PRE-OPERATIVE TEACHING MANUAL

1. We recommend that you complete a Department of Motor Vehicle Application for Handicap Placard for Temporary Disability Registration Card prior to surgery.  This may be issued for a period of 3-6 months in an effort to assist you with transportation and ambulation issues before and after surgery.  We have applications available for North or South Carolina included in your surgery packet and we will complete applications from other states that you bring or mail to the office.  

2. It is a rare that we have our patients donate blood (Autologous Donation) prior to surgery; we believe it is better for our patients to utilize a medication named Procrit® to assist their own bodies to increase the number of circulating red blood cells before and after surgery.  To determine if you need Procrit®, you will receive a prescription for a CBC (complete blood count) that is to be taken to the hospital lab or to your primary care physician about 6-8 weeks prior to your surgery.  When we receive your results, our Procrit® nurse will contact you with you with further instructions.  The Procrit® Patient Information sheet is included in your surgery packet.

3. You will be provided a medication prescription for Iron tablets prior to surgery, these will assist your body with building new red blood cells.  The Procrit® nurse will instruct you when to start this medication when she calls with your CBC result.  Try to wait to take this medication about an hour and a half after your evening meal – this allows your body to absorb more of the medication.  However, if the Iron tablet upsets your stomach – then take it with your evening meal to protect your stomach.  The Patient Instructions for When to Start Iron sheet is included in your surgery packet. 

4. Constipation can be a problem for patients taking Iron tablets, pain medication and as you recuperate following surgery.  An Information for Our Patients: Constipation sheet is included in your surgery packet.  To assist with keeping you as comfortable as possible, it is important that you work to prevent constipation pre and post-operatively.

5. To reduce the incidence of blood clots, you will receive a prescription for a blood thinner called Coumadin® (Warfarin is the generic name) either before or after your surgery.  Your physician will determine the length of time you will remain on this medication based on your health history.  For your protection and for dosing changes, you will have blood drawn while in the hospital and after you are discharged.  A home health nurse will come to your home after discharge from the hospital (usually on Monday and Thursday) to draw blood and you will be contacted that same day with any dosage changes when the results are received.  It is important that you take this medication exactly as instructed.  If you were on Coumadin prior to surgery and managed by your primary care physician or cardiologist, you will be instructed when they should resume Coumadin management.  It is important that you follow the dietary, medication and safety restrictions that are noted on the Information for Our Patients: Constipation sheet and the Information on Coumadin / Warfarin sheet .

Note:  If you are already on Coumadin, this may be stopped prior to surgery and you may be started on a medication named Lovenox, as “ a bridge” to reduce the incidence of blood clots while you are off Coumadin.   Lovenox is an injection, you will be instructed in how to administer subcutaneously (similar to an Insulin injection just under the skin) in your abdomen.  Your nurse will specify when you are to stop your Coumadin and when to start the Lovenox.  You will be placed back on Coumadin in the hospital and you will be discharged home on Coumadin.  Upon the completion of dosing your Coumadin based on your orthopedic needs, you will be referred back to your primary care physician or cardiologist for ongoing non-orthopedic Coumadin management.  

6. There are certain medications that you may need to stop prior to surgery, as they can interact with other medications you will be placed on before and after surgery.  It is important that you tell your nurse all the medications that you take – including aspirin and vitamins or herbs – as these may interact with other medications you will be taking.  Please review the Medications to Stop Taking Before Surgery sheet and circle any medications listed that you are on and the time frame for stopping them before surgery.  Generally, two days after your last dose of Coumadin, you may resume any medications that were stopped before surgery.  Most NSAIDS (non-steroidal anti-inflammatory drugs such as Aleve, Naprosyn, Mobic…) are not resumed after surgery, but if you have a diagnosis such as Rheumatoid Arthritis and have stopped these medications before surgery – please contact your rheumatologist to determine when you should resume these medications post-operatively.

7. Basic Post-op instructions from your surgeon are provided in your surgery packet and speak to medications to finish or resume, diet, activity, weight-bearing, suture removal, showering, driving, swimming, and travel to name a few.  Depending on whether your surgery is for hip or knee, please read over these before surgery and don’t hesitate to ask us any questions that you may have.  Your surgeon will assess you prior to discharge from the hospital, and will instruct you and the nurses in any changes specific to your condition.

8. Antibiotic dental prophylaxis information is included in your surgery packet.  We recommend that any dental work, that needs to be performed, be completed prior to surgery.  Depending on your dental health, we may schedule you to have teeth pulled prior to surgery to reduce the chance of infection.  Following surgery, it is generally recommended that you wait about 6 months before you have any dental work performed and then, for at least the next 2 years, – you take an antibiotic one hour prior to any dental procedure, or any bowel or bladder procedures.  Also included in your surgery packet is a card that you can carry in your wallet to remind you and to notify others that you have had a total joint replacement and that you may need antibiotics prior to certain procedures.

9. Your surgeon may recommend specific equipment to assist you in your recovery after surgery.  We have included a Back to Action! sheet in your surgery packet – Back to Action! or one of their representative companies will contact you prior to surgery to discuss insurance coverage and delivery options.  

10. For our patients that are still working, we will complete a Work Status.  This is to assist you in notifying your employer of the approximate length of time that you may be out of work and to begin any disability or FMLA processes.

11. Educational booklets may also be included in your surgery packet or provided by your surgeon to assist you and your family with understanding and preparing for you upcoming surgery.  Some area hospitals also provide a free educational class by physical therapists and nurses that you and your family can sign up for prior to surgery – this information and the number for registering is included in your packet.

12. We recognize that preparing for surgery can be frightening and perhaps overwhelming.  We have included a Checklist of Things to Do in Preparation for Your Upcoming Surgery in your packet to assist you in ensuring you have obtained all medications and completed all appointments before surgery.  Your surgeon’s Test and Surgery scheduler will also complete an Appointments for Surgery Patients sheet as we will schedule all of you pre-op appointments for medical clearance, anesthesia and follow-up in the office just prior to surgery or for your first post-op visit.

13. A list of OrthoCarolina names and phone numbers have been included in your surgery packet to assist you with completing disability and FMLA forms.

14.  We do recommend that you contact your insurance company prior to your scheduled procedure, to determine that the facility where your procedure will be performed is on the Preferred Provider List and our Business Office will obtain pre-certification. Should you have any questions, please contact the business office at 704-323-2455.