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Reportage: Fatima, - Time for surgery

Two persons, one doctor and one "patient" trying to walk after surgery
Picture is not linked to any patient.

In this series of reports, you will learn about the process for surgical treatment of advanced osteoarthritis, starting from when a patient first sees an orthopedic specialist to ultimately receiving surgery. We will give you insight into the multiple healthcare visits one needs in order to undergo joint replacement. If you or someone you know is waiting to see an orthopedic doctor for assessment of osteoarthritis that may require surgery, this series will give you an idea of what the healthcare process will look like.

The majority of those who see an orthopedic specialist for the first time get there through referral from a primary care doctor. In this series, we follow patients during their visits to specialist doctors at Skåne University Hospital in Lund. All patients have given their consent to our presence during their healthcare visits, and we have informed them that this text will not contain any personal information that can be linked back to them. All names in these reports have thus been replaced, and the images are not from the patients themselves.

In this third part of the series, we continue to follow Fatima, who suffers from a painful osteoarthritic knee, for which she will undergo surgery to have her joint replaced with a prosthesis. Fatima had the same surgery in her other knee a few years back. Today, we will accompany Fatima through her surgical procedure.

Fatima arrives at the hospital early in the morning, the first of the patients to receive knee replacement surgery here today. She sits in the waiting room for a little while, before she in called in to the unit that will oversee her surgery. Fatima is shown to a changing room to dress for surgery, and then waits a little more before it's time. A nurse comes and prepares Fatima’s PVC, which is a small, thin tube that is inserted into a vein, for delivery of any drugs that may be needed during surgery.

When everything is prepared, Fatima is wheeled to surgery, where the anesthesiologist or anesthesiology nurse awaits. A patient may be put under general or spinal anesthesia during knee replacement. Spinal anesthesia acts locally on the legs and is often administered in combination with a mild sedative to help the patient relax during surgery. In contrast, general anesthesia involves relaxation of muscles throughout the entire body, with breathing handled by a respirator. Routines for choice of anesthesia may vary between departments, but are of course based on individual assessment of each patient. At the ward where Fatima is being operated, the routine is for patients not to receive general anesthesia for knee replacement, and this is also the case for Fatima. However, the sedative she receives alongside her spinal anesthesia makes her drowsy, and she sleeps deeply throughout the procedure.

In the operating theatre, there is a person who is in charge of anesthesia, a surgical nurse, a surgical nurse assistant, and two doctors who will perform the procedure itself, of which at least one is an orthopedic specialist. Everyone in the room has their specific tasks, but they also work closely with each other.

Fatima's operation takes about an hour, and when it is finished, she is sent to an intensive care unit where she stays for a few hours and is kept under observation. Fatima is doing well after the surgery, relieved from pain and feeling good, given the circumstances. After an hour or so, she is moved to the ward where she will stay overnight. On the day of the surgery, in the afternoon a physiotherapist comes by and talks to Fatima, highlighting how important it is to start moving as soon as possible after surgery, if everything goes according to plans. Later in the day, Fatima tries walking with crutches, with staff present for assistance. She says she has a slightly surreal feeling, but that it feels good to be up and about so quickly. She hopes the improvement will continue in the coming days as well.

Fatima goes home the day after the surgery, with a follow-up appointment in two weeks to remove the stitches. The exact timing and procedure of how stitches are removed may vary from clinic to clinic. In Fatima’s case, she will return to the orthopedic department in Lund where she had her first visit to have her stitches removed. The procedure will be performed by a nurse who is experienced in this type of post-surgical care, and will be able to assess whether the joint is healing as it should. They take special care to monitor and minimize the risk of infections. If there are signs of infection, a doctor is called in to make an assessment and take further measures as necessary.