At Johns Hopkins Medicine, we aim to provide you with quality patient care during your visit. To help guide you through your care, we have outlined information on what you may expect before, during and after your orthopaedic visit. Your experience may vary depending on the type of inpatient or outpatient procedure you are getting, as well as which Johns Hopkins location you are visiting.
At any time, don’t hesitate to contact your doctor through MyChart or by phone if you have any questions.
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Preoperative education can vary depending on what kind of procedure you are getting. It could be an informal discussion of the procedure with your medical team or a more formal educational session. Patients undergoing complex procedures such as hip or knee replacement often benefit from an education session that teaches what to expect and how to maximize your recovery.
Some orthopaedic procedures require you to make changes in your home. These changes are meant to make your home a safe environment when you return from the hospital. Someone from your care team may need to visit your home to assess if any adjustments are needed to optimize your safety in recovery.
A preoperative examination with additional tests may be necessary. You will receive a letter with instructions of where to go and what to do to prepare for your procedure. Your surgery may require blood replacement through intravenous transfusion. If you wish to donate your own blood (autologous blood donation), you will be contacted about arrangements for the donation. Autologous blood donations are drawn approximately three weeks before your surgery.
Depending on what orthopaedic procedure you are getting, you may receive a call from the presurgical unit several days before your surgery. The staff will review your medications, insurance information, what to bring or not to bring, and confirm your procedure and arrival time.
You will be asked to bring a list of medications you are currently taking. This helps ensure that you are taking the proper medications while in the care of your surgeon. It also prevents duplication, and may prevent any drug-drug or drug-disease interactions.
If the surgeon feels you will benefit from an evaluation with the anesthesiologist ahead of time, it will be arranged before your surgery. Otherwise, you will meet the anesthesiologist in the ambulatory surgery unit just before surgery.
You will be asked to sign an informed consent form before any surgical procedure. Please read it carefully, and make sure it has your correct identification information and lists the correct kind of surgery or procedure you are having.
Advance directives tell us your decision regarding who should speak for you and what medical decisions they should make if you become unable to speak for yourself. If you have an advance directive or a MOLST (Maryland Order for Life-Sustaining Treatment), please give a copy to your nurse on the day of surgery. A template may be obtained during your initial clinic visit if you’d like to create an advance directive.
All our offices and medical campuses are smoke-free facilities. For your own health, there should be no smoking or drinking of alcohol at least 24 hours before surgery, as these activities delay the healing process. If you require assistance with abstaining from either, tell your surgeon.
On the Day of Your Surgery
You will first arrive at the surgery registration area, where staff will provide you with an identification wristband and a gown. They will ask you a number of questions to initiate the paperwork needed for your procedure, as well as explain what to expect during your procedure. Your surgeon will review the type of surgery you are getting and any potential complications.
Your belongings may be stored in a locker if your surgery doesn’t require an inpatient stay. If you will be admitted to a hospital, it is preferable that your belongings are sent home.
An escort will walk you to the ambulatory surgery unit. While you wait to be taken to the operating room, your nurse or anesthesiologist will start intravenous fluids. Your care team may ask you a few more questions in preparation for your surgery. Your anesthesiologist will help you decide which type of anesthesia is best for you. If you haven’t already completed a consent form, you will be asked to fill it out.
While you wait to be taken to the operating room, your anesthesiologist will administer your anesthesia. Your anesthesiologist will be at your side throughout the surgery to monitor your condition.
Once in the operating room, you will be prepped for surgery. The skin where the incision will be made will be cleansed with an antimicrobial agent and shaved if needed. All body areas will be draped except the part that will be operated on.
Health care providers aim to prevent surgical site infections by practicing a multitude of precautions aimed at cleansing the surgical site and protecting you from bacteria that could cause an infection.
The medical staff will ask your name and birthdate, confirm your specific surgery or procedure, and verify the side of the body to be operated on. The doctor may mark the site on your body to be operated on.
Before the surgery or procedure, the team will perform a “time out” to ensure, among other things, that they are doing the correct surgery on the correct body part on the correct person.
Your surgeon will guide the team through the actual operation. Depending on the length and complexity of your surgery, a number of other team members will be present. The team may include nurses, surgical residents, physician’s assistants, nurse practitioners, surgical technicians and patient aides.
Once the surgery is complete, you will be taken to the post-anesthesia care unit (PACU). You will be continuously monitored by a nurse until you are fully awake and alert. Your nurse will explain the equipment and any additional clothing, dressings or tubes that were placed on you. Your care team will also provide instructions for activity and any exercises you need to perform during this period.
Depending on the type of surgery and your postoperative condition, you will proceed to one of four areas once your surgery is finished:
- Intensive care unit (if your condition is unstable and requires intensive care)
- Intermediate care unit (as you are transitioning out of the ICU)
- Inpatient orthopaedic unit (if you are stable, but the surgeon needs to monitor you for a few days)
- Home (if it was outpatient surgery and you can recover safely at home)
Rehabilitation and Home Care
Your rehabilitation team may include physical, occupational, speech, activity and recreational therapists. Rehabilitation can occur at any point of your care. You are able to see therapists as an inpatient, as an outpatient or in your home. Your physician will determine which therapist you see and for how long.
Following surgery, you will be evaluated and treated by a physical therapist. This may start as soon as the day of surgery. Following your surgeon’s recommendations, a physical therapist will assist you with:
- Getting out of bed and moving safely
- Gradually increasing your mobility
- Choosing an assistive device to walk safely, such as a cane, walker or crutch, based on your strength, coordination and ability to follow instructions.
An occupational therapist will evaluate your level of functional independence and work with you to develop goals for therapy. Following surgery, a person’s ability to take care of their daily living tasks can be impaired due to pain, restrictions of movement or weakness.
An occupational therapist can help you perform daily living tasks safely through training in the use of adaptive equipment. You will also go through a strengthening program and learn special techniques that conserve energy. Occupational therapy will enable you to return home safely and with confidence following your orthopaedic surgery.
This type of therapy is typically not needed after orthopaedic surgery. It may be necessary if you have trouble swallowing or other complications from having any type of breathing tube inserted during surgery.
Home care services are made up of skilled nursing, physical therapy, occupational therapy, social work and home health aides. These providers will be assigned depending on your needs post-surgery.
Preparing for Discharge
Your care team will monitor your progress and recovery during your stay and help you plan to continue recovery after you have been discharged. The length of your stay is determined by the care plan that you and your care team develop together. Once the goals of the plan are met, it’s safe to leave. Your social worker and home care coordinator will make arrangements for your discharge, whether it’s to home or to another care facility.
Your surgeon will discuss with you the best ways to control your pain after orthopaedic surgery. Your care team will monitor the effectiveness of these methods and modify them as needed. Your doctor will prescribe medications and other methods to improve your comfort post-operation.
Take the medicine as directed. Taking more than the prescribed dose can be dangerous.
Depending on the type of surgery, it may also be necessary to take medicine to prevent blood clots. Your nurse or case manager can answer any questions about your medication.
Know the appearance of your wound. Your surgeon will write orders regarding the cleaning and bandaging of your wound and a nurse will give you a demonstration before you go home after surgery. Always clean your hands before and after caring for your wound.
Report the following signs and symptoms to your surgeon:
- Drainage or odor from the incision
- Increased swelling or pain in the surgical area
- Increased redness
- Numbness or tingling
Follow-up appointments with your doctor help monitor your wound healing and overall recovery progress.
- Make sure you understand the instructions your doctor or nurse gives you about taking care of your wound, any new medications you may need to take or assistive devices you may need to use.
- Make sure you know who to contact if you have questions or problems after you get home.
- If you have any symptoms of infection, call your doctor immediately. Antibiotic treatment may be necessary. Infection can occur in the bladder, respiratory tract, ear, teeth, gums or other areas that come in contact with the bloodstream. Signs of infection include:
- Redness or pain at the surgery site
- Drainage at the surgery site
Getting Back to Activity
Your surgeon will help you return to activities safely after orthopaedic surgery. He or she will let you know of activities to avoid, as well as when you can safely return to driving, exercise, sexual activity and other things.
Be aware of any exercise restrictions ordered by your surgeon, which will be written on your discharge instructions.
Follow your exercise program as outlined by the physical and/or occupational therapists. They will assess your abilities to perform what you learned before discharge and help improve performance and set goals to gain more independence.
It's important to continue the exercise programs given to you as part of your daily routine. Your endurance will continue to improve. Continue to use any of the home aids and devices to protect and reduce stress on the surgical areas.
Your physician will advise when it is safe for you to drive after orthopaedic surgery. As a passenger, the following tips will make your trip a safe and enjoyable one:
- Have the driver park the car a few feet from the curb so that you enter and exit the car from street level rather than the curb.
- Have the seat pushed back before getting into the car.
- Use a firm cushion to raise the seat height.
- Sit down first, then bring legs in pivoting to face forward.
- Use your seat belt.
- Your physical therapist will advise you of any special precautions you need to use as a passenger.
Your surgeon will write any water-related restrictions in your discharge summary. Depending on your surgery, a shower may be a safer option than a bath. Showering is easier and safer when you use the following items:
- A rubber mat or other type of nonslip surface.
- Grab bars
- Long-handled sponge
- Hand-held shower hose
- Your occupational therapist will advise you which of the above items are necessary.
Resume your normal diet. Eat plenty of foods high in protein to help with healing. A nutritionist is available to visit you before discharge if you have questions about your diet.
Some pain medications can cause constipation. Eating high-fiber foods, fresh fruits and vegetables and drinking at least eight glasses of fluid each day can help. Unless instructed otherwise, take a laxative when necessary to relieve constipation. Your surgeon may also prescribe a stool softener to aid your bowel function.
Normal sexual activity is possible upon discharge, although some modifications may be necessary. Your surgeon will advise you of any restrictions.
The sensitivity of metal detectors can vary. If your surgery results in a prosthesis, it may cause the alarm to sound. Tell the security officer that you have a prosthesis. A hand-held wand will be passed over the prosthesis to confirm its presence.