Patient Resources
Frequently Asked Questions
After surgery, when is my first appointment?
Your first appointment will be between two to three weeks after surgery. You will need to call Dr Maina’s rooms to schedule the appointment upon your discharge (contact details below). Thereafter, Dr Maina will advise when your follow up appointments will be.
Do I need to quit smoking?
It is advisable to stop smoking around the time of surgery.
If scheduling an elective procedure, stop smoking six (6) weeks before your surgery. You will need to stay non-smoking for six (6) months thereafter. Smoking significantly increases the risk of infection and slows bone healing among other ill-effects on the healing body.
How do I look after my cast?
If you have a cast applied to your arm or leg, you will be asked to look after it in several ways to avoid complications:
- To elevate the fracture (to the level of the heart or higher) to limit swelling within the cast. This is especially crucial in the first week after surgery or injury. If an arm sling is available, use it when active during the day.
- Keep the cast clean and dry. The cast is made of fibreglass, and is outwardly water resistant, but the cotton and stockinet lining the inside are not. Make sure to protect the cast from getting wet – particularly around bath times. If it does get wet, please contact Dr Maina’s rooms as soon as possible to have the cast changed.
- To protect the cast from water, there are various cast covers on the market, available at local pharmacies (Dischem) /online (wantitall etc) to make cast care easier. Alternatively, home-made options can be attempted. Avoid the risk of leakage by not immersing the limb in water unnecessarily.
- Do not put weight or walk on the cast if it is on your lower limb, unless a rubber ‘walking heel’ has been installed at the time of application. You will need to use crutches while your lower limb cast is on to keep weight off.
When is my cast a problem?
As swelling decreases, and the fracture heals, the cast may grow loose with time. A cast that is too loose does not immobilise the extremity and should be replaced with one that fits more snugly. Please contact Dr Maina’s rooms to revise the cast if it becomes too loose and the implants underneath are affected.
The cast that is too tight (from progressive swelling) is a significant problem as excessive swelling can stop blood from flowing to the extremity. This can result in a complication called “compartment syndrome”, which is potentially both limb and life threatening. This type of swelling can sometimes happen after surgery or injury if the cast or back slab (half a full cast) is too snug.
The first most important signs of compartment syndrome are:
- Pain disproportionate to the injury
- Pain that is not controlled by painkillers
- Pins and needles in the toes/fingers
- Late signs are a pale or blue, cool extremity.
Compartment syndrome is an orthopaedic emergency and the cast MUST be removed immediately.
How long should I take time off work/school?
You will be advised to rest for a minimum of two weeks before returning to work following surgery. One is welcome to attend school/work sooner than two weeks, however the period of ‘sick leave’ is essential to ensure better pain management (through regular access and use of medication, elevation of the affected extremity and enforced rest). This avoids the risk of compartment syndrome and limits the impact of side effects from use of painkillers.
Once Dr Maina has confirmed that you can begin to resume some physical activity and exercise regime, do so safely, and with the guidance and help of a physiotherapist and/or occupational therapist if necessary.
When should I change my dressings, and when can I shower?"
Do not remove the sterile dressing applied to the surgical wound. It must remain on for two weeks after surgery. The surgical incision heals best without excessive manipulation and exposure.
You will need to make an appointment for a two week wound check with Dr Maina (or a wound care nurse as required).
If the dressing comes loose, gets soiled or wet within two weeks, please contact Dr Maina’s rooms to arrange a wound check and a dressing change as soon as possible. After two weeks, the wound will generally be clean and dry. You will be able to shower/bath as per usual thereafter.
When can I resume bathing/showering?
It is crucial that you keep the wound clean and dry for the first two weeks after surgery to avoid the risk of infection.
Ensure this by covering the wound with a plastic dressing or bag when in or near water. Sealed cast are bags (as indicated above) can be used for this.
There is a small risk of post-operative infection, so be sure to keep your surgical wound clean and dry by changing the dressing as instructed. If you experience any increased pain, delayed healing, pus, or a bad smell, please get in touch with Dr Maina as soon as possible.
When should I have my skin clips/ stitches removed?
Skin clips and non dissolvable stitches will be removed by Dr Maina/a wound care nurse at approximately two weeks or more.
Dissolvable and subcutaneous stitches (clear stitches) usually dissolve or fall off spontaneously after two weeks, once the wound has healed. These stitches do not actively get removed unless the knot becomes prominent or an irritant.
You will usually be required to start rehabilitation after two weeks when the wound has healed. Do not immerse the wound for a prolonged time in bath water/swimming pool water for a month after surgery.
What are the signs of a blood clot or DVT (deep vein thrombosis)?
- A painful, swollen leg
- Severe calf pain/’cramping’ on moving or applying pressure to the calf, back of the knee or thigh.
If you should have these symptoms, the potentially life-threatening risk of a blood clot may be present. Please attend your closest emergency department for urgent investigation and assessment.
DVT’s are largely dangerous for the risk they pose if the clot breaks off and lodges elsewhere in the body. A clot lodged in the brain may cause a stroke; in the lungs, they may obstruct respiration; in the heart, clots may cause a heart attack; and in the gut, the clots may cause bowel ischemia and death.
If you have an increased risk of blood clots or have had joint replacement surgery, you will need to take oral anticoagulant therapy (typically Xarelto) to continue to keep your blood thin for a duration of between three to four weeks after surgery.
If you suspect you have had a DVT, do not wait to schedule an appointment with Dr Maina. The emergency physician at your local casualty will commence treatment and contact Dr Maina and/or the on-call physician as needed.
What are the signs of infection?
Fever, redness, localised pain, odour and wound drainage may suggest infection. If this occurs to your wound at any time, kindly contact Dr Maina’s rooms urgently.
What are TED (hose) stockings?
These are tight, white, thigh-high compressive stockings usually prescribed for less mobile individuals to prevent the risk of a DVT or blood clot (Signs listed above). In the event of a hip replacement or intramedullary nail of the lower leg, you will be required to wear the stockings on both legs for a minimum six (6) weeks after your surgery. TED stockings also limit swelling in the operated limb.
How soon after surgery may I travel?
You should avoid long distance travel for at least six (6) weeks after surgery.
The body protects itself after surgery by encouraging increased blood clot formation, therefore, the time immediately after surgery is particularly dangerous for potential travellers.
The increased risk associated with travel is linked to immobilisation (sitting for a long time in a small space), dehydration (through drinking fluids that encourage fluid loss like coffee, alcohol) and low humidity (in air conditioned spaces).
There are other individual risk factors predisposing one to blood clots, so, even beyond this stipulated time, if you should travel, ensure that you keep moving and wear compressive stockings until fully recovered.
What if I run out of pain/other medication?
If you should run out of pain control medication prescribed to you on discharge, please contact Dr Maina via email. In the email, kindly include the contact details of your local pharmacy/pharmacist as well as name of medication required and duration required to aid in arranging your prescription.
Please avoid taking anti-inflammatory medicines unless otherwise advised by Dr Maina.
When may I start bearing weight after surgery?
For lower limb surgery, if you’ve had a knee arthroscopy (keyhole surgery), you will need to keep all weight off the leg for a week. This is because the cartilage is somewhat softened by the water-filled joint during surgery. Keeping weight off for a few days prevents cartilage damage.
For broken bones, if you have had surgery, unless otherwise indicated, you will need to keep weight off the limb for six weeks (or more) depending on the condition.
For torn ligaments and tendons, you will need to keep weight off the affected extremity to allow swelling and pain to settle. If you have had your Achilles tendon repaired, you will need to keep weight off the affected limb for six weeks while your cast gets changed every 2 weeks.
If you have had a meniscal repair done, you will need to keep the weight off for at least 6 weeks, and limit knee flexion in the ROM (Range of Movement) brace as discussed with Dr Maina.
What does rehabilitation (physiotherapy and occupational therapy) involve?
After surgery, if required, you may need as assessment and mobilisation of the affected limb. If necessary, Dr Maina will refer the relevant medical professional to you to see you before/on discharge. Please note that this additional expense may not always be covered by your medical aid.
After your discharge from hospital, it will be your responsibility to schedule your follow-up appointment(s) with the physiotherapist and/or occupational therapist yourself.
It will be your responsibility to check what costs your medical aid will or will not cover. These costs and number of sessions required may be discussed with the relevant allied medical professional.
If you have a physio/OT of your own, you are welcome to continue to rehabilitate with them. Their feedback via email/in writing would be appreciated.
What is the cost for follow up and postoperative visits?
There is no fee for follow up appointments within the first month after surgery. Thereafter, there is a nominal fee billed for appointments and procedures carried out. Costing for these can be obtained from Dr Maina’s rooms.
You will need to call Dr Maina’s reception to schedule an appointment to see her at:
- 2 weeks
- 6 weeks
- or another time as discussed
How will my cast be removed?
Your cast will be removed with a special orthopedic oscillating saw that can cut medical-grade fiberglass. In use, when removing your cast, the saw may vibrate quite fast, be loud, and may get warm, but is safe to use. The worst that could happen may be a superficial abrasion through the cotton wool, from the tiny teeth of the saw.
How will my wires be removed?
Unless your wires are buried under the skin or the tip of the wires is threaded, k-wires will usually be taken out in the hospital emergency department or consulting room by Dr. Maina. The cast and dressings are removed at the consultation, and the wires manually removed. The procedure is quick and, because the wires will have been in your bone and skin for almost a month, stings only a little.
RAF, WCA & RMA
Dr Anne Maina is an orthopaedic surgeon with a special interest in lower limb, hip and knee pathologies. She brings a wealth of experience and exceptional skills in care and restoration of musculoskeletal system pathologies to her work.
Dr Maina is a medical services provider registered with the Compensation Fund (Workmen’s Compensation Act [WCA]). She therefore has the capacity to treat and address the various occupational health needs of employees who have sustained accidental injuries while on duty (IOD), ensuring impeccable clinical expertise.
Dr Maina is also registered to include patients insured with the Rand Mutual Assurance [RMA] Group who are employed in the mining and metallurgy industries. She is well positioned to address employees in these fields who require attention for their orthopaedic conditions.
Dr Maina also provides assessments for medicolegal patients lodging claims from the Road Accident Fund [RAF]. Her unique skill set gives patients the opportunity to acquire professional assessments while maintaining ethical standards. Furthermore, Dr. Maina provides a detailed and thorough documentation of orthopaedic injuries, giving the claimant and her clientele the benefit of her expertise and attention to detail.
