There are significantly more professionals involved in the surgery, hospitalization, and aftercare than just the surgeon. In fact, unless you have gone through the process before, you may be surprised how many different people are needed to make things run smoothly. This chapter takes a moment to list the cast and crew, so that you can be familiar with some of the roles that each member plays.
Orthopaedic Surgeon
The orthopaedic surgeon is the main physician involved during hospitalization for hip and knee surgery. The surgeon is the one responsible for evaluating the need for surgery and performing the surgery itself. The surgeon also manages the orthopaedic care after the surgery in the hospital and in the office in the months afterwards.
Most orthopaedic surgeons have a fairly extensive educational background and training, including 4 years of medical school beyond college, at least 5 years of residency training, and most of those performing joint replacement as a subspecialty have at least one more year of fellowship training in adult reconstruction. Board certification then requires at least a couple of more years of qualified practice and credentialing.
Internist / Primary Care Provider
While the orthopaedic surgeon is focused on the surgery itself and directing the preoperative and postoperative care, most surgeons rely on the patient's primary care provider or the hospital internist (hospitalist) to assist with preoperative evaluation and medical clearance. At our center (and most facilities where a large number of joint replacement surgeries are performed), the internist usually also follows the patient throughout the hospital stay in order to manage blood pressure medications, diabetes, and other nonsurgical issues.
We prefer for the patient's own family primary care provider to follow them in the hospital, but many of our patients come from other cities or states for their surgeries. In these cases, we recommend that patients allow us to consult one of the hospital-based internists (or hospitalists) to follow them during their hospital stay. This internist then transfers care back to the primary care provider after the hospitalization.
Anesthesiologist
The anesthesiologist is the physician responsible for administering and safely monitoring anesthesia during the surgery. For most lower extremity surgeries like knee and hip replacements, they administer spinals, epidurals, or regional blocks in addition to general anesthesia. They usually meet with patients the morning of surgery to explain which type of anesthesia will be used, review the patient's history and medications, and if necessary set up special monitoring like arterial lines, Swan-Ganz catheters, and other special needs. They also monitor the patient's overall status during surgery and in the recovery room, adjusting blood pressure, giving medications as needed, and administering blood transfusions if required. The anesthesiologist usually checks on patients after surgery as well to ensure that they are not having any problems after the anesthesia.
Physician Assistants (PA's)
Physician assistants, or PA's, are professionals who have extensive medical training, including at least 3 years of medical training after an undergraduate degree. They practice under the supervision and license of the physician. In our practice and in the hospital, they are critical members of the team who are invaluable in helping to care for patients. During the day, the orthopaedic surgeon cannot always be everywhere; patients may come to the office for an urgent problem while we are in surgery, or patients may arrive in the emergency room while we are at the office seeing patients. In these cases, we rely on the PA's to be our eyes and hands when we cannot physically be there, communicating back to us what is going on and providing limited treatment (such as treating a hip dislocation or setting a fracture in the emergency room). The PA's also help out in the office, frequently giving joint injections and seeing patients for routine wound checks or suture removal after surgery.
The physician assistants also round on the patients every day, change dressings, order medications, and monitor laboratory and test results. They are usually the first available if there is an issue and we are occupied in the operating room. In our practice, each surgeon often sees all of his patients in the hospital most days, with the physician assistant communicating to us on the days when we cannot be there.
Resident Physicians
In most teaching and specialty hospitals, resident physicians may play a role in caring for patients. At our facility, we often have orthopaedic surgery residents from Yale University (with which we are affiliated) and abroad who come to learn advanced surgical techniques. For this reason, most centers that offer the newest and most cutting-edge technologies and surgeries will often have resident physicians. These doctors have completed medical school and typically at least several years of orthopaedic surgery training at this point. While they may be present as assistants during surgery and in rounding on patients on the wards, they are present to learn, not to perform independent surgery. Patients sometimes express concerns that the resident may be the one to "do the surgery," but in our practice, the surgery itself is always performed by the patient's surgeon with one to three assistants present.
Nurses
It goes without saying that the orthopaedic nurses are essential to care and recovery after surgery. At our hospital (and most busy centers that do a large volume of orthopaedic surgery), the orthopaedic unit has its own nurses who are familiar with orthopaedic patients and surgeries. There are nurses who work specifically in the recovery room and those who take over on the orthopaedic ward once the patient arrives.
Physical Therapists
Physical therapists are another essential team member, usually meeting with most patients the day of or the day after surgery. They are trained to help patients safely get up and start moving, and they are responsible for teaching patients how to walk, sit, and get around after surgery. The physical therapist usually provides reinforcement and repeated teaching of the surgeon's directions, particularly in regards to what precautions need to be followed, how much weight the patient can put on the limb, and practicing activities of daily living like putting on clothes and shoes.
Most patients will continue physical therapy after discharge, either at a rehabilitation facility or at home with a visiting therapist, and then often with an outpatient physical therapy facility.
Discharge Planner/Coordinator
Most patients leaving the hospital have special needs for aftercare, either in the form of arrangements for visiting nurses and physical therapists at home or for making arrangements for transfer to a short term rehabilitation facility. At our hospital, we have several discharge planners whose full time job is making these arrangements. They typically meet with patients the day after surgery to begin making these arrangements, and to make sure that everything is in place when the patient gets home. If a hospital bed or special supplies are needed, the discharge planner checks with the insurance carrier and makes sure that these things are arranged.
Medical Assistants
The medical assistant in the office is the person responsible for coordinating and scheduling surgery, preoperative testing, and preoperative medical clearance. In my office, this is frequently the person that most of my patients get to know the best and usually talk to first whenever they have a question or need to get in touch with me. She can get urgent messages to me in the operating room between cases, schedule visits and surgeries, and direct medical questions to either myself, our physician assistants, or other physicians (such as the patient's primary care provider or other specialists, such as a cardiologist).
Visiting Nurse (VNA)
The visiting nurse and/or physical therapist is responsible for seeing the patient at home. Not all patients require VNA services, but many do until they are able to get out of the house on their own. The VNA checks to see that the surgical site is healing properly, looks over medications, does a brief physical exam, and contacts the surgeon's office if there are any problems or concerns.
Please remember the information on this site is for educational purposes only and should not be used to make a decision on a condition or a procedure. All decisions should be made in conjunction with your surgeon and your primary care provider.
