Charles Hope, MD: FAQ

BEFORE THE SURGERY

Before surgery, your doctor will perform a complete physical examination to make sure you don't have any conditions that could interfere with the surgery or the outcomes. Routine tests, such as blood tests and X-rays, are usually performed a week before any major surgery.

  • Discuss any medications you are taking with your doctor and your family physician to see which ones you should stop taking before surgery

  • Discuss with your doctor options for preparing for potential blood replacement, including donating your own blood, medical interventions and other treatments, prior to surgery

  • If you are overweight, losing weight before surgery will help decrease the stress you place on your new joint. However, you should not diet during the month before your surgery

  • If you are taking aspirin or anti-inflammatory medications or warfarin or any drugs that increase the risk of bleeding you will need to stop taking them one week before surgery to minimise bleeding

  • If you smoke, you should stop or cut down to reduce your surgery risks and improve your recovery

  • Have any tooth, gum, bladder or bowel problems treated before surgery to reduce the risk of infection later

  • Eat a well-balanced diet, supplemented by a daily multivitamin with iron

  • Report any infections to your surgeon. Surgery cannot be performed until all infections have cleared up

  • Arrange for someone to help out with everyday tasks like cooking, shopping and laundry

  • Put items that you use often within easy reach before surgery so you won't have to reach and bend as often

  • Remove all loose carpets and tape down electrical cords to avoid falls

  • Make sure you have a stable chair with a firm seat cushion, a firm back and two arms

DAY OF & AFTER THE SURGERY

Here are some important tips:

  • Have someone available to take you home, you will not be able to drive for at least 24 hours

  • Do Not drink or eat anything in the car on the trip home

  • The combination of anaesthesia, food, and car motion can quite often cause nausea or vomiting. After arriving home, wait until you are hungry before trying to eat. Begin with a light meal and try to avoid greasy food for the first 24 hours

  • If you had surgery on an extremity (leg, knee, hand or elbow), keep that extremity elevated and use ice as directed. This will help decrease swelling and pain

  • Take your pain medicine as directed. Begin the pain medicine as you start getting uncomfortable, but before you are in severe pain. If you wait to take your pain medication until the pain is severe, you will have more difficulty controlling the pain

WHAT ARE THE ADVANTAGES OF COMPUTER ASSISTED NAVIGATION

The goals of Total Knee Replacement are to provide pain relief and restore function. Correction of deformity and balancing the soft tissue envelope are crucial to optimizing the performance and durability of the knee replacement. Standard surgical instrumentation uses either metal rods inserted up the thigh bone and down the shin bone or metal clamps that attach to the outside of the leg. Slotted metal blocks are coupled to the rods and guide the saw blade. Variations in diameter and curvature of the bones as well as the thickness of the soft tissues make these guides less accurate. Most studies show conventional guides will result in getting the knee to within 5 degrees of straight 70% of the time.

Computer navigation replaces the rod and clamps with infra-red cameras and instruments that are used to assess the deformity and guide placement of the slotted blocks which control the saw cuts. Additionally it allows the surgeon to check the cuts for accuracy. Studies have shown this results in getting the knee within 3 degrees of straight 94% of the time.

The Mako Robotic Arm Assisted Technique combines a preoperative CT scan with intraoperative navigation and saw blade control. The CT scan predicts the deformity and creates safe zones for the saw. Intraoperative navigation allows dynamic assessment of soft tissue balance and subsequent fine tuning of the surgical plan such that the tissues are balanced predominantly through subtle changes in the bone cuts rather than cutting or stretching the tight ligaments. The result is a better balanced knee replacement with less pain and swelling which speeds recovery.

WHAT PERIOPERATIVE OPTIMIZATIONS ASSIST WITH REDUCING THE CHANCE OF INFECTION IN THE PATIENT

Hip and knee replacements are complex surgeries which are typically successful in providing pain relief and restoring function. My goal is to stack the deck in favor of every patient having an optimal outcome. Attention to detail and bringing the best team to the operation is paramount. The patient is an integral part of the team and we want you in the best shape possible.

Avoiding or decreasing tobacco and nicotine improves wound healing and decreases infection.

Obesity increases the risk of getting arthritis, increases the risk of perioperative complications and decreases the durability and function of the joint replacement. Any amount of safe weight loss will make the surgery easier on me and the recovery easier on you. Water walking is an ideal way to improve strength and endurance while promoting weight loss with exercise well tolerated by arthritic joints.

Correction of preoperative anemia through iron supplements (or infusions if necessary) and special medications decrease the risks of blood transfusion, infection, and medical complications while promoting postoperative energy and vigor.

Vitamin supplements improve wound healing (Vit C), facilitate bone health and strength (Vit D) and decrease anemia (Vit B12).

Preoperative education allays fears, minimizes confusion and empowers patients to control their recovery.

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CHARLES HOPE, MD

TOTAL JOINT: HIP, KNEE, TOTAL JOINT