At ORCA, we want all patients and non-patients to have timely access to accurate and complete information about their medical diagnosis, care and treatment. To help you better understand your condition or procedure, we invite you to explore these resources and encourage you to ask questions of your ORCA provider.
For Women – Stop Birth Control Medications
If you are taking contraceptive medication (birth control pills or shots), you need to stop taking them four to six weeks before your surgery. Oral contraceptives have been found to be associated with blood clots, which can lead to deep vein thrombosis, pulmonary embolism and possible permanent damage or even death. This normally minimal risk is greatly increased when activity is reduced due to surgery. Make sure Dr. Vermillion knows if you are taking this medication, and when you stop taking it.
Pre-operative Visit to Surgeon
You should have an appointment with Dr. Vermillion 7 to 10 days before your surgery. This will serve as a final checkup and a time to ask any questions that you might have. Make sure you bring your list of all medications you are taking, including any herbal remedies.
Post-operative Visit to Surgeon
MAKE SURE YOU HAVE A POST-OP APPOINTMENT SCHEDULED WITH DR. VERMILLION. You should set this up at your pre-op appointment.
Stop Medications that Increase Bleeding
10 days before surgery stop all anti-inflammatory medications such as Aspirin, Motrin, Naproxen, Vitamin E, etc. These medications may cause increased bleeding. You may continue Celebrex. If you are on Coumadin or Plavix you will need special instructions for stopping the medication. You should stop your Coumadin or Plavix at least 7 days prior to your surgery. Check with the physician who manages this medication for instructions for safely stopping. Some herbal and naturopathic medications, such as fish oil and ginger, also may cause increased bleeding and should be stopped at least 10 days prior to your surgery.
Prepare Your Home For Your Return From The Hospital
Have your house ready for your arrival back home. Clean. Do the laundry and put it away. Prepare meals and freeze them in single serving containers. Tend to any necessary yard work or other household chores. Pick up throw rugs and tack down loose carpeting. Remove electrical cords and other obstructions from walking areas. Install nightlights in bathrooms, bedrooms and hallways. Arrange to have someone collect your mail and take care of pets, small children, or other dependents if necessary.
Contact Your Insurance Company
Find out if any pre-authorization, pre-certification, or second opinion is required. Failure to clarify these questions may result in a reduction or denial of benefits, or delay of surgery.
Preregister At The Hospital
Get any required laboratory tests. The doctor will give you instructions on this. See your primary care physician to obtain preoperative medical clearance if so instructed. The hospital will typically call you to pre-register. If you have not heard from them by 2 days prior to your surgery you should contact them.
You will need the following information to pre-register:
- Patient’s full name, address and telephone number
- Marital status
- Social Security Number
- Name of insurance policy holder, his/her address and phone number, and his/her work address and work phone number
- Name of insurance company, mailing address, and group and policy numbers
- Patient’s employer, address, phone number and occupation
- Name, address and phone number of nearest relative
- Name, address and phone number of someone to notify in case of emergency (this can be the same person as the nearest relative)
- When you come to the hospital bring your insurance card and driver’s license (or other photo I.D.)
You will need to shower with a special soap once a day for 2 days prior to surgery. You will receive the soap from the hospital. This special soap will reduce the amount of germs on your skin prior to surgery. Shower prep before surgery: Pour the special soap on a wash cloth. Wash all areas of your body, except face and vaginal area, with the special soap. Wash the area where you are going to have surgery thoroughly. Rinse as usual and dress as usual. Do not shave legs, underarms, etc. at this time due to risk of infection. Nicks or rashes from shaving that become infected can lead to cancellation of your surgery. You should not shave less than one week prior to your surgery.
Find Our Your Arrival Time at the Hospital
Call the hospital after 2:00 p.m. on the day before surgery (call on Friday if your surgery is on Monday) to find out what time your procedure is scheduled. You will be asked to come to the hospital 2 hours before the scheduled surgery to give the nursing staff sufficient time to start IV’s, prep and answer questions. It is important that you arrive on time at the hospital, so that all necessary preparations can be made. Arriving late could result in your surgery being pushed back to a much later time.
Do Not Eat or Drink
Do not eat or drink ANYTHING after midnight, EVEN WATER, unless otherwise instructed to do so. Chewing gum is also not allowed. If you take regular medications, check with your physician who handles those medications to see if you should take them before surgery, or if you can wait until after the surgery. If you are advised to take the medication according to your regular schedule, do so with only a small sip of water. Do NOT take medication for diabetes on the day of surgery, unless you are instructed to do so by your physician.
- Bring your insurance card or driver’s license or photo I.D.
- Bring a list of your current medications, including doses and amounts. Do not bring the actual medications. The hospital will not allow you to take medications brought from home, and they may get misplaced.
- Leave jewelry, money and other valuables at home.
- If you have Advance Directives (a Living Will) bring a copy with you.
- Both hospitals have valet parking during certain hours. If valet parking is not available there is free parking available in hospital lots.
- Go to the admitting department. You will be taken to the pre-op area to wait for a nurse who will get you ready for surgery.
- In the pre-op area the nurses will start your I.V., and scrub your operative site. The operating room nurse and the anesthesiologist will interview you. You will see Dr. Vermillion in the pre-op area, or in the operating room before your procedure starts. You may have a family member wait with you in the pre-op area.
You should expect to be in the hospital for 3 days for a total joint replacement or extensive cartilage repair; unless you qualify for SwiftPath, you may go home same day. Arthroscopy patients are usually outpatient and may stay anywhere from a few hours to 24 hours. Physical therapists will get you up and walking on the first day after your surgery. You may have group therapy and exercise.
You will go home on the third day after your surgery as long as there are no complications. Someone will need to drive you home. DO NOT plan on driving yourself. You will receive written discharge instructions concerning medication, exercise, physical therapy, etc.
All medical care should be individualized to a patient’s functional level, medical condition, and personal choice.
- Keep injured arm or leg elevated with pillows (above the level of the head).
- No weight bearing on the injured extremity unless Dr. Vermillion orders it in your discharge instructions.
- Keep activity to a minimum.
- Take medications as prescribed. NO ALCOHOL!
- Bring your medication bottles to your post-operative appointments at Dr. Vermillion’s office.
Cast and Splint Care
- Keep clean and dry.
- Do not put anything between the cast and your skin (e.g., coat hangers or pencils).
- Take special care of a new cast or splint. Do not walk on splints, as they may break.
- Allow new cast to dry approximately 48 hours before handling or writing on it.
- As the cast dries it will become cooler and lighter.
- Never remove a cast yourself.
Control Your Pain
- Use your pain medication as needed. You will recover faster if you keep your pain to a minimum.
- Use your pain medication according to instructions. Do not exceed the recommended dosage.
- Take your pain medication at least 30 minutes before physical therapy.
- Change your position every 45 minutes throughout the day.
- Use ice for pain control. Dr. Vermillion often prescribes a Game Ready ice machine for post-op pain control. Use it as directed, which means you should have it on whenever you are inactive.
- DO NOT TAKE ANTI-INFLAMMATORIES SUCH AS IBUPROFEN UNLESS APPROVED BY DR. VERMILLION. Non-steriodal anti-inflammatories (NSAIDS) have been shown to retard, or even stop, the healing process in cartilage.
Use Your CPM and/or Game Ready Machines as ordered
- Dr. Vermillion frequently prescribes a Game Ready ice machine for post-op pain control. The Game Ready provides intermittent cooling and pressure to reduce swelling and speed healing. You should have the Game Ready on whenever you are inactive.
- Continuous Passive Motion Machines (CPM) move your leg for you, which helps reduce swelling, move blood from the joint, and prevent stiffness. In most patients after extensive joint surgery, attempts at joint motion cause pain, so the patient avoids moving the joint. This allows the tissue around the joint to become stiff, and scar tissue to form, resulting in a joint that has limited range of motion. It often takes months of physical therapy to recover that lost motion. The CPM gradually moves the joint without the use of the muscles, which helps prevent this post-operative stiffness and speed your recovery. You will need to use it for several hours every day. If you have been given an immobilizer brace, be sure to remove it before using the CPM.
- You can use the CPM and Game Ready at the same time.
- You should continue to use these machines for 2 to 4 weeks after your surgery.
- A representative from the company will issue you these machines prior to your surgery so that you can begin using them immediately post-op. When you are finished with them they will be returned to the company. Normally insurance does cover the cost.
Physical Changes You May Not Expect
- Your appetite may be poor. Drink plenty of fluids to keep you from getting dehydrated. You will be hungry again eventually!
- You may have difficulty sleeping. This is normal. You can help yourself get sleep at night by not napping too much during the day.
- You will have reduced energy levels during the first month.
- Pain medication contains narcotics, which can cause constipation. Use stool softeners or laxatives such as milk of magnesia if necessary, and be sure to drink plenty of fluids.
You may be given Lovenox to help avoid blood clots in your legs during this time of decreased activity. Blood clots can lead to a life threatening condition culled a pulmonary embolism, which happens when a blood clot travels from the legs to the lungs. Lovenox is a blood thinner. You will receive instructions in the hospital about how to use the Lovenox and for how long. Lovenox is an injection given into the fatty tissue of the stomach. You will administer this injection at home for 7 to 10 days after your surgery.
- You will be asked to wear special pressure stockings to help compress the veins in your legs, to help keep swelling down and reduce the chance for blood clots.
- If you have problems with swelling in your operative leg, elevate it for short periods throughout the day, with the leg elevated higher than your heart. Notify Dr. Vermillion if you notice increased pain or swelling in either leg.
- Wear the stockings continuously, removing for only 1 to 2 hours twice a day. As Dr. Vermillion when you can stop wearing the stockings. Usually it will be about 3 weeks after the surgery.
- Keep your incision dry. You may shower 3 days after surgery. After showering apply a fresh, dry dressing.
- Keep your incision covered with a light, dry dressing until your staples are removed, usually about 10 to 14 days.
- Notify Dr. Vermillion if you have increased drainage, redness, pain, odor or heat around the incision. If you feel warm or sick take your temperature. Call Dr. Vermillion if your temperature is 101 degrees farenheit or higher.
Changing Your Dressing
- Wash your hands.
- Open all the new dressing change materials.
- Remove the old dressing.
- Look carefully at the incision for increased redness, an increase in clear drainage, yellow or green drainage, odor, or skin around the incision that is hot to the touch.
- Dr. Vermillion may have ordered Betadine. If so, use one Betadine swab to paint the incision from top to bottom. Turn the swab over and paint it again from bottom to top. Use the remaining swab to paint the drain site.
- Pick up the ABD pad by one corner and lay over the incision. Be careful not to touch the inside of the dressing that will be touching the incision.
- Place one ABD pad lengthwise of the incision, and place the other pad crosswise to form a “T” to cover the drain site.
- Tape the dressing in place.
(If any of these signs occur, notify the office immediately, day or night.)
- Increasing swelling of fingers or toes, even with elevation.
- Numbness or tingling.
- Increasing inability to move fingers or toes.
- Poor circulation or discoloration of fingers or toes.
- If any of the above occur with a splint, remove and re-wrap ace bandage more loosely.
- Signs of infection include swelling or redness at the incision site. Also watch for changes in the amount, color or odor of drainage. Increased pain in the hip or fever greater than 100 degrees Farenheit may also be signs of infection.
- You can help prevent infection by taking care of your incision as explained.
- If you had joint replacement surgery you now have an increased risk of infection when you have dental work or other surgery. For at least 2 years after your surgery you will need to take prophylactive antibiotics if you have any type of dental or surgical procedure. Notify your other physicians and your dentist that you have an artificial joint.
Blood Clots in Legs
Surgery may cause the blood to slow in the veins of your legs and create blood clots. This is why Dr. Vermillion prescribes Lovenox after surgery. It is possible that a clot will develop despite these efforts to avoid them, and if this happens you may need to be admitted to the hospital to get blood thinners intravenously. A blood clot can turn into a pulmonary embolism, which is a very serious complication, so it is very important that you get treatment promptly if a blood clot is suspected.
- Signs of blood clots in your legs include swelling in your thigh, calf or ankle that doesn’t go down when you elevate the leg. Pain or tenderness in your calf may also signal a blood clot. Please note that a blood clot can form in EITHER leg, not just the leg you had surgery on.
- You can prevent blood clots by doing the foot and ankle exercises you were shown in the hospital, walking, wearing your compression stockings, and using your blood thinners (such as Coumadin) as instructed.
When a blood clot breaks away from the vein and travels to the lungs it is called a pulmonary embolus. This is a very serious, potentially life-threatening condition, and you should call 911 immediately if you suspect that you have a blood clot.
- Signs of a pulmonary embolus include sudden chest pain, difficult and/or rapid breathing, shortness of breath, sweating, or confusion.
- You can help prevent a pulmonary embolus by preventing blood clots in your legs, and getting treatment promptly if you suspect a blood clot.
Knee Cartilage Repair Protocol
High Tibial Osteotomy-Femoral Condyle Protocol
Medial & Lateral Ankle Stabilization Protocol
Lateral Distal Femoral Osteotomy Protocol
Medial Patellofemoral Ligament Protocols
International Cartilage Repair SocietyDr. Vermillion is a member of this international group which specializes in research and the exchange of knowledge about cartilage repair.
Alaska Regional Hospital
Providence Alaska Medical Center
Creekside Surgery Center
Genzyme BiosurgeryGenzyme is the laboratory where a patient’s cartilage can be grown for Carticel transplants.
BiometBiomet is the source of our unicondylar knee implants.
StrykerStryker is the source of some of the implants used by Dr. Vermillion for joint replacement surgeries.
SynviscInformation on the lubricating joint injection.
CarticelInformation on Carticel implantation.
Alaska Medical SolutionsAMS provides equipment used by our patients for post-operative recovery