CONTACT INFORMATIONThree Rivers Orthopedic St. Margaret Office .....................................................................................412-782-3990

............................................................................................................................................................ Fax: 412-782-3993

Three Rivers Orthopedic Natrona Heights Office ............................................................................... 724-226-1199 ........................................................................................................................................................... Fax: 724-226-1479

UPMC St Margaret ...................................................................................................................................412-784-4000

Harmar Outpatient Center ......................................................................................................................412-784-7500

Orthopaedic Inpatient Unit ......................................................................................................................412-784-4475

Care Management ......................................................................................................................................412-784-4169 (Including social workers and case managers)

Thank you for choosing Three Rivers Orthopedic Associates –UPMC. Our mission has remained the same since opening our practice in 1964: To provide exceptional care to those patients who choose us for their orthopaedic needs.

We are committed to using the latest treatment options to restore each patient’s health and previous level of functionality. Our board-certified orthopaedic surgeons specialize in providing services for a variety of conditions, including fracture care, hand surgery, total joint replacement, minimally invasive (MIS) hip and knee replacement, arthroscopy, foot and ankle problems, spinal surgery, and sports medicine.

This Patient’s Guide to Recovery isn’t intended to be a replacement for speaking with your orthopaedist and our staff about what you should expect during the recovery process. Instead, we hope you will use this guide as a launching point for conversations about your care at Three Rivers Orthopedic Associates–UPMC and UPMC St. Margaret.

This guide provides general information about what you should expect before surgery, the day of surgery, and your recovery process in the days and weeks to come.

We hope that you will find this guide helpful as you prepare for your upcoming orthopaedic surgery at UPMC St. Margaret. Please do not hesitate to contact us if you have any questions or concerns about your procedure. We thank you for trusting us with your care.

ABOUT OUR FACILITIESIn the heart of the Alle-Kiski Valley, UPMC St. Margaret is a center of excellence in orthopaedics. This 250-bed acute care and teaching hospital provides residents convenient access to the area’s finest physicians and health care providers.

UPMC St. Margaret offers patients a wide range of services, including orthopaedic surgery, radiology, emergency medicine, and cancer care. Private patient rooms and dedicated staff who work to ensure that the care provided meets the needs of each individual patient, are some of the ways that UPMC St. Margaret upholds its mission of providing the highest level of quality care.

An extension of UPMC St. Margaret, UPMC St. Margaret Harmar Outpatient Center is an ambulatory care center that provides surgical services that do not require an overnight stay in the hospital. This two-story facility, located minutes from Route 28 and the Pennsylvania Turnpike, has pre- and postoperative suites, five operating rooms, and a large comfortable patient and family waiting area.

The physicians and staff of Three Rivers Orthopedic Associates—UPMC have every confidence in the quality of care being delivered from both of these facilities.

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WHEN YOU ARRIVE

Parking and Registration

Patients and families/visitors• Park in designated visitor parking lots.

• Valet Parking and One-Day Parking passes also are available. Visit our parking attendants near hospital Entrance C.

• If you have bags or luggage because you are being admitted, leave it in the car so that it is not a burden to you.

• If you need crutches or a walker, bring them into the hospital.

• If a family member or friend is dropping you off, go to hospital Entrance A.

• Be sure to keep your parking ticket with you. It will be validated by a liaison for a discounted parking fee.

• After entering the hospital at Entrance A, turn right and then an immediate left. The ASU is at the end of the hall on the right.

• Register at the ASU waiting area front desk.

Preoperative Area

Patients• The preoperative (pre-op) area is where you will

be prepared for your procedure.

• You will be given a hospital gown and foot coverings to wear.

• A member of the pre-op staff will weigh you, check your heart rate, blood pressure, and temperature.

• A nurse may ask you to confirm some of the information that you provided during your pre-op phone call.

• Additional pre-op testing or blood work may be completed at this time.

• An IV will be placed to be used for medications during your procedure.

• You will meet with members of the surgical team to discuss your procedure.

• You also will meet with the anesthesia team to discuss your options for anesthesia.

Families/visitors• Once preparation is complete, you will be able

to see your loved one before they are taken to surgery.

• Please limit the number of visitors to two.

• Please remember to respect the privacy of other patients and remain calm and quiet to allow our staff to focus on patient care.

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Operating Room

Patients• When the time comes for your surgery, you

will be taken from the pre-op area to the Operating Room.

• Your visitor(s) will be directed back to the ASU waiting area.

• The surgeon may give you an estimated length of time for your procedure. Remember that this is only an estimate. Each patient has specific needs and we want to ensure the best care possible for every patient.

Families/visitors• If you decide to leave the ASU while you wait,

let the liaison at the front desk know and leave your cell phone number so that you may be contacted if necessary.

• Be sure to wear appropriate attire, including shoes and shirts, throughout the hospital.

• While waiting for your loved one, you are welcome to watch TV in the ASU waiting area. You may use personal computers, DVD players, or game consoles with headphones. Free Wi-Fi service is available.

• We kindly ask that you set your cell phone to vibrate.

• Enjoy complimentary beverages and feel free to bring food or drinks from the cafeteria or elsewhere.

• Staff may contact you with updates during a long procedure. Remember that you also may track the progress of your loved one through the patient tracking screens located in the ASU waiting area and in the hallway.

• The surgeon may contact you after the procedure. However, keep in mind that the length of time in which you may be contacted could depend on the surgeon’s schedule. Please be available to talk to the surgeon when contacted by the surgical staff.

Recovery Room

Patients• There are two recovery areas which are

referred to as ‘phase one’ and ‘phase two.’ The Postanesthesia Care Unit (PACU) is phase one and the ASU is phase two.

• Based on your condition, you may be required to spend time in both the PACU and the ASU.

• Most patients go to the PACU, phase one of recovery, first. In the PACU, the nursing staff watches you closely, monitoring your heart rate, blood pressure, temperature, and breathing.

• The nurses also may give you medication to control your pain and any possible nausea.

• If you will be admitted the same day as your procedure, your family or visitor(s) may be brought back to the PACU to see you during scheduled visitation times.

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ABOUT YOUR SURGERYYou and your physician have selected UPMC St. Margaret for your surgery. Our staff will do all they can to assure you are comfortable and informed during your brief stay with us. Here are some things you should do to prepare for your surgery.

• Testing ordered by your surgeon must be done in advance, either at UPMC St. Margaret or at your physician’s office. Check with your insurance company about where tests can be performed.

• Laboratory pre-testing may be scheduled within 90 days of your surgery. Lab hours; Monday through Friday 6 a.m. to 7 p.m. Weekends 7 a.m. to 3 p.m. Call ahead for express lab registration 1-866-334-LABS (5227)

• History and physical exams may be scheduled within 30 days of your surgery by calling 412-784-2216.

• If you will need physical therapy visits for crutch training, you should schedule those visits in advance by calling 412-784-5010. Evening and Saturday appointments are available.

• You will be contacted 1 to 2 days before your surgery with your pre-op instructions. If you have questions, call 412-784-4828.

What to do the day before surgery• Do not eat or drink after midnight. (that includes

chewing gum, breath mints and water.)

• Bathe or shower.

• Remove nail polish.

• Avoid alcoholic beverages 24 hours prior to surgery.

• No smoking or chewing tobacco 24 hours prior to surgery.

• Call your surgeon if you develop a cough, cold, or flu-like symptoms.

• A nurse will notify you of any changes in your arrival time.

• A responsible family member or other adult must drive you home and stay with you 24 hours after surgery.

• Do not use hair spray or gel 24 hours prior to surgery.

Provide a complete list of current medications including prescriptions, vitamins, herbals and any other over-the-counter medications you are taking.

Some medications should be discontinued prior to surgery. Please check with your surgeon.

The day of your surgery• Enter the hospital at entrance A and proceed to the

Surgical Waiting Room. Bring insurance cards and papers from your physician’s office if instructed. Check in at the waiting room desk.

• Do not take medications the day of surgery unless a physician or nurse instructs you to take your medication.

• Wear comfortable clothing that is easy to remove.

• Do not wear jewelry (including rings) or make-up. Remove all body piercings.

• Do not wear contact lenses. Bring your glasses with a case.

• Leave all valuables at home.

• If you expect to be admitted to the hospital, bring a small bag with belongings and leave this in the car until your room is assigned after surgery.

• If you will need crutches or a walker, bring them into the hospital. Bring a pillow and leave it in the car for the ride home.

• If no one can stay during your surgery, have the phone number available for the nurse to contact the person driving you home at the time of discharge.

• Bring your inhaler, insulin, and/or CPAP machine.

• A parent or legal guardian must accompany any patient under age 18.

• Remember to have your parking ticket validated by a nurse.

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WHAT YOU NEED TO KNOW BEFORE SURGERY

Ten days before surgeryStop taking any medications that could cause increased bleeding. These medications include:

• all aspirin products, including 81 mg baby aspirin

• ibuprofen or naproxen (Advil®, Aleve®, or Motrin®)

• Plavix®, Aggrenox®, or Pletal®

• Coumadin (should be stopped six days before surgery, unless otherwise instructed)

• all herbal and natural supplements, including glucosamine, fish oil, etc.

(Please refer to the entire list of “Medications to avoid prior to surgery” in the pre-op booklet you were given at the time you scheduled your surgery.)

You may continue to take Tylenol and Celebrex up to the day of surgery.

The night before surgeryDon’t have anything to eat or drink starting at midnight the night before your surgery. This includes gum, candy, coffee, and water. Your surgery could be cancelled if you don’t follow this direction.

Arrangements for your arrival at UPMC St. Margaret A nurse from UPMC St. Margaret will call you one to two days before your scheduled surgery to let you know when you should arrive at the hospital. At that time, the nurse also will tell you what prescription medicines you should take the morning of your surgery. You may take those medicines with a small sip of water.

What to bring to the hospitalOnly bring personal hygiene items such as toothbrush, toothpaste, and deodorant. You also should bring loose-fitting workout clothes. We recommend that you bring footwear that you normally wear, such as tennis shoes. You will need these items after surgery.

Preparing your home for after surgeryIt is important to get your home ready for your return. Our goal is for all of our patients to go home from the hospital. The following preparations should help make things easier:

• Have all laundry washed and put away.

• Have clean linens on the bed.

• Prepare and freeze meals.

• Complete all yard work.

• Remove any obstacles from your living space, including throw rugs, electrical cords, and loose carpet.

• Install night lights in hallways, bathrooms, and bedrooms.

• Arrange for someone to take care of a pet if needed. Some pets can be a fall risk, so arrangements should be made to help lower this risk.

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THERAPYTherapy will begin the day of surgery for some patients, depending on your operation. Otherwise, physical and occupational therapy will start the day after surgery (postoperative day 1). You will have therapy sessions once in the morning and once in the afternoon. Your therapy program is designed with your individual needs and the exercise protocols that your surgeon has established.

Day of Surgery You may have an evaluation with physical therapy on the day you have surgery, depending on your operation. All other evaluations start on postoperative day 1 (the day after the operation). The evaluation will include an introduction to your exercises. The evaluation also will include an assessment of your upper and lower body strength, and your ability to perform daily activities.

Finally, it will include learning how to use a walker, crutches, or cane as needed.

Postoperative PeriodYou will have therapy twice a day, once in the morning and once in the afternoon. You will receive education on self-care and your daily living needs.

You will be encouraged to progress during your therapy sessions in order to improve your recovery after surgery. You will need to meet certain goals before you can go home, to make sure you are able to manage your activities safely.

The speed of your recovery depends mostly on you.

GOING HOMEThe case manager will meet with you and your family on postoperative day 1 to discuss discharge planning. He or she will assess any of your after-hospital needs or barriers.

Our goal is to plan for all of our patients to return home. Home care services are available if needed.

If ordered by your surgeon, Home Health will assist with any injections, perform wound checks, and bandage changes, etc.

If other discharge plans are necessary, the social worker and the case manager will help you.

The case manager and the social worker will work together with the orthopaedic team to make sure your discharge is a smooth transition from the hospital to the next level of care that you may need. Our goal is to minimize your concerns and anxiety and provide quality care to meet your expectations.

Day of DischargeOn the day you are discharged from the hospital, your nurse will review your instructions with you and will answer any questions you may have. Most patients go home from the hospital but if you need additional care, the case manager and the health care team will have made plans for you already.

When you go home, you will receive any prescriptions your surgeon or medical doctor has for you. The nurses from Three River Orthopedic Associates will schedule your follow-up appointment and you will receive an appointment card to remind you of your appointment date and time.

Please call our office, Three Rivers Orthopedic Associates–UPMC at 412-782-3990, if you have any questions or concerns about your care after you are discharged.

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FAQ–FREQUENTLY ASKED QUESTIONS

Who will be performing the surgery?Your surgeon will perform the surgery with a physician assistant or orthopaedic resident and a specialized operating room team.

How long will the surgery take?Your surgeon will give you and your family an estimate of the time needed to perform the surgery. Most operations can be done in one to three hours, but some take more time. You will go to the Recovery Room after your surgery, where you will spend between two and three hours before going to the Orthopaedic Unit.

If you had a MIS total hip or MIS total knee done you will go to the pre-op area for your first physical therapy session after you have recovered from anesthesia and then be transported to the Orthopedic Unit.

Will I need an assistive device, such as a walker, crutches, or cane?The operation you had will determine if an assistive device is necessary.

How long will my new hip or new knee last? It is impossible to predict how long a joint replacement will last for any patient. However, recent studies suggest that patients who have had modern total joint replacements have remained satisfied for many years.

When will I be able to go back to work?This will be discussed during your initial follow-up visit with your surgeon, which usually is between two and three weeks after your surgery.

What should I do about forms that need to be completed for my employer?All forms need to go through the office to be completed.

What physical activities will I be able to participate in after surgery?Your surgeon will discuss with you which activities are compatible with the type of surgery you had and when you can safely resume those activities. In general, low-impact physical activities are acceptable. These activities include swimming, golfing, dancing, hiking, bowling, and gardening. Patients who have had joint replacements should avoid high-impact activities like tennis, running, basketball, and skiing.

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A PATIENT’S GUIDE TO RECOVERY AFTER ORTHOPAEDIC SURGERY

QUESTIONS TO ASK BEFORE I GO HOME

My room number ________________________________

My phone number _______________________________

Nursing unit phone number _______________________

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NOTES

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XXXX-0000-0000 PATEX405649 LGH/BS 06/12 © 2012 UPMC

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THREE RIVERS ORTHOPEDIC ASSOCIATES — UPMC 200 Delafield Road Suite 1040 Pittsburgh, PA 15215

Heights Shopping Plaza 1624 Pacific Avenue, Suite A Natrona Heights, PA 15065