the patient’s condition and possible questions, and offer treatment options including surgery.
Our care map can help to navigate this process.
All patients are seen as referrals from physicians or nurse practitioners. It is expected that prior to referral to Dr. Klippenstein an initial workup will have been completed, including an examination, xrays, and occasionally additional special tests. If appropriate, a trial of non-operative treatment will already have been initiated, which may include medication, activity modification, exercises, physiotherapy, injections, or bracing.
Referral to an orthopaedic surgeon is usually made if these measures have not been successful, and surgery is being considered. A referral to Dr. Klippenstein does not imply that surgery will be necessarily booked or even recommended, only that the bone or joint issue will be further reviewed and treatment options discussed. In some cases a referral to a non-surgical musculoskeletal specialist will be helpful and this can be discussed with the family physician.
Patients should bring with them:
- The completed Patient History Form (see Shoulder History Form and Knee History Form) received with the appointment information, if they have a shoulder or knee problem.
- A list of all medications they currently take, and a list of any allergies.
- Any braces or orthotic devices that they have been using.
- A family member or friend if they wish.
- An interpreter if English communication might be a challenge.
After discussion of the presenting problem with Dr. Klippenstein, an appropriate examination will be carried out and available test results reviewed. If possible a confirmation of the patient’s condition and appropriate treatment options will be offered at the initial consultation, but sometimes additional imaging or appointments will be necessary to clarify a diagnosis and treatment plan.
If the patient is having a test such as an MRI and knows they will be seeing Dr. Klippenstein subsequently, the imaging technician should be reminded to forward a copy of the report to Dr. Klippenstein at the Brandon Clinic.
If non-surgical treatment has not already been initiated, options including physiotherapy, bracing, injections, or medication may be suggested. In some cases surgery will not be recommended as the best choice. If surgery is felt to be a suitable option, the procedural alternatives will be reviewed, and related information and resources provided. Expected post-op recovery, rehabilitation, and time off work and sports will be discussed.
Patients are encouraged to ask questions about their condition and the treatment options, as we feel that improved understanding leads to appropriate expectations and ultimately optimal outcomes. Patients are never pressured into making decisions regarding surgery in the office, and may wish to consider their options at home or in discussion with family members or other medical professionals.
Better understanding of a condition and its treatment can facilitate appropriate expectations and optimal outcomes. Patients are therefore encouraged to ask questions, and may wish to take notes. Patients are not obliged to make decisions about surgery at the initial consultation, and may wish to take some time to decide, and possibly discuss this with family or their physician.
If surgery is being considered, decisions should be made jointly with the surgeon and the patient (or their responsible caregiver). It is helpful therefore if patients have some understanding of the condition and its treatment options. (see Ortho Patient Education )
Communicating with other patients who may have had similar surgery can also offer valuable insight. (Talk To Someone)
If a decision to proceed with surgery is made at the initial consultation, booking forms will be completed and surgical arrangements made.
If a patient initially prefers to defer a surgical decision, and decides sometime later to proceed with recommended surgery, a follow-up appointment should be made with Dr. Klippenstein’s office.
If a surgical procedure is being planned, booking forms and consent will be completed. Patients will require a pre-operative history and physical with their primary care giver. THE PRE-OP EVALUATION SHOULD BE COMPLETED AS SOON AS POSSIBLE TO EXPEDITE A SURGICAL BOOKING DATE. Sometimes other medical issues need to be addressed before proceeding to surgery.
It is important to have a reasonable understanding of the surgical procedure, including the expectations of outcome, potential complications, rehabilitation issues, and possible time off work. These issues should be discussed with the surgeon at the time of booking the surgery.
(See Resources and Downloads)
Dr. Klippenstein performs a variety of arthroscopic procedures at the Minnedosa Health Centre as well as Brandon. This can often shorten the wait for surgery as more major or in-patient procedures are not performed here. It may also shorten the transportation for some patients.
Once the pre-op History and Physical form is received from the referring physician’s office, the Brandon or Minnedosa OR booking office will arrange the surgical date. The patient will be advised by the hospital of their date by mail or by phone, and attempts will be made to give as much advance notice as possible. Preoperative instructions will also be given, and it is very important that all these instructions are followed closely, as if not, occasionally the surgery will be cancelled.
The wait for surgery varies by the type of procedure and where it is performed, and an estimate only of the particular wait for a booked procedure can be given at the office. The Brandon Clinic has no involvement in this part of the booking and cannot provide any information regarding actual surgical dates.
Those patients booked for joint replacements or other more major procedures are expected to attend the Prehab Clinic at BRHC. Patients will be contacted in advance to attend this half day clinic, scheduled a month or two before the surgical procedure itself. It provides an opportunity to meet with a multidisciplinary team to provide further information about the surgery, review medical conditions which may have an impact on anaesthetic and surgical success, and answer any questions which patients may have. Advice to help reduce potential complications will be given. Attendance at the Prehab Clinic has been shown to improve patient preparedness, comfort with the surgical process, and even outcomes. In some cases an appointment with an anaesthetist will need to be made as well.
Booklet Download: Prehab Osteoarthritis Clinic
Surgery dates are arranged by the hospital, and the Brandon Clinic is not involved in booking or setting of dates. Patients should present to the Pre-op area as booked at either the Brandon Regional Health Centre or the Minnedosa Health Centre. Instructions will have been given regarding fasting, medications, and what to bring, and these should be followed closely. It is especially important to arrive on time and those traveling from a distance may wish to stay in Brandon the night before.
Patients should be accompanied by a relative or friend, who may wish to wait at the hospital until after the surgery or return at a suggested time. Further questions can be asked of Dr. Klippenstein or the anaesthetist before surgery. The surgeon should be advised at this time if a note for time off work is needed. Insurance papers can be brought to the first follow-up appointment, as these cannot usually be completed until at least the first post-op visit. Details of the operation will be relayed to the patient or family after surgery or at the first follow up visit.
Most procedures will take advantage of post-op multimodal pain control measures. Discharge instructions and prescriptions will be given to the patient or their family. Patients will need someone to drive them home and be with them for the first 24 hours. Physiotherapy referrals are usually arranged at the first follow-up appointment.
If patients are to be admitted to hospital after surgery, they will be given appropriate instructions, and will usually be admitted to Ward 200.
Postoperative follow-up instructions will be given at the time of discharge from hospital. All patients are scheduled for at least one post-op visit with Dr. Klippenstein. If there are staples or stitches to be removed, we prefer that this is done under Dr.Klippenstein’s supervision. Most follow-ups are done at the Brandon Clinic, while patients with casts or backslabs will be followed up at the Fracture Clinic.
If physiotherapy is required, this will be arranged at the first follow-up visit. As much as possible arrangements are made with a patient’s previous physiotherapist if they’ve had one, or at their local hospital or nearby physiotherapy facility. Dr. Klippenstein routinely receives progress reports from the physiotherapists involved, and concerns can also be passed on by them.
Postoperative rehabilitation is critical to the success of surgery, and is as important as the surgical procedure itself to ensure an optimal outcome. It is expected that the patient will comply as best possible with activity advice, exercise programs, and physiotherapy. It is of course impossible to guarantee any surgical result, but compliance with postoperative instructions and rehabilitation will give the best chance for a satisfactory result.
Instructions regarding signs of potential post-op complications will be given. If there are concerns regarding complications following surgery, prompt contact should be made with Dr. Klippenstein’s office (204-571-7136), the patient’s family physician or local hospital, or the BRHC Emergency Department (204-578-4166).