(01) How long will I need to wait for appointments?
Initial appointments are made as promptly as our office schedule allows, and this wait time can vary according to the particular problem, backlog of patients, and operating schedules. The wait time may be several months. Patients are notified, usually by letter, as soon as a date has been assigned. Dr. Klippenstein reviews all consultation requests, and consideration is given if the referring physician identifies issues of particular urgency.
During this time it is important that non-operative treatment such as physiotherapy is initiated, and all imaging is completed if possible. This can potentially shorten the time to possible surgery.
Follow up appointments are usually made more quickly, within a few weeks of booking, completion of ordered tests, or surgery.
(02) What if I can’t make it to my appointment?
It is very important to notify Dr. Klippenstein’s office as soon as possible if you cannot, for any reason, make it to an appointment, even if it is just before the appointment itself.
Also, it is helpful to notify the office if you will be late, to ensure that your spot will be kept. Occasionally Dr. Klippenstein will be detained or needed at the hospital unexpectedly, and appointments will be running late. If the patient wishes to wait, they will be seen when Dr. Klippenstein returns, but they also have the option of rebooking.
You may receive an appointment reminder by email, if we have that contact information.
(03) How long will I need to wait for my surgery?
The time from booking of a surgical procedure to the date of surgery varies according to the procedure being performed. Operations that require an in-patient stay, such as joint replacements, take the longest, as there is a limit to how many patients can be admitted at one time. Outpatient procedures have a considerably shorter wait time. This reflects attempts to optimize the operating room time. Another limiting factor is anaesthetist availability, and there has been a significant shortage in Brandon in this area for some time. Fewer anaesthetists means fewer operating slates, which lengthens all wait times. Additional factors include hospital bed availability, slow-down times to accommodate staff holidays, unexpected equipment availability issues, and hospital funding.
One opportunity to reduce wait times for some arthroscopic procedures is the surgical program at Minnedosa Health Centre, which is a part of Prairie Mountain Health. Dr. Klippenstein operates in Minnedosa several times a month, and will usually make this option available for suitable patients. These wait times are usually less than those for BRHC.
In most cases an approximate wait time can be estimated by Dr. Klippenstein at the time of booking, but it must be understood that this is an approximate range only, and subject to hospital factors that cannot always be predicted. The hospital surgical booking offices schedule all procedures, and the Brandon Clinic does not have access to this information. In general, inpatient joint replacement procedures may wait a year or more, outpatient partial knee replacements and reconstructive arthroscopic procedures may wait 4-6 months, and simple arthroscopic procedures may wait 2-3 months.
Some patients want to defer their surgery dates for work or holiday reasons. It is difficult to always accommodate these requests, and the hospital booking office has only a certain amount of flexibility to do so. If a patient turns down 2 or 3 of the offered dates, their booking may be placed at the end of the list or canceled completely. We realize that unavoidable situations occur that can make surgical scheduling difficult, and we strive to be as reasonable about this as possible, within the limits of an overcrowded and backed up medical system.
(04) What if I have to cancel my surgery?
All surgical procedures require patients to confirm the offered surgical date before they are fully booked. If at any time after this confirmation patients need to cancel their surgery for any reason, it is very important that the hospital surgical booking office (BRHC 204-578-4117, Minnedosa 204-867-8727) be notified as soon as possible. In most cases the hospital will try to rebook the case at the next available date for that type of procedure, unless there are outstanding issues that need to be addressed first. If original or alternate dates offered are not accepted, within reason, the hospital reserves the right to return the booking to Dr. Klippenstein for review as to whether surgery will still be performed.
(05) What kind of anaesthetic will I have?
Surgical procedures may be performed under general anaesthetic, when the patient is asleep with a breathing tube providing oxygenation, under spinal anaesthetic when the patient is frozen from the waist down via medication injected in the lower back, or local anaesthetic, when freezing is injected only at the incision site. Sometimes the anaesthetist will augment the anaesthetic with a regional block by needle injection, which adds additional post-op pain control for 12 to 24 hours.
Dr. Klippenstein will discuss the options for the particular surgery when the procedure is booked, but the final decision is made between the patient and the anaesthetist on the day of surgery. It is very important to note if the patient or a blood relative have ever had any adverse reaction to an anaesthetic previously.
(06) Will I have any pain during surgery?
All surgery is performed under some form of anaesthetic, and should not cause any significant pain. However, there may be discomfort with some aspects of the anaesthetic such as needle insertion or tourniquet pressure. With a spinal anaesthetic, there may be a persistent mild sensation of touch or pressure, but not sharp pain. Some patients prefer not to be aware or hear anything with a spinal anaesthetic, and can request sedation to help them doze during the procedure. There may be some throat discomfort or nausea after a general anaesthetic.
Typically multimodal pain management techniques are used to reduce pain in the post op period, such as nerve blocks, long acting local anaesthetic, cold therapy, and various medications.
(07) How long will I be off work after my surgery?
Time off work depends on the type of procedure, patient specific conditions, healing rate of the individual, response to rehabilitation, potential postoperative complications, and the type of work to which the patient is returning. Desk type work can be resumed as soon as the patient can safely and comfortably get to their desk, and has use of their upper extremities. Heavier manual work or jobs requiring walking or periods of time on one’s feet will take longer, and will usually require that the patient is off their walking aids and mobilizing safely.
Sometimes temporary functional bracing will facilitate an earlier return to work. Often a patient can return to limited or part time work duties as a graduated return to work. Return to work planning should begin when the surgery is booked, and an estimate requested in Dr. Klippenstein’s office. Physiotherapists can also help with return to work planning.
(08) When can I return to sports?
There are of many variables that affect safe return to sports after injury or surgery. These can be discussed with Dr. Klippenstein at your office visits. This will depend on healing of the affected tissues, recovery of range of motion and strength, and progress with exercises and physiotherapy. Usually a gradual, activity-specific return is planned, and the therapist is often involved in this planning. Compliance with post operative instructions is paramount to optimal outcomes and appropriate return to sports and recreational activities.
(09) When can I drive after surgery?
The primary consideration for return to driving after surgery is driving safety. In most cases this will determine the length of time as opposed to the specific injured or operated area. In general, one should not return to driving until one has use of both of the hands and arms.
With a right total knee replacement one should wait about 6 weeks after surgery, and with a left total knee replacement about 2 weeks. For a right or left partial knee replacement, one should wait about 1 to 2 weeks after surgery.
Driving can commence shortly after most arthroscopic knee surgeries, once the patient’s pain is controlled and they are off crutches. One should not drive with a cast or fracture boot on the right foot. Seat belts and shoulder harnesses should always be used after shoulder surgery, even if this is uncomfortable. A seatbelt will never compromise shoulder surgery, and can be a life saver in an accident.
(10) Can I get a second opinion?
It is always the patient’s prerogative to get a second surgical opinion, and in fact if there are significant doubts or concerns about surgery, it is recommended that Dr. Klippenstein or the referring physician be advised. Orthopaedic surgery should always be a joint decision by the surgeon and the patient or their responsible caregiver. If another opinion is requested, it can usually be arranged.
(11) Will I need a blood transfusion?
It is very rare for patients to need a blood transfusion for the types of procedures that Dr. Klippenstein performs. While it used to be more common after joint replacements, medication is now used that reduces the amount of postoperative bleeding significantly, especially for elective cases. If a transfusion were ever needed, a consent would need to be obtained from the patient.
(12) Will I need pain medications after surgery?
Patients will be provided with a prescription for pain killers at the time of discharge from hospital. In most cases it is advisable to start with simple over-the-counter pain killers such as acetaminophen (eg Tylenol) or ibuprofen (eg Advil) before the pain gets too bad, and take these on a semi-regular basis for the first day or two. A prescription for a stronger pain killer will also usually be given, for use if simple medication doesn’t help. Ice or cold therapy devices are usually quite helpful, used on an hourly basis for the first day or two, and can reduce the amount of pain medication needed. We do not usually prescribe narcotic medication. If refills are needed, these should be obtained from the family doctor.
(13) What costs might be involved?
The majority of office, hospital, and surgical costs are covered by Canadian provincial health insurance, as provided by the patient. Some braces are also covered, but crutches, some braces and orthotics, and cold therapy devices are not. There have been some recent changes in provincial policy that pass some of these costs on to the patient, and out-of-province patients will be covered according to their particular provincial plan. Also, patients may need to pay for insurance or disability forms, sick notes, or special letters of consideration for other purposes.
(14) What can I do to improve my chance for a satisfactory outcome?
It is our belief that the best outcomes and satisfaction result from a close working relationship between the patient, their surgeon, and the therapists. As such, good communication between all parties is key. As much as possible, all instructions should be followed as closely as possible, all appointments should be kept, any concerns should be brought forward, and physio and exercise plans followed diligently. Appropriate activity modifications and restrictions are important to prevent re-injury or delayed healing. Increased rest and sleep, and attention to a balanced diet are important for a healing individual who will often be in a state of increased energy deficit after surgery.
Smoking causes significant deleterious effects to healing tissue, as it reduces the concentration of oxygen being carried by the blood to the injured area, and increases the rates of complication. Smoking cessation, or at least significant reduction, will increases the rate and chances of healing for most types of surgery. The best improvements are achieved if this occurs several weeks before surgery, and maintained during the rehabilitation phase. Some patients are actually able to stop smoking altogether when they take this opportunity, with all the additional benefits that this brings. A referral to the Smoking Cessation Program at BRHC can help in this regard.
Excessive weight, or elevated Body Mass Index (BMI) can result in anaesthetic and surgical technical difficulties, increased post-op pain and complication rates (including wound healing complications and infection), and poorer outcomes. It can be very helpful to target a more normal BMI prior to surgery. For example, each pound of reduced body weight results in an approximately 4 pound reduction in weight experienced by the knee. Therefore, a 10 pound weight loss produces a 40 pound improvement at the knees. Again, overweight patients who take this opportunity to reduce their weight sometimes achieve significant lasting BMI reductions, with the associated improvement in their general well being.
The current or targeted BMI can be calculated using the tool below:
Aim for a healthy weight https://www.nhlbi.nih.gov/health/…
(15) When can I have my other knee operated on?
Some patients have similar problems with both knees. If an arthroscopy is planned, both knees can often be treated under the same anaesthetic. If a knee replacement is booked, either partial or total, the most severely affected knee will usually be treated first. The second knee can be replaced once satisfactory recovery is achieved, usually within 6 to 12 months. Occasionally, both knees can be replaced under the same anaesthetic, which reduces the number of hospital stays, overall recovery time, and infection rate. Patients must be approved for double procedures, pending assessment of their knee condition, associated medical problems, and approval by anaesthesia.
(16) What about time off work and insurance forms?
Time off work forms should be requested at the time of surgery. Sometimes a tentative return is designated, with a more specific date determined at follow ups when it becomes clearer when a partial or full return is appropriate. There is no charge for these forms if requested at the hospital.
Insurance and disability forms should be brought to the Clinic at the time of follow ups, when required information will be available, including return to work dates. These dates cannot usually be determined until there has been at least one postoperative follow up, when the patient’s response to surgery and potential delays are identified. It is therefore usually not possible to complete these forms on the date of the surgery itself. They will be completed as promptly as possible. Fees for these forms are either covered by the patient’s insurance plan, or are based on a payment schedule set by the Brandon Clinic.
Often the patient’s family physician can complete these forms, and this may expedite the process.
(17) Is same day (outpatient) knee replacement surgery a good idea for me?
Many patients are suitable for same day, or outpatient knee replacement surgery. Most of these are partial knee replacement surgeries, although some total knee replacement surgeries can qualify. Patients often prefer to have their immediate post-op recovery in the familiarity and quiet of their own home, where they can follow their own daily schedule, eat their own food, and enjoy the comforts they are accustomed to. This can also reduce the exposure to hospital acquired infections, and usually reduces the wait time to surgery, as an inpatient bed is not required.
We have had considerable success accommodating outpatient knee replacement surgery with newer modalities of pain and bleeding control, reduced needs for narcotic medication which can cause nausea and vomiting, and accelerated mobilization protocols. This is a safe and well established option that many have taken advantage of. Next day outpatient follow-ups, 24 hour phone access for nursing advice, and outpatient physiotherapy are arranged, and it is extremely rare for patients to need readmission to hospital.
Careful selection of patients suitable for outpatient knee replacement is critical, and appropriate home supports, certain medical conditions, advanced age, risk of falling, and specific patient requirements are factors in making this decision. All patients selected for outpatient knee replacement surgery will receive the necessary information and support to facilitate this.