Orthopaedic Department

The inpatient ward is located on the ground floor of the main hospital building. It also includes the provision of care in the orthopaedic outpatient clinic. This part is also situated on the ground floor of the hospital.

The accredited department of orthopaedics provides care for patients with degenerative diseases of the musculoskeletal system, mainly of the weight-bearing joints, including implantation of total hip and knee joint replacements, as well as treatment of chronic and traumatic diseases of the soft components of the joints (arthroscopy, anterior cruciate ligament reconstruction). An integral part of care is the prevention of congenital hip dysplasias in newborns and its basic conservative treatment. Specialized procedures are referred to a higher type orthopedic department after a complete examination.

What we deal with

• Endoprosthetics of patients with arthrosis of the weight-bearing joints, including revision surgeries
• Injuries and post-traumatic conditions of the soft parts of large joints with urgent and planned arthroscopic and conventional surgery
• Outpatient conservative therapy of primary and secondary arthrosis of the weight-bearing joints
• Outpatient operative therapy of orthopaedic diseases - carpal tunnel syndrome, extirpation of bursae...
• Basic diagnostic care for patients with primary bone tumours, including arranging specialised care at a higher centre
• Acute traumatology of the entire musculoskeletal system
• Management of post-traumatic conditions and complications of orthopaedic procedures
• Diagnosis, prevention and treatment of congenital developmental defects of the musculoskeletal system, with particular focus on the prevention and conservative treatment of developmental dysplasia of the hip joints

Definition of expertise

Orthopaedics is a surgical specialty concerned with the anamnestic data, examination, diagnosis, prevention, treatment and rehabilitation of congenital or acquired diseases, deformities and functional problems (traumatic or non-traumatic) of the musculoskeletal system; continuous research and specialty and continuing education are an integral part of the specialty. The study and research of these diseases is considered essential.

Traumatology of the musculoskeletal system is an integral part of the field. Orthopaedics also works in synergy with other surgical disciplines, especially general surgery and traumatology, neurology, paediatrics, FBLR, medical prosthetics and complement medicine.

AMBULANCE

DEPARTMENT

Preoperative examination sequence

The basic pre-operative examination will be performed by your general practitioner on an outpatient basis. The examination includes blood tests, an ECG and, if necessary, an X-ray of the heart if you are a smoker or over 50 years of age. It is advisable to arrange this examination in good time (at least one week before surgery, but no more than 4 weeks if you are healthy and 2 weeks if you have a chronic condition). If you do not have the results and medical conclusion on admission, your surgery will be postponed!

• If you have a chronic illness or are over 50 years of age, your GP will refer you for an internal examination.
• If you are taking hormonal contraceptives, take them off one month before your planned surgery!!!
• With all the results and the conclusion from the general practitioner (internal medicine doctor), you will come to the Hořovice Hospital the day before the operation, where an anaesthetic pre-operative examination will be carried out.
• The anaesthesiologist will recommend the type of anaesthesia that is most suitable for you after evaluating the results you have brought with you and talking to you. It is possible that the doctor may want to repeat some tests or add others, so it is absolutely necessary to come to the surgery the day before. The examinations will be completed during the day in the inpatient ward or in the specialist outpatient clinics in NH. Please be aware that these examinations can be time consuming (some lasting several hours), so it is not possible to arrive at the hospital on the day of surgery or the evening before!!! Based on the additional examinations, the anesthesiologist will come to the ward again to evaluate them and write the so-called premedication (administration of drugs before anesthesia). Pre-operative preparation for the operation aims to prevent serious complications (thrombosis, embolism, alegic reaction,...) and starts the evening before the operation! Although you may think that arriving at the hospital on the morning of the day before the operation is a "waste of time", this is not the case and for organisational reasons it is not possible to ensure a good pre-operative preparation if you arrive on the day of the operation. We believe that your health is the most precious thing for you and therefore you do not want to gamble with it unnecessarily.

Reception

On the day of your scheduled admission, please come directly to the inpatient orthopaedics department.

Information for patients - instructions before and after TEP (total endoprosthesis) surgery:

Hip TEP Surgery .pdf

What to take with you to the hospital

• Pajamas
• Underwear
• Bathrobe
• change of clothes
• personal hygiene items
• towel, washcloth
• health insurance documents
• crutches, canes and other aids that you will need after the operation (a voucher for these will be written by your doctor in advance)
• medications to be taken (for the expected duration of the hospital stay)
• Valuables and money: you can store your valuables and money in the hospital's central safe. You will receive a written proof of safekeeping against which the items will be released to you on discharge from the hospital. The hospital is not responsible for the loss of loose items stored off-site. We recommend that you do not take large sums of money and valuable items to the hospital in your own interest
• Clothes and personal items.
• Medicines. If you are taking certain medications to treat a specific condition, please take them with you to the hospital and give them to the nurse on arrival on the ward. Your doctor will include them in the range of medicines that will be given to you during your hospital treatment. As it is very important to coordinate your overall treatment, please do not take any medicines during your hospital stay that your doctor does not know about - even those you normally take at home (prescription or purchased). You will receive all necessary medications from the nurses at the prescribed dose and time.

What special things should I bring?

• All the results of your pre-operative tests
• personal belongings
• elastic stockings. A voucher will be written by your GP or vascular surgeon, or you can buy them from the medical supplies. If you do not bring elastic stockings, your lower limbs will be bandaged with an elastic bandage.
• Underarm crutches or French canes. If you do not own them and your doctor has not prescribed them within the past 2 years, we will assign them to you in our department.

Procedures for which written informed consent is required

• Total joint replacement (hip, knee)
• Arthroscopy
• Diagnostic and therapeutic procedure
• Treatment of fractures in adults

Admission of patients

Please arrive for your appointment the day before your scheduled surgery between 8am and 9am.
You do not have to fast and we recommend drinking a lot the day before the surgery!!!
First, report to the central reception, where you will need your ID and health insurance card. Once you have registered, you will go to the ward where you will ring the "reception" bell and wait for further instructions from the nurse. You will then be sent to the anaesthetic outpatient clinic for a review of all pre-operative investigations.
You will discuss the type of anaesthesia with the doctor and any questions you may have about the anaesthesia will be answered. You will be seen by a reception nurse on the ward, who will write a sick note, register you, arrange any tests that the anaesthetist has ordered, and familiarise you with the running and layout of the ward and other staff.
During the morning you will be seen by an orthopaedic doctor. If you are not going to have any further examinations, you are free to move around the hospital grounds (not outside!), but always report to the nurse that you are leaving the ward.
Smoking is prohibited in all areas of the hospital!
In case you are going for surgery on Monday, you must come to the reception on Friday, after completing all the necessities related to the reception (see above), you can go home (on a pass) and come to the ward on Sunday between 5 and 6 pm (you can eat and drink!).

What to expect before surgery?

• The evening before surgery:

Take a shower.
Before 10pm, you will be given one small and painless injection under the skin (preferably in the abdomen) and, depending on the anaesthetist's advice, one tablet of medicine to help you sleep better before the procedure.
If you go to the ICU (intensive care unit) after surgery (especially after TEP), pack personal hygiene items, medicines, compensatory aids (glasses, hearing aids, etc.), and a mobile phone in a small bag.
You must not eat or drink or smoke from midnight onwards, even if you have chosen to have the procedure performed under anaesthesia (block). By following these guidelines, you will reduce the possible risks of anaesthesia.

• In the morning before surgery:

Take a shower if you have not done so the night before.
Lie back on the bed and keep your lower limbs off the bed for at least 30 minutes, then put an elastic stocking on your healthy (non-operated) limb; this is necessary to prevent the development of venous inflammation in the lower limbs.
Depending on the anaesthesiologist's office, you may be given premedication in the form of medication (usually Oxazepam, Dithiaden) by the nurse in the morning to alleviate fears of surgery and reduce any complications of anaesthesia (allergic reaction).
If you have diabetes, blood will be taken from your finger in the morning to test your glucose levels and then you will be given an insulin infusion to drip before you go into theatre - you may also be given a smaller infusion in other cases (e.g. patients with allergies or respiratory problems).
Before you go to theatre, the nurse will warn you and ask you to go to the toilet - remove all jewellery, including peercing, and remove dentures if you have them.
Just before you leave, you may still receive an injection into the muscle - depending on the anaesthetist's surgery.
You will go to the operating theatre accompanied by a nurse and an orderly on the bed.
You will undress at the operating theatre transfer point. You can keep only disposable panties, which are available in the medical supplies.
You will then be collected by the operating theatre staff.

What can I expect after surgery?

After surgery, you will be in the recovery room, which is part of the operating rooms, until the anesthesia wears off (30 minutes to 2 hours). You will then be collected by a ward nurse and an orderly who will take you back to the ward.
After your TEP (endoprosthesis) operation, you will be transferred to the post-operative room on the orthopaedic ward where you will be monitored until your condition has stabilised (usually by the next day) and then transferred back to your standard room.
You may still have an infusion when you leave theatre, after which the regime will depend on the type of anaesthesia:
1) if you are under general anaesthesia - CA (you have been put to sleep): - you must not eat or drink for approximately 2 hours. After that you can drink tea (fizzy water and fizzy drinks make you vomit!), if you don't want to vomit and feel fine you can drink normally - getting out of bed is individual and depends on how you feel and the type of surgery. The first getting out of bed is always with a nurse present!!! Most patients get up the next morning.
For pain, you will be prescribed analgesics (tablets and injections) or stronger opioids (injectable)
2) if you are post epidural anaesthesia - EDA (so called. "block", you can't feel the lower half of your body) - you must not sit up or lift your head for 6 hours after you arrive from theatre, you will lie flat without a pillow (this is necessary to avoid complications of anaesthesia - headache, vomiting) - the moment you start to feel your lower limbs enough to hit your side, you can be rolled onto your side if the type of surgery allows it - if you do not vomit, you can drink as soon as you arrive in the room - getting out of bed after an EDA is individual (usually the next morning) and depends on how you feel and the type of surgery. The first time you get up is always with a nurse!!! - if you are in pain you will be prescribed analgesics (tablets and injections) or opiates (injectable)
3) if you are after a so called ankle block or local anaesthesia LA (numbing with a pich) - you can eat and drink as soon as you arrive in the room - if you feel well, you can get up accompanied by a nurse as soon as you start to feel the numb part - the exception is leg and foot procedures, where you should stay lying down for at least 6 hours to prevent possible bleeding

Discharge

The attending physician will inform you of your discharge during your morning visit. Your doctor should tell you the preliminary length of hospital stay, depending on the surgical procedure, before the operation. Please arrange to be collected from the hospital in the morning, preferably by 10 am.

After TEP surgery, we provide transportation home or to rehabilitation by ambulance. After other procedures, we only provide ambulance transport in exceptional cases! All information regarding follow-ups and regimens in the days following surgery will be in the discharge note you will receive for the doctor who operated on you. You will give the next discharge report to your GP. Along with the report, you will receive a sick note or a prescription for any medication you will continue to take.

Rooms:

The ward has standard and superior single rooms with en-suite facilities. Room facilities. In addition, the patient has the possibility to order extra meals according to the menu.

Room reservation:
The superior rooms are widely used by patients and therefore they must be booked in advance directly with the attending physician when ordering the operation or by phone with the attending staff: head nurse, Andrea Růžičková, +420 311 551 002

Prices of superior rooms and beds:
Cenik_nadstandardni_pobytove_sluzby_2.pdf

Billing and payment:
The final amount for a superior room, or superior food and beverages is paid at the end of the hospitalization at the NH cash desk. You can pay on weekdays until 2.30 p.m. by credit card or cash. Outside working hours, on weekends and on public holidays, when the cash desk is closed, pay the bill at the ward (cash only). In both cases, you will receive a receipt for payment. Payment for the superior room does not include the inpatient bed charge. This is billed separately.

IMPORTANT NOTICE: The superior room service only includes the enhanced standard of hotel services. It in no way implies a different treatment of patients by the attending staff.

The recommended times for visits to the orthopaedics department are every day from 14:00-18:00 or by personal appointment.

For intensive care beds (IMP) - by appointment only.

Health information for the patient's relatives

Prices of superior rooms and beds

The current offer of superior accommodation services can be found here:

Price list_nadstandardni_pobytove_sluzby.pdf

Billing and payment

The final amount for a superior room, or superior food and beverages is paid at the end of the hospitalization at the NH cash desk. You can pay on weekdays until 2.30 p.m. by credit card or cash. Outside working hours, on weekends and on public holidays when the cash desk is closed, pay the bill at the ward (cash only). In both cases, you will receive a receipt for payment. Payment for the superior room does not include the inpatient bed charge. This is billed separately.

Ordering a superior room

Head nurse, Andrea Růžičková, +420 311 551 002

Important note. In no way does it imply a different approach of the attending staff to the patients.