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Total Joint Program

Thank you for choosing The Surgical Center at Columbia Orthopaedic Group for your upcoming joint replacement. We look forward to providing you with excellent service. Many of our patients have questions about what they can expect the days leading up to surgery, the day of surgery, and the days following. We would like to provide you with information that will help us better serve you. Below are commonly asked questions. If you do not find the answer to your question, please feel free to contact one of our Nurse Navigators with The Surgical Center Columbia Orthopaedic Group at (573) 449-6537.

Before Surgery   Day of Surgery   After Surgery   Partial Knee Replacement Questions

Before Surgery

Will someone from The Surgical Center at Columbia Orthopaedic Group contact me before my Total Joint surgery?
Yes. You may receive a couple of calls from our facility.

  • Your Total Joint Nurse Navigator will contact you 24-48 hours prior to surgery. They will conduct a review of your health history and medications and provide instructions for surgery. Please plan about 20-30 minutes for this call. This is the time to ask any questions you might have about your procedure.
  • You will be enrolled with Force Therapeutics. This platform provides you contact with your Nurse Navigator & surgeon's office via secure text. You also will be provided care instructions, videos, and exercises prior to and after surgery. Force Therapeutics also provides a way for your surgeon to track your progress via forms that you will be asked to fill out at specific intervals.
  • A representative from the business office will contact you to address financial matters regarding your procedure—insurance coverage, co-payments, and deductibles. This call applies only to the facility fee for surgery.

I have already provided my health history information to my surgeon's office. Why do I have to review my health history with the Nurse Navigator?

  • The surgery center will receive all of your medical history information from the surgeon's office before they call you to review your health history.
  • During this call, we will ask some additional specific questions that better assist our anesthesia provider in planning your anesthesia care.
  • Your safety is our top priority, so we want to make sure all of the information we have on file is up to date, accurate, and complete. This will also give you the opportunity to remember health information that you might have forgotten during your preoperative visit with the surgeon.

Are there any tests required before my total joint surgery?

  • Your surgeon will give you orders for necessary testing to make sure you are healthy for surgery.
  • Testing and evaluations may include but are not limited to labs, EKG, chest x-ray, sleep study, and/or dental clearance.
  • We would like for you to complete any testing 3-4 weeks prior to surgery, if possible, in order to review and prevent any delays.
  • Be sure to have your doctor's office send all necessary paperwork regarding pre-operative tests and blood work to your surgeon.
  • Your surgeon will also ask you to be evaluated by a Medical Internist to ensure that you are healthy enough for surgery.

What should I do if I notice a change in my physical condition leading to my surgery?

  • Call your surgeon's office if there are any changes to your well-being prior to your procedure.
  • Signs/symptoms of cold or flu (fever, cough, sinus drainage, nausea, vomiting, diarrhea, etc.) should all be reported to your surgeon's office right away.
  • Scratches, bug bites, bruises, abrasions, rashes, blisters, etc. of the operative extremity should be reported to your surgeon's office right away.
  • With advanced notice, we can try to avoid any delays to your scheduled joint replacement.

Will I get to speak to the person doing my anesthesia before my surgery?

  • Yes. Before surgery, you and your anesthesia provider will discuss your history and review the anesthesia plan; this is when you'll be able to voice all of your questions and concerns.
  • Make sure to communicate any anesthesia concerns you have during your pre-op call with our Nurse Navigator.

Are there certain medications I should avoid?

  • Your Nurse Navigator will give you specific instructions regarding your medications during your pre-operative phone call.
  • During the call, do not forget to mention the use of blood thinners, blood pressure/heart medications, and diabetic medications. If you take any blood pressure medications ending in "artan" or "pril," do not take for 24 hours BEFORE surgery.
  • If you are on any anti-inflammatory or aspirin-based medication, you will need to stop these 5 days BEFORE your surgery date.
  • STOP Coumadin 5 days BEFORE surgery and Plavix 7 days BEFORE surgery if you routinely take these medications.
  • Your Primary Care Physician may also give you additional instructions regarding your home medications.

Do I need to shower before surgery?

  • Yes. Showering will help prevent surgical site infections.
  • Shower the night before and the morning of your surgery. Avoid aggressively scrubbing the area of the surgical site.
  • Wash your hair with shampoo first.
  • Using a clean washcloth for both showers, wash your body with a liquid antibacterial soap.
  • Do not shave near the surgical site.
  • Once you have rinsed thoroughly, use a clean towel after each shower.
  • Do not use lotions, powders, or perfumes after showering.

What risks are involved with my total joint surgery?
Major risks include, but are not limited to, infection, blood clot formation in the leg (DVT), chronic pain, stiffness, pulmonary embolus, injury to surrounding ligament, nerve, or blood vessels, and the need for possible further surgery.

What can be done to reduce my risks?

  • To reduce your risk of infection, you will receive IV antibiotics prior to surgery and oral antibiotics to take after surgery. After surgery, your surgeon may prescribe antibiotics for you to take before other invasive medical procedures, including dental cleaning. This could be anywhere from the first year after surgery to a lifelong measure.
  • To reduce your risk of blood clot, you will receive a blood thinner (usually aspirin unless otherwise instructed), leg pumps to help with circulation during your recovery stay, and early mobilization and walking.
  • To reduce your risk of chronic pain and stiffness, you must work hard on your physical therapy which is key to your success. If you don't do your therapy, your knee will get stiff, and you will be unhappy with the results. If you work hard on therapy and regain your motion, you should be pleased with your results. Expect 2-6 weeks of therapy after surgery, depending on your surgeons' recommendations.

Day of Surgery

What should I wear to The Surgical Center at Columbia Orthopaedic Group?
On the day of your surgery, be sure to wear loose-fitting clothing, making it easy to dress and undress yourself. Also, wear good walking shoes.

Is it okay to wear makeup and nail polish?
No. Please do not apply makeup the day of your surgery and remove nail polish prior to your arrival.

May I smoke the day of my surgery?
No. We strongly recommend you avoid smoking 12 hours prior to your surgery and for as long as possible leading up to the day of your surgery and the days following. Smoking could create complications with your anesthesia. Quitting two weeks before surgery helps improve your lung function & quitting for at least six weeks allows for proper wound healing. We strongly recommend smoking cessation for life.

What items should I bring with me the day of my surgery?

  • Photo ID and insurance cards; we are required to verify these during check-in at the facility. Without them, your procedure will be canceled or postponed until you can provide them.
  • Any and all medications needed during your stay (home medications & prescribed meds for after surgery).
  • Wear eyeglasses and bring a case to store them in while you are in surgery; do not wear your contact lenses.
  • CPAP machine if you have been diagnosed with sleep apnea.
  • Walker and a good pair of walking shoes.
  • Pillows to prop your leg up in the car.
  • Do not bring any valuables such as loose money, rings, or other jewelry.
  • Payment for your procedure (deductible, co-payment, etc.)

When should I arrive?
You will be given specific instructions with regard to your arrival time the day before your scheduled surgery.

Why can't I know my arrival time sooner than the day before surgery?
The surgery schedule may change several times leading up to the day before your surgery, so it is very commonplace to provide an arrival time the day before surgery to avoid multiple calls and confusion.

What should I do when I get to The Surgical Center at Columbia Orthopaedic Group?
When you enter the facility, you will be greeted at check-in. Admission and verification will take around 10-15 minutes. We will have several documents to review with you at check-in and do not want you to feel rushed during the process. We have built the time needed for registration into your arrival time. Please remember to bring:

  • Photo ID
  • Insurance card(s)
  • Payment for your deductible or co-pay

What will happen after checking in?
After checking in, a nurse will take you through a 30-45-minute pre-operative assessment that includes:

  • Confirming your information
  • Meeting with your anesthesiologist
  • Meeting with your surgeon
  • Meeting with your OR nurse
  • Taking your vital signs
  • Starting an IV
  • Performing any additional tests required on the day of surgery

Once you are ready, your friends and family will be able to join you in this private room until it is time for your procedure. Please limit to 2 guests at a time.

How do I ensure I receive the correct procedure on the correct surgical site?

  • There are no greater goals for The Surgical Center at Columbia Orthopaedic Group than to keep you safe and provide you the care you need. We follow rigorous national guidelines and protocols (National Patient Safety Goals) with regard to both.
  • Before surgery, you will meet with your doctor to confirm the procedure and the correct surgical site. The surgeon will write his initials on your skin near the surgical site with a specialized skin marker.
  • For your safety, you will be asked multiple times by the members of your health care team to confirm your name, date of birth, planned procedure and which side.

What is your part in ensuring your safety?

  • Please be patient and understanding when you are asked numerous times to confirm the same information. This process is all part of a proven safety initiative, and you should find comfort in knowing your healthcare team is committed to your care and outcomes.
  • Speak up. Do not hesitate to voice any concerns and ask questions throughout this process.

How long will surgery take?
Surgery takes approximately 1-2 hours.

After Surgery

When can I see my family and friends after surgery?

  • A nurse will be closely monitoring your vital signs after your procedure. As soon as you are awake, we will ask your family or friends to see you.
  • Up to 2 guests are welcomed in the recovery area at the same time.

How soon will I be permitted to eat something?

  • You will receive a snack in the recovery area.
  • Your recovery nurse will review specific instructions for you to follow with regard to your immediate diet.
  • Plan to drink lots of fluids (no alcohol) and initially maintain a light post-operative diet.
  • Some commonly recommended foods for the immediate post-operative period include soups, potatoes, pasta, applesauce, and rice.
  • Some common foods to avoid include milk products, spicy, greasy, fatty, and fried food.
  • Your nutrition will play a role in your healing. Make sure you are eating an adequate amount of protein to aid in wound healing.

Will I go home after surgery?

  • If you have a partial knee replacement often times you are able to leave the same day as your surgery.
  • If you have a total knee replacement or a total hip replacement you will stay one night at The Lodge on Keene Street. The Lodge is conveniently located in the same building as The Surgical Center. Their staff will work closely with you and your support person to ensure you are comfortable with your plan of care and will continue to provide education preparing for you to safely go home. You will receive physical therapy while at The Lodge the day of surgery and the morning after.
  • Your Nurse Navigator will have discussed with you your plans for therapy and will have helped facilitate setting it up, whether that is home health or outpatient physical therapy.

What should I expect?
You should expect to have some pain after surgery. Some people experience more pain than others. You will take pain pills for approximately 2-6 weeks and then taper off the next few weeks.

What should I do when I get home?

  • You should not make plans to do anything after your surgery except go home and rest.
  • Your Nurse Navigator will discuss specific home care instructions with you and the responsible party who is taking you home.
  • Plan to have someone stay with you for at least the first 24 hours after surgery.

What should I do if I am not feeling well at home?
Your Nurse Navigator will discuss warning signs with you prior to discharge. If you exhibit any of these symptoms or severe pain not controlled by your prescribed pain control regimen, you should:

  • Contact your surgeon immediately
  • Head straight to the nearest emergency room, or
  • Call 911

Any urgent concerns after hours or on the weekend, we do have an orthopedic surgeon on call thru Boone Hospital Center, and you can reach them at 573-815-8000. Any concerns between the hours of 8-5 Monday-Friday, can be addressed directly with your surgeon's office or your Nurse Navigator.

How will I avoid infection at the surgical site?
Your Nurse Navigator will review specific instructions to care for your surgical site. Remember to follow our protocol for bathing and cleaning your surgical site.

  • Hand washing is one of the best ways to prevent the spread or transfer of germs and infection.
  • The day of surgery do not hesitate to ask friends, loved ones—and even those caring for you at the facility—if they have washed their hands or used alcohol foam prior to entering your room. You should also take care to wash your hands throughout this process.

When should I begin taking my normal medications?
In most cases, you will be instructed to continue with your usual medications after surgery. Should changes to your medication routine be needed, your Nurse Navigator will discuss with you.

How will I manage my pain?

  • Your surgeon will speak with you before your procedure about what to expect and how your pain will be managed. From the time you are admitted, to our post-operative call at home, we will be asking you to describe your pain level and working to make sure your pain is well controlled.
  • You will be asked to rate your pain on a scale of 0-10, 0 being no pain and 10 being the worst pain imaginable.
  • Follow directions for pain medication closely and remember that most of them will take at least 45-60 minutes to begin working effectively. Therefore, consider taking the next dose before the pain becomes unbearable.
  • It is extremely important to do your exercises, which you will not want to do if you are in extreme pain. If you are not able to walk & do your exercises due to an intolerable pain level, please call your Nurse Navigator or surgeon's office.

Will I be sent home with prescriptions?

  • Your surgeon may provide your prescriptions to you at your office visit prior to surgery or the day of surgery.
  • Your Nurse Navigator will instruct you and your support person on how to take your medications.
  • Most of our surgeons have your medications filled COG's pharmacy, located on the second floor. We will ask your family to pick this up while you are in surgery.

What should I expect during my follow up call after surgery?
Your Nurse Navigator:

  • Will ask a series of specific questions to assess your recovery.
  • Will review your discharge instructions and plan of care, as needed.
  • This is a time intended to allow you to ask any questions you might have about your recovery process.
  • If you are experiencing an urgent issue, do not wait for us to call you. Please follow up with your surgeon's office as instructed.
  • If you are running low on pain medication, please notify your surgeon's office 5 days prior to needing the refill.

Partial Knee Replacement Questions

What is a partial knee replacement?
A partial knee replacement is an alternative to a total knee replacement for some patients with osteoarthritis of the knee when the damage is confined to a particular compartment of the knee. The implants and surgical techniques have improved over the past several years, and a partial knee replacement is now an option even for younger, more active patients. About 5% to 6% of patients with arthritic knees are estimated to be eligible for partial knee replacement. In a partial knee replacement, only the part of the knee that is damaged is replaced with a prosthesis. All of the normal ligaments of the knee are left intact.

What is osteoarthritis?
Osteoarthritis is the wearing away of the connective tissue called articular cartilage within the joint. Articular cartilage prevents one bone from scraping against the other. The cartilage acts as a shock absorber in the joint and allows for smooth and stable movement within the joint. When the cartilage thins, the joint can inflame, and you may feel pain and stiffness in the joint and your range of motion may be limited.

Am I a candidate for a partial knee replacement?
Patients whose knee osteoarthritis is limited to either the medial, lateral, or patellofemoral (kneecap) aspect of the knee may be considered. You must also have sufficient range of motion, limited inflammation, and no ligament damage. There are occasions where your surgeon may decide that you are not a suitable candidate once the surgery has begun and they are able to evaluate all of your joint more clearly. In those rare occasions, a total joint replacement is performed.

What are the advantages of partial knee replacement over total knee replacement?
There have been studies conducted that show when compared to total knee replacement, partial knee replacement better preserves range of motion and knee function by preserving healthy tissue and bone in the knee. Along these same lines, patients tend to be more satisfied with partial knee replacement compared with total knee replacement. There is also typically less blood loss during surgery, and recovery is typically faster than that seen after a total knee replacement. Because of this, the surgery can often be performed as an outpatient procedure.

Is it possible that I may have a total knee replacement and not a partial knee replacement?
If your surgeon sees that the arthritis in your knee is more advanced than what they expected based on your preoperative exam and imaging studies, then they would typically perform a total knee replacement instead. You do not want to have only part of your knee replaced if the adjacent compartments of our knee are nearly worn out. This could lead to a premature need for conversion to a total knee replacement in the years to come, and our goals for you is to get you feeling better for the longest period possible with the least chance of needing additional surgery down the road.

How long will surgery last?
Surgery takes approximately 1-2 hours.

How long will my joint replacement last?
Advancing technology has significantly increased the life of total joint implants. Still, just as your original joint wore out, a joint replacement will wear out over time as well. The life expectancy of your implant will depend on your age, weight, activity level and medical condition. Every patient is different, and we cannot guarantee that any implant will last for any specific length of time. Studies show that about 95% of implants are doing well at 10 years and 85% are doing well at 20 years.

What causes the implant to potentially fail?
Loosening of the implant, wear of the plastic, infection, and instability are the main reasons for failure.

What materials are used to make the prosthesis?
Partial knee replacements have a cobalt/chromium or oxinium cap on the end of the thigh bone, a titanium plate on the top of the shin bone, and a high-grade plastic (highly cross-linked ultrahigh molecular weight polyethylene) padding locked into the titanium plate. Occasionally, all plastic is used on the tibia depending on the size of the implant or cobalt/chromium.

What brand of implants do you use?
Your surgeon will use either Zimmer, Biomet, or Smith and Nephew.

Will I go home after surgery?

What should I expect after surgery?
You will be up walking and moving your knee the day of surgery. A physical therapist will see you in recovery prior to discharge. The therapist will help you mobilize your knee and ensure that you are safe to go home and that you know how to use your assistive devices. Once home you will continue with regular usage of pain pills as needed, ice machine usage, home exercise program. Depending on a few factors, you will either have home health or outpatient physical therapy to ensure you are progressing appropriately. You will see your surgeon back in about 3-6 weeks for a range of motion check.

Is it normal for my knee replacement to click?
Yes, the parts are hard surfaces and clicking is normal and not a sign of problems.

Is the numbness on the outside of my knee replacement incision normal?
Yes, the infrapatellar branch of the saphenous nerve is always cut with a knee replacement incision, leaving behind a numb spot on the outside of the knee. This can occasionally improve with time.

When can I return to work?
This greatly depends upon your type of work (laborer, non-laborer), your pain tolerance, and work flexibility. For most office jobs you can likely return at around 2-4 weeks. If you are on your feet more, or are a laborer, it could be 4-6 weeks.

What activities should I do?
You will focus on therapy and walking the first 2-4 weeks after surgery. You will then ease back into your activities like golfing, hiking, biking, swimming, etc. By 1-2 months you will be tolerating most of your usual activities. After 2 months, things will continue to improve but at a slower rate over the course of the year.

What are my restrictions?
Typically, the only restriction that your surgeon will give after a partial knee is that you should not run or jog for exercise. This is because of the repetitive impact involved in these activities, which can lead to premature loosening or wear.

Can I drive after the surgery?
You may resume driving when you are off of narcotic pain medications, and when you can move your right foot rapidly from the foot to the brake. If you are not confident in your ability to accomplish full breaking in an emergency, then you should not drive as you may cause yourself or others injury. Typically, this can be 3-4 weeks after a right knee surgery, or 1-2 weeks after a left knee surgery.