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Thank you for choosing Hinsdale Orthopaedic Associates for your orthopaedic care. You have made a great decision, as your care is my priority. I sincerely believe that teamwork and good communication will lead to the best outcome for you. My staff and I are here for you and are happy to answer any questions you may have along the upcoming process.

Choosing to have surgery is not an easy decision and, in fact, can cause anxiety in many people. In order to ease this anxiety, we have written down everything you will need to schedule surgery. If time allows, you will also have a pre-operative appointment with a physical therapist to go over pertinent information as it relates to your care. I recommend that you bring a family member or close friend to this appointment who will be helping you after surgery to better understand and assist in your recovery.

Please carefully review the following information in this packet:

Pre-Surgical Information:

  • Additional Imaging – required for specific procedures
  • Pre-Operative Testing – to ensure optimization for surgery
  • Pre-Operative Physical Therapy Appointment Information
  • Insurance Authorization – understanding the process for approval
  • Day of Surgery – what to expect the day of your procedure

Post-Surgical Information:

  • Rehabilitation Information – instructions for physical therapy
  • Opioid Medication Agreement – use and important information
  • FMLA/Disability Paperwork – process for filing documentation
  • Frequently Asked Questions

As I stated above, my staff and I are always here for you. If you have any questions or concerns please do not hesitate to contact my office.

I look forward to helping you return to your daily life without pain.

Nikhil Chokshi, MD

Pre-Surgical Information:

  • Additional Imaging –
    • You may need additional imaging (CT Scan or MRI) for a specific knee replacement you are receiving. You will be instructed on this; if you are not told that you require this additional imaging then you do not need it.
    • CT Scan: This will need to be completed at either St. Joe’s Hospital or Silver Cross Hospital; please call their central scheduling department to schedule the date and time of this test. This needs to be done AT LEAST 4 weeks out from the date of surgery; the sooner the better to accommodate the time necessary to customize your cutting blocks.
    • MRI: This will need to be completed at our Hinsdale Orthopaedics MRI Center at Silver Cross Hospital. This test needs to be done AT LEAST 8 weeks from the date of surgery but ideally can be done within 6 months if able.
  • Pre-Operative Testing –
    • Your pre-operative testing orders were printed out and given to you the day surgery was recommended. These tests typically need to be completed within 30 days of the surgery date.  These can be done either at the hospital or with your primary care physician if they have the ability to complete all of your testing; please check with them ahead of time to avoid any unnecessary or repeat visits for testing.
  • Please do not wait until the week before surgery to start your testing; begin this process AT LEAST 3-4 weeks out from your scheduled date to allow for results to be received.
    • After completion of your testing you will need to see your primary care physician to review your completed testing. They will need to provide us with a document stating you have been medically cleared for surgery.
    • Please remember it is the patient’s responsibility to ensure that all testing and medical clearance has been received by our office prior to your surgery date. If not received by our office your surgery may be rescheduled or cancelled.
  • Pre-Operative Physical Therapy Appointment Information –
    • You may receive a call from our physical therapy department regarding a pre-operative appointment. This appointment includes a subjective and objective assessment with a physical therapist. You will also be fitted for any DME braces, slings, and other post-operative equipment as well as gait training and instruction of post-op exercises, home modifications, and restrictions you may/will have.
    • If scheduled this appointment is requested to help optimize your post-operative recovery. You will not be required to attend this location for your post-op therapy; however, if convenient, you may schedule your future visits there.
  • Insurance Authorization –
    • Our office will contact your insurance company (if applicable) to obtain authorization/approval for surgery. While most insurance pre-authorizations can occur within a few days, some insurances can take several weeks. Please keep this in mind prior to calling regarding approval status.
    • If this is a work-related injury, authorization will come from your case adjustor.
    • You, as the patient, have the right to confirm your coverage and benefits with your insurance carrier prior to surgery. 
  • Day of Surgery –
    • We will go through all the details of the day of surgery at your pre-operative physical therapy appointment.
    • If you do not have a pre-op therapy appointment we will give you this information in a packet the day of surgery.
    • Remember to wear comfy clothing, bring your medications (if received prior) with you as well as your durable medical equipment including crutches, walkers, braces, slings, etc. Please bring them inside and do not leave them in your car.
    • Make sure you have a ride to and from surgery
    • You are not permitted to have any food or drink after midnight day the day prior to surgery.

Post-Surgical Information:

  • Rehabilitation Information –
    • If your surgery is done on an inpatient basis, home health will be recommended to provide therapy services. The home health agency will reach out to you directly and coordinate your first visit after discharge from the hospital.
    • If your surgery is done on an outpatient basis, your physical therapy orders *if applicable* will be given to you post-operatively the day of surgery and sent home with you along with discharge paperwork. Please refer to the contents of your blue Hinsdale Orthopaedic Folder. If this information is not included in this folder then you do not require immediate physical therapy; we will coordinate any future therapy visits at your first post-op appointment.
  • Opioid Medication Agreement –
    • Narcotic medications (such as Norco/Hydrocodone, Tramadol, Percocet, etc) are typically prescribed in order to manage acute post-operative pain. You will be given your prescriptions either before surgery at your pre-operative appointment or after surgery in your blue patient folder.
    • If you have chronic pain and are managed by a pain specialist please consult with them prior to surgery as they will be responsible for post-operative pain management.
    • Failure to follow all the conditions of prescription management including dosage and instructions can result in determination to no longer provide future refills. Please refer to your post-operative paperwork in regards to specific directions for proper use of narcotic medications.
  • FMLA/Disability Paperwork –
    • Please contact your employer and/or their human resources department in order to start the process for filing.
    • It is our policy that completion of any and all paperwork of this nature will take 10-14 days to complete. Please keep this in mind and communicate this with your employer. To expedite paperwork please fill out as much as you can.
  • Frequently Asked Questions –
    • Can I have injections prior to surgery?
      Due to increased infection risk we do not give injections into the surgical joint within 12 weeks/3 months of surgery.
    • What time should I arrive the day of surgery?
      You will receive a call from the facility the day before surgery (usually in the afternoon or early evening between 1-5 pm) to let you know what time to arrive. If you do not receive a call by 5pm the day before your surgery please call the hospital or surgery center directly. Dr. Chokshi’s team does not have control or manage your arrival time.
    • Do I need to take antibiotics for dental procedures?
      For the first year after joint replacement this is required.
    • Do I need to schedule an appointment for pre-op labs?
      No, an appointment is not necessary. Please go to the hospital on a walk-in basis and ask for the outpatient testing department at the information desk. They will guide you to the correct location depending on your hospital of choice.
    • Can I get my additional imaging done closer to home?
      The additional imaging we recommend for surgery are special scans and therefore can only be completed at certain locations that have the capabilities of completed these types of scans. Please go to the recommended facilities to avoid complications, repeat testing, or cancellation of surgery.
    • When can I drive after surgery?
      You cannot drive while taking narcotic pain medication. Most patients with lower extremity surgery feel comfortable driving 4-6 weeks post-op. Please practice safely getting from the gas to the brake. If you have shoulder surgery you cannot drive for 6 weeks post-op.
    • Will I need an implant card for airport metal detectors?
      No special card is needed for metal detectors. Just inform TSA about your implant. Upon request we can supply you with a card but this will not accelerate your airport security experience. You most likely will still require extra screening in the form of a wand or pat down.

Decolonization for Staphylococcus aureus: What to Know

Staphylococcus aureus is a germ that lives on the skin and in the noses of many healthy people.  Staphylococcus aureus germs do not cause any problems for most people but sometimes these germs can cause serious infections including surgical wound infections.  There are two main kinds of Staphylococcus aureus:

  1. Methicillin-Resistant Staphylococcus aureus or “MRSA
    Resistant to some antibiotics that are commonly used to treat these infections.
  2. Methicillin-Sensitive Staphylococcus aureus or “MSSA
    Not resistant to antibiotics that are commonly used to treat these infections

What does decolonization mean?
Decolonization is the process to reduce these Staphylococcus aureus germs from your skin and nose.  Decolonization helps to prevent surgical site infections and other infections in people who carry the Staphylococcus aureus germ by reducing the number of these germs on your skin and in your nose.

Why are we decolonizing for Staphylococcus aureus?
Decolonization helps to prevent surgical site infections and other infections in people who carry the Staphylococcus aureus germ by reducing the number of these germs on your skin and in your nose.

How am I decolonized for Staphylococcus aureus?
A nasal ointment will be prescribed for you if you are having a total joint replacement. A special soap (or wipes) are recommended for all patients to clean your body prior to your surgery.  Please follow the instructions included on the following page in order to properly disinfect prior to surgery.  If your surgery is scheduled within five days and all five days of decolonization are unable to be completed prior to surgery then it will be finished after surgery.  Please call our office with any questions.

Decolonization for Staphylococcus aureus: Patient Instructions

Nasal Ointment – Bactroban (Mupirocin 2%) – Joint Replacements

  1. You will be provided with a prescription for this medication; please contact your pharmacy to make sure they have received an electronic prescription.  If they have not received our request please inform our office as soon as possible.
  2. Apply a pea-sized amount of ointment on the tip of a cotton swab.
  3. Apply ointment to inside front part of one nostril.
  4. Gently press nostril together and release several times (for approximately one minute) to spread the ointment in the nostril.
  5. Repeat process in the other nostril using the other end of the cotton swab or a new swab.
  6. Do this process twice daily for the five days prior to your surgery.

Chlorhexidine Gluconate (CHG) Application – Bath/Shower

  1. You are recommended to buy a soap with CHG (Hibiclens or BactoShield).  You do not need a prescription to buy the soap; this can be purchased over-the-counter at your local pharmacy.
  2. First, shampoo and rinse your hair with your usual shampoo.  This is done first so the CHG soap is not washed off by your shampoo.
  3. Using a clean washcloth, apply the CHG soap to all areas, avoiding your face and hair.  Do not use above your chin.  Make sure to wash under your arms, your groin area, and between any skin folds.  The soap will not bubble or lather; this is normal.
  4. Rinse the CHG soap off your skin thoroughly.  Do not wash off with any other soap or cleanser.
  5. Dry off with a clean towel and put on clean clothing.
  6. Do not use any lotions, creams, or perfume after washing.
  7. Use the soap once a day for the five days prior to your surgery.

Chlorhexidine Gluconate (CHG) Application – Wipes

  1. You are recommended to purchase the wipes from Hinsdale Orthopaedics; you can also buy them at local pharmacies but often they are hard to find.  They are $10 each; you will need 2 packs.
  2. Use the first pack of cloths the night before surgery to prepare the surgical area. Vigorously scrub skin back and forth for 3 minutes, completely wetting treatment area, then discard. Use the second cloth for larger areas.  Allow area to air dry for one minute; do not rinse.  After the pack has been opened discard any unused cloths.
  3. Use the second pack of cloths the morning of your surgery following the same instructions listed above in step 2.
  • American Academy of Orthopaedic Surgeons
  • American Association of Hip and Knee Surgeons
  • International Congress for Joint Reconstruction
  • American Society for Surgery of the Hand
  • Orthopaedic Trauma Association