Before Surgery Q:What are the major risks to joint surgery? A:Most surgeries go well without any issues, but infection and blood clots are two possible complications. Your care team will share exercises, medications and other treatments with you that help prevent these complications. Q:Should I exercise before my joint replacement? A:You should definitely exercise if you are able. You should contact your surgeon with specific questions about exercise and can also receive a special sheet to guide you through a personal exercise program. Q:How long will I be in the hospital? A:The average length of stay in the hospital is 3 days. Q:Do you offer pre-operative classes? A:The Evarts Joint Center conducts bi-monthly, 90-minute joint classes for patients who will be having joint replacement surgery. Attendance is very important as the class will prepare you for a smooth experience in the hospital and to do your part after discharge to ensure a full recovery. We encourage family members and caregivers to attend as well. To sign up for class or to ask questions about the class, call (585) 784-2966. You'll find out about: The mechanics of the joint The joint replacement procedure How to prepare for surgery Anesthesia options Your hospital stay Pain management The recovery process Rehabilitation options Equipment you may need after surgery You'll meet the physical therapist, occupational therapist and social worker you'll be working with. There will be plenty of time for questions; plus, when you leave the class, you'll receive a business card with contact numbers to use if you have questions after you've left the session. Q: How long does the surgery last? A: We reserve approximately 2 to 2 ½ hours for surgery. Some of this time is taken by the operating room staff to prepare for surgery. The surgery itself is usually 1 to 1 ½ hours. Q: Will I be asleep during surgery? A: You may have a general anesthetic, which most people call “being put to sleep”. Most patients may have a spinal or epidural anesthetic, which numbs the legs only. With this option you may also receive sedation that will make you relaxed and comfortable. The choice is between you and the anesthesiologist. For Total Knee Replacements: Most patients have a combined technique using both general and regional anesthetic methods. Q: Will the surgery be painful? You will have discomfort following surgery, but we will keep you comfortable with appropriate medication delivered either through your IV, an epidural, or nerve blocks that have been placed by your anesthesiologist. By day one you will be taking oral pain medication which can be adjusted to manage your pain appropriately. Q: Who will be performing the surgery? Your orthopaedic surgeon will perform the surgery. Residents, Physicians Assistants and Nurse Practitioners assist during the surgery. Q: What are the major risks? Most surgeries go well, without any complications. Infection and blood clots are two complications. (See section in this guide titled, “Recognizing and Preventing Complications”.) Q: How long, and where, will my scar be? Total Hip Replacement: Your scar will usually be around 6 inches long, along the hip and thigh. The actual length may vary. Total Knee Replacement: Your scar will usually be around 6 inches long, along the knee and thigh. The actual length may vary. Q: Will I need a blood transfusion? A: It is not uncommon to need a blood transfusion after joint replacement surgery. The need for a blood transfusion is patient dependent and varies with the age and medical status of each individual. When a blood transfusion is needed, blood products are provided by the local American Red Cross. Q: Should I exercise before the surgery? Yes, if you are able. Follow the exercises on the pull out sheet of this book (Appendix X). Please contact your surgeon with special circumstances or concerns about exercise. Q: What are Advanced Medical Directives? A: Advance Directives are a means of communication to all caregivers the patients’ wishes regarding health care. If a patient has a Living Will or has appointed a Health Care Proxy, and is no longer able to express his or her wishes to the physician, family, or hospital staff, the hospital is committed to honoring the wishes of the patient as they are documented at the time the patient was able to make that determination. It is Highland Hospital’s policy to place patients’ wishes and individual considerations at the forefront of their care, and to respect and uphold those wishes. We encourage you to Read and Review Patient Bill of Rights which you will receive when you are admitted to the hospital (in Same Day Surgery Unit). Types of advanced directives are: Living Will Written instructions that explain your wishes for health care if you have a terminal condition or irreversible coma, and are unable to communicate. Appointment of a Health Care Proxy This is a document that lets you name a person (your agent) to make medical decisions for you, if you become unable to do so. Health Care Instructions Your specific choices regarding the use of life-sustaining equipment, hydration and nutrition and the use of pain medications. On admission to the hospital, you will be asked if you have an Advance Directive. If you do, please bring copies of the documents to the hospital with you, so they can become a part of your medical record. Advance Directives are not a requirement for hospital admission. If you would like more information about completing a Living Will, and/or appointing a Health Care Proxy, contact your primary care physician. Q: Who are the Anesthesiologists? A: Board Certified and Board Eligible physician anesthesiologists staff the Operating Room (OR), and the Post Anesthesia Care Unit (PACU) at Highland Hospital. Q: What Types of Anesthesia are Available? A: Decisions regarding your anesthesia are tailored to your personal needs. The types available for you are: • General Anesthesia provides loss of consciousness. • Regional Anesthesia involves the injection of a local anesthetic to provide numbness, loss of pain or loss of sensation to a large region of the body. Regional anesthetic techniques include spinal blocks, epidural blocks, and leg blocks. Medications can be given to make you drowsy and blur your memory. Q: Will I Have Any Side Effects from Anesthesia? A: Your anesthesiologist will discuss the risks and benefits associated with the different anesthetic options, as well as any complications or side effects that can occur with each type of anesthetic. Nausea or vomiting may be related to anesthesia or the type of surgical procedures. Medications to treat nausea and vomiting will be given if needed. The amount of discomfort you experience will depend on several factors, including your choice for the route of pain medication delivery, especially the type of surgery. Your doctors and nurses can relieve pain with medications. Your discomfort should be tolerable, but do not expect it to be totally pain-free. Q: What Will Happen Before My Surgery? A: You will meet your anesthesiologist immediately before your surgery. Your anesthesiologist will review all information needed to evaluate your general health. This will include your medical history, laboratory test results, allergies, and current medications. With this information, together you will determine the type of anesthesia best suited for you. He or she will also answer any further questions you may have. You will also meet your surgical nurse. Intravenous (IV) fluids will be started and pre-operative medications may be given, if needed. Once in the operating room, monitoring devices will be attached such as a blood pressure cuff, EKG, and other devices for your safety. At this point, you will be ready for anesthesia. If you would like to speak to your anesthesiologist before you are admitted to the hospital, this can be requested at the time of your pre-surgical screening. Q: During Surgery, What Does My Anesthesiologist Do? A: Your anesthesiologist is responsible for your comfort and well-being before, during and immediately after your surgical procedure. In the operating room, the anesthesiologist will manage vital functions, including heart rate and rhythm, blood pressure, body temperature and breathing. The anesthesiologist is also responsible for fluid and blood replacement when necessary. Q: May I Choose an Anesthesiologist? A: Although most patients are assigned an anesthesiologist, you may choose to request one based on personal preference. Requests for specific anesthesiologists should be submitted in advance, through the OR scheduling secretary at (585) 341.6706.