Once we have decided together that a joint replacement is the right step, a series of things happen in a fairly set order. This chapter walks through them so nothing comes as a surprise.
Consent — understanding the operation
Dr Broadhead will go through the operation with you in detail: what it aims to achieve, what it involves, the risks that matter, and what recovery asks of you. You will sign a consent form, but the form is the least important part. The point is that you can explain the operation in your own words before you agree to it. Bring your questions written down; bring a family member if you like.
Costs, in writing
You will receive a written quotation before any procedure, setting out any out-of-pocket expenses. Dr Broadhead is a member of the Australian Medical Association and uses AMA fee recommendations as a guide. The estimate covers the surgeon, surgical assistant, anaesthetist, hospital and any implants, so you can see the full picture in one place.
If you choose treatment in a public hospital, your care is fully covered by Medicare with no out-of-pocket cost. You will be placed on the hospital’s waiting list — for a joint replacement this is typically more than twelve months — and as RPA is a teaching hospital, your operation may be performed by a supervised training registrar. If you are treated privately, a date can be planned around your schedule.
Tests before surgery
You will have some routine tests so the anaesthetist and surgeon can plan safely: blood tests, a heart tracing (ECG) and sometimes a chest X-ray. Further X-rays or scans of the joint itself may be arranged to plan your implant — this is how “custom” planning is done, whether or not any robotic assistance is used in theatre.
The anaesthetist
Before the operation you will be assessed by the anaesthetist — at a pre-admission clinic, in the rooms, or by phone. Most joint replacements are done under a spinal anaesthetic, a general anaesthetic, or a combination; the anaesthetist will recommend the safest option for you and discuss their fee. If you see a cardiologist or other specialist, bring their letters — it genuinely helps.
What you can do yourself
The weeks before surgery are not a waiting room. Four things measurably improve results:
- Keep moving. The stronger the muscles around the joint going in, the faster the recovery coming out. Public patients are invited to the Osteoarthritis Chronic Care Program; private patients can see a physiotherapist for a pre-surgery program.
- If you smoke, stop or cut down. Smoking impairs wound healing and raises the risk of infection and anaesthetic complications.
- If you are carrying extra weight, losing some before surgery lowers your risk.
- Deal with infections early. A skin wound, a bad tooth, or a bladder infection near the time of surgery can seed infection in a new joint. See your GP about any of these before your operation.
Medicines, fasting, and the day itself
If you take blood-thinning medicines — aspirin, clopidogrel, warfarin, apixaban, rivaroxaban and similar — you will be told exactly when to stop them. Do not stop them on your own; do not keep taking them past the date you are given either.
The hospital will contact you the day before surgery with your arrival time and fasting instructions. As a rule you will fast for at least six hours beforehand. Follow the instructions exactly — eating when you should not can mean your operation is cancelled on the day.
What to bring: your medicines (or an accurate list with doses), any allergy details, comfortable clothes, toiletries, and your health fund or Medicare details. Leave valuables at home.