Pre and post surgery

--What are the different types of surgery?

Emergency surgery is when someone has had an accident or injury and needs treatment as soon as possible. For example, if you break your wrist, ankle or femur and the bones become misaligned, a surgeon will need to set the bones in the correct position to ensure the best return of function. Sometimes setting the bones needs to be done via an operation with wires, plates and/or screws to hold the bones in place. 

Elective surgery is scheduled in advance. The term ‘elective’ can be a bit misleading. Sometimes people need to have surgery, but it’s not an emergency, so it’s called ‘elective’—an anterior cruciate ligament (ACL) repair (or ‘knee reconstruction’) surgery, for example. It is important to remember that waiting times for orthopaedic elective surgery in the public health system varies from about 50 to more than 150 days. However, for some conditions you may have to wait a number of years.

Some common elective orthopaedic procedures include:

Ligament surgery

• In the knee—anterior cruciate ligament (ACL) reconstruction
• Around the ankle
• Around the shoulder (sometimes called shoulder stabilisation surgery)

Bone realignment

• Bunionectomy (removing a bunion)
• Limb lengthening or shortening
• High tibial osteotomy

Removal of loose bodies from joints

• Arthroscopy of a joint such as the knee, hip or shoulder

Releasing pressure on nerves

• Carpal tunnel
• Spinal laminectomy (may include a fusion)
• Spinal discectomy

Regardless of the procedure, it is important that you are well informed and take an active interest in the process. A good idea is to write down questions that you have about your surgery or the recovery prior to your appointment to discuss with your health professional.

--Do I really need surgery?

About 1 000 000 Australians have orthopaedic (bone, ligament, muscle and tendon) surgery each year. While the decision to have surgery is sometimes very straightforward (a knee that is giving way following an ACL tear), this is not always the case.

Many conditions such as knee arthritis, knee meniscal tears and low back pain respond well to non-operative management. If you have been told that you have one of these conditions, it is a good idea to make sure you have trialled the non-surgical options before you discuss the option of surgery with your GP.

Simple steps such as decreasing the load on an arthritic knee by losing weight, strengthening muscles or using an aid can significantly decrease your pain and assist in improving your function. Your physiotherapist can help you with this.

Sometimes non-operative treatment is not effective. If you have undertaken an extended treatment program with your physiotherapist and still have ongoing symptoms, you and your GP may consider referral to a surgeon. Surgery in combination with appropriate rehabilitation can be very effective. 

It is important to be aware that there are some conditions for which surgery is not effective—even if you have bad pain. For example, back pain without any neurological symptoms may not improve with surgery, likewise knee surgery for early arthritis is not recommended.

If the surgery is for a child, it is particularly important to understand the longer term results of having, or not having the surgery.

--How can I prepare for surgery?

The fitter and stronger you are before surgery, the better your outcome will likely be. You can prepare for surgery by:

• staying as active as possible (consider alternatives such as water exercise if you experience pain with walking)
• losing weight if you are overweight or obese
• quitting smoking (your GP can provide support with this)
• keeping your muscles as strong as possible, your joints as mobile as possible and your cardiovascular fitness as high as possible (try to increase these if you can)
• eating well—research has shown that people who are poorly nourished tend to have more complications after surgery than those who eat well. See the Australian Guide to Healthy Eating for more information.

--What can I do to recover after surgery?

You will need to follow your doctor’s advice regarding exercise after your operation. In some cases, this is to simply rest, whereas other types of surgery require rigorous exercise immediately post-surgery. After your operation, you may be given exercises to prevent blood clots or deep vein thrombosis. You may also be required to wear support stockings to help with circulation.

Preparing to go home

You may need to start preparing a few things for your recovery prior to your surgery. This may include organising friends or family to help out with tasks that may be difficult after your operation (driving kids to school, for example), preparing food in advance and making adjustments at home (such as rails on steps or moving furniture around).

--How much pain is normal after surgery?

It is normal to have some pain post operation. Your doctor will have organised for you to take some medications home with you. You will need to see your GP to have further prescriptions for any strong medications—make an appointment for two days after you get home.

Use the prescribed medications, including pain medicines, at the prescribed intervals. It is important not to let the pain build up early in your recovery as it then becomes more difficult to get the pain back to a tolerable level.

--How do I know if I need physiotherapy or other medical attention after surgery?

You should be provided with information when you are going home on the things that you need to look out for and seek help for if they occur.

Some facilities may provide a phone number for you to call if you are worried about the symptoms that you are having, such as wound bleeding or oozing, excessive pain, heat around the area of surgery, chest pain, calf pain or shortness of breath. If you experience chest pain, calf pain or shortness of breath – call your doctor or go to emergency.

You may find when you first go home after your operation that it is more painful than when you are in the hospital. This often occurs because you are doing more for yourself than when you were in the hospital.

Some important symptoms that require review by a medical professional include increased discharge from the wound, increasing redness around the wound, chest pain, calf pain, shortness of breath and increasing pain that is not able to be controlled with the medications provided.

--How can physiotherapy help me pre and post surgery?

Your physiotherapist is well placed to provide advice and education about the procedure, how it will impact on you and what to do to maximise the outcomes from the operation.

Before your operation physiotherapists can help you with targeted and specific exercises.

Cardiovascular exercises

Cardiovascular exercises help you keep active and stay fit, including activities such as walking, jogging or water exercises.

Strengthening exercises

Strengthening exercises are recommended as they provide support for joints and bones. While it may be uncomfortable to do the exercises, your physiotherapist will only recommend those that are likely to help.

Range of motion exercises

Range of motion exercises help improve joint movement and function. They look to move the joint through its full range of motion and can help reduce pain, keep your joints flexible, and improve balance and strength.

Stretching exercises

Regular stretching can help relieve tight muscles and control discomfort in painful joints by improving joint range.

Your physiotherapist can also help you identify and use complimentary treatments, such as heat, ice, massage, braces and walking aids, that can help manage pain and assist in improving daily function.

--How effective is physiotherapy for my recovery pre- and post-surgery?

Physiotherapy is often recommended by orthopaedic surgeons after surgery. Physiotherapy has been shown to provide benefits in decreasing pain, strengthening muscles and improving how you function.

--What can I do at home pre- and post-surgery?

Each type of surgery has specific restrictions as well as activities that should be undertaken. You should follow your doctor’s advice about this. In general, it is important to control post-operative swelling and pain, carry out prescribed exercises with the recommended frequency, take regular rests as a part of your recovery and start a gentle walking program if recommended by your physiotherapist.

--How long until I’ll feel fully recovered after surgery?

The duration of your recovery will depend upon:

• the type of surgery you have had
• how fit and well you were before the surgery
• how long you had to wait for the surgery.

As a general rule, you will have a rapid recovery in the first three to six months. After that, if you continue to work on your rehabilitation, you will continue to improve for one to two years.