Preparing for Joint Replacement Surgery: Everything You Need to Know

July 5, 2018

Needing surgery isn’t something most people get excited about. From doctor appointments and screenings, to the operation itself and recovery, the whole process can be daunting. But it doesn’t have to be. This guide will help you better understand the complete patient experience for joint replacement surgeries in Ontario so that you’re organized, prepared, and ready for your surgery.

Before you start reading, try taking our Preparing for Joint Replacement Surgery Quiz to see how much you already know!

Joint Replacement Surgeries in Canada

By 2031, it’s projected that nearly one in four Canadians will be over the age of 65. ^[1] As a large percentage of the Canadian population reaches this age bracket, joint replacement surgeries are going to become more common.

Knee replacement and hip replacement surgeries have already earned the top spots as the most common types of inpatient surgeries in Canada, directly after caesarean section deliveries.^[2] In fact, the Canadian Institute for Health Information recorded a 20% increase in hip replacement surgeries and a 20.3% increase in knee replacement surgeries between 2009-2010 and 2014-2015.^[3]

total number of inpatient surgeries in Canada by type in 2016-2017 View Larger

Why are so many Canadians having joint replacement surgeries? Well, as a result of the advancing age of the general population, a significant number of Canadians are beginning to experience osteoarthritis and/or fractures from falls, which then creates a huge demand for knee and hip replacements.

Unfortunately, this can mean longer wait times for surgery. But luckily, Canadians live in a country in which these surgeries and some of the post-operative care are covered by our healthcare system.

Specifically, residents of Ontario account for more than 38% of the Canadian population, so the increasing need for joint replacement surgeries will have the most impact on Ontario’s healthcare system.^[4]

$Infographic doctors, hospital, and fracture$

What the Ontario Government Funds for Your Surgery and Recovery

OHIP: What It Does and Does Not Cover

Have you ever gone to a doctor’s appointment, or to get some form of medical test and asked, “is this free, or do I have to pay anything?” Ontario’s government-run health plan is called the Ontario Health Insurance Plan (OHIP). OHIP pays for various health care services that are considered to be medically necessary, such as visits to your family doctor, as well as emergency health care services.

Here’s a quick list of all the services that are covered/not covered by OHIP:

covered/not covered services by OHIP View Larger

For more information about each of these services, you can visit the Government of Ontario’s webpage about What OHIP Covers.

To keep things focused on joint and hip replacement surgeries, the guide will look more closely at three of the thirteen services from the above chart, along with post-operative recovery services.

1. - Hospital Stays and Visits
  - Ambulance Services
  - Prescription Drugs
  - Post-Operative Recovery Services

Let’s take a closer look at what is covered, and what fees you might be responsible for.

Hospital Services and Stays

Prior to your surgery, you’ll likely be required to take various types of tests at the hospital. These test results will help the Surgeon and Anesthesiologist identify any precautions that need to be taken during your surgery. Thankfully, OHIP does cover all costs associated with these screenings.

During your overnight stay in the hospital after surgery (between 3.7-6.3 days on average^[2]), there are some services that will not be covered by OHIP and will be left for you to pay. However, if you have private insurance and/or health benefits from your employer, these costs may be covered by your benefits plan. A list of hospital services that are covered/not covered by OHIP include:

Hospital stay services covered/not covered by OHIP View Larger

Ambulance Services

If you decide to recover at home instead of in the hospital and you are in need of emergency care, ambulance services to bring you back to the hospital are covered by OHIP. However, most of the time you will be responsible for an ambulance service co-payment charge of $45.00 for the ride.^[5]

Prescription Drugs

While you are recovering in the hospital, all of your drugs will be covered under OHIP. However, your insurance and/or health benefits from your employer will be responsible for the costs of any needed prescription drugs once you are discharged from the hospital. If you don’t have private insurance or health benefits from your employer, you’ll have to pay for these prescription drugs out-of-pocket.

Post-op Recovery Services

Anyone that stays overnight in the hospital for joint replacement surgery will be eligible for OHIP-funded physiotherapy services, either in a clinic-based setting, or at your home. There’s no need to stress about finding a physiotherapist because your Patient Care Coordinator (provided by the LHINs) will help coordinate your treatment. Your personalized program, or Episode of Care, will be determined according to your individualized condition.

physical therapy orthopedic surgery infograph

If you wish to receive additional physiotherapy treatments later on, you’ll be required to pay for them either through your insurance/health benefits covered by your employer, or from your own pocket. The clinic that provides your publicly-funded physiotherapy will also likely offer private-pay services. If you’re looking for additional physiotherapy treatments, Closing the Gap Healthcare has 11 physiotherapy clinics throughout Ontario to help with your recovery.

While physiotherapy is the most common post-op recovery service, OHIP also covers a number of other costs associated with your outpatient care. A list of the services that are covered/not covered by OHIP include:

Outpatient services covered/not covered by OHIP View Larger

Of course, there are some exceptions to the chart above; costs considered to be “Not Covered” may be worth discussing with your assigned Care Coordinator.

What Do Care Coordinators Do?

Care Coordinators are regulated health professionals that are experts in nursing, home support, social work, occupational therapy, physiotherapy, and/or speech therapy. They act as your guide for your recovery once you are declared a patient. Your Care Coordinator will assess your health care needs based on your current living arrangements and support system, and develop a plan to make sure you receive the care that you require.

Care Coordinator infograph

Services that your Care Coordinator may help you with include:

1. - Assessing your health care needs and answering any questions you may have
  - Working with you to develop an individualized care plan
  - Helping you get support when you leave the hospital
  - Coordinating your home care services (e.g. physiotherapy, occupational therapy, wound care nurse)
  - Helping you access supplies and equipment
  - Recommending services such as meal programs and support groups
  - Providing resources so that you can complete your recovery in the comfort of your own home
  - Helping you find alternate living arrangements, including long-term care or short-term care homes if you find that it is too difficult to recover at home

Medical appointment infograph

A Care Coordinator will be assigned to you and acts as your point-of-contact in obtaining health care services and information. If you find that your needs have changed prior to your surgery or during your recovery, your Care Coordinator is the person to contact.

Getting Prepared for Your Surgery and Recovery

Your Care Coordinator will help provide guidance for your recovery after your surgery; however there are a few things that you should research and prepare for yourself prior to your initial consultation and surgery date, including: surgery wait times, how to prepare for your consultation, required pre surgery tests, and the decision between recovering in a short-term care facility vs. at home.

Wait Times: How Long Until You Get Your Surgery

Wait times for joint replacement surgeries are considerably long. But, how long is the wait exactly? In Ontario, wait times are not the same across cities and hospitals. Interestingly enough, there is now an official website where you can compare wait times for a specific surgery in hospitals near you. You can even check:

1. - the time between the date you receive a referral from your family physician and your initial consultation with your surgeon
  - the time from your orthopedic surgery approval to your actual surgery date.

Unfortunately, the wait time between the date in which you receive a referral from your family physician to your initial consultation with your surgeon can be up to 6 months.

Consultation with Your Surgeon: Questions to Ask About Your Recovery

All patients that have been referred to an orthopedic surgeon by their family doctor will have a consultation with the surgeon. The surgeon will assess your condition and your medical history by asking questions during your consultation, to determine if surgery is actually necessary. It’s important that you can effectively communicate and understand any past illnesses, family diseases, and any other factors that would determine your candidacy for joint replacement surgery.

infograph checklist medicine scale for surgeon consultation

Once you have been approved for surgery, you should ask your surgeon the necessary questions about your surgery and your recovery. Some questions that you can ask include:

1. 1. How long will my stay in the hospital be?
  2. How much help will I need for my recovery?
  3. Do I need any equipment for my home?
  4. Is there anything that I need to monitor or be cautious of (e.g. infections, blood clots) after my surgery? If so, how can these issues be prevented?
  5. How long will I be required to do physiotherapy?
  6. How long will I be in recovery until I can return to my daily activities?
  7. When should we have a follow-up visit after my surgery?
  8. Am I required to see my family physician after my surgery?
  9. Am I required to take any medication – and if so, for how long?
  10. If I have complications, such as an infection, who should I contact?

If there are any other questions that you may have for your surgeon, never hesitate to ask. Individuals that plan ahead for their recovery tend to see better outcomes since their stress is greatly minimized by the comfort of preparedness. Ensuring that you have all the necessary equipment, supplies, and medication organized prior to your surgery will make your life much easier.

Types of Screenings and Tests Required Before Surgery

In most cases, individuals will likely have to take the same tests prior to surgery. Some of the more common tests include:

1. - Blood tests such as a complete blood count (CBC) and kidney, liver, and blood sugar tests
  - Chest x-ray to check your lungs
  - ECG (electrocardiogram) to check your heart

blood drop doctor ECG infograph

Depending on a person’s age, general health, weight, and smoking status, if the surgeon identifies any potential risk of complication, the surgeon may insist on additional screenings. Additional tests and screenings that may be required prior to your surgery include:

1. - Heart stress test. During this test, a technician will place patches called electrodes on the patient’s chest. These patches will be attached to an ECG monitor that will follow the electrical activity of your heart during the test. The patient will then be required to complete some form of cardio exercise for approximately 10 to 15 minutes until the test is complete.
  - Pulmonary function test. This test may be required to test how well your lungs are functioning. If you take a lung function test, you will be required to sit and breath into a mouthpiece that will be connected to a device called a spirometer; this instrument records the amount and quickness of your breath over a period or time.
  - Imaging tests, such as an MRI scan, CT scan, or ultrasound test

Short-term Care Facility vs. Home Care: Which One is Right for You?

One of the most important decisions you will have to make is where you want to be for your recovery. There are advantages and disadvantages to both short-term care facilities and home care services, but both are great options. It all just depends on your personal preferences, your finances, and your available support system.

1. - Personal preference. Do you prefer to recover at home, or in a facility with specialized resources?
  - Available support system. Do you have friends and family that can help out and assist with your recovery?
  - Finances. Do you have private insurance and/or health benefits from your employer that could help offset some of the out-of-pocket expenses if you choose to recover at home?

senior male with senior infograph

The average cost of a short-term care facility ranges from approximately $60-$85 per day^[6], depending on the type of accommodation, versus recovering at home, which has no incremental costs other than services like equipment rental and meal delivery, for example. Of course, you receive different levels of care with each option, and there are pros and cons for each:

short term care facility vs home care pros and cons chart View Larger

Again, your Care Coordinator can help you with this decision. But, it is important that prior to your surgery you start thinking about what will be the best option for you.

Post-op: How to Make Your Recovery Easier

Here are some simple, but important things you can do to reduce the length of your recovery:

Engage in Physical Activity

Exercise not only improves your mood, but helps to improve the function of your joint. Additionally, physical activity can help reduce blood clots in your legs (a common concern of recovering patients), reduce your pain, and help prevent constipation.

Don’t worry, your physiotherapist will teach you how to do daily exercises, use the stairs safely, and walk with your walker (if needed). Just make sure to take it slow at first before your physiotherapist gives you specific instructions and exercises.

Eat a Healthy Diet

Maintaining a healthy weight is important for your recovery. Moderate weight loss prior to your surgery is preferred; sometimes your surgeon may suggest weight loss. But, it’s just as important to maintain a healthy weight during your recovery since extra weight can put additional pressure on your knees and hips. In fact, just 1 extra pound of weight gain puts approximately 4 extra pounds of force on your joints!^[7]

Remember to Relax

There is a fine balance between being physically active to prevent blood clots and joint stiffness, and the need to relax. During your recovery, you are likely to feel fatigued and tired. Your body is going to need time to heal, so make sure that you try to balance your activity level with a good amount of rest. Try catching up on some movies, books, and TV shows with occasional breaks to do your physiotherapy exercises.

Prepare, Prepare, Prepare

No matter your choice of location for recovery, the best thing you can do is prepare. Ensuring that you have everything thought through – including your meals, living arrangements, appointments, and medications – can make a world of difference. It can help reduce your stress before your surgery, and especially when you aren’t very mobile during your recovery, you’ll thank yourself.

Roles of At-Home Care Workers: What to Expect

Your Physiotherapist and Their Role in Your Home

The number of physiotherapy visits you’re provided will be determined by your Care Coordinator. Funding for physiotherapy is based on what is called an Episode of Care (EOC) model; this means that the delivery of treatment is not limited to a certain number of visits, but rather continues until you have reached your goals as indicated by your treatment plan.

senior citizens exercising

When your physiotherapist comes to visit you at home, he or she will work with you in the following areas:

- - Walking with your walker and/or crutches
  - Walking without your walker and/or crutches
  - Daily exercises to improve movement and functionality of your joints
  - Using the stair safely

Your Nurse/PSW and Their Role in Your Home

Your Care Coordinator may help arrange for a Nurse or PSW to help you while recovering at home. However, the provision of home care, other than physiotherapy, depends on your general health, age, and physical capabilities.

infograph senior getting assistance from nurse and senior couple and hobbies

During your hospital stay, the nurse will teach you how to tend to your incision site. If a home care Nurse if provided, he or she will provide the following services:

1. - Changing your bandage
  - Ensuring that your incision stays clean and free of infection
  - Administering medication

If a PSW is provided, he or she will help you with the following:

1. - Bathing/grooming
  - Meal planning and preparation
  - Feeding
  - Toileting
  - Light housekeeping
  - Laundry
  - Companionship
  - Lifts and transfers
  - Escorting to medical appointments

Pre and Post Surgery Checklist

Joint replacement surgery (or any surgery for that matter) is a lengthy process from the time of your first visit to your family doctor, to the end of your recovery after surgery. Depending on wait times, the amount of pre-operative tests needed, and your recovery plan, the whole surgery process can take a considerable amount of time. That’s why preparation and organization is crucial in making the experience easy and stress free. Using a checklist is a good way to help ensure that you’re ready for your surgery, as well as your recovery. Good luck!

pre-surgery and post op checklist View Larger