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Alta Bates Summit Medical Center Orthopedic Surgery HandbookIntroductionThank you for choosing Alta Bates Summit Medical Center for your orthopedic surgery. Thishandbook was designed to help you, your family and your friends prepare for your upcomingorthopedic surgery, to help you understand what to expect during your hospital stay and yourrecovery and to help you regain optimal function as quickly as possible. It is important tounderstand that your surgery and care will be delivered in a standard manner, in compliance withevidenced based best practices, while recognizing that each patient has different and uniqueneeds and your experience will be dependent upon them.
The various chapters in this handbook willhighlight specific information that you mayfind helpful and pertinent to a specificsurgical procedure.Please bring this handbook with you whenyou attend all preoperative appointmentsand when you come to the hospital for yoursurgery.Every patient’s condition is individual andyour care will be coordinated carefully tomeet your specific needs by a team ofsurgeons, physicians, nurses, physicaltherapists (PT’s), occupational therapists(OT’s) and case managers.THANK YOU for the opportunity to serveyou! From your Orthopedic Center ofExcellence team here at Alta Bates SummitMedical Center we welcome you!Alta Bates Summit Orthopedic Center ofExcellence provides a full continuum ofservices: Preoperative education and medicaloptimizationPrehab classesSurgeryDesignated orthopedic nursing careon the postoperative floorPhysical and Occupational TherapyNutritional servicesImaging servicesHome health servicesOutpatient ServicesPostoperative rehabilitation classes
Appointments in Preparation for SurgeryPatient Name:Orthopedic Coach’s Name:Preoperative Appointments:Preoperative Clinic Medical Optimization Appointment:Date:Time:Location: 3100 Summit St., Ste. 2549 OaklandPlease bring the following completed forms to this appointment:Your Orthopedic CoachDischarge Planning QuestionnaireMedication ListSleep Apnea QuestionnaireAnesthesia QuestionnaireAdvanced Directive, if you have onePreoperative Appointment With Your Surgeon (generally about 1 week before surgery):Date:Time:Location:Make sure that your orthopedic surgeon’s office has up-to-date insurance informationSurgery:Date:Surgery Time:Arrival Time:Surgery Location:Alta Bates Campus:2450 Ashby Avenue, Berkeley(1st Floor Surgical Services)Summit Campus:350 Hawthorne Avenue, Oakland(Take Elevator A, go to 3rd Floor East, Merritt Pavilion, Surgery Intake)Postoperative Appointments:Postoperative Appointment with your Surgeon:Date:Time:Location:Postoperative Physical Therapy Appointments (if ordered by your e:Time:Location:
Prepare For Your SurgeryPlanning for your surgery and having realisticexpectations about your recovery period areimportant.It is important to remember that although you arein the hospital, you are not sick. This surgery is notbeing performed on an emergency basis; therefore,you have time to arrange and prepare yourself andyour home situation for a successful recovery.This handbook can be used as a checklist to becompleted before your surgery and a referencewhen you return home from the hospital. Somequestions to answer before you are admitted to thehospital for your surgery include the following:Select Your Orthopedic Coach:Identify who will help you after surgery onceyou are discharged home?We strongly encourage you to designate anOrthopedic Coach who will be able to assist andsupport you for one to two weeks once you aredischarged home from the hospital with activitiessuch as meal preparation, shopping and other tasksthat you need assistance with. Your OrthopedicCoach does not need to be a medical professional, itcan be a spouse, a domestic partner, an adult child,a relative, a friend or any other responsible personof your choice. Your Orthopedic Coach shouldattend your preoperative medical optimizationappointment at the Preoperative Clinic, at least onephysical therapy session in the hospital and bepresent at the hospital at the time of discharge sothat he/she can hear your final dischargeinstructions and have an opportunity to have anylast minutes questions answered. Attending thesesessions will enable your Orthopedic Coach to learnthe information that is shared with you andtherefore be better able to assist you in preparationfor your surgery and during your recovery. YourOrthopedic Coach will be one of the most importantsources of support and encouragement for youbefore surgery, during your hospital stay and mostimportantly when you are discharged home afteryour surgery. While you are in the hospital, yourOrthopedic Coach’s name will be written on thewhite board in your hospital room and we willprovide a complimentary parking pass for him/herfor the day or two that you are in the hospital.Attend All Preoperative Appointments:Have You Scheduled Your PreoperativeAppointments?In the weeks before your surgery you will have atleast 2 appointments for final preparation forsurgery. Surgical Evaluation and medical optimization atthe Preoperative Clinic. Preoperative appointment with yourorthopedic surgeon. Optional: Appointment with your Primary CarePhysician (PCP) ONLY, if requested by yoursurgeon.The team of physicians and practitioners willdiscuss your individual healthcare needs with yourorthopedic surgeon and provide writtendocumentation of surgical clearance.Surgical Evaluation at the PreoperativeClinic Appointment:Your surgeon will refer you to our PreoperativeClinic for preoperative medical optimization andeducation. The Preoperative Clinic is located at3100 Summit Street Suite 2549 in Oakland. ThePreoperative Clinic will call you to schedule yourpreoperative appointment after your surgeon’soffice has scheduled your surgery with the hospital.This comprehensive appointment will lastapproximately 2-3 hours and will include a History &
Physical, medical testing such as lab work and/or anEKG, an educational class and a meeting with a casemanager to begin the discharge planning process inpreparation for your return home after surgery.Based on this evaluation, a determination will bemade if any other specialist referrals, such ascardiology, are required before your surgery.3. Plans for Discharge Questionnaire (mailedto you).4. Your Advanced Directive (if you have one).It will be scanned into your hospital medicalrecord.5. Sleep Apnea Questionnaire (mailed to you).Please read this handbook in its entirety BEFOREattending the Preoperative Clinic appointment.Preoperative Appointment with yourOrthopedic Surgeon:The role of the Orthopedic Coach begins by havingthem attend your preoperative appointment at thePreoperative Clinic. Please bring your OrthopedicCoach and be prepared to spend 2-3 hours at thisappointment.Your surgeon will discuss the final plans for yoursurgery and review the risks, benefits and possiblecomplications associated with your surgery. This isan opportunity for you to review the procedure andask all your final questions before your surgery.The preoperative educational class will be held in agroup setting with an instructor which will give youand your Orthopedic Coach the opportunity to askquestions and gather more information about anypart of your surgical process or recovery. Having allyour preoperative needs taken care of at one visitwill minimize your travel time, worry and stress.Please complete and bring the following to yourpreoperative appointment at the PreoperativeClinic:1. Completed Medication List or actualbottles of medications you are currentlytaking. Please write down the medicationname, dose and how often you take eachmedication. Please include prescription,over-the-counter and herbal medications.You will be instructed on which medicationsto take and NOT take before your surgery.Some medications such as herbalsupplements and anti-inflammatory drugsshould be stopped for several days prior tosurgery. These medications can thin yourblood and cause unnecessary bleeding aswell as adverse side effects.2. Anesthesia Questionnaire (mailed to you).Complete Dental WorkDo you need to have any dental work done?Any dental work that you need to have done in thenear future should be completed before yoursurgery. Teeth cleanings can be done up to oneweek before surgery, but more invasive dental workshould be completed at least three weeks prior toyour surgery.Following your surgery, it is recommended that youwait 6 months to have any elective dental workincluding teeth cleanings performed. Please talk toyou surgeon for additional instructions.During dental cleanings, your gums may bleed whichallows bacteria to enter your bloodstream. Bacteriaare strongly attracted to metal and can travelthrough your bloodstream to your new joint andcause a joint infection. This is not common;however, it can occur. For this reason, if you arehaving a joint replacement, please tell healthcareproviders that you will need antibiotics before anydental work or invasive procedures.
Preparing for Your Return HomeDetermine Where You Will Stay:Where will you stay after being dischargedfrom the hospital?The majority of patients will return home aftersurgery, but some patients may choose totemporally stay at the home of their OrthopedicCoach, family member or friend following theirdischarge from the hospital.You will meet with a case manager at yourPreoperative Clinic appointment who will reviewyour discharge plan with you. (Your surgeon maypostpone your surgery until you have secured theneeded support for a safe discharge to home, so besure to bring your Orthopedic Coach to thisappointment).The case management team supports you and yourOrthopedic Coach during the hospital stay and helpsprepare you for discharge. Case managers areavailable to discuss discharge options, answer basicinsurance questions, and assist in arranging otherhome care services.Prepare Your Home:Is Your Home Safe For Your Return? If there is no one available to assist you when youget home, you might need to consider other optionssuch as hiring a private home health aide until youare able to care for yourself.In the unlikely event that you need skilled nursingfacility level care, the case manager can provide youwith a list of skilled nursing facilities to choose from.You can choose the facility that works best for youand you are encouraged to look at them in advanceof your surgery. You might also want to check withyour insurance company to ensure that you have askilled nursing facility benefit. We work closely withseveral local skilled nursing facilities to ensure thatthey are knowledgeable about the expected courseof your recovery and collaborate with them onquality outcomes. Most insurance companies do notprovide transportation between the hospital and askilled nursing facility. We encourage you to checkwith your insurance company preoperatively todetermine if transportation is a covered benefit ofyour insurance plan. Remove and store throw rugs to avoidtripping or catching a walker or cane.Move all lamp and phone cords out of yourwalking path.Clear clutter from your home that may be inthe way when walking.Reposition furniture to allow for use ofassistive devices, such as walkers, if needed.Have stable chairs with armrests available(rolling office chairs are not suitable). Makesure that the chair is high enough to allowyou to maintain any precautions that arespecific to your surgery.If your bedroom is on the upper level of yourhome, create a sleeping area on the firstfloor, if possible, for the first couple of weeksespecially if you are having surgery on yourhip, knee, ankle or spine.Place non-skid mats in your shower and/orbathtub if the surface is slippery when wetto prevent falls.A commode, shower bench and otherassistive devices can improve safety in thehome. If needed, plan to purchase theseitems before surgery.Secure handrails on stairs and inshower/tub.Check your bed for appropriate height andraise the bed as needed.Ensure that you have lamps within easyreach, especially in the bedroom or installnight lights.
Put dishes, bathroom articles and frequentlyused items where they are easy to reach(generally at waist level).Have extra pillows available for appropriatepositioning.Prepare to manage pets that could be atripping hazard.Household Chores:Who will help with household chores anderrands? Meal Planning:How will your meals be provided for you whenyou return home? Move items in the refrigerator from lowershelves to mid-level shelves.If you live alone, make meals ahead of timeand freeze them, buy nutritious preparedfoods that are easy to reheat or aremicrowaveable,checkyourlocalsupermarket to see if they have a deliveryservice or check out online grocery shoppingand delivery services such aswww.shop.safeway.com.You will not likely be able to drive for a fewweeks after your surgery (exact durationdetermined by your surgeon), so make sureyou have enough meals prepared or havesomeone available to do your shopping.Make plans for your Orthopedic Coach,friends or helpers to do meal preparation.Pets:Who will care for your pets? Plan ahead for the care or feeding of yourpets while you are in the hospital, and for thefirst few weeks when you get home.Make plans for your Orthopedic Coach,friends or helpers to do light housework andlaundry.You will likely not be able to drive for severalweeks after surgery. Arrange to have yourOrthopedic Coach, friends or family help youwith errands, grocery shopping and gettingto doctor appointments. Your surgeon willgive you medical clearance to begin drivingagain following your surgery when it isappropriate.Ride to the Hospital:Who will drive you to the hospital on the day ofthe surgery and who will drive you home fromthe hospital?In addition to arranging how you will get to thehospital on the day of your surgery, you will alsoneed to plan a ride home from the hospital whenyou are discharged. You will not be able to driveyourself home.If you are having surgery on you hip, knee, ankle orspine and anticipate having difficulty ambulating inthe initial postoperative period, consider requestinga temporary Disabled Person Placard. Yoursurgeon’s office can provide you with the temporaryDMV placard application if he/she feels that you willbenefit from it during your recovery. The applicationcan also be obtained at your local DMV office, atwww.dmv.ca.gov or by calling 1-800-777-0133. Theplacard application must be authorized and signedby your surgeon before returning it to the DMV. Thetemporary placard may be granted for a maximumof 6 months at the discretion of your surgeon.
Physical Preparation for Surgery:Have you physically prepared yourself forsurgery?One key aspect of planning for your surgery ispreparing yourself physically. Strengthening yourmuscles is important in order to have a speedyrecovery. A stronger lower body will make it easierfor you to stand and walk after surgery. If you arehaving a total hip, knee or ankle replacement orspine surgery, your leg may feel very different aftersurgery. The exercises listed in this educationalbinder for the lower body are similar to those thatyou will be asked to do after surgery. It would bebeneficial for you to practice these exercisesbefore surgery to familiarize yourself with them.Strengthening your upper body is also veryimportant. After surgery, your arms are responsiblefor supporting a great deal of weight that is shiftedoff the operated joint if you are having a total hip,knee or ankle replacement. A strong upper bodywill assist with movement in and out of bed andchairs and when using walkers or crutches. If youare having shoulder surgery, your operated arm willbe in a sling and you will not be able to use theoperated arm for several weeks.In addition, overall health plays a clear role in thesurgical and recovery process. If possible, continuewith your walking program before surgery with thegoal of gradually increasing the time that you walkto at least 30 minutes at a time. Walkingstrengthens the heart and circulatory systemenabling your body to cope better with the stressesof surgery. If you are not currently doing a walkingprogram, please consult with your doctor ortherapist before starting a walking program. Alwaysuse any assistive device already prescribed to youand make sure you walk in a safe environment. Ifyou are unable to walk for exercise, consult yourphysician about other options including waterexercise. See the Joint Replacement Resourcesection for more information for locations wherewater therapy is offered.If you are already doing exercises specificallyprescribed to you by a doctor or therapist, pleasecontinue with those exercises.You may also benefit from our structured PrehabProgram. This program is recommended for mostpatients by your surgeon to improve yourcardiovascular fitness, strength and balance beforesurgery as well as teach you the exercises that youwill be asked to do postoperatively. The Prehabtherapist will customize a program to meet yourindividual needs and prepare you for a successfulrecovery and a safe discharge to home.What are patients saying about the PrehabProgram?“I’m really glad I did Prehab to help me get in bettershape before surgery. It made rehab much easier.”“Prehab helped me feel more prepared and recoverfaster.”Please talk with your surgeon or the NursePractitioner at the Preoperative Clinic to find out ifthe Prehab Program would be beneficial for you.The Prehab program is most effective if it is initiatedat least 4 weeks before surgery, but even 1-2sessions before surgery can provide you with a greatbenefit.Nutritional Preparation for Surgery:Are You Eating Healthy?It is important to eat a nutritious diet before andafter surgery to help your body heal and prepareyou for the rehabilitation process. Every changethat you make to improve your nutrition before
found in green leafy vegetables like spinachand kale, beans, dried fruits like raisins andapricots. Good sources of dietary ironinclude, red meat, chicken liver, clams,mussels, oysters, canned sardines andsalmon.surgery will enhance your body’s opportunity tosuccessfully recover from surgery. This includeseating foods from all of the food groups and takinga multivitamin with minerals daily. Starting now, weencourage you to eat a well-balanced diet includingfoods high in fiber, protein, iron, calcium andvitamin C and D. FiberFiber assists in normal bowel function. If canbe found in fruits, vegetables, cooked driedbeans, dried fruit and whole grain products.To help avoid constipation, you will need todrink at least 6-8 cups of water daily beforeand after your surgery. ProteinProtein is a very important building block formuscle and bone. It is found in meat, fish,eggs, poultry, nuts, dairy products, soyproducts and cooked dried beans. Youshould plan to have protein at each mealbefore and after your surgery. IronIron helps to produce hemoglobin, asubstance found in red blood cells.Hemoglobin helps to carry oxygen to thebody’s tissues. Without sufficient iron, youmay feel weak, tired and irritable. Iron is CalciumCalcium is an important component of bone.In order for your body to absorb calcium,your body also needs Vitamin D. Calcium canbe found in milk products, calcium fortifiedfoods, some dark green leafy vegetables andin a pill form. It is recommended for men toget 1000 milligrams of calcium each day andfor women to get 1200 milligrams of calciumeach day. Please ask your Primary CarePhysician (PCP) if he/she recommends youtake a calcium supplement in addition to themultivitamin with minerals. Vitamin CVitamin C is important for wound healingand bone formation. It is found in citrusfruits, green and red peppers, collard greens,broccoli, spinach, strawberries, tomatoesand potatoes. If you take a multivitaminwith minerals, it will contain enough vitaminC that you do not need to take an additionalvitamin C supplement.
recovery and to help you regain optimal function as quickly as possible. It is important to . Alta Bates Summit Medical Center Orthopedic Surgery Handbook . The various chapters in this handbook will highlight specific information that you may fin
