FAQ

Where does Dr. Nawas see patients in the office?

What are your business hours?

Our practice hours are from 8:00 am to 5:00 pm, Monday through Friday.

How do I schedule an appointment?

You can schedule an appointment by using one of the following methods:

1. Complete and submit the online appointment request form on this website.
2. Email Dr. Nawas’ medical assistant at teamnawas@orthomo.com.
3. Call us directly during our working hours at 314-782-1994.

What should I bring with me when I come for my first appointment?

Please remember to bring the following:

• Driver’s license or state-issued photo ID
• Insurance information
• Current medication list
• Medical records pertaining to your orthopedic problem
• Operative report(s) if you’ve had prior surgery on the affected joint within the past 10 years
• Imaging reports (x-rays, MRIs, CT scans) from prior doctor visits and the actual images on a CD.

What kind of shoulder surgery do you perform?

I perform arthroscopic shoulder surgery for a variety of conditions including rotator cuff tears, labral tears, biceps tendinitis / tears, shoulder instability, loose bodies, shoulder separation, impingement syndrome, acromioclavicular arthritis, and frozen shoulder. I also perform arthroscopic revision rotator cuff repair and superior capsular reconstruction when rotator cuff repair is not feasible.

I perform open shoulder procedures including treatment of clavicle fractures, biologic and prosthetic shoulder resurfacing, anatomic total shoulder replacement, reverse total shoulder replacement, and revision shoulder replacement.

What kind of elbow surgery do you perform?

I perform arthroscopic elbow surgery for treatment of loose bodies, OCD lesions, and mild osteoarthritis.

I perform open elbow procedures including ligament repair and reconstruction (Tommy John surgery), distal biceps and triceps repair, treatment of chronic tennis elbow, and treatment of radial head fractures.

What kind of hip surgery do you perform?

I perform arthroscopic hip surgery for a variety of conditions including hip labral tears, impingement syndrome, cartilage defects, hip dislocation resulting in loose bodies, tears of the ligamentum teres, gluteus medius tears, bursitis, psoas tendinitis, and snapping hip syndrome. I perform revision hip arthroscopy including labral augmentation and reconstruction when indicated. I also perform endoscopic and open proximal hamstring repairs.

I perform primary total hip replacement for osteoarthritis, post-traumatic arthritis, avascular necrosis, and arthritis secondary to hip dysplasia. I offer both the direct anterior approach and the mini-posterior approach. Both techniques have their merits and both result in excellent outcomes for the vast majority of patients.

What kind of knee surgery do you perform?

I perform arthroscopic knee surgery for a variety of conditions including meniscus tears, cartilage defects, loose bodies, patellar instability, as well as isolated and combined ligament injuries involving the ACL, PCL, MCL, and/or LCL. I offer individualized treatment for ACL tears including primary repair, augmentation, reconstruction, and revision surgery.

I perform open knee procedures including patellar and quadriceps tendon repair, biologic cartilage repair techniques, prosthetic resurfacing for cartilage defects, tibial osteotomy, and partial knee replacement.

What kind of leg/ankle surgery do you perform?

I perform Achilles tendon repair, ankle fracture repair, repair of syndesmosis injuries, and fasciotomy for treatment of exertional compartment syndrome.

Where does Dr. Nawas perform surgery?

What time is my surgery?

In most cases, I am not able to provide an estimated time for your surgery more than a few days ahead of time. This is because circumstances such as patient medical factors or equipment availability may necessitate a schedule change. You will be contacted at least 48 hours before surgery and provided with a confirmed surgery time and requested arrival time. The surgery center always has the final say in times.

Do I need pre-operative medical clearance?

This is procedure dependent, and you will be guided either by my office or the surgery facility where you will have your procedure. Patients planning to have total joint replacement surgery can expect to undergo pre-operative medical screening and/or optimization.

Will antibiotics be prescribed before or after surgery?

No antibiotic prescription is needed before surgery. You will receive an IV dose of antibiotics at the surgery center just before your procedure. You may be prescribed antibiotics after certain procedures, such as total joint replacement, or if there is reason to believe that infection risk is elevated in your case.

When will I start physical therapy?

In most cases you will start within 48 hours of your surgical procedure. We will provide a physical therapy script and you will need to choose a facility and schedule your first visit before having surgery. It can be difficult to make last minute arrangements.

In some cases, the first PT visit may be scheduled 7-10 days after surgery if an initial period of immobilization is needed (ie. fracture repair).

Do I need to do my post-op physical therapy at your location?

If you live or work nearby, we would love to have you complete your rehab at the physical therapy office in our building. Otherwise, we will guide you to a physical therapist or PT group near you that is well versed in treating your condition after surgery.

When should I call your office if I’m having issues after surgery?

If you experience any of the following, please alert my office:

• Fever above 101.5-102°
• Increased drainage or swelling
• Pain not controlled by pain medication
• Inability to bear weight on your surgical leg
• Severe insomnia
• Swelling in foot or calf that is accompanied by coolness or decreased sensation in the foot
• Confusion/disorientation

When can I drive after surgery?

Please refer to your procedure specific surgery discharge instructions. The answer can be anywhere from a few days to 6 weeks At a minimum, you will need to be off opioid pain medications and be able to safely control your leg.

When do I get my stitches out?

If external, non-absorbable stitches were used for your incision(s), they will be removed 10-14 days after surgery.

What is hip arthroscopy?

Hip arthroscopy is a minimally invasive, precise, outpatient procedure which allows the surgeon to accurately diagnose and repair various hip injuries and conditions. It requires general anesthesia and typically around 90 minutes of surgical time. With the patient asleep on a special hip table, the surgeon typically establishes 2 to 3 portals (very small incisions) on the outer aspect of the hip. Through these portals, the surgeon introduces a hip length arthroscope and dedicated arthroscopic hip instruments to perform the procedure. At the end of surgery, each portal is closed with a suture that is removed at the postoperative clinic visit. Recovery involves short term bracing and use of crutches as well as an individualized rehabilitation program. Full recovery timeline is approximately 4-6 months.

Am I a candidate for hip arthroscopy?

Hip arthroscopy is indicated for treatment of various hip problems when they have not responded to conservative care. These conditions include labral tears or deficiency, impingement syndrome, cartilage lesions, loose bodies, gluteus medius tears, hamstring tears, bursitis, psoas tendinitis, and snapping hip syndrome. It can be performed for adolescents and adults alike.

It is generally not suitable for treatment of hip osteoarthritis, inflammatory arthritis, or avascular necrosis. Isolated hip arthroscopy is also not recommended for conditions such as moderate to severe hip dysplasia (congenital shallow hip socket). The overall health of hip articular cartilage is more important than patient age when determining who is a candidate for hip arthroscopy.

How long is recovery from hip arthroscopy?

You can expect to be on crutches and in an articulating hip brace for 10-14 days, after which you can typically resume normal walking and driving. Some patients who undergo a procedure called microfracture or drilling for cartilage defects may need to be on crutches for 6 weeks.

A formal outpatient physical therapy is initiated immediately after surgery and is recommended for at least 3 months, with an average frequency of twice a week. You can expect to return to higher level activities and sports within 4-6 months.

Is it important that my surgeon be a specialist in hip arthroscopy?

The short answer is yes. Hip arthroscopy is a technically demanding procedure and regarded among the toughest skills to master in all of orthopedic surgery. As such, experience matters from the standpoint of being able to perform it well and efficiently on a consistent basis. Maybe even more important is knowing when it should and shouldn’t be performed and being able to design a treatment plan that meets each patient’s goals. Ultimately, expertise is crucial in order to minimize treatment failures and the need for revision surgery.

How much experience does Dr. Nawas have treating hip injuries and performing hip arthroscopy?

I have treated acute and chronic hip injuries and have regularly performed hip arthroscopy since 2010. Currently, I perform approximately 100 of these procedures annually. I am among the most experienced hip arthroscopists in Missouri and Southern Illinois. I have performed arthroscopic hip preservation surgery on professional, collegiate, and high school athletes, weekend warriors, injured workers, and active people from all walks of life. I also perform revision hip arthroscopy and advanced techniques such as labral augmentation and reconstruction as well as articular cartilage repair.

What is your success rate for this surgery?

The good news is over 90% of my patients have a satisfactory or excellent outcome. Several patient related factors may affect your results, including age, pre-existing arthritis or dysplasia, compliance with postoperative instructions, and postoperative physical demands. Avoid the temptation to compare yourself to someone you know, as every patient is unique and heals at their own pace. Please be patient, work closely with your physical therapist or trainer, and listen to your body.

What are the risks of arthroscopic hip surgery?

Hip arthroscopy is very safe and complications are uncommon. However, patients should be aware of potential adverse effects including:

• Those related to general anesthesia
• Injury to surrounding nerves, blood vessels, or joint structures such as cartilage
• Instrument breakage inside the joint
• Temporary numbness or tingling in the thigh or foot
• Delayed wound healing and portal site infection
• Deep hip joint infection (extremely rare)
• Fractures of the hip or leg (very rare)
• Compartment syndrome (very rare)
• Avascular necrosis (rare)
• Hip instability (rare)
• Blood clots forming in the legs (<1%)
• Abnormal bone formation in soft tissues after surgery (2-3%)

Do you ever perform hip arthroscopy preventatively?

No, it is not recommended that hip arthroscopy be performed based solely on an abnormal imaging result. It should only be considered if you have persistent symptoms from a structural hip injury or condition.

What tests are needed to diagnose a labral tear or impingement syndrome of the hip?

I start with a complete X-ray series of the pelvis and affected hip. Further work up may include a high resolution MRI or MR Arthrogram (MRI scan after injection of contrast dye and gadolinium into the hip), diagnostic hip injections with local anesthetic, as well as 3D CT scans for surgical planning.

I am being referred for evaluation and treatment of a labral tear that was already diagnosed or previously treated elsewhere. What information do I need to bring to the office?

We ask that you send or bring with you all pertinent clinical notes, operative reports, imaging reports, as well as the imaging studies themselves. X-Ray and MRI images can usually be provided by the imaging center on a CD. It is important that Dr. Nawas personally review prior images and not just the report before making clinical or surgical recommendations.

I have been diagnosed with hip impingement or a labral tear. Should I avoid physical therapy or discontinue if I already started?

No, you should not. Physical therapy is an important part of the treatment plan for several reasons:

1. Patients with these conditions often have significant longstanding functional deficits or compensatory injury patterns which contribute to a patient’s symptoms and can be improved with a dedicated hip rehabilitation program.
2. Insurance plans typically require up to 12 weeks of conservative treatment including a dedicated physical therapy program before authorizing surgical treatment for these conditions.
3. Even if you end up needing surgery, patients who completed a program preoperatively generally experience an easier recovery from surgery and have better short term outcomes.

Do I need surgery for my labral tear?

Patients with labral tears can often be treated with an individualized non-surgical treatment plan which may include rest, activity modification, ice and heat, anti-inflammatory medications, physical therapy, and therapeutic hip injections. Physical therapy cannot “heal your tear” but is rather designed to identify and correct functional deficits to optimize core stability, pelvic posture, and movement patterns. This process can succeed in reducing or resolving your symptoms. Patients who have persistent pain and functional limitations after undergoing this treatment plan can elect to undergo hip arthroscopy.

I was told that I have a spur or bump on my femur causing hip impingement. Was I born with it? Does it mean that I have arthritis?

Cam lesions (the bump) are not a congenital problem and there is no evidence that they are transmitted genetically. They are also different from arthritic spurs. Currently, the most accepted theory is that repetitive stress to the growth plate in the femoral head (the ball of the hip joint) at a critical time of development may result in asymmetric bone growth. Generally, we are referring to stresses generated from running, kicking, ice-skating and jumping. There is certainly a higher prevalence in athletes who performed at a high level during adolescence.

Can hip arthroscopy be safely performed on growing adolescents?

Hip arthroscopy may safely be performed on skeletally immature patients (generally 13-14 and older in my practice) and is relatively common. Based on my experience as well as multiple studies, there is no negative effect on the proximal femoral growth plate. This is true even when cam lesions on the femoral neck need to be resected.

Am I a candidate for total hip replacement?

Patients with degenerative joint disease (arthritis) or avascular necrosis of the hip are candidates for total hip replacement if they have persistent pain and dysfunction affecting work or quality of life, significantly limiting activity, or resulting in a fall risk and other safety concerns. Surgery is indicated when patients have trialed and failed conservative care such as activity modification, simple modalities like ice & heat, topical and anti-inflammatory medications, physical therapy, and in some cases therapeutic injections.

What surgical approach do you perform for hip replacement?

I perform both the muscle-sparing direct anterior approach and the mini-posterior approach to the hip. Both techniques have their merits and both result in excellent outcomes for the vast majority of patients. I may recommend either the anterior or posterior approach for certain cases based on patient specific factors.

How much experience do you have performing hip replacement surgery?

I perform over 100 hip replacements each year. I have been in practice since 2011.

What are the implants made of?

A hip replacement prosthesis typically consists of 4 components. The various components are made of titanium, a medical-grade plastic called polyethylene, as well as a ceramic or cobalt-chrome alloy artificial ball.

Will my new joint set off security alarms at the airport?

It may be detected but TSA staff is familiar with joint replacements. Inform the security staff you have a metal implant when you are being screened.

Are there medical requirements to undergo hip replacement surgery with Dr. Nawas?

I strongly believe in medical optimization prior to undergoing elective joint replacement to reduce surgical risk and potential complications. As such, and in accordance with national guidelines, I will not recommend surgery in these scenarios:

• Uncontrolled heart or lung disease
• Uncontrolled or poorly controlled diabetes (Hemoglobin A1C 8.0 or above)
• Morbid obesity with Body Mass Index above 40.0
• Active tobacco use
• Untreated alcoholism or drug dependence
• Untreated clotting disorders
• Active infections
• Open wounds or ulcers
• Poor oral hygiene / infections
• Severe anemia
• Malnutrition
• Lack of social or family support for postoperative care

The practice will gladly assist in medically optimizing patients for surgery by working with primary care physicians and medical specialists. The goal is to identify and correct risk factors to make surgery as safe as possible.

What are the possible risks and adverse effects of hip replacement surgery?

Hip replacement surgery is very safe and complications are uncommon. However, patients should be aware of potential adverse effects including:

• Those related to general anesthesia
• A cardiovascular event such as a stroke or heart attack brought on by the stress of surgery (rare with medical optimization)
• Injury to surrounding nerves or blood vessels
• Deep hip infection (1 in 200)
• Delayed wound healing and superficial infection
• Hip instability/dislocation (<1%)
• Leg length discrepancy (typically within 2 millimeters)
• Fracture during implantation (rare)
• Partial thigh tingling or numbness (anterior approach)
• Blood clots forming in the legs (rare with preventative medications)

How long does it take to perform hip replacement surgery?

The procedure is typically completed in 90 minutes depending on the complexity of the patient’s hip condition.

How long will my artificial joint last?

It’s difficult to predict how long an individual’s replacement will last and no guarantees can be made. However, a recent study of 60,000 patients showed that 85% of implanted hip replacements were still functioning well at 20 years. Factors that affect longevity of the implant include patient age at the time of surgery, activity level, and metabolic factors.

How long will I stay at the facility after surgery?

If you have surgery early in the day, you can expect to be discharged the same day of your operation. An overnight stay may be needed to address patient specific issues that may arise including intractable pain or nausea, urinary retention, insufficient functional status, and exacerbation or monitoring of underlying medical issues.

Where will I do physical therapy after surgery?

Physical therapy after surgery can be initiated by a home health agency for the first 2 weeks followed by a transition to outpatient physical therapy. You may also start outpatient therapy immediately after surgery.

Can I climb stairs after surgery?

A physical therapist will work with you on stair climbing before you leave the facility. They will teach you the proper way to climb stairs and make sure you are comfortable doing so. At home, it is recommended to only do stairs twice a day (once in the morning and once in the evening). After one week, this can gradually be increased.

When can I drive after surgery?

Time differs and depends on the side of the replacement and the surgical approach. It can take anywhere from 2 to 4 weeks or possibly longer before you are able to drive. Please arrange in advance for transportation during this time. You must be off of any opioid pain medication.

When can I shower?

I typically use a waterproof dressing that allows you to shower immediately after surgery. Pat dry afterwards. No baths or soaking until explicitly told you may do so. Please follow your specific discharge instructions given to you after surgery.

Is bruising expected after surgery?

Yes. It is common to have some degree of bruising after surgery but everyone is different. Some will only experience redness around the incision. Others will have bruising down the entire leg. Both are considered normal and will typically resolve over 10-14 days.

When can I return to work?

It can vary depending on your preoperative function, surgical approach, job description, and availability of light duty. But the answer is anywhere from 2 to 8 weeks.

What is my activity level expected to be after surgery?

Every patient is different. You should be increasing your activity level daily, but let pain be your guide. The majority of your recovery will take place in the first 4-6 weeks after surgery and the remainder will come over the next year. A good number of patients will overdue it at some point! If and when you do, you will experience increased pain and swelling.

What positions can I sleep in?

I recommend that you sleep on your back. If you choose to sleep on your side, make sure you place a pillow between your legs. Your physical therapist will assist you initially into this position and give you proper instructions.

When can I resume sexual intercourse after surgery?

The majority of patients can safely resume sexual intercourse after surgery. In general, the time to consider resuming intercourse is when you are back to your normal activities without pain. Below are a few guidelines to keep in mind:

• Less than 90˚ of bending at the hip/waist
• Initially you should assume a more passive role
• Avoid extremes of motion
• If you were given hip precautions, maintain those precautions during sexual intercourse
• Consider using pillows for support and comfort