FAQ

• Before Your First Office Visit to Renaissance Orthopaedics

• During Your First Office Visit to Renaissance Orthopaedics

• After Your First Office Visit to Renaissance Orthopaedics

• About Total Joint Replacement and the Recovery Process

• About Billing and Insurance

• Questions from Dr. Stanley's Patients

Frequently Asked Questions Before Your First Office Visit to Renaissance Orthopaedics

Where is your office located?
Dr. DiGioia and Renaissance Orthopaedics are located in our specially designed office at Magee Hospital in Oakland, situated on the first floor, just across from the piano in the main lobby. With Dr. Kevin Stanley in the practice, we are the regions only program in Patient and Family Centered Orthopaedic Care. We accept new patients to service any of your orthopaedic needs and welcome the opportunity to reconnect with patients who know us too!

Are you still located at Magee?
Our Program is the only one of its kind in Western Pennsylvania and a model for the region and despite what you may have recently heard, we plan to stay at Magee and in Pittsburgh for a long time!! I grew up in this area where providing care to patients is our number one priority.

Where can I park?
There is on-site self parking available, but we suggest that you take advantage of the special valet parking service at the main entrance which will speed your visit. There is an attendant there who will assist you when you arrive.

Can you give me directions to Magee?
I will mail a packet to you which includes directions, parking info and paperwork we will need to help speed your visit which you can complete at home to save you time in the office on the day of your appointment. Also see our Map and Directions webpage.

How long will my appointment be?
Approximately 45 to 60 minutes, and we try very hard to stay on time, because we know your time is valuable.

Are you located in Oakland and isn't there often construction and traffic?
Although there is construction often occurring in Oakland, we are on the periphery. Also see our Construction Updates webpage or you can check the UPMC website to obtain construction updates.

Should I bring anything with me?
Yes, if possible please bring any films and reports for x-rays, MRI's, or bone scans completed, which are relevant to the body part being evaluated, if performed within the past year. Also, it is a good idea to bring a pair of shorts to allow for a more thorough exam.

Will you need my old records?
Yes, operative reports for scopes performed within the past 6 months, and reports for ANY prior total joint replacement.

What will be done at my appointment?
X-rays will likely be taken, you will be evaluated, and then recommendations will be made based on those findings.

I have been x-rayed recently, will x-rays be repeated?
Yes, it is very likely you will undergo new x-rays because Dr. DiGioia and Dr. Stanley prefers special views that will help with your evaluation.

Frequently Asked Questions During Your First Office Visit to Renaissance Orthopaedics

Will Dr. DiGioia be administering my injections?
Dr. DiGioia will not be performing your injections when you come into the office, but rather this part of your care has been entrusted to our highly qualified Physician Assistant, Jen, and our Nurse Practitioner, Ann, who will give your injections.

Are Jen and Ann doctors too?
Jen and Ann are not doctors. Jen is a Physician Assistant and Ann is a Nurse practitioner. They are both highly educated and qualified to be a part of your care in our office. Both Jen and Ann work closely with Dr. DiGioia to ensure you get the desired results of your care.

Do I need to pay my copay while I am in the office? /How can I pay my copay? What is my copay in your office?
Your agreement with your insurance company requires that you pay your copay at the time of your office visit. You may pay your copay in the form of a check or in cash; we offer receipts for both. If unsure of copay amount, you can check the back of your insurance card or contact your insurance company.

Frequently Asked Questions After Your First Office Visit to Renaissance Orthopaedics

Does Dr. DiGioia do the surgery himself?
Yes, he does not have any residents or fellows. He uses physician assistants, who assist him in the operating room, and also see you with Dr. DiGioia in the hospital after surgery.

What is arthritis?
Cartilage acts as a cushion for the weight bearing surfaces of the joint. When arthritis sets in, the cartilage between your joints begins to wear over time, and eventually, the bone wears down too. This causes the inflammation and pain, which prevents you from maintaining your active lifestyle.

What is minimally invasive total joint replacement?
This surgery is not truly "minimally" invasive, but, more accurately, "less" invasive. There is a smaller incision and less muscle work involved.

Will my insurance pay for the physical therapy that has been prescribed?
In order to verify if your insurance will pay for physical therapy services, please call the member services number listed on the back of your insurance card. When you speak with your insurance company, be sure to inquire about the number of visits you are eligible for and what your out of pocket expense will be.

Why was I charged an Office Visit when I only came in for an injection?
Since you were evaluated by the Nurse Practitioner or Physician Assistant at your injection appointment, you were charged an Office Visit fee and are responsible for your co-pay.

Why was I charged an Office Visit fee when I came in for a post-op visit?
Though you were in your postoperative period, you were evaluated for a new problem during the course of your postoperative visit. When you are evaluated for a new problem you are charged an Office Visit fee.

Once I decided to have the surgery, how long before I can get on the schedule?
After you have decided to schedule you will usually be able to get a surgical date within 4 to 8 weeks.

What restrictions do I have after total joint replacement?
None. We have no restrictions on our patients. The only activity we do not allow patients to do is jogging for exercise, as it accelerates the wear on your new joint. You can resume all other activities based on your comfort.

How long does it take for the injections to start helping?
Depomedrol injections can take up 10-14 days until you notice pain relief. Synvisc can take up to 5-6 weeks after the third injection.

Is there a limit to the number of knee injections I can get?
As long as the injections are helping your pain for at least 3 months, then you can continue them indefinitely. You can have Depomedrol injections every three months and if you are a candidate for Synvisc, then you can alternate Depomedrol and Synvisc. You can have Synvisc every six months and receive a Depomedrol injection 6-8 weeks after you have completed your Synvisc series.

Is there a limit to the number of hip injections I can get?
Patients are able to have a total of 2 hip injections, 6 months apart from each other and 3 months prior to having a hip replacement. We limit the number of injections, because after the initial 2, studies have shown an increased risk of infection after total hip replacement.

Am I a candidate for Synvisc?
We have found that Synvisc works best on patients who still have some level of cartilage. If you still have cartilage, then you may be a candidate. If you have endstage arthritis or are "bone on bone", then it is not as successful and can often make your pain and inflammation worse. With end stage arthritis, the DepoMedrol injections are the strongest anti-inflammatory we have, and if they do not work for at least 3 months it is probably time for you to consider surgery.

How do I know when I am ready for surgery?
When you have endstage or "bone on bone" arthritis, injections are helping the pain less than three months, and your quality of life is being affected by your pain, then you will be a surgical candidate. Until you reach this point, Dr. DiGioia will continue to advise conservative treatment. In some cases, even if you are experiencing these symptoms, but are overweight or have significant medical problems that will not be cleared by your medical doctor or cardiologist you may not be able to undergo surgery.

Why have I been asked to lose weight prior to my surgery?
Knee and hip replacements wear out just like your regular knee and hip. For every lb of extra weight, that is 6 lbs of pressure on both your knees and hips! If you are 10 lbs overweight, that is 60 lbs on your knees and hips! If you would wear out your new knee or hip, it would require a revision or redo surgery, which can have more complications and higher risks. We know it is hard to lose weight because of pain, but the role of the injections is to relieve pain and allow you to be more active. We also recommend contacting the Magee weight loss program, which is here to help with both surgical and non-surgical treatment! Dr. DiGioia wants you to be in the best shape possible before your surgery so that you can have the best results afterwards.

Frequently Asked Questions about Total Joint Replacement and the Recovery Process

How do I know when I am ready for surgery?
When you have endstage or “bone on bone” arthritis, injections are helping the pain less than three months, and your quality of life is being affected by your pain, then you will be a surgical candidate. Until you reach this point, Dr. DiGioia will continue to advise conservative treatment. In some cases, even if you are experiencing these symptoms, but are overweight or have significant medical problems that will not be cleared by your medical doctor or cardiologist you may not be able to undergo surgery.

Why have I been asked to lose weight prior to my surgery?
Knee and hip replacements wear out just like your regular knee and hip. For every lb of extra weight, that is 6 lbs of pressure on both your knees and hips! If you are 10 lbs overweight, that is 60 lbs on your knees and hips! If you would wear out your new knee or hip, it would require a revision or redo surgery, which can have more complications and higher risks. We know it is hard to lose weight because of pain, but the role of the injections is to relieve pain and allow you to be more active. We also recommend contacting the Magee weight loss program, which is here to help with both surgical and non-surgical treatment! Dr. DiGioia wants you to be in the best shape possible before your surgery so that you can have the best results afterwards.

Once I decided to have the surgery, how long before I can get on the schedule?
After you have decided to schedule you will usually be able to get a surgical date within 4 to 8 weeks from the time you call the office.

What is arthritis?
Cartilage acts as a cushion for the weight bearing surfaces of the joint. When arthritis sets in, the cartilage between your joints begins to wear over time, and eventually, the bone wears down too. This causes the inflammation and pain, which prevents you from maintaining your active lifestyle.

What is minimally invasive total joint replacement?
This surgery is not truly “minimally” invasive, but, more accurately, “less” invasive. There is a smaller incision and less muscle work involved.

What restrictions do I have after total joint replacement?
None. We have no restrictions on our patients. The only activity we do not allow patients to do is jogging for exercise, as it accelerates the wear on your new joint. You can resume all other activities based on your comfort.

Does Dr. DiGioia do the surgery himself?
Yes, he does not have any residents or fellows. He only uses physician assistants, who assist him in the operating room, and also see you in the hospital with Dr. DiGioia after surgery.

What medications do I stop prior to surgery?
All medications w/ASA base, blood thinners, NSAID’S such as aleve and ibuprofen, all arthritis medications except for Celebrex, and vitamin E. Please ask if about any herbal supplements you may be taking.

Can I take Tylenol?
Yes.

Can I take Celebrex?
Yes, unlike other arthritis medications, you can take Celebrex right up to the day of your surgery. We also use Celebrex as a pain medicine after surgery.

Do I need to take an anticoagulant after surgery?
All of Dr. DiGioia’s surgical patients are to have Lovenox injections for 2 weeks postoperatively and then ASA for 2 weeks. There is no need for anti-coagulants after that unless specified by Dr. DiGioia. Some patients that have a higher risk for blood clots may have to take the blood thinners for a longer time.

How soon after my total joint replacement can I return to work?
You may return to work as soon as you feel comfortable. Following a normal TKR/THR a patient should be out of work no longer than 8-12 weeks.

Will I be able to go to a rehab facility after surgery?
Insurance companies are no longer covering stays in rehabilitation facilities after joint replacement. We will ensure that you are fully weight bearing the night of surgery and are able to do stairs prior to discharge, then for 2-5 days following discharge a physical therapist will come to your home to work with you, and finally you will attend outpatient therapy for 2 to 4 weeks at a physical therapy close to your home. 99% of our patients are able to return home after surgery without any problems. On occasion, however, if there are medical or surgical issues, patients will be sent to a skilled nursing facility, but we always prefer our patients to go home if possible.

How long do I need to continue physical therapy after my surgery?
You may continue or discontinue physical after your 1 month postoperative appointment based on your comfort. TKR patients not getting a minimum flexion of 110 or extension of -5 will need to continue physical therapy.

What is continuous passive motion or CPM?
After a total knee replacement, patients are sent home with a continuous passive motion machine (CPM), which helps you bend the knee and straighten it. It is only for patients who have had a total knee replacement and functions to improve motion.

After my knee replacement, will I get to bring home a CPM?
Yes, all of our total knee replacement patients will bring home a CPM, or continuous passive motion machine, which helps with knee bending and improves knee motion.

What pain medications can I take after surgery/ how many refills will I have?
After surgery you will be given a pain medication with one to two refills, and finally Darvocet with one refill, as needed. You will also be given Celebrex for the first 2 weeks and longer if you are having pain or stiffness.

When can I re-start my medications?
All of your normal medications should be re-started by your 1 month postoperative appointment.

Do I need to take antibiotics for colonoscopy and dental procedures after I have had total joint replacement?
Yes. Your other surgeons will give you antibiotics for any surgical procedures. You will always need to take an antibiotic any time there is a risk of bleeding or a procedure will break the skin because of the risk of infection to your replaced joint.

When can I swim again after my total joint replacement?
You may swim once the incision is completely healed, which usually takes about 3 weeks.

Is swelling and/or bruising normal after TJR?
After total knee replacement surgery, patients can have swelling up to around 2 to 3 months and bruising can be down the leg.

What can I do about night time pain and start up stiffness postoperatively?
Stretch and move the joint frequently and take Celebrex 200 mg po twice a day or once a day before bed. If you have tried these methods and they have not been successful, you should check with your medical doctor about Requip for restless leg syndrome or Ambien for sleep.

What should I do about difficulty going up and down stairs or getting in and out of chair after my total knee replacement?
These difficulties are usually due to quad muscles being weak. The patella is a free floating bone and is dependent on the muscles to keep it in place. You should continue physical therapy for quad strengthening.

Is clicking normal after total knee replacement?
About 50% of patients develop clicking after total knee replacement. This is normal and there is no need to be concerned unless there is pain associated with the clicking.

What is the primary symptom that I should be concerned about after total hip replacement?
Groin pain more than 12 weeks postoperatively is the only concern with your hip prosthesis. Groin pain after total hip replacement for the first several weeks can be within the normal limits of healing, since it takes that long for bone growth into the prosthesis to occur. If the pain persists after 12 weeks, call the office and we will take new x-rays and further evaluate you. Pain on the side of the hip, pain in the buttock, or low back pain are likely due to a back problem or related to muscles and should be evaluated separately.

How long can I expect my total joint replacement to last?
75% of people are still with their original prosthesis and doing well at 15 years. This is not to say that once it is year 15, you will start having problems. Also, these are modular systems, so we can often catch wear early enough to go in replace ONLY the part that is worn. This is why we obtain new x-rays every three years!

Does Dr. DiGioia do the “new knee” for women?
The new knee for women is more of a marketing ploy. In fact, Dr. DiGioia uses knee implants made by Zimmer, the same company marketing the knee “for women”. Dr. DiGioia makes precise measurements on every patient to fit the prosthesis to the bones, giving each patient a personalized knee rather than a knee associated with his or her gender. Every patient receives a prosthesis that is accurately measured to fit him or her perfectly so the idea of a knee for women is already in practice in our office.

Would I benefit from hip resurfacing as opposed to hip replacement?
Dr. DiGioia is not an advocate of hip resurfacing because it does come with certain risks. For example, there is an increased risk of AVN, or avascular necrosis, a condition in which part of the blood supply to the head of your hip dies, and increases the risk of fracture. Also, long term results have yet to be published in medical journals. The benefits of hip resurfacing are the metal on metal articulation which prevent accelerated wear and the larger heads which lower the chance of dislocation, both of which Dr. DiGioia incorporates into his hip replacement surgeries. In short, the total hip replacement surgeries that Dr. DiGioia performs offers all of the benefits of hip resurfacing without the risks, making hip replacement a better choice.

Frequently Asked Questions about Billing and Insurance

Why does my hospital bill show a Physician Assistant charge on the day of my surgery? Doesn’t Dr. DiGioia do the surgery himself?
Dr. DiGioia performs all surgeries himself; the Physician Assistant (PA) acts as a special assistant to Dr. DiGioia in the operating room during your procedure. The PA also sees you and monitors your condition and progress while in the hospital, along with Dr. DiGioia.

Are you participating with my insurance?
Par insurance: We are participating with your insurance company, but if you still have questions about the specifics of your coverage, you should contact your insurance company via the number on the back of your insurance card to obtain the details.
“Non-par” insurance: While there are many insurance companies that we do participate with, we are not participating with your insurance company currently.
Unfamiliar insurance: You will need to address questions regarding your coverage in our office directly to your insurance company at the Member Services number listed on the back of your insurance card.

Will my insurance pay for the physical therapy that has been prescribed?
In order to verify if your insurance will pay for physical therapy services, please call the member services number listed on the back of your insurance card. When you speak with your insurance company, be sure to inquire about the number of visits you are eligible for and what your out of pocket expense will be.

Why was I charged an Office Visit when I only came in for an injection?
Since you were evaluated by the Nurse Practitioner or Physician Assistant at your injection appointment, you were charged an Office Visit fee and are responsible for your co-pay.

Why was I charged an Office Visit fee when I came in for a post-op visit?
Though you were in your postoperative period, you were evaluated for a new problem during the course of your postoperative visit. When you are evaluated for a new problem you are charged an Office Visit fee.

Frequently Asked Questions from Dr. Stanley's Patients

Where can I go to get an MRI/bone scan, etc?
You can have your testing done at Magee or any radiology facility or hospital that is close to you.

What do I do when my MRI/bone scan, etc. is completed?
After you have had your test, call the office and schedule a follow-up appointment for your results.

How do I get the results of my MRI/bone scan, etc.?
After your test, call the office to schedule a follow-up appointment. Dr. Stanley will explain and discuss your results at this time.

How long will I have to go to physical therapy after surgery?
Depending on the procedure you underwent and how well you are recovering, you will need therapy anywhere from 4 to 12 weeks postoperatively.

How long will I be in the hospital after surgery?
Most surgeries Dr. Stanley performs require a hospital stay of 2 to 3 days.

How long will I be off work after my surgery?
Dr. Stanley decides how long you will be off of work based on the type of surgery, your recovery process, and the type of job you are employed in. In most cases, patients return to work in about 4 to 6 weeks.(non surgical patient)

Does the doctor want to see me after physical therapy?
Dr. Stanley does prefer that you return to the office after you have completed a course of physical therapy, in order to monitor your progress and provide you the best care.

When physical therapy is completed should I have another session?
After you have completed your therapy, if you feel you require more sessions, or it has been recommended to you by your therapist, call the office for Dr. Stanley’s approval.

Will I need a CPM after surgery?
Depending on the type of surgery, you may need a CPM machine. For total knee replacements, knee scopes, or manipulations you will need a CPM machine. For total hip replacements you will not need a CPM machine. (non surgical patient)

Can I get a stronger pain medicine?
No, if the pain medication you are taking is not providing you enough relief, Dr. Stanley recommends taking an over the counter anti-inflammatory.

How long do I have to keep my brace on?
The time frame you have to wear your brace depends on type and extent of injury, as well as Dr. Stanley’s assessment at follow up visits.

Do I have to wear my brace all the time?
The doctor will instruct you on the proper usage of your prescribed brace.

Will my insurance cover the brace/CPM?
You will need to verify this information with both the company providing your brace or CPM machine as well as with your insurance company.

Do I need the doctor’s “okay” to renew a physical therapy order?
Yes, because physical therapy requires a prescription you will need approval from your doctor.

Will I start physical therapy right after surgery?
If you have had inpatient surgery, then you will need to begin your physical therapy right away. If you have had an outpatient surgery, then Dr. Stanley will make this determination and advise you postoperatively.