By: Dr. Rebecca Van Heuklon, Doctor of Physical Therapy &
Dr. Jill Murphy, Doctor of Physical Therapy
It seemed fitting that we write about how to prepare for and what to expect when having a major orthopedic surgery since the topic was fresh on our minds as both of us recently underwent orthopedic surgeries. Once the decision has been made to have surgery, it can be a scary time. You likely have many questions as you figure out how to prepare for surgery, how you will feel coming out of surgery, what the rehabilitation process will consist of, and most importantly, if it will be successful in allowing you to return to work and the activities you love. Hopefully, this article will ease some of your anxiety, stress, questions, and concerns.
Once you have been diagnosed with an orthopedic injury requiring surgery, it is common to want to schedule surgery right away. However, it is important that you feel comfortable with your choice of surgeon. How do you choose the right surgeon? First, you want to feel comfortable and have good rapport with your surgeon now, so that if any complications do occur, you can trust your surgeon and his or her decision-making process. You also want to choose a surgeon who has done your procedure before, lots of times, and has good outcomes for that particular procedure with previous patients. Finally, your surgeon and his or her staff should be readily accessible to answer your questions, whether by phone, on-line messaging, or in person. Urgent appointments should be available when needed, and the physician and staff should take their time explaining what you need to do in terms of testing prior to surgery, how the procedure day will go, and what will happen after surgery regarding follow ups, rehabilitation, and recovery time.
Next, you should educate yourself on the types of procedures available for your particular injury, and if different or just one single approach to cases like yours exist. Start by asking your surgeon about your options. He or she can give you the pros and cons, including the type of anesthesia, type of graft, components of a total joint, etc. Then you can go home and read more about each choice. Some orthopedic surgeries are fairly cut and dried, like a straight forward shoulder rotator cuff repair. Others may have choices, like what type of hardware, minimally invasive or open approach, or what type of graft is used in the repair of a structure. Even rotator cuff repairs can start with one diagnosis going into surgery, and frequently you will end up with some extra clean-up of the joint (called debridement), labral tears requiring repair, and worn out tendons being cut, repaired, or reconstructed. While some of these decisions can be a discussion point between you and your physician, it is important to remember that if the surgeon does the surgery one way all the time, this is the method with which the surgeon will be most experienced. If you are not comfortable with your particular surgeon’s approach or you would like to pursue a different method, seek out a different surgeon who is an expert in the precise graft/components/approach you prefer and schedule a consult. This is the best way to optimize the outcome of your orthopedic procedure.
Pain management is high on the list of patient concerns for every surgical procedure. Get to know your options for your procedure and ask for the benefits and drawbacks of each when discussing surgery with your physician. If you have allergies, significant co-morbidities, history of addiction, anxiety, or fear of waking up in the middle of surgery, discuss these concerns with your physician. Decisions will need to be made about whether you are awake or asleep during surgery (sometimes options are limited), and for pain control once you go home or to a rehabilitation facility. Not everyone reacts to medication the same way, so be sure to be specific when developing a pain control plan with your surgeon to spare any surprises in your post-operative pain management. And always remember that if something is not working, you can call your provider and any plan can be adjusted to better control your pain, or to better control any side effects you may have from pain medications.
You should also be comfortable with where your surgery will take place. Out-patient surgery centers are low-key and convenient compared to hospital surgical centers, but not all invasive and complex surgeries can be performed in the out-patient surgery setting. Sometimes other problems you may have, like heart or breathing problems can make your surgery a bit higher risk, making the hospital the safest place to have your surgery done, just in case. Obviously, the location should be clean and well-staffed with licensed, qualified professionals for anesthesia, nursing care, and post op recovery.
Orthopedic surgeons know that while their surgerical handiwork is very important, it’s frequently your physical therapist that ensures a smooth and successful outcome. Your choice of where you will have rehabilitation after your orthopedic surgery may be one of the most important decisions you make. Is the physical or occupational therapy clinic you choose staffed with highly qualified doctors of physical therapy or occupational therapists with masters degrees? Are they experienced in rehabilitating your particular injury and surgical procedure? You will be seeing your therapist a lot in the days and weeks after surgery, so be sure that appointments will be convenient in both location and the time of day available to schedule, including when you return to work or school. Also find out whether or not your physical or occupational therapist has specialized training in manual therapy techniques like joint mobilizations. This particular treatment technique will ensure a faster, less painful, and more complete recovery following orthopedic surgery. You also want to have great rapport with your therapist. Being comfortable discussing your progress and prognosis, asking questions and for clarification, and working together as a team to address your functional deficits will expedite your recovery.
Once you have selected your treating providers, the next step is to prepare for the use of any braces, immobilizers, and assistive devices like crutches or a walker that you might need immediately after surgery. Feeling prepared can help ease some anxiety going into surgery. If your surgeon wants you to wear a brace, ask if you can get fitted for the brace before surgery, so you aren’t having to adjust straps or trying to figure it out how to put it on while you are tired and in pain. Each surgeon has different recommendations on how long to wear an immobilizer or brace, when to wear it, and if it should be locked at a certain angle or allowed to bend, so follow your surgeon’s instructions precisely. It is also likely that due to weakness, bracing, and discomfort, you will need to use crutches or a walker to help you move around after a lower extremity or major spine surgery. Many providers assume that you have obtained your own assistive device, are properly fitted for the device, and know how to safely and effectively use it. If you are not properly fitted or trained in using crutches or a walker, it may be important to see a physical therapist to learn how to use your device for walking, getting into/out of a chair or car, or going up/down the stairs safely. You may need to ask your surgeon to refer you to physical therapy (or just refer yourself) so this step can be done before surgery to improve your confidence in moving around your home and community. The last thing you want after undergoing surgery is to have a fall that results in injuring your new joint or graft, putting you back at square one.
It is also important to prepare your home for surgery. Ensure that all trip hazards, including cords, rugs, and clutter are cleared to allow you to move around safely. Remember that pets can become significant trip hazards as well as he or she eagerly greets your return home or accompanies you up and down the stairs. You and your pet may do better if your pet is housed elsewhere for a week or two until you are more stable on your feet. Also, make sure you have clear and well-lit walkways to navigate in your home. Crutches and walkers may require a wider walkway than usual and may require some rearranging of furniture. If your mobility is more limited, you may need to install some grab bars to help you with toileting or safely getting into/out of the shower. Assistive tools such as a toilet seat riser and shower chair or tub bench may also be helpful in the bathroom.
You will also want to stock up on multiple large ice packs and/or use an ice therapy machine that circulates ice water to help control pain and swelling after surgery. If your doctor writes prescriptions for pain or nausea medication before surgery, have the medications picked up ahead of time so they are ready for you. If the surgeon writes the prescriptions for you the day of surgery, have someone designated to pick them up from the pharmacy for you when you come home so you won’t have to worry about getting them yourself. It can also be helpful to have some food prepared ahead of time to allow for easy and healthy meals after surgery, as your standing tolerance and ability to use your affected limb will be limited.
Having a travel plan to get to and from surgery as well. You will need someone to drive you and help you get into the house after surgery. If your surgeon recommends wearing a brace that should be locked straight, make sure you are able to adjust the seat to accommodate a straight leg and enable you to get into and out of the car maintaining a straight leg. You might need to borrow a larger car that allows your leg to be straight or a car or SUV that sits higher to improve the ease of getting in and out. If you don’t have access to a car that allows you to get home, you might need to arrange transportation using a medical transport service. You will also need to plan for transportation after surgery to get to appointments and run errands. If you have surgery on your left lower extremity, as long as you are off pain medication and can safely get into and out of the car independently, you can begin to drive again. If you have surgery on your right lower extremity, you will likely need a driver for a longer period of time until you can move your right leg independently with sufficient speed, strength, and comfort to drive safely.
One of the most important factors in feeling prepared for surgery is to feel confident that you will have a significant other, family member or friend who will be available to assist you those first few days after surgery when your mobility and independence will be most limited.
Finally, you should feel comfortable with all of your choices. If you are feeling nervous about something in your surgery plan, whether the surgeon, surgery location, anesthesia, pain control, or specifics of your procedure, talk to someone about this, so all of your worries can be alleviated prior to the day of surgery. Take your gut instincts seriously; promptly address any factors that may prevent you from a good surgical and rehabilitation experience and a full return to the activities you love.