Pre-operative Information - During Your Hospital Stay

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When do you need to present to the hospital?

In general you get admitted to the hospital on the day of surgery however in certain circumstances you may need to be admitted the night before surgery. Our staff will let you know what you need to do and when you are required to present to the hospital.

Where to go on the day of surgery?

On the day of surgery you present to the admission office in the hospital with your referral for admission (RFA) form, your medicare, insurance card and any imaging films you have. You hand all these documents to the person in the admission office and they will process your papers, which may take few minutes. After the paper work is done then you will be directed to your hospital bed.

Depending on the hospital you are admitted in I may pay you a visit either in the admission area, the ward where your bed is, the pre-op area or the holding bay. When I meet you I will ask you few questions, which may sound as if I am meeting you for the first time. These questions are very important and they are part of our protocol to avoid any mistakes regarding the site of surgery. They include:

  • What surgery are you having today?
  • Can you please point to the limb we will operate on?
  • Can you show me the area we will operate on?
  • Do you recognize your signature on the consent form and are you consenting for this procedure?
  • Do you have any questions?

Then after these questions, myself or one of my assistants will mark the area we will operate on with a permanent marking pen with an arrow and initial name.

What happen in the hospital before surgery?

Once you get to the hospital ward you will be taken to your designated bed and one of the nursing staff will assist you with getting changed into a hospital gown. The nurse may ask you few more questions and may take your vital signs as blood pressure and temperature, etc…

Sometimes your anesthetist pay you a visit to ask further questions and perform an examination on you to make sure that you are ready for the operation. After all the necessary procedures are done you will be asked to rest waiting your turn in surgery. We do our best to minimize the time that you have to wait however sometimes it may be difficult to be precise since there are many factors that are beyond our control such as the complexity of the surgery ahead of you. We appreciate your understanding and patient.

What Happens During Surgery?

Once your theatre is ready for you a member of the theater staff will come to escort you in your bed to theatre. A member of your family may accompany you to the outside door of theatre beyond this point is access is for staff only unless the patient is a minor and need accompanying parent.

Depending on what hospital you are in you may be taken to the pre-op unit or to the holding bay in theatre where a member of the staff will receive you and your papers and may ask you few more questions close to the questions that I asked you and the staff member will double check the site of surgery and the consent form. This multiple checking is very vital to ensure that you get the best outcome so please be patient.

The anesthetist and his nurse or technician will come to see you and take you to the anesthetic bay where they will hook monitor cords to your chest, limbs, blood pressure cuff to your arm and they will insert one or more intravenous access where you will receive medications and fluids through. You will be given a dose of prophylactic antibiotics to decrease the chance of infection and premedication drugs, which make you drowsy. From this point onward, you will be regarded as under anesthesia and you will not be asked any more questions. You will either have spinal, epidural or general anesthesia. You and the anesthetist mainly depending on your medical condition, type of surgery and other factors make this decision regarding the type of anesthesia.

Once you are under anesthesia we may insert a urinary catheter if indicated and position you in the most appropriate way for the surgery. Using a disinfectant solution we will prepare the area of surgery then we apply sterile drapes to isolate the area of surgery from the surrounding environment. We practice complete sterile nontouch technique to ensure minimizing the possibility of infection.

We perform the operation with the help of one or two surgical assistants who are usually medical officers experience in assisting or orthopaedic surgeons in training, a scrub nurse, one or more scout nurses, and a company representative that provide the implant we will be using in case of joint replacement surgery. All the staff involved in your operation are professional and experienced in the field of orthopaedics. Every member of the team has a vital role in insuring the success of the procedure.

We strongly believe in minimal handling of tissue and using the latest evidence based techniques in an efficient manner. The surgery in general terms will involve a smallest possible wound that insure proper identifying of the pathology and performing an accurate procedure, non touch technique, minimal dissections of soft tissue, efficient time utilization to minimize blood loss and decrease morbidities, anatomical closer of deep wound and cosmetic closer of the skin. For information about individual procedures please review the Education section.

Once we close the wound, a sterile dressing is applied on the wound and the sterile drapes then will be removed. The anesthetist then starts the process of waking you up if general anesthesia is used. Then you will be transferred to the recovery room where one of the recovery nurses will receive you. the recovery nurse will ensure that you have sufficient pain control, observe your vital signs, monitor your blood loss from the drain and make sure that you are fully awake before you will be transferred back to the ward to your bed. The process in recovery takes around one hour. Depending on what hospital you are having the procedure at, a postoperative X-Ray may be performed before you leave theatre if you had a joint replacement surgery.

The operation time vary depending on the complexity and type of surgery, in general may vary from one to few hours, however the whole process from getting to the holding bay till you are back in the ward may take several hours so please reassure your loved once that it is not unusual that the whole procedure might take long time.

What Happens After the Surgery?

The average hospital stay after knee joint replacement is usually three to five days. The vast majority of people who undergo joint replacement surgery have dramatic improvement. This improvement is most notable one month or more after surgery. The pain caused by the damaged joint is relieved when the artificial joint is implanted during surgery. Other conditions such as fractures patients will notice improvement of pain but in a different way. One have to remember that fracture patients are completely different category of patient since they were in most cases completely normal with no pain before the injury so the expectation of getting back to this stage after surgery is impossible, because fracture healing take weeks and sometimes months. On the other hand joint replacement patients before the surgery usually they have significant pain that prevent them from sleep so as soon as they undergo surgery they will notice significant improvement.

The same day after you have your procedure the nursing staff will do a close observation to your vital, fluids input and output. Depending on the hospital policy family members may pay you a visit and I will be visiting you before leaving the hospital unless there is an emergency situation somewhere else.

As a general rule we recommend that mobilization should be as soon as possible so the first day after surgery you will be visited by the hospital physiotherapy staff who will aid you to get out of the bed and start mobilizing according to our recommendation. One the same day the nursing staff will remove the drain tube if there is one.

Once you become comfortable to use the toilet the nursing staff will remove the urinary catheter if you have one.

This usually happen in the first to second day after surgery.

Over the few days post surgery the physiotherapists will visit you on daily bases. At first, you may walk with the help of parallel bars, and then a walking device such as crutches or walker will be used until you are able to support your full body weight. After about 6 weeks, most people will be walking comfortably with minimal assistance once muscle strength is restored with physical therapy. Once you are safe with mobilization and you feel ell enough then you will be discharged home. This may vary based on the complexity of surgery and your general health.