Surgical procedures

After the proper diagnose confirmed in clinic and having received a notification for hospitalization, patients should receive a pre-surgery work-up at the hospitalization services. These may include: CBC, liver function, renal function as well as X-ray, Standing Scanogram, blood type and cross-match, anesthesia information and other procedures etc. Please see (Appendix 1,2)
  • One day prior to the operation, the doctor in charge will explain to patients the content of the surgical operation and what to pay attention and look out for after the operation. Afterwards the patients are to sign the forms for surgical consent, clinical information, and consent for blood transfusion etc. Then the medical staff will inform patients about meal times. Please see (Appendix 3)
  • On the day of the operation, we will establish a intravenous line and at the appropriate time, we will send the patient to the operation room and do a last minute check up to make certain about the surgical site and the type of surgery that will be performed on the region.
  • After being anesthetized, we will inject antibiotics to prevent infection. The main method of anesthesia would be through spinal anesthesia. Only for exceptional cases we use general anesthesia.
  • The surgical operation will take about two hours long
  • After the operation, patients can request for PCIP for pain control

Hospitalization and recovery

  • Patients are to be hospitalized for 8 days. During the hospitalization, aside from providing care for the wound, patients also receive physical therapy. After being able to reach 90 degrees in motion of knee, patients will be to be discharged from the hospital.
  • After leaving the hospital, patients should continue physical therapy at home using a walker or cane in walking. After about six to eight weeks, patients are allowed to walk without aid.

Risks
  • Risks from anesthesia: Risks of the heart, brain, lungs, and other regions are not directly related to the surgical site.
  • Risks during surgery: neurovascular injuries.
  • Risks after surgery: Infection, or failure in recovery may affect range of activity, function, severe skin damage on the wound
  • The surgical operation will take about two hours long
  • long-term risks: damaged artificial joint, loosening of implants (infection or non-infection related.) Please see (Appendix 4, 5)


Knee joint replacement surgical operation hospitalization notification

Patients receiving the knee joint replacement need to be hospitalized for approximately 8 to 10 days. Below are lists of medical events during hospitalization:
  • Day of Surgery and hospitalization
    • Blood test, electrocardiogram, chest x-ray
    • Nothing by mouth (includes water and food) 6-8 hours prior to surgical operation.
  • Day of surgery to the day of discharge:
    • Partial anesthetization: After operation, patients need to stay inactive in bed for 8 hours and must follow directions for meal times (before meals, please drink three sips of water, if there’s no signs of discomfort or abnormality, then proceed with the meal), be aware and avoid food stuck in the throat.
    • Caring for the wound: three days after the surgical operation, the medical treatment team will provide new dressing for the wound and observations.
    • Patients will receive oral analgesic to relieve pain as well as three days of antibiotic injection to avoid infection.
    • Patients may be discharged if not feeling any signs of physical discomfort after changing dressings for the wound,
    • After being discharged from the hospital, patients should watch for any signs of fevers, swollen wounds, or pus excretion. If experiencing any of the above, please return to the hospital immediately.
  • Return to the hospital regularly for check ups


Hip joint replacement surgical operation hospitalization notification

Patients receiving the hip joint replacement need to be hospitalized for approximately 8 to 10 days. Below are lists of medical events during hospitalization:
  • Day of Surgery and hospitalization
    • Blood test, electrocardiogram, chest x-ray
    • Nothing by mouth (includes water and food) 6-8 hours prior to surgical operation.
  • Day of surgery to the day of discharge:
    • Partial anesthetization: After operation, patients need to stay inactive in bed for 8 hours and must follow directions for meal times (before meals, please drink three sips of water, if there’s no signs of discomfort or abnormality, then proceed with the meal), be aware and avoid food stuck in the throat.
    • Caring for the wound: three days after the surgical operation, the medical treatment team will provide new dressing for the wound and observations.
    • Patients will receive oral analgesic to relieve pain as well as three days of antibiotic injection to avoid infection.
    • Patients may be discharged if not feeling any signs of physical discomfort after changing dressings for the wound,
    • After being discharged from the hospital, patients should watch for any signs of fevers, swollen wounds, or pus excretion. If experiencing any of the above, please return to the hospital immediately.
  • Return to the hospital regularly for check ups

Artificial joint replacement surgical operation consent form

Personal information
Patient’s name :  
Patient’s date of birth :  
Patient’s medical record number :  
Principal operating surgeon :  
A. Intended surgical procedure (If the medical terms are not clear, please provide brief explanations)
1. Type of illness: Left, right, knee, hip, shoulder, elbow, joint
  □ Degenerative arthritis
□ Rheumatoid arthritis
□ _____________
2 Suggested surgical procedure:
  □ Artificial knee joint replacement surgical operation
□ Redo artificial knee joint replacement surgical operation
□ Artificial elbow joint replacement surgical operation
□ Artificial hip joint replacement surgical operation
□ Redo artificial hip joint replacement surgical operation
□ Artificial shoulder joint replacement surgical operation
□ Partial artificial joint replacement for (knees, hips, shoulders)
□ Others__________________-
3 Reasons for surgery
 
B. Doctor’s statement
1 I have, to the best of my ability, fully informed the patient about the surgery, especially to the following:
  □ Reasons for suggested surgery, the procedure and scope, its risk and success rates, and the possibility of blood loss.
□ Possible complications and its treatment
□ Consequences for refusal of operation, and other alternative treatment
□ Temporary or permanent symptoms that may occur after the surgery
□ I have provided some written information pertaining the surgery (if available) to the patient.
2 I have given sufficient time for the patient to ask questions regarding the surgical procedure, and answered them as such:
  (1)_________________________________________
(2)_________________________________________
(3)_________________________________________
Name and Signature of the Principal Surgeon
  Date: year     month    day
Time:   hour   minute
 
C. Patient’s statement:
1 The doctor has explained to me, and I fully understood the surgical necessity, nature of procedure, risks and success rates, and other information regarding the operation.
2 The doctor has explained to me, and I fully understood the risk of choosing other alternative treatment.
3 The doctor has explained to me, and I fully understood the situations that might occur after the surgical procedure, and the risk of not undergoing surgery
4 I fully understood that there might be blood loss in surgery. I □ agree  □disagree with any blood transfusion.
5 In regarding to my questions and doubts of my illness and the proposed surgical procedure, my doctor had provided me with adequate answers.
6 I fully understood that during the surgery, the surgeon might necessarily remove certain organ(s) or tissue(s) from my body. The hospital will preserve it for a period of time, and judiciously disposed at a later date.
7 I fully understood that at present, this surgery is the best option, but there is no guarantee that it would improve the conditions of my illness.
In accordance with all the agreements above, I give my full consent to undergo this surgery
Consent given by:                            relationship: patient’s Address:                                   Telephone number: Date:     year       month     day         Time:    hour   minute
Witness:                                   signature: Date:     year       month     day         Time:    hour   minute
 
Additional comments:
A. Risk of surgery
1 Excluding surgery done under local anesthesia, there is possibility that the lungs will partially collapse and lose function, increasing the risk of pulmonary infection, which need antibiotic treatment and other respiratory care
2 There is the possibility that blood vessels of the legs might be blocked, causing pain and swelling. Although it is rare, the blood clots might move into the lungs, and will cause life-threatening situation.
3 The pressure of the heart might aggravate heart conditions, and also possibility of strokes.
4 The institution and its medical staff will treat and operate on the patient, to the best of their ability. However, no guarantee is given for the success of the operation and other unexpected situations that might occur, including death.
B. Reasons for risks from surgery
  □ Seniors (>65)  
□ diabetes                 
□ anesthesia
□ cardiovascular disease
□ lung function damaged
□ others______
□ liver function damaged
□ kidney function damaged
C. Possible illness that may result from surgery:
  □ Pneumonia
□ Wound infections, separation of wounding, bleed, wound necrosis
□ Limited range of body activity
□ Deep infection
□ Nerve injury
□ Dislocation
□ Loosening of implant
□ Deep vein thrombosis
□ Fracture around the implant
□ Uneven length of legs
□ others ________
D. Treatment and care after surgery:
  □ Take deep breaths, and cough
□ Pain relief and pain control
□ Inhalation therapy
□ Drain care ( □ catheter   □ wound drainage tube)
□ Early up and about (second day after surgery)
□ Caring for the wound
□ Follow instructions from the doctor, do not eat or drink unless being told
□ Rehabilitation therapy
□ others________________


Patient Instructions: after knee joint replacement surgery

  • Conditions after the surgical procedure
    • Usually, lumbar anesthesia is used during the surgical procedure. 8 hours after the surgery, patients must lay completely flat in bed. Pillows are not to be used when lying in bed.
    • The incision will be covered with Elastoplasts and gauzes. A drainage tube will be placed in the wound. After 2-3 days, the doctor will decide when to remove the tube
    • After anesthesia wears off, patients will begin to experience pain. Patients should take deep breaths to relax muscles and reduce pain. If needed, patients may also request for pain shots. Patients may also request for PCA to relieve pain on a self-pay basis.
    • After regaining complete conscience, patients can drink water unless the doctor instructed otherwise. At times patients will experience nausea resulting from anesthesia and pain relief shots. Patients may not eat if experiencing nausea. If not, eating is allowed.
    • The medical staff will apply ice to the wound to prevent excessive swelling, pain, and bleeding
    • The medical staff will assist to place pillows sideways and under the knees of the patients to keep the knee in position.
    • After surgery, patients experiencing pain from the lower leg or the foot and excessive swelling must immediately notify the medical staff in order to receive treatment.
  • Recovery: Post surgery
    • In accordance to the doctor’s instruction, usually, the second day after surgery, the medical staff will assist and teach patients how to use “Knee exerciser” (CPM) to help patients do the bending and stretching exercises starting on a 40-50 degree angle. Everyday, the bending exercises will increase 5-10 degree angle until the knee joint can regain normal function in which is it is able to bend over 90 degrees.
    • When initially practicing the exercises, patients may feel uncomfortable. We will adjust the CPM to a slower pace by reducing the angle degree. If experiencing extreme pain or unusual conditions, please immediately stop the CPM and notify the medical staff as soon as possible
    • Body exercises after surgery:
      • After surgery, patients can begin to do exercises with their toes and ankle(s) if the pain is bearable.
      • Joints that didn’t undergo surgery will not be affected and are able to function well in physical activity.
      • Quadriceps muscle movement: begin first day after surgery.
      Method: Lie flat and stretch out the surgical leg and compress thigh muscles. Make sure the backside of the knee joint is faced down on the surface of the bed. Hold to this position for five minutes.
    • Ankle exercises: begin first day after surgery
      Method: Lie flat and stretch out the surgical leg and flex both feet back and forth as if warming up for an exercise. Roll both feet for five minutes.
    • Leg lifting exercises: begin three days after surgery
      Method: Lie flat with both legs stretched out. Lift the surgical leg high and leave it hanging in the air for five seconds before putting it back down. Rest for five seconds and repeat the process.
    • Bending and flexing of the knee: begin three days after surgery
      Method: Move towards the edge of the bed in a sitting position with legs still stretched out. Move to a position where your thighs are on the side of the bed and your lower legs are stretched out hanging in the air and slowly put your leg down. After you are adjusted and feel comfortable with the position you may slowly put down the surgical leg. Because the bed is soft, the pressure caused from the legs will force the bed to sink down. Press down on the surgical leg with force for ten seconds, then let go. The bed will slowly help the leg sprint back to position. Repeat this process 8-9 times.
  • Treatment at home:
    • After returning home, patients need to continue practicing the exercises: Quadriceps muscle movement, ankle exercise, leg lifting exercise, and bending and flexing of the surgical leg
    • When out of bed, patients must use mobility aids or other devices to prevent falling over.
    • After removal of stitches, patients are allowed to bath and shower but please be careful not to slip and fall. The wound needs to be kept as clean and dry as possible. If there are any unusual changes in the wound, please immediately return to the hospital to get a check up.
    • Avoid injury and excessive weariness
    • Avoid abrupt and intensive exercises
    • Three months after the surgery, patients must use mobility aids and clinic tracks until doctors agree that patients may walk without it.
    • Swollen legs may be caused by long-distance walk. If patients are experiencing this problem, please reduce the walking distances, and when walking, the thigh should be raised high. Apply ice to the surgical region.
    • Increase amount of activity everyday. Be sure to take adequate rest every time after exercising for thirty minutes.
    • Patients may not drive until they gain permission from their doctors when reaching the usual amount of activity.
    • Patients must follow strictly to the instructions on the amount of activity given by their doctors.
    • When feeling capable, patients may work starting from working for lesser hours until feeling comfortable with your body conditions.
    • Patients must avoid the following exercises: squatting, long-distance walking, carrying heavy objects, climbing stairs, and mountain climbing.
    • Please maintain an ideal weight; when carrying heavy objects, use wagons or trolleys; when climbing stairs, use the handrail to reduce burden from the knee.
    • When catching a cold, having infections on the skin or other areas, or having a dental treatment, please notify doctors about having had undergone a joint replacement surgery on the knee, let your doctor know about your condition and treatment status in order for them to decide whether or not to give antibiotic injections
  • When experiencing the below, please return to the hospital to receive a re-check up immediately:
    • Irritations: Red, swollen, liquid oozing from the wound, or increase in pain and fever.
    • Severe pain from the wound.
    • Unable to increase amount of activity caused by the pain from the wound.
    • Injuring or bruising the wound when falling or tripping over.

Patient Instructions: after hip joint replacement surgery

  • After the surgery
    • After regaining complete conscience, patients can drink water unless the doctor instructed otherwise. At times patients will experience nausea resulting from anesthesia and pain relief shots. Patients may not eat if experiencing nausea. If not, eating is allowed.
    • Please keep the surgical area dry. If bleeding, immediately contact the medical team.
    • Please follow directions given by the medical team. Turn your body over every two hours to avoid damaging of the skin cells from the back resulting from lying too long on it.
    • Please follow directions given by the medical team. Make sure you carry out the breathing deeply and coughing exercises. Cough out phlegm to prevent any lung diseases.
    • When lying down, patients must place a pillow in between both legs to keep the legs spread outwards in a natural position. When turning over the body, both legs must grip a pillow.
    • When feeling pain in the wound, patients may take the doctors’ advice to receive pain-reducing injections. Patients may also take deep breaths and relax muscles to reduce pain
    • Take in water and vegetables to avoid constipation
    • After surgery, patients may begin to practice exercises contracting muscle areas in the thigh, knee joint, and ankles.
    • After surgery, patients may get off their beds and move around using mobility aids or other devices if the wound is in a bearable condition. Note that there may be no burden on the wound.
  • Positions that need attention on within three months after surgery In order to prevent dislocation of the joint please pay attention to the below:
  • Treatment at home:
    • After returning home, patients need to continue practicing the exercises: thigh muscle contracting exercises, hip joint (abducting) exercise, ankle exercises.
    • After surgery, within three months, activity out of bed should be aided by a mobility aid or device.
    • Driving is prohibited within three months after surgery.
    • Patients must follow strictly to the instructions on the amount of activity given by their doctors. Avoid the following activities: squatting, long-distance walks, carrying heavy objects, mountain climbing, or other intensive exercises.
    • Maintain an ideal weight.
    • If experiencing the following on the wound, return to the hospital immediately to receive a re-check up: redness, swollenness, liquid oozing from the wound, fever, intense pain or when injured and bruised.
    • Avoid injuries or abrupt and intensive exercises. If experiencing sever pain in the hip joint area, deformed lower body, possibility of dislocation of hip joint, immediately contact the doctor.
    • After surgery, if patient are receiving treatment for other diseases or illness, please notify your doctor about your artificial joint surgical history in order to receive the best treatment by your doctor.

    If you have any questions, it is our pleasure to answer for you.

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