THE INFORMATION INCLUDED IN THIS SECTION IS FOR DR. WEEDEN'S PATIENTS AND MAY NOT REFLECT "TREATMENT RECOMMENDATIONS'' OF THE OTHER DOCTORS AT THE TEXAS HIP & KNEE CENTER. We would like to thank you for choosing Doctor Weeden and The Texas Hip and Knee Center for your joint replacement procedure. We are sure that you will have many questions before and after your operation. We would like our patients to be as informed as possible. Hopefully, some of these questions will be answered in the following pages. Please take the time to read this information packet and keep it handy so that you can reference it when needed in the coming weeks and months. We look forward to assisting you with your questions and hope that your surgical experience will be both positive and rewarding. Office Phone Number 817-877-3432 WHAT
IS MIS “MINI INCISION” TOTAL HIP AND KNEE SURGERY? IN
THE BEGINNING...... It is important to be as prepared as possible prior to undergoing a hip or knee replacement. After surgery is scheduled, we ask all of our patients to see their primary care physician for a routine pre-operative evaluation approximately two to four weeks prior to their operation. You will need to contact your physician regarding this pre-operative evaluation. If you do not have a primary care physician, our office staff can assist you in finding one. Additionally, we ask that some of our patients donate autologous blood (your own blood) prior to the operation. You will be given an information sheet with the phone number to the Carter Blood Bank. It is important to call this number and schedule an appointment at a facility closest to your home. No matter which location you choose, autologous blood donations may not be made sooner than 30 days prior to your surgery. You will be scheduled for an appointment in our office within one to two weeks prior to your surgical intervention. At that visit, you need to have the following:
Some of the hospitals do provide pre-operative information, including a visit to physical therapy and a discussion with the orthopedic team and nurses. You can ask one of our nurses if the hospital where you are undergoing surgery provides this information. The Plaza Medical Center web site is also very informative (see the orthopedic section). It is important to exercise and be as active as possible prior to surgery. Exercises, which focus on the muscles of the hip and knee, are also encouraged to help you after your surgery. It is also important to take appropriate multivitamins or vitamins as instructed by your primary care physician. Additionally, it is important to eat a well balanced diet, including lots of protein, which will assist in healing after surgery. WHAT IS MIS “MINI INCISION” TOTAL HIP AND KNEE SURGERY? More than 30 million people in the United States suffer from osteoarthritis.
There are now new and exciting procedures using clinically proven
implants for total hip and knee surgery. The implants are inserted
through smaller incisions, which are typically 2-5 inches in length
rather than the standard 10-12 inch incisions. Mini incision hip
and knee replacement is a less invasive alternative to traditional
joint surgery. It involves smaller incisions with specialized instruments.
Another less invasive technique is hip resurfacing which preserves
future femoral bone. Dr. Weeden has performed this surgery on patients as young as 18 years of age to patients in their 90’s. However, the majority of patients undergoing this procedure are age 55 and older. Dr. Weeden can discuss if you are a candidate for this procedure. A number of factors determine whether or not a patient is qualified to undergo a MIS procedure. Unless you have significant body size (obesity) or excessive deformity in the joint, the majority of procedures performed by Dr. Weeden are less invasive. An ideal candidate is someone who has osteoarthritis of the hip or knee and is in excellent health, not too heavy, and fairly active. Candidates may also include people who are not responding to other forms of treatment, such as medication or therapy. Dr. Weeden and Texas Hip and Knee Center in Fort Worth, Texas, has performed more less invasive total hip replacements and mini-total knee replacements than any other site in Texas. Dr. Weeden was in one of the first group of surgeons in the country performing these techniques and has been performing these surgeries since 2002. We routinely teach these new techniques to other physicians from around the region and work to develop and improve the techniques and the implants utilized. You may have a visiting surgeon observing your procedure for educational purposes. Any visiting surgeon has been certified by the hospital and will only observe and not participate during your operation. Additionally, Dr. Weeden and
the other physicians utilize surgical assistants and train orthopaedic
fellows at the time of your surgery. This may appear on your insurance
or Medicare statement. You should not be charged over and above
what your insurance or Medicare covers. If you do receive a bill
outside of your insurance, please call our office for assistance. If you have bilateral joint replacement, one
of the partners may assist in your surgery to decrease your surgical
time. DO
I NEED TO CONTACT MY INSURANCE COMPANY TO LET THEM KNOW I AM SCHEDULED
FOR SURGERY? WHEN
SHOULD I BEGIN TO DONATE BLOOD FOR MY SURGERY?
These are recommended units to be donated; however,
more or less may be required, depending on your specific surgical
requirements or religious beliefs. If you are having surgery due to an infected prosthesis, you are not permitted to donate blood for surgery. ARE
THERE CERTAIN MEDICATIONS I SHOULD DISCONTINUE BEFORE MY SURGERY? IF
I NEED DENTAL WORK, SHOULD I HAVE IT DONE BEFORE MY SURGERY? ARE
THERE CERTAIN PREPARATIONS I SHOULD MAKE PRIOR TO MY
ADMISSION TO THE HOSPITAL? If your spouse or family will be caring for you at home, talk to them about your concerns. It may be beneficial to prepare meals and freeze them prior to your hospitalization so you have nutritious meals available for you when you arrive home from the hospital. Following your surgery, a physical therapist will be instructing you on how to go up and down stairs. If your bedroom is on an upper level in your home, you may want to make arrangements to have a bed on the lower level if you think you would prefer not going up and down stairs following discharge for the first 4-10 days. Prepare as much as you can prior to the surgery so you don’t have to rely on your spouse, family, or neighbors to do unnecessary running around after your surgery. Look around your house and make sure you can access the rooms in your home with a walker or crutches. Remove throw rugs that could potentially cause you to slip or trip. If you have pets that might get in the way after surgery, you may want to make arrangements for them to spend a few days with a neighbor or other family member until you are more comfortable. If your spouse is taking care of you after surgery, you may want to take into consideration that this is a role that may be new to them. Most individuals are discharged home with a walker or crutches, which are obtained in the hospital. Most patients with partial or complete knee replacements are able to walk with a cane as soon as possible and this can be obtained through your therapist or at a local drug or medical supply store. Most patients with hip replacement or hip resurfacing procedures are asked now to use a cane for about 2 to 4 weeks. In contrast, some revision surgery patients may have to use a walker for six to eight weeks. Dr. Weeden will determine which walking aid is best for you and the duration of use. Handicapped parking stickers may be obtained if the form is brought to our office. However, I encourage you to only use this temporarily. Walking is an excellent form of exercise during your hip and knee recovery. WHAT
HAPPENS IF I DON'T HAVE ANYONE AT HOME TO TAKE CARE OF ME AFTER
SURGERY? SURGERY AND POSTOP QUESTIONS.......... WHEN
DO I ARRIVE
AT
THE HOSPITAL
FOR MY
SURGERY? WHAT
SHOULD I BRING
TO THE
HOSPITAL? WHAT
HAPPENS
THE
DAY OF SURGERY? The length of your surgery will depend on the procedure you are having done. Primary hip and knee procedures take approximately 1 1/2 to 2 hours. Revision hip and knee procedures take longer. After surgery, you will be placed on a hospital bed. Normally, you are still quite drowsy from the anesthetic, so you may not even be aware that this is taking place. Most knee patients will have a knee immobilizer on the operated knee. However, we will get your knee moving with a machine on the afternoon of surgery. Hip patients will have a special pillow placed between the legs (an abduction pillow). Revision hips and knees may have a special brace after surgery. You will then go to the recovery room. The nurses will make sure that you are comfortable and after a couple of hours, you will be transferred to your hospital room. With a spinal, your feet and legs may be numb for 3 to 6 hours. You will have a catheter in your bladder so you will not have to get up to use the bathroom. You will need to use the bedpan if you have a bowel movement or if able the nurses may assist you to the restroom. Most patients have pain medication ordered that will be given as directed by the doctor. If you are in severe pain, please talk to your nurse so that additional medication may be given. You may also have a device wrapped around your legs that will inflate and deflate periodically. This is called a sequential compression device and will assist in the prevention of blood clots and help with your circulation. There will be a device called an Incentive Spirometer (IS) for you to breathe into a number of times throughout the day in order to expand your lungs. You will also have some support hose placed on the legs after surgery (TED hose). Your I.V. fluids will continue and you will be on a liquid diet for approximately a day following surgery. Your G.I. system needs time to “wake-up” after surgery, and introducing solid food too soon may cause problems and nausea. Foods will be introduced slowly and, after a few days, you should be back to your regular diet. Depending on how you are doing, the nurses will probably have you sitting on the side of your bed by the end of your first day in the hospital. Minimally invasive procedures may walk on the afternoon of surgery or begin movement of their knee in a knee movement machine. The therapists will be coming in to see how you are doing and exercises are usually started soon after surgery. Knee patients will be started on a machine that will help with their range of motion as well as isometric and muscle strengthening exercises. All joint patients will have therapy on a daily basis. You will also have Occupational Therapy so the therapist can assist and advise you in performing activities of daily living. The therapist will stress certain precautions, and it is important to maintain these precautions as instructed. Some hip and knee revisions require a brace after surgery to assist in recovery. This will be applied before your therapy is initiated. If a brace is required, it is typically utilized for four to six weeks from the date of surgery. An internal medicine physician (heart or lung doctor) will usually visit you during your hospital stay to assist in your care. Most family physicians do not come to the hospital and Dr. Weeden believes that it is important to have an additional physician assist in your care during your hospital stay and recovery. The doctors I recommend are docs I would let take care of my family. WHEN
WILL I
BE DISCHARGED
FROM THE
HOSPITAL? WHEN
DO I
RETURN TO
SEE THE
DOCTOR TO
HAVE MY
STAPLES REMOVED? Sometimes, patients can have wounds that become irritated from the staples, especially if it is near the time for the staples to be removed. Do not apply salves, topical antiseptic, or anything else to the wound. The wound should be kept dry and bandaged until your staples or sutures are removed. If you develop night sweats or a fever greater than 101°F following discharge, please call our office. This may be indicative of a postoperative infection, and we would need to make arrangements to see you in the office for a wound check, or you may be referred to a local emergency room. Most patients will run a low grade surgery at night after joint surgery (99 to 100) for 3-7 days after surgery. WHAT
SHOULD I
DO IF
I HAVE
ANY DRAINAGE
FROM MY
WOUND AFTER
MY STAPLES
ARE REMOVED? WHEN
DO I
STOP TAKING
THE COUMADIN? Your surgeon will determine when you stop taking Coumadin (if you were prescribed this medication). You are at increased risk of developing blood clots following hip and knee surgery so it is important that you stay on this medication until your medical doctor advises you to discontinue taking the medication. Blood tests may be ordered periodically while you are on the Coumadin. These can be done on an outpatient basis, or a nurse will come to your home if you are home-bound. (We do not have the equipment to test blood in our office). Adjustments to your medication may be made, depending on the results of your lab work. YOU SHOULD NOT TAKE ASPIRIN OR ANTI-INFLAMMATORY MEDICATION WHILE ON COUMADIN. Also, if you take Vitamin C supplements, discontinue the supplements until you stop taking the Coumadin. The dose of coumadin will likely change during the time you are on it, this is normal and note that the staff is regulating the medication to keep your blood thin enough for clot prevention. If you should have calf pain, leg cramping, or an excessive amount of swelling in your leg, do not hesitate to call our office. Sometimes, even though you are taking Coumadin and using the TED stockings, you may develop a blood clot. There is a certain test that would need to be done to make the proper diagnosis (usually an ultrasound). Never hesitate to call our office if you have concerns or questions or go to a local ER. WHEN CAN I
SHOWER AFTER
MY SURGERY? WHAT
ABOUT PAIN
MEDICATION? WHEN
MAY I
DRIVE FOLLOWING
MY SURGERY? WHEN
MAY I
RETURN
TO
WORK FOLLOWING
SURGERY? WHAT
HAPPENS
WHEN
I GO
THROUGH
METAL
DETECTORS
AT
THE AIRPORT? AM
I SUPPOSED
TO TAKE
ANTIBIOTICS
FOR
DENTAL WORK
AFTER MY JOINT REPLACEMENT? WHEN
MAY I
RETURN
TO
ACTIVITIES
IN
WHICH I
PARTICIPATED
PRIOR
TO SURGERY? Your prosthetic joint should enable you to return to activities of a normal nature. Joint replacement is intended to relieve your pain, but there are certain things you will not be able to do because of the risk of dislocation. THE PRECAUTIONS YOU WERE TAUGHT IN PHYSICAL THERAPY SHOULD BE ADHERED TO FOR 4-6 WEEKS. Restrictions and precautions you were taught by the doctors, nurses, and therapists are to be followed as directed by Dr. Weeden. What about sex????? Talk to Dr. Weeden MAY
I EXERCISE
WITH A
NEW JOINT
REPLACEMENT? The activities you engage in following total joint replacement are dependent on the type of joint you had replaced. Primary total hip patient, knee and hip resurfacings are permitted to ride a stationary bike, swim, walk, play golf, cross country ski, or play doubles tennis and participate in other activities which would not be detrimental to their prosthesis following the appropriate recovery period. Hip Resurfacing patients can run after the first year of recovery. Golfers may chip and putt after 4 to six weeks (if able) and begin play at 2-3 months. Revision hip and knee patients are limited due to the fact that multiple surgeries have weakened the muscles, and they should be careful regarding the types of physical activities in which they engage. Regardless of what you would like to do from a physical standpoint, first check with your doctor before you begin any type of physically strenuous activity. Remember, the best exercises you can perform are walking and swimming. You don’t have to climb a mountain or participate in a marathon to be physically active. WILL MY HIP OR KNEE JOINT CLICK OR MAKE NOISE AFTER SURGERY? Since most of the joint replacements are a combination of metal, plastic, and titanium, it is not uncommon for you to notice clicking or popping - that the joint feels “mechanical”. The clicking is noticed more in knee replacement than hip replacement. The does tend to decrease over time yet typically never goes away. This does not mean that there is a problem or a concern with the joint. Younger patients will notice that the joints are “artificial” more than elderly patients. One needs to remember that these joints are made of artificial materials and with normal walking, twisting, sports, and bending, you may perceive the mechanical nature of an artificial joint. I am hoping to design a knee in my lifetime that feels more normal than today’s current implants. CLOSING THOUGHTS Remember to be realistic regarding your joint
replacement. Your new prosthesis will permit you to return to normal
activities of daily living. There will be certain activities you
may not be able to perform due to the strain and stress on your new
prosthesis and the risk of dislocation. The important thing to remember
is your prosthesis will allow you to perform your daily activities
with less pain. We hope your surgical experience, both pre-operatively and postoperatively, will be pleasant and rewarding, and we will be there every step of the way to answer any questions you may have regarding the process. May your new prosthesis return you to a pain-free existence and allow you to once again participate in the activities you enjoy! If you have any questions regarding this information, please feel free to call our office. I would like to wish you excellent success with your hip and knee replacement, and my staff and I look forward to participating in your care. We will do everything possible to provide you with the best hip and knee replacement. Good luck with your upcoming surgery! Sincerely, Steven H. Weeden, M.D. |