Your orthopaedic surgeon may ask that you have a general medical checkup before you come in to the hospital.
The place to start is with your regular physician. Usually, this is a physician who specializes in internal medicine or family practice. He or she will have a good knowledge of general medicine and will identify any medical problems that need to be addressed before surgery.
If you do not have a family physician, your orthopaedic surgeon may be able to provide a referral.
Your internist or family practitioner will do a medical clearance. He will review your medical history, physical examination, and your preoperative testing and will order any additional tests that need to be done. He will deter-mine if any medical problems require further evaluation before surgery. If you are taking certain medications, he will tell you what medications need to be taken on the day of surgery or if any medications need to be stopped.
For example, if you are on a maintenance dose of steroid medication such as Prednisone, your doctor will make sure that you are given the proper doses before surgery and that the medication is continued afterward. If you are diabetic and take insulin, you will need to know what dose to take on the morning of surgery and what dose to take afterward. Your insulin dose is likely to increase in the postoperative period due to the stress of surgery.
If you are on a blood thinner, such as Coumadin, your internist or family physician will tell you when to stop taking the medication. For some heart problems, it may be necessary for you to have some kind of anticoagulation until right before the day of surgery. When you stop Coumadin you will go on a blood thinner with a shorter duration of activity such as Lovenox.
This can be taken up until a few hours before surgery. Your primary physician will regulate the timing and dosage of any anticoagulation before you go to the operating room. During this period, he may want to obtain blood tests to monitor your status.
Your regular physician can refer you to a subspecialist if you have certain types of medical problems. If you have heart disease, he may ask you to see a cardiologist to evaluate your cardiac status. The cardiologist could do further cardiac testing such as an echocardiogram or stress test. He would also determine if you needed special monitoring such as telemetry after surgery.
If you have a history of asthma or chronic lung disease, your regular physician may ask that you see a pulmonologist so that the condition of your lungs is optimized before you have anesthesia. He might also refer you to a urologist if you have chronic urinary problems that could cause an infection.
If a serious medical problem is identified, you may have to delay or postpone surgery until the problem can be treated. While this can be frustrating, it is better not to have a problem in the operating room or in the hospital after surgery.
When you are in the hospital, your regular physician may visit you or designate a hospital based physician called a hospitalist to see you in his place.
Overall, most people will require preoperative medical clearance before surgery. If you are young, healthy, and have no ongoing health issues or medical problems, then a medical consultation may not be necessary. If there is any question, you should ask your orthopaedic surgeon whether you need clearance at the time you schedule your surgery.