therapy, follow-up appointments
with your surgeon, or arrangements with family should you require
help at home. If you anticipate on staying in a transitional care
facility after your procedure, this will be arranged for you by
social services during your hospital stay. Similarly, any home care
health aid needs will be arranged on an as-needed basis by the
hospital or your surgeon’s staff.
Preoperatively on the day of your
surgery, you will be required to arrive at the hospital about 1
½ - 2 hours prior to the scheduled start time for your procedure.
You will be required to register with the hospital and then you will
be directed to a semi-private pre-operative waiting room. Friends
or family may wait with you in this room. You will be asked to
change into a hospital gown, and to store all your personal
belongings. A number of hospital personnel will see you prior to
your procedure including nurses and anesthesia staff, as well as
your surgeon. This time is used to further discuss anesthesia and
to make more specific decisions about your care based on your
medical history and physical examination. If there are any
concerns about your health or preparededness for surgery, these will
be discussed with you and the anesthesia staff, your surgeon, and
any other providers involved. Sometimes, additional labs or tests
may be obtained during this time to get the most current information
about your medical health. Also, you will receive fluids via a tube
placed into one of your veins, called and intra-venous line, or
“I.V.”. This is also the line through which medications are given
to you during your surgery.
You will be taken on a hospital bed to
the operating room accompanied by someone from anesthesiology and a
nurse.
Intra-operatively, your vital signs will be monitored, such as
your pulse, blood pressure, temperature, and amount of oxygen going
to your tissues. For many extremity procedures, a tourniquet is
inflated tightly around your upper leg or arm once you are asleep to
avoid excess blood in the operative area , which can impair exposure
and visualization during your procedure. Occasionally, this
tourniquet can leave a bruise, which might appear 1-2 days after
surgery. If bruising does occur, this is not worrisome and will
disappear over the next 1-2 wks of recovery. After your procedure,
you will be taken to a post-operative recovery area to be further
monitored for a short period of time as you come out of your
anesthesia, and then back to your waiting room. If you wish your
surgeon to discuss your surgery with any family or friends, they
should be in the surgery waiting area when the volunteer from
the hospital calls for them. You will be released from the hospital
when your blood pressure, heart rate, breathing, and pain are stable
and under control. Instructions will be reiterated to you as
directed by your surgeon.
Post-operatively, you will
follow up with your surgeon to check your incisions and to discuss a
recovery plan, including any anticipated restrictions for work and
play. Many times this recovery plan may involve visits to physical
therapy prior to your first post-operative appointment. If this is
the case, your surgeon’s nurse will give you information on setting
up these appointments prior to your surgery. It cannot be
overstated that for many surgical procedures, achieving a positive
result is often dependent on your adherence and commitment to the
surgeon’s post-operative plan. If at any time you are unclear about
what recovery and rehabilitation will be for a given procedure, it
is wise to contact your surgeon’s nurse or meet with your physician
to further discuss the anticipated recovery routine prior to having
surgery.
Any surgery can pose a risk to you, the
patient, even though modern science has made surgery more and more
routine. Risks of surgery will be discussed by
your surgeon on the day surgery is recommended and/ or scheduled and
by the anesthesia staff on the day of surgery. Complications of
surgery are rare, but do occur. In general, if you feel you
are experiencing excessive bleeding, pain, cramping, loss of
sensation, or if you have general medical concerns, you should call
our office or go to the emergency department immediately.
ARTHROSCOPIC SURGERY
Arthroscopy is a surgical method used
to treat many conditions. This procedure involves introducing
several instruments into a problem joint through tiny incisions,
each about one centimeter long. Today, many orthopedic problems
that were once operated on in an “open” fashion, can now be done
through the arthroscope. In addition, some procedures can be
attempted through the arthroscope, but end up becoming an "open"
procedure to obtain the best results.
Through each of the incisions, a
different instrument is placed, including a port to infiltrate the
joint with fluid for better visualization and irrigation, a port for
the camera, and one or more ports for a variety of instruments that
can be introduced to surgically correct the problem. The scope is
just a method, and can be used to treat several kinds of problems,
some of which are:
-
Cartilage tears, such as
meniscal tears in the knee or glenoid labrum tears in the shoulder
-
Excisions of loose pieces and/
or tight impinging bands called “plicas” in the knee
-
Debridement of scar tissue and/
or arthritis
-
Debulking of excess tissue that
forms in response to injury and can impinge a joint
-
Decompression of an area such as
a bone spur in the shoulder
-
Release of tissue that causes
poor mechanics in a joint, such as misalignment of the knee cap
-
Release of tight tissues that
impinge on important nerves, such as with carpal tunnel syndrome
-
Assist in revascularization
poorly vascularized bone
-
Aid in visualization during
reconstruction of ligaments (e.g. the anterior cruciate ligament in
the knee)
-
Aid in diagnosis through
visualization of an affected area
The advantage of arthroscopic surgery
is that only tiny incisions are made, and thus recovery and pain is
theoretically less than an open, more invasive procedure. However,
the recovery and rehabilitation plan after arthroscopic surgery
depends on what problem the scope was used to treat. In general,
most procedures on the lower extremity allow you to be up walking (a
modest amount is recommended) after you are discharged to your
home. With physical therapy, your motion and strength will recover
much faster. In the case of upper extremity surgery done
through the scope, you will likely be advised not to use the hand or
arm for any repetitive motions or heavy lifting for a period of
time. You may, however, be allowed to return to work with
restrictions and then gradually returned to normal activities. The incisions from arthroscopic surgery are expected to
completely heal within two weeks.
LUMBAR SPINE SURGERY
Low back pain is one of the top five
reasons patients visit their doctors. About 80% of people will
experience low back pain at some time in their life. Most causes of
low back pain resolve over time or can be managed non-operatively.
However, back surgery is indicated for a small subset of individuals
where the anticipated benefits outweigh the risks of undertaking a
major surgical procedure. Understanding the indications and
expectations of low back surgery is important before undergoing any
procedure.
The most common indications for back
surgery are when a back condition causes a persistent neurological
problem or severe, persistent leg pain. A neurological problem may
be noticed as decreased strength or involuntary “foot drop”,
decreased sensation, or lost reflexes in one or more of the lower
extremities. Severe leg pain that is constant in nature is a result
of impinging nerve roots at the level of the spine that occasionally
cannot be managed with physical therapy or lifestyle modifications
that attempt to decrease inflammation or alter poor mechanics.
Lumbar spine surgery involves placing
your body face down on a table with your knees bent so that your
back is level, like a table. The length of the incision depends on
how many levels of the spine in the back are affected, the size of
the patient, and the need for visualization deep down into the
spine. Spinal surgery is always done with the patient completely
asleep, as any uncontrolled motions can have a devastating affect on
the procedure.
Low back surgery can be done to remove
bony parts of the spine that cause narrowing in the spinal canal and
exit points of the nerve roots. It also can be done to remove any
disc herniations, free fragments, or other causes of impingement. A
fusion is a procedure where bone from the patient’s hip or from a
cadaver is laid down on the spine to fuse two or more levels
together, thus limiting motion and ideally decreasing the potential
for further problems in that area.
Post-operatively, patients having had
low back surgery will be in the hospital 1-2 nights to recover.
Recovery involves rest and at least six weeks off work, with no
lifting, bending, stooping, or twisting during this time. Patients
who have had a fusion can expect to be immobilized in a back brace
for a period of time while the bony fusion heals and becomes
strong. It is important to note that the goal of back surgery is to
stop the progression of any nerve damage caused by disorders in the
back, but it cannot “fix” any existing damage to nerves. Back or
leg pain is hopefully relieved, but residual discomfort can occur,
but is hopefully diminished.
TOTAL JOINT REPLACEMENT
SURGERY
A total joint is an artificial joint
(called a prosthesis) that replaces a badly damaged joint
in order to help the joint function more normally and with less
discomfort. Many conditions can cause joint damage, including a
variety of arthritis conditions such as osteo-arthritis (“wear and
tear” arthritis), rheumatoid arthritis, and post-traumatic arthritis
(arthritis that forms over time after a severe fracture injury).
Currently, most joints can be replaced
if needed. The most common joints replaced are the knee and hip,
followed by the shoulder, elbow, and fingers. When making the
decision to undergo total joint replacement surgery, it is important
to understand what total joint replacement surgery can and cannot do
for you. Over 90% of patients who undergo such a procedure
experience a dramatic reduction in pain which results in a
significant improvement in the ability to perform their common
activities of daily living. However, it is important to understand
that total joint replacement cannot make you into a super athlete or
allow you to do more than you could do before you developed
arthritis. In fact, following surgery, you will likely be advised
to avoid some types of activities for the rest of your life as these
may cause accelerated wear on the prosthesis.
The materials used today in total
joints are highly durable. These materials are usually some kind of
metal such as titanium or cobalt chrome (an alloy of steel) or
ceramic, and a very durable plastic (which comes in two types of
formations) called polyethylene. The metal or ceramic components
are used to cover the end of bone surfaces (see diagrams) and the
plastic components are meant to mimic the surfaces of articular
cartilage (the cartilage that covers the ends of bone and is worn
away in
arthritis conditions). The weight of these components compared to
the body’s natural bony joint components are essentially the same. Similarly, allergy to any of the component materials is
rare, but if there is concern you can be tested for prior to undergoing
any procedure.
In general, a total joint procedure
involves removal of the old worn surfaces and replacement with new,
smooth, frictionless surfaces. In order to do this, “cuts” need to
be made at the ends of bones that make up the joint to properly
place these new surfaces and make them as similar as possible to the
old joint. These new surfaces or components can either be cemented
in or “press fit” into the bone without cement. Each procedure has
its own indications about what kind of materials will be used and
whether or not cement will be used to secure the prosthesis.
How long an artificial joint lasts
depends on a variety of factors including proper placement or fit,
wear and tear on the surfaces, and avoidance of complications.
Possible complications of total joint replacement will be discussed
by your surgeon, but in general, these are: infection, blood loss,
blood clot, dislocation, wear and tear, fracture, and loosening of
the prosthesis. Patients who are no more than thirty pounds
overweight at the time of their procedure and who follow their
surgeon’s physical therapy and recovery plan can expect to have
better results long term and a decreased chance of any of these
complications.
The hospital will provide pre-operative
teaching concerning your recovery after a total joint replacement. In general, you will stay in the hospital for
two to four days after your procedure, and longer if there are other
concurrent concerns about your medical health. This time is focused
on general recovery, getting your pain under control, and helping
you move again by getting started on physical therapy. Whether or
not you go home or to a transitional care facility will depend on
your progress during this time and your situation at home.
Depending on what joint is replaced,
it will likely be recommended you avoid certain activities such as
jogging, high impact sports, heavy lifting, or extremes in range of
motion. In addition, any time you undergo a medical procedure,
including dental work, you should be given antibiotics prior to
reduce your chance of developing an infection that travels to the
joint. In addition, the "metal" in your body will require that
you carry a card when you travel explaining that you have a
prosthesis. You will also no longer be able to have a
procedure that uses magnetic resonance (MRI) in that area because
the image will be obscured.
For further questions about total joint
procedures, please contact our office at 952-931-9718 or
952-403-3399. |
