 Q: Do I have to be referred by my family physician to make an appointment? A: We do take self-referrals. However, if your insurance is such that you need a referral from your primary care physician, that must be in place prior to your appointment. Q: Will I be expected to pay my co-pay at the time of visit? A: Yes, co-payments are due at the time services are rendered. Q: Where are you located? A: We're located at 404 Shoppers Drive - Winchester, Kentucky 40391. Please reference our CONTACT section of the site for more contact information. Q: Is your office handicapped accessible? A: Yes, if a wheelchair is needed please let our staff know and they'll get one for you. Q: Is there anything that I need to bring with me at the time of appointment? A: Please bring your insurance card and Workers' Comp information, so that copies can be made for our records. Also, a list of your current medications and any X-rays or MRI's that may be pertaining to your present injury as well as co-pay. Q: Will there be paperwork to complete when I get to the office? A: Yes, we update all patient and medical information yearly. It's important to have accurate information at all times. You may readily access our office forms online by clicking H E R E. Q: I need a copy of my records for an appointment with another doctor. How do I get these? A: In order to maintain the strict confidentiality of the individual who is receiving medical care or services, a consent form for the release of confidential information must be in writing and signed by the patient, a parent or legal guardian if patient is a minor. After receiving this signed form, we'll send the information directly to the doctor. Q: Is my insurance accepted at your office? A: Please check this site to see if your insurance is listed. If it is not listed, please check directly with your carrier, as insurance plans are always changing. Q: Can I send my son or daughter in for their appointment by themselves, since I will be working. A: Before medical care or services can be rendered on a minor, authorization must be obtained from the patient's legal guardian or parent, either in person or via fax. The same holds true if a minor is brought into the office by coach or another individual, friend, etc. Q: Do I need to get my old X-rays, MRI's, CT's, etc? A: Yes, any studies that have been done for the area you are being seen for would be helpful, along with the reports if possible. You may need additional x-rays depending on what studies or x-ray views you have. Q: Will my insurance pay for these x-rays? A: In most cases your insurance will pay for any diagnostic x-ray deemed necessary by the doctor. Please check before hand with you insurance provider to make sure! Q: What happens to the x-rays, etc. that I bring to the office? A: Your films will be kept in the office until the doctor no longer is in need of them. At that time, they will be sent to the facility where they were actually taken. If you wish to take the films you brought in with you or have our office keep them for you, just let the x-ray tech know. Q: Can I speak to the doctors or their nurses when I call your office? A: Normally when the doctor is in the office he is busy seeing patients. If the nurse is available she will help you. However, if the nurse is busy with patients she will return your call as soon as possible. You may give your message to one of our receptionists or be connected directly to voice mail. Q: Do you take Workers' Compensation cases? A: Yes we do, however, it's important that all necessary forms be completed. We will also be asking for a copy of your regular health insurance in the event of a problem with your Workers' Compensation claim. Q: How do I file a Workers' Comp claim? A: A First Report of Injury form needs to be completed by injured worker, employer and physician. Then this completed form is sent to the Bureau of Worker's Compensation. Q: What are Orthopaedics? A: Please refer to this L I N K for a better and more complete section of information. Q: What are your hours of operation? A: Please refer to this L I N K for a better and more complete section of information. Currently our hours of operation are Monday through Friday 8:30am - 4:30pm. Q: What is an orthopaedic surgeon? A: An orthopaedic surgeon is a medical doctor with extensive training in keeping your bones, joints, ligaments, muscles, tendons, cartilage and, spine in good working order. Together, all of these parts of our bodies make up our musculoskeletal system. Q: Who becomes an orthopaedic surgeon? A: Orthopaedic surgeons are men and women from a variety of backgrounds who all share the desire to help people improve their quality of life through improved musculoskeletal health. Q: Why would you see an orthopaedic surgeon? A: Orthopaedic surgeons have the greatest knowledge of and experience with the wide range of conditions and treatment options available in musculoskeletal care, many of which do not involve surgery. Musculoskeletal injuries and conditions are the most common reason why we see a doctor. Q: How long will my total joint replacement last? A: We expect most hips and knees to last more than 20 years. Long-term studies have shown that 90% of knee and shoulder replacements and 85% of hip replacements are functioning well at 20 years. However, this is not a guarantee. A second replacement, or revision surgery, may then be necessary. Q: What is the artificial joint made of? A: It is usually a combination of a metal allow and a high density plastic which fits together to give you your new joint. Q: What are the results of joint replacement? A: Over 90% of patients achieve good and excellent results with relief of pain and maintenance of mobility. Q: Is it possible I could be made worse? A: Yes. Complications such as infection could result in a worse situation. However, the chances of this happening are 1% or less. Q: What are the major risks of surgery? A: Most surgeries go well, without any complications. Infection and blood clots are two of the complications which concern us. To avoid these, we give antibiotics and blood thinners before and after the surgery. We will ask you to sign a consent form before the surgery, outlining these and other potential risks. Q: Do I really need surgery? A: After your orthopaedic surgeon decides you are a candidate for this surgery, you then must decide if your pain and disability justify undergoing it. There is no harm in waiting if conservative, non- operative methods are controlling your pain. Q: Am I too old for surgery? A: Age is not a problem, if you are in reasonable health and have the desire to continue living a productive, active life. You will be asked to see your personal physician for his/her opinion about your general health and readiness for surgery. Q: How much does the surgery cost, and will my insurance pay for it? A: Insurance companies typically pay for the costs of surgery, however, there are some plans that have restrictions on the amounts they pay and who they pay (some only pay the hospital, not the doctor, and vice versa). Some plans may have limitations or exclusions that do not allow for the carrier to pay for certain procedures. Because of all the different insurance carriers each having different rules and regulations, this is evaluated on a case by case basis. Before your surgery, we will be able to give you an approximate patient responsibility for Doctors Heilig and Grau’s charges. We can provide contact information so that you can obtain patient responsibility amounts from the surgical facility and anesthesiologists office. Q: Will I need a second opinion prior to the surgery? A: The office secretary will contact your insurance company and let you know whether a second opinion is required. Q: How long does the surgery take? A: The amount of time needed for surgery depends on the type of procedure being done. Some cases take as little as 30 minutes, some can take as long as 3 hours. This will be discussed with you before you schedule surgery so that you know what to expect the day of surgery. You will be asked to arrive at the facility prior to your surgery time to allow the operating room staff to prepare you for the surgery. Q: Do I need to be put to sleep for this surgery? A: Your may have a general anesthetic, which most people call "being put to sleep". Or you could have a spinal, or epidural anesthetic, which would not require you to be asleep. The choice is between you and the anesthesiologist. Q: Will the surgery be painful? A: You will have pain following the surgery, but we will keep you comfortable with appropriate pain medication. Generally most patients are able to stop very strong pain medication within 1-2 days. Patients will then be prescribed narcotic medication that is not as strong. Pain medication usage depends greatly on the type of surgery done and is evaluated on an individual basis. Q: Who will be the one doing the surgery? A: Doctors Heilg and Grau performs all of their surgeries. An assistant is may be used during the joint replacement surgery, and you will be billed separately by that assistant. Q: How long will I have to stay in bed? A: You will stay in bed the day of your surgery. However, on the next day you will get up, and should be walking. Depending on the type of surgery done, you may be limited in the amount of weight you can put on your legs, or you may be restricted to using a sling. Q: Can I eat the day of surgery? A: No. You can have nothing to eat or drink after midnight the night before surgery. You may take certain medications (blood pressure medication, for example) with a small sip of water. Failure to follow pre-operative directions may result in your procedure being cancelled. Q: How long will I be in the hospital? A: Three days for total knee patients, three days for total hip patients, and one day for total shoulder patients. There are several goals that you must achieve before you can be discharged and some people achieve them more quickly than others. Other surgery, such as knee and shoulder arthroscopy or carpal tunnel release, is considered outpatient surgery; you will go home the same day after recovering from anesthesia. Q: How long, and where, will my scar be? A: The scar length will vary with the type of surgery being done. Arthroscopy surgery usually has 2 to 3 small, quarter inch incisions. Doctors Heilig and Grau do minimally invasive joint replacements, with incisions for the hip, knee and shoulder ranging from 3 to 5 inches. Doctors Heilig and Grau can advise you at your appointment what they would expect to encounter for your particular procedure. Q: Will I need a walker, crutches, or a cane? A: After knee and hip replacement surgery you will need a walker and then progress to a cane. You may borrow them or the hospital can arrange for them to be delivered to your home after discharge. For knee arthroscopy surgery, you may want to have a pair of crutches on hand. Typically, patients do not need crutches after this type of surgery. Doctors Heilig and Grau can give you their recommendations based upon the repair needing done. Q: Will I need any other equipment? A: For patients having hip and knee replacement surgery, you may need a high toilet seat and shower seat, which the hospital can arrange to be delivered to you or you may rent or borrow. There is other equipment that the hospital will supply with instructions for use. These are used for approximately two to three months. For patients have shoulder surgery, you may be required to be in a sling after surgery until your follow up appointment at Doctors Heilig and Grau’s office. If the office knows ahead of time that you will need a sling, we will try to give you one to bring with you on the day of your surgery. Otherwise, should one be needed, the surgical facility will provide one for you. Q: Where will I go after discharge from the hospital? A: Most joint replacement patients are able to go home directly after discharge. In special circumstances your physician may transfer you to a rehabilitation facility for a few days. Q: Will I need help at home? A: Yes. The first several days, or weeks, depending on your progress, you will need somebody to assist you with meal preparation, etc. Joint replacement patients will have a home health care nurse come to your house for the first two weeks that your are at home. Family members or friends should be available to help. Q: When will I be able to drive my car? A: If you had surgery on your left leg, and you have an automatic car, you may be able to drive within a few days. If it is your right leg, or if you have a standard shift car, you may not be able to drive for couple of weeks or more depending on the type of surgery you have had. Joint replacement patients should expect it to take at least 2 weeks before being able to drive. If you had shoulder surgery and are wearing a sling, you are not allowed to drive until after Doctors Heilig and Grau discontinues the use of your sling. This applies to shoulder replacement as well as shoulder arthroscopy patients regardless if you have a standard or automatic car. Q: Will I need physical therapy when I go home? A: The hospital will arrange for hip and knee replacement patients to have a home physical therapist to provide physical therapy at your home for the first 2 weeks. Following this, you will probably go to a physical therapy facility 2-3 times a week to assist in your rehabilitation. This should last approximately 4-6 weeks, depending you’re your progress. If you are having outpatient surgery, usually physical therapy will be prescribed at your postoperative visit. The length of time you need physical therapy following outpatient surgery depends on the procedure done and the extent of the needed repair. Q: Can I shower? A: As a general rule, most patients can remove the dressings, place band-aids over the small incision, shower, remove the band-aids, pat the wound dry, and re-apply band-aids. Until the wounds are healed and the sutures removed, you should not soak in a hot tub or immerse in a swimming pool. Surgical wounds are to be kept as clean and dry as possible. Q: Should I change the bandage? A: Yes. You will be given directions upon discharge from the surgical facility as to when to change your surgery dressing. Normally, you will change the dressing the day after surgery and change it at least daily until you return to our office. Often the dressings will be damp, and there can be a small amount of bleeding present. This is normal and there is no cause for alarm, however, you will need to change the dressing more than daily. Excessive or prolonged bleeding should be reported immediately. Q: How often will I need to be seen following surgery? A: Your follow up care will vary with each type of surgery and with the extent of repair done during surgery. Joint replacement patients will be required to follow up with Doctors Heilig and Grau on a yearly basis after they complete normal postoperative care. It is very important to see Doctors Heilig and Grau yearly to evaluate the condition of the prosthesis. During these visits, you will receive an examination and x-rays to ensure a healthy joint replacement. Q: When will I be able to get back to work? A: The timing depends considerably to the type of surgery done and upon your commitment to recovery. Please discuss this with Doctors Heilig and Grau when scheduling your surgery. Q: When can I have sexual intercourse? A: The time to resume sexual intercourse should be discussed with your orthopaedic physician. Joint replacement patients will have certain restrictions of their motion at certain points of their recovery. Q: Will I have any restrictions following this surgery? A: Yes. You may be restricted from performing high-impact activities, such as running and basketball. You will also be restricted from performing contact sports, such as football. Low impact activities such as dancing, golf, hiking, swimming, gardening, may be appropriate. This, again, depends on the type of surgery performed and the extent of repair needed and should be considered on an individual basis. Q: What are Advance Medical Directives? A: Advance Directives are a means of communicating to all caregivers the patients' wishes regarding health care. If a patient has a Living Will or has appointed a Health Care Agent, and is no longer able to express his or her wishes to the physician, family or hospital staff, the Medical Center is committed to honoring the wishes of the patient as they are documented at the time the patient was able to make that determination. There are different types of Advance Directives: LIVING WILLS are written instructions that explain your wishes for health care if you have a terminal condition or irreversible coma, and are unable to communicate. APPOINTMENT OF A HEALTH CARE AGENT (sometimes called a Medical Power of Attorney) is a document that lets you name a person (your agent) to make medical decisions for you, if you become unable to do so. HEALTH CARE INSTRUCTIONS are your specific choices regarding use of life sustaining equipment hydration and nutrition and use of pain medications. On admission to the hospital, you will be asked if you have an Advance Directive. If you do, please bring copies of the documents to the hospital with you so they can become a part of your Medical Record. Q: Will this surgery get rid of all of my pain? A: This question goes to the very heart of expectations and disappointments after surgery. If you have pain that is coming from elsewhere, (i.e., another source besides the replaced joint, that pain will continue after surgery.) Such pain may be caused by osteoarthritis, rheumatoid arthritis, fibromyalgia, back disease, poor circulation or damaged nerves. Such pre-existing conditions continue after surgery and may compromise the result of joint replacement surgery. An artificial joint made of metal and plastic is no match for the real thing. It takes time and re-education of muscle, ligaments, tendons, nerves and the brain to get accustomed to an artificial joint. In some instances, a low-grade, mild pain may persist for several years despite an otherwise successful result. Artificial joint replacement of the hip and knee should therefore be considered if, and only if: All other methods of treatment have failed to help you. You have debilitating and severe pain with loss of function. You are emotionally and psychologically prepared for surgery. You have a thorough and comprehensive understanding of the operation and the potential outcomes. Experience shows that motivated patients who satisfy these criteria and keep a positive outlook typically have the best results. Q: Do knee replacements hurt more than hip replacements? A: People perceive pain in highly individual ways. Generally, knee replacements tend to be more painful. Why? Heavy muscles cover and support the hip joint, whereas the knee joint is close to the skin. The nerves that carry pain sensations from the hip and knee joints differ. After knee replacement, the physical therapist pushes you to move the knee and regain mobility, whereas with a hip replacement, the therapist has less of a role, other than teaching you how to walk with assistive devices. Q: If my hip is arthritic, why does my knee hurt? A: Pain refers from the arthritic hip to the knee. This happens in other places in the body. For example, a heart attack can manifest as shoulder and arm pain that goes up the neck. The nerves that supply the hip joint also supply the knee joint. Even though you may feel pain in your knee, it might actually come from your hip joint. Addressing the hip problem will lead to pain relief in the knee in such situations. With one major arthritic joint, it is not uncommon for people to limp, compensate or alter their gait. Even subtle compensation can cause pain developing in adjacent joints. People with a diseased hip may develop back and knee pain, or pain in the opposite hip and knee. People with major arthritis in one joint sometimes have arthritis in other joints. When you protect a diseased and worn-out joint during load bearing, other joints bear the weight and that can lead cause them to hurt. Taking care of the worn-out joint usually relieves some, or all, of the pain radiating to other locations. Q: How much pain can I expect with a hip or knee replacement? A: These days, not very much at all. Most patients are pleasantly surprised at how little pain is present early on. Later, as sore muscles start moving, and muscles weakened by long standing arthritis start to gain strength, some aches and pains are inevitable. Many reasons explain the decreased after first-time hip or knee joint replacement surgery. One, the anesthesia techniques have advanced. We were using femoral nerve blocks and spinal anesthesia which greatly reduce or eliminate pain after surgery. Since the femoral nerve blocks also make it difficult for the patient to move the leg during therapy, we recently switched to a continuously infusing “pain buster” pump that drips an anesthetic drug directly into the joint via a thin catheter for 24-48 hours after surgery; with this modality, we have been able to eliminate the need for any nerve block since patients do not hurt. The anesthetic infusion serves to block the pain fibers right at the surgical site. In addition to the above, we also inject a mixture of anesthetic and anti-inflammatory drugs directly into the knee tissues during total knee replacement. This helps with post-surgical pain relief considerably. Finally, we begin anti-inflammatory, anti-nausea, anti-constipation, and narcotic pain medications before the surgery, right when you are in the pre-surgical area getting prepared for surgery. By pre-empting nausea, pain, constipation, and the other unpleasant side-effects of surgery, the overall experience is improved considerably, compared to what we did just a few years ago. None of this changes the fact that ANY surgery is still a serious undertaking, and is associated with certain risks and side-effects that you need to know about, no matter how rare their occurrence. For a description of things that can go wrong in surgery, please click here. Q: How much physical therapy will I need after surgery on my hip or knee? A: With the two-incision hip replacement, physical therapy is needed only to help you learn to use a walker or crutches, and instruct you on partial weight bearing. For a month after surgery, usually home health will help you with therapy and exercises at home. Few, if any total hip patients now need extensive therapy because the muscles are not cut as they used to be with our latest surgical methods. An occasional patient may need therapy after the one month interval, and this can be addressed on an individual basis. With the new minimally invasive knee techniques, about half of our patients do not need any physical therapy beyond one month. During the first month, the therapy is at home anyway. The rest of the patients need outpatient physical therapy that we can arrange on an individual basis. Q: How long do artificial hip and knee joints last? A: For most patients who undergo an expertly-executed hip or knee replacement procedure, the implants should last the rest of the life of the patient.The 15-20 year data on the longevity of total hips and total knees is very encouraging. More than 90 percent of the implants still function well in many studies. This is not a guarantee or assurance. Many things can go wrong, such as fractures, implant failure, late infections and deterioration in your overall health. Joint replacement longevity depends on: How well you take care of yourself and your health. Understanding and respecting the limitations of a prosthetic lifestyle. Activity level. Understanding that things like running, racquetball, tennis, jogging, jumping and high-impact aerobics or sports compromise the longevity of your prosthetic joint. Q: My knee is degenerative and I am not ready for a replacement. Will arthroscopic surgery help? A: It depends on the extent of arthritis. If the pain suddenly turns worse, or the knee catches or locks, then arthroscopy often helps relieve acute symptoms. In almost all cases of knee arthritis, the arthroscopic procedure allows us to make a couple of small holes, look inside the knee, get an idea of the extent of the degenerative change, shave off and remove any loose pieces, and trim away any sharp, torn cartilage edges. Almost everyone feels better after such a procedure. Whether such a procedure will help in your specific case is an individual decision. Arthroscopy can be very useful at temporizing the situation and might be preferable to a complete knee replacement. Arthroscopy does not prevent the eventual need for further surgery. In most cases, arthritis progressively destroys joints and makes further surgery inevitable. Q: Will I gain or lose any leg length as a result of my surgery? A: It is not possible to gain or lose leg lengths to any significant degree with a knee replacement, because your ligaments guide how thick the polyethylene insert can be. Whatever is taken out of the knee joint must be replaced with artificial parts in order to balance the knee for optimal performance. During hip replacement, because the ball at the top of the femur is removed entirely, the surgeon has more control of your leg lengths. In most, if not all cases it is possible to nearly equalize leg lengths after hip replacement, keeping in mind that normally, our two legs are not quite equal to begin with. We aim to reproduce the pre-existing leg lengths, but slight lengthening is sometimes necessary to achieve optimal stability in a hip replacement and avoid the complication of dislocation of the artificial parts. Q: How may joints can one have replaced? A: It is possible to have multiple joints replaced safely. It is wisest and safest to get these done one at a time, starting with the worst one first. Some of our patients have had more than a single hip or knee replacement. In certain instances, it is possible to have both hips and both knees replaced with artificial implants. Q: How big will my scar be? A: The routine hip replacement can be done through two incisions. One is about an inch long. The other is anywhere from two to four inches, depending on the size of the patient, the degree to which the tissues are contracted from long-standing degenerative disease, and the degree to which the hip is deformed. Most knee replacements require a four-inch incision, with variability necessary to accommodate each patient's individual anatomy and needs. A: The size of the incision does not affect healing, although who would not prefer a smaller incision? The key is what the surgeon does once the incision is made. With the MIS-2-incision total hip procedure, the muscles are simply pushed apart, and the recovery is dramatically better than with any standard hip approach, regardless of the size of the incision. Patients who have had this procedure on one side, and the standard, traditional approach on the other side for a prior hip replacement cannot stop telling us how much easier and faster the recovery with the MIS-2-incision hip replacement is. Likewise, in knee replacement, independent of the size of the skin cut, the key is not to invade the quadriceps muscle. Traditional knee replacement surgery required that the quadriceps muscle be cut for exposure, and then re-stitched. By using custom instruments that we have designed in our operating rooms over the past several years, and by sharing our experiences with colleagues elsewhere around the country, we can spare the quadriceps muscle, resulting in a much easier and quicker recovery. Q: I have arthritis of the hip or knee joint. The joint surfaces are rough instead of being smooth; so won’t therapy and exercise before surgery hurt the joint? A: No, the human joints are living tissues and they respond very well to a regular program of light, aerobic exercise when osteoarthritis develops. Proper nutrition, regular exercise, weight loss, and over-the-counter anti-inflammatory medications help relieve the pain of osteoarthritis. These non-surgical methods should always be considered before embarking upon any surgery. Q: With the new, minimally invasive surgery methods, should I not go ahead and have my joint replaced, or should I wait longer? A: New technology, easier surgical methods, and better implants should never enter your decision making process to embark upon any surgical intervention. It is imperative that you try non-surgical methods described elsewhere on this web site first. Surgery is always the last option; and it is best avoided if possible. Joint replacement surgery is always a salvage procedure for your own joint that is worn out. So, it is best to wait until you have uncontrolled pain, or if the symptoms otherwise interfere with living your life. No matter how advanced our surgical methods get, the fact remains that the joints you were born with are the best that nature offers. Keep them as long as you possibly can. Q: Another orthopaedic surgeon looked at my knee or hip x-rays and said that the arthritis is really bad. I was advised to have surgery done quickly, because waiting will only make things worse. Can I safely wait in such a situation? A: Yes. Waiting till symptoms dictate the need for surgery is always wise. Do not let any doctor, no matter how well-intentioned, talk you into surgery. You can safely wait; the deformity of arthritis can always be easily corrected by surgery. About the only downside to waiting is that as muscles get weaker, the recovery from surgery may take a little longer. You can of course avoid this by maintaining reasonable body weight, and a program of light exercise to keep your muscles in shape. We have performed surgery on even severely deformed knees and hips that have been misshapen since birth or since an accident during childhood. Experience shows that even those patients who have waited for many years with an arthritic joint do very well after joint replacement surgery. There is never any hurry to rush into elective, first-time joint replacement surgery. One exception applies to revision, or re-do surgery. If your joint was replaced many years ago, and the wear particles are starting to dissolve bone, we may advise you to have surgery sooner rather than later. This is to avoid further compromise of bone. Another exception applies to joints that have a suspected infection of the prosthetic device. In those cases, corrective surgery is recommended early, so that the infection does not penetrate the bone. Q: How much do the implants weigh? What are they made of? A: The usual hip and knee parts are made of metal alloys, commonly cobalt-chrome and titanium. Both are extremely durable, and inert, (i.e., they do not react with the body.) For the bearing parts, (i.e., that parts that do the actual moving, ultra-high molecular weight polyethylene is the most common bearing, followed by polished metal, and ceramic.) In a primary, (i.e., first-time hip or knee replacement) the parts weight around 5 pounds or so, which is more than the weight of the bone we remove. But, given the strength of human muscles, you will not feel any change in weight. The knee or hip may feel tired easily early on in your recovery, but as you gain strength, this will disappear. So, in summary, the artificial parts weigh more than what we take out, but this fact is of little, if any, clinical consequence. |
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