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Q: Do we need to make a pre-op appointment ourselves?
A: No. About 6 weeks prior to surgery you will receive a mailing with information regarding your surgery, including the date and time of your pre-op appointment. The date of the pre-op appointment is usually 2 weeks before your surgery date.
Q: Is it necessary to make an autologous blood donation? (The donation of your blood prior to your operation for use only if you need a blood transfusion during or after your surgery.)
A: While an autologous blood donation is not necessary, it is recommended because it is the safest blood available. Even though blood from donors are tested to eliminate all KNOWN risks, a transfusion of your own blood is the safest because it completely eliminates the risk of acquiring diseases that may be transmitted by blood transfusion.
Age, weight, medications and medical conditions such as heart disease usually do not preclude autologous blood donations. However, there are some conditions that may exclude you or may require you to obtain a clearance from your doctor. You should discuss your individual circumstance with a specialist at out Neely Cell Therapy and Collection Center (617-636-6453) to determine whether or not you are a good candidate for autologous blood donations.
Q: Should I get vaccinated before my joint replacement surgery?
A: Yes, you should make sure you are up to date on your flu and pneumonia vaccines. However, some people should not get inactivated influenza vaccine or should wait before getting it. Tell your doctor if you have any severe (life-threatening) allergies. A severe allergy to any vaccine component is also a reason to not get the vaccine. For example, while allergic reactions to influenza vaccine are rare, the influenza vaccine virus is grown in eggs so people with a severe egg allergy should not get the vaccine. If you have had a severe reaction after a previous dose of influenza vaccine, tell your doctor. Tell your doctor if you ever had Guillain-Barré Syndrome (a severe paralytic illness, also called GBS). You may be able to get the vaccine, but your doctor should help you make the decision.
People who are moderately or severely ill should usually wait until they recover before getting flu vaccine. If you are ill, talk to your doctor or nurse about whether to reschedule the vaccination. People with a mild illness can usually get the vaccine.
Q: Will we be provided with a list of rehabilitation centers? Will my insurance cover the costs?
A: Upon request, we would be glad to provide you with a list of rehabilitation centers in your area for you to research prior to your admission. Alternatively, you can get a list of rehabilitation centers on your own - if you have access to a computer, go to massgov.org and search for skilled nursing facilities. If there is a particular place you are interested in, you can always do an internet search and retrieve the ratings, comments and any other information for that particular center.
Whether or not your insurance covers the costs of your rehabilitation center depends on your insurance carrier. If you have any questions regarding coverage it is recommended that you call your insurance company.
Q: What am I allowed to eat and drink the night before my surgery?
A: It is extremely important that you neither drink nor eat anything the night before your surgery, however clear liquids may be consumed up until midnight. After midnight, ABSOLUTELY no food or liquids can be consumed.
Q: On the day of my surgery, is there valet parking?
A: Yes. There is valet parking right in front of South Building. The cost of valet parking is the same as that in our parking garage.
Q: Does Dr. Smith use sutures (stitches) or staples and about how long does the surgery last?
A: Total joint replacement surgery last about 3-4 hours. Dr. Smith uses sutures. Most of his stitches are done underneath the skin, though there may be a few on the outside. If you see any loose threads after your surgery it is important that you DO NOT pull at them. If the loose threads become bothersome, they may be trimmed with scissors.
Q: Which day is "post-op day one"?
A: The day of your surgery is considered day zero, so post-op day one would be the day after your surgery, post-op day two would be two days after your surgery, and so on.
Q: How does the femoral blocker work?
A: A femoral block is considered a regional anesthesia. In regional anesthesia, a numbing medication is injected around the nerves that transmit pain signals from the area involved in the surgery. The procedure “blocks” the nerves, ensuring that you will not feel pain during or immediately after surgery.
Depending on the specific numbing medicine (local anesthetic) used, the effects of the block can last even longer, ranging from hours to days. For some types of surgery, you may receive an infusion catheter, a very thin tube which can continuously bathe the nerve area in numbing medicine for an average of 2-3 days. Once the medication runs out, the catheter is removed, a simple procedure that you or your caretaker can perform. The femoral block will get taken out 48 hours after surgery.
Q: When is the femoral blocker administered?
A: Before your surgery, the regional anesthesiologist will locate the pertinent nerves using ultrasound or electrical stimulation to determine the optimal injection site. The numbing medication can then be injected with precision, without irritating or injecting the nerves themselves. This is generally done one half hour to one hour before your surgery.
Getting this nerve block is no more painful than getting an IV. Your skin will be numbed before the procedure, and you may also receive mild sedation prior to the procedure.
Regional anesthesia can be used by itself or with conscious sedation, meaning you are drowsy but do not require an airway device to assist in breathing as you would during general anesthesia. If you prefer, we can also combine regional anesthesia with either intravenous sedation or general anesthesia, both of which allow you to “sleep” during surgery. You will have the opportunity to discuss your preferences with your anesthesiologist prior to surgery.
Q: Where is the femoral blocker administered?
A: For surgeries involving the knee, nerve blocks are most commonly performed at the groin (femoral block).
Q: How long, on average, are patients in rehabilitation centers?
A: The length of stay at a rehabilitation center varies by individual. Factors such as your level of functionality prior to surgery and your rate of recovery help determine your length of stay.
Q: How soon can I resume sex after a hip or knee replacement operation and what positions are safe?
A: You can resume sexual activity as soon as you are comfortable, in any position that does not cause discomfort or break your total joint precautions.
Q: Are hip precautions for life?
A: Yes, the precautions are for life and should be strictly adhered to for the duration of the healing and muscle strengthening. However, hip precautions can be relaxed on once the hip is strong and healed.
Q: Driving after getting a joint replacement.
A: For a replacement operation on the right leg, hip or knee, it is wise to wait a 4-6 weeks and no longer taking and medications that impede your driving ability. By that time, you have control of your reflexes, making driving safe. For the left side, with an automatic transmission, usually 2-3 weeks with a pillow on seat and no longer taking medications that impede your driving ability and able to safely get into and out of the car.
Q: Dental work after a joint replacement.
A: The reason it is recommended that all your dental work be up to date prior to your surgery is because it is possible, in some situations, for bacteria from the mouth, teeth or gums to travel through the bloodstream and settle in an artificial joint and infect the joint. In an attempt to prevent this occurrence, representatives from the American Dental Association and the American Academy of Orthopedic Surgeons developed recommendations for people with joint replacements who are planning on having certain dental procedures done. These are guidelines only. Because your dentist knows the extent of any dental work you may require, he or she is the best person to determine whether a course of antibiotic treatment is appropriate for you. If antibiotics are necessary, your dentist should write the prescription for you. Routine cleaning of your teeth should be delayed for several weeks after surgery.
Q: For what dental procedures do I need preventative antibiotics?
A: You won’t need to get preventive antibiotics for most dental procedures, however, because you have an artificial joint your risk of contracting a blood borne infection is higher than normal. So preventive treatment is advised if the dental procedure involves high levels of bacteria. You should get preventive antibiotics before dental procedures if: You had a joint replacement, have had previous infections in your artificial joint or you have an inflammatory type of arthritis such as rheumatoid arthritis.
Q: Do I need to take an antibiotic every time I go to the dentist?
A: Whether or not you need an antibiotic for a dental appointment depends on what you will be having done. You should consult your dentist prior to your appointment to find out. If you do need an antibiotic, your dentist should write the prescription for you.
This precaution is only for the dentist, but if you happen to cut yourself and it looks like it is getting infected, you should immediately consult a doctor.
Q: How soon can I fly on an airplane after hip or knee replacement surgery?
A: As soon as you are comfortable with sitting down, you can fly. Usually, 3-4 weeks is the minimum realistic time. During flying or driving long trips, exercise your calf muscles and ankles frequently. Also, get out of the car, or walk the aisle of the airplane to avoid the possibility of blood clots. Take the blood-thinners that are prescribed after surgery to reduce the risk of blood clots and wear your white anti-embolism stockings.
Q: Do I need an ID card to carry in order to get through airport security with an artificial hip or knee?
A: Yes, we have these cards for you to carry. With heightened security measures however, be prepared to have the security personnel at airports screen you more thoroughly. In some cases, patients have been escorted to a private area and have been asked to show security personnel their surgical scar.
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