Our Orthopaedic Surgery Process

Scheduling Surgery

• You may schedule your surgery at the time of your office visit or if you wish to contact us after further consideration you may contact Nancy LaLiberte
  ○ 603.431.5858
  ○ [email protected]
• Preparation for surgery is a multistep process that involves patient education, health optimization, preoperative rehabilitation, medical clearance, and laboratory work.
• If you are interested in same-day discharge after your joint replacement, please indicate this during your scheduling so the necessary arrangements can be made in advance.
• Occasionally, your surgeon or medical doctor may want to order additional diagnostic testing prior to surgery. This may include additional X-rays, a CT scan, MRI, or cardiac tests such as a stress test or echocardiogram.
• Preadmission testing and Anesthesia: Most patients will require a preoperative visit to see the anesthesia service and perform necessary laboratory tests in preparation for surgery
• Our office can help arrange any additional tests and office visits
• If during the preparation process your medical doctor or the anesthesia team decides that you are not medically cleared for surgery due to increased risk, your case may need to be rescheduled to a later date to address any risk factors.
• Waitlist for Cancellations: If you wish to have your surgery date moved up we can place your name on a waitlist for cancellations of previously scheduled surgeries.

PreHab

• PreHab is short for preoperative rehabilitation and this has been shown in published studies to improve outcomes after surgery
• The goal of prehab is to strengthen the muscles around the involved joint which facilitates earlier return of function and reduces muscle inhibition after surgery
• PreHab focuses on exercises that do not aggravate the involve joint and helps mentally prepare patients for the postoperative therapy that is necessary to recover
• The emphasis of PreHab is on self-directed exercise under the direction of a therapist who can educate you on the proper exercises and techniques
• For patients who will requires crutches or a walker, PreHab will also focus on strengthening the arm and shoulder muscles that support you during the early recovery when these assistive devices are necessary.
• PreHab can be done at a location near your home or place of work and is an opportunity for you to develop a relationship with a physical therapist who can guide you through the recovery process.
• Please contact our office to obtain a referral if this was not done at the time of surgery scheduling.

Shared Decision Making

• Shared Decision Making is a process by which patients and physicians come to a mutual decision about the best course of care using evidence-based guidelines through a process of open communication. It infers that patients fully understand, treatment alternatives, expected outcomes of each treatment option as well as the risks and benefits of the chosen treatment.
• The goal of this process is for patients to take an active role in deciding what is best for them based on personal, social, and ethical values.
• With regard to joint replacement, risk factors associated with complications and poor outcomes are well defined and many of these risk factors can be optimized prior to surgery. It is critical that you understand surgical risk and what you can do personally to prevent it.
• See also this article from the New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMp1109283