FAQ's

1. If we have not discussed surgery in detail or if you would like to discuss surgery further, please come in for an appointment and we can schedule surgery at that time.
2. If we have previously discussed the surgery and I have answered all your questions to your satisfaction, then you can schedule by calling my surgical coordinator Shannon V. at 571-472-0479

Please contact my athletic trainer Kendall Robinson at [email protected]. She will likely be able to answer most of your questions. If she cannot or you would like to speak with me directly, I will call you back to discuss further.

You may, depending on your age, weight and health. You should have been given a prescription for testing and a pre-operative clearance when we booked you for surgery in our office. If you did not receive a clearance prescription or we did not mention one, you likely do not require any testing. If you are unsure, please contact my surgical coordinator Shannon V. at 571-472-0479 for instructions.

1. For most surgeries, this is highly recommended and should begin two days post-op. We recommend you call the schedule those appointments as soon as you have a surgical date as they fill up fast.
2. We have many PT locations and facilities with the Inova network that we work with regularly. If you did not receive a location list or would like to schedule an appointment at any one of the Inova PT locations please call 877-604-6682.
3. If you are planning to go to a physical therapy facility other than one at Inova, please schedule this to begin two days after your surgery, unless we discussed otherwise.
4. I have likely provided you with an individualized physical therapy prescription and protocol when we booked you for surgery in the office. Please bring that prescription and protocol with you to your first physical therapy visit so they know how I would like them to treat you.

1. On rare occasion, a prescription for pain medication may have been provided in our office when you scheduled your surgery.
2. Typically, however, prescriptions will be provided to you on the day of surgery. If for some reason, you would like to make other arrangements, please contact my surgical coordinator Shannon V. at 571-472-0479 prior to your surgical date.

1. The Loudoun Ambulatory Surgery Center that I operate at, has the capability for you to securely complete your medical history on-line. I strongly recommend that you complete this prior to your surgical date. This will not only save you time and stress the day of your surgery, but will also enable the anesthesia and nursing team to be better prepared for your particular medical needs. This can be completed at www.onemedicalpassport.com.
2. If you would like to contact the pre-operative nursing staff at Loudoun Ambulatory Surgery Center you can call them directly at 571-209-6441. If you have insurance questions for them, you can call them at 571-209-6427.
3. If you are scheduled at Fairfax Hospital - Professional Services Building Surgery Center, your medical history has been transferred over automatically as they are on the same system as our office. Nothing additional needs to be done by you. 
4. If you would like to contact the Fairfax Hospital - Professional Services Building Surgery Center presurgical nurses you can call them at 703-970-6564. If you have billing questions for the facility, you can contact them at 571-423-5750
5. Your medical doctor or the representative from the surgical facility should have informed you as to which of your medications you should not take and when to take the others. Make sure that you take your medications properly the day before and the day of surgery. Additionally, unless I have suggested otherwise, you should stop all aspirin and anti-inflammatories (other than Celebrex) 7-10 days prior to your surgery.
6. You should have been instructed by the surgical facility when to stop eating and drinking the night before surgery. For surgeries in Loudoun, they will call you by the night before surgery to give you this information. For surgeries in Fairfax, our surgical coordinator Shannon V. will call you two days prior to surgery to discuss this info. It is very important to follow these instructions. Failure to do so, will likely result in anesthesia canceling your surgery.

1. You should have been contacted by the surgical facility where your surgery is to be performed. They should have advised you what to bring to the surgical facility. Make sure that you bring all of the documents that they requested, including your photo ID and insurance card.
2. If I have provided you a brace, sling or crutches or you have been provided an ice machine sleeve, please bring these to the surgical facility.
3. Someone will need to drive you home from the surgical facility. They do not need to stay with you at the surgical facility, but they will need to be available when you are ready to leave. UBER's are not allowed and you will not be allowed to leave the facility without a responsible adult driver. 
4. It is a good idea to bring something to occupy yourself (ie. newspaper, magazine, book, laptop or Ipad, etc.) as there may be some waiting time.

1. Give yourself plenty of time so that you are not rushed. You may be nervous and surgery can be stressful. There is no need for additional stress.
2. I suggest that the night before your surgery, you organize all the things that you wish or need to bring to the surgical facility and place them all together so that you do not need to look for them the day of surgery. Don’t forget your insurance card and a photo ID.
3. It is a good idea to make sure that you bring a copy of the address of the surgical facility and if needed a print out of the directions to the facility. I also suggest bringing the surgical facility’s phone number with you in case you get lost or are running late.
4. You may shower the morning of the surgery. Please do not apply any post shower lotions or powders, however.
5. It is recommended that you not wear any make-up, metal clips in your hair or jewelry. In fact, I would leave all valuables at home.
6. I suggest wearing loose, comfortable clothing.
7. Remember to follow the “no eating or drinking rules” that were given to you by the surgical facility.

1. First you will check in and be asked simple demographic questions (ie. Name, age, etc.). Please have your ID and insurance card available.
2. You will then be taken to the “Holding Area” by a staff member of the surgical facility. It is here, where the staff will prepare you for surgery.
3. A nurse will greet you and ask some medical questions, put in an IV (intravenous access), give you IV fluids (Saline) and any medications that the anesthesiologist or I have requested.
4. Members of the anesthesia team will then speak with you. They will discuss what you should expect before, during and after surgery. They will also discuss the various types of anesthesia that they recommend.
5. For some procedures, you may be able to get a regional “block”. This is numbing medication administered by a needle that is positioned with the assistance of ultrasound imaging. If you are a candidate for this, the anesthesiologist will discuss this in detail with you.
6. I will meet you in the holding area. We will review my postoperative instructions and what you can expect after surgery. You will have an opportunity to ask any questions that you may still have.
7. You will then be taken to the OR and will be asked to move to an operative bed where the anesthesiologist will place various painless monitors on you.
8. If General Anesthesia is to be used, it will then be administered by the anesthesia team.
9. The surgery will be performed and afterwards you will then be taken to the first “Recovery” area (PACU). Here you will continue to be monitored and you will have a chance to rest and sleep.
10. Once you wake up, you will be brought to the second “Recovery” area (Second Stage) where you will be given something light to eat and drink and instructions will be provided to whomever is going to take you home.
11. Once home, you should expect to rest the remainder of the day. You should have received verbal or written instructions from me which lists my recommendations for elevation, ice, medication and activity modification.
12. If after surgery, you have any concerns or questions, please call our nurses line at, 703-970-6424 or contact my athletic trainer Kendall Robinson at [email protected]

1. It is best to take your medication before experiencing pain. This will lessen the amount of pain you will experience and can reduce your overall need for pain medications.
2. Whether you had a regional block or not, I suggest taking 1/2 a dose of the pain medication that I provided, 6 hours after you arrive home. Pain free periods following a regional block will vary based on type of medication and block.  Standard blocks can last 6-24 hours. If you had an Exparel block which is a long-acting medication that can last 48-72 hours you will be notified prior to the block and you will receive a teal bracelet. Loss of sensation, motor function, and numbness/tingling is normal during this period. If you experience these effects for longer than 72 hours please contact my office. 
3. If you are tolerating the medication, I then recommend taking a full dose of the medication every 6 hours for the first 36 hours. If you are not experiencing pain at that point you may discontinue as tolerated.
4. If you are still experiencing pain after 36 hours, take your pain medication according to the prescription instructions as needed to help relieve your pain.

1. The staff at the surgical facility should have discussed this with whoever brought you home.
2. Typically, I would suggest eating relatively “light” foods like jello or soup at first and then advance as tolerated.

1. Often the pain medication that I have prescribed contains Tylenol (Acetaminophen). If so, you should not take any over-the-counter Acetaminophen (Tylenol) products. Too much Acetaminophen can be harmful to your liver.
2. If you are no longer taking the prescription pain medications prescribed to you post-operatively or feel like you don't need that level of pain control, you are welcome to take any over-the-counter pain medication you wish in place of the prescription medication.

1. We should have reviewed this preoperatively. You may also have received a handout describing appropriate wound care instructions upon discharge from the surgical facility or hospital.
2. Routinely for arthroscopic procedures, the dressing should remain dry and intact for 48 hours and then can be removed down to skin. If there are white strips going across your incision (ie. following ACL reconstruction surgery), please leave them in place. It is Ok to get the small puncture sites wet and then you can cover them with Bandaids. For any longer incisions (ie. following ACL reconstruction surgery), I would prefer that you keep them dry and also covered with Bandaids. If they get wet, don’t worry. Simply pat them dry or use a blow dryer to dry them and then cover them with Bandaids or gauze and tape.
3. Routinely for shoulder replacements, I have placed a water proof dressing over your incision. You my get this wet in a shower. After showering, simply dry the bandage with a towel.
4. Routinely for all other non-arthroscopic procedures, please keep the incision(s) dry. If it gets wet, don’t worry. Simply pat them dry or use a blow dryer to dry them and then cover with Bandaids or gauze and tape.
5. Unless otherwise instructed, please do not put any ointments, lotions, creams or any other topical products on your incisions.
6. If I have provided you specific instructions that differ from those above, please follow the instructions previously provided.

1. Don’t worry. If you do not have a cast or splint, simply dry the incision with a blow dryer or pat dry with a clean towel. Then cover with Bandaids or gauze and tape.
2. If you got the inside of your splint or cast wet, please call our nursing staff at 703-970-6424 or email my athletic trainer Kendall Robinson at [email protected].  It may need to be changed. If you are unable to get a hold of my staff before the end of business please present to an urgent care center or emergency room for assessment. 

1. In most cases, I suggest that patients start physical therapy two days after their surgery. This should have been discussed prior to surgery and perhaps afterwards. Each case is individualized, so if you have not received a physical therapy prescription and protocol and you believe that you should have, please contact our nursing staff at 703-970-6424
2. If you plan to use a facility outside Inova for your post-op PT, you will need to make these appointments yourself and bring a copy of my protocol to your first visit.
3. I have provided a personalized prescription and protocol for physical therapy at the office visit we scheduled you for surgery. Be sure to bring those both with you to your first PT session.
4. Please refer to the PT protocol section here for specific details.

1. It is normal to have some discomfort after any surgery. Most often, pain medications won’t completely eliminate all pain.
2. If the pain is severe, you have cold blue extremities, severe swelling, nausea and vomiting call our nurses at 703-970-6424. Otherwise, I would suggest elevation of the surgical limb and application of ice and if you have not done so, please try these.
3. If your general health does not preclude you from taking anti-inflammatory medications (Aleve, Advil, Ibuprophen, Motrin, etc.), you may try one of these in addition to the pain medication that I have prescribed. Do not take additional Acetaminophen (Tylenol) if your pain medicine has Acetaminophen in it.
4. If you are still having pain that concerns you, please call our nursing staff at 703-970-6424 or go to a local Emergency Department

1. We have likely prescribed to you an anti-nausea medication to accompany the pain medication we prescribed post-operatively. You may take this as prescribed.
2. Your nausea is likely directly related to the amount of prescription pain medications you are taking. If your pain allows and you can start weaning off of the prescription pain medications and attempt to eat bland diet, this will directly improve you nausea.

1. A low grade fever (<101.5) can be normal 24-48 hours after general anesthesia. The recommendation for these low grade fevers in the early postoperative period is to take deep breaths, cough or laugh. It is also ok to take Tylenol to lower your temperature unless your pain medication contains Acetaminophen or Tylenol. You may also take an anti-inflammatory if your general health allows it. 
2. If your fever is > 101.5, lasts longer than the first 48 hours after surgery, is accompanied by chills or if you are concerned or have any questions about your fever, please call our office at 703-970-6424 or go to a local Emergency Department.

1. It is often unsafe to drive just after surgery. If you have had an upper extremity surgery, you are using a sling or are in a cast or splint, your ability to steer and control the car is likely impaired. Similarly, if your surgery was on your lower extremities, studies have shown increased braking time (time delay until able to press on the brake adequately), even when the surgery was performed on the left leg. Furthermore, the usage of pain medications and driving is strictly prohibited by law.  Additionally, in the state of Virginia is it illegal to drive with a cast, sling or splint. 
2. I recommend not driving for 2-6 weeks depending on the specific  surgery and only when you are confident that you can drive, steer and brake safely. I suggest practicing in a parking lot, in off hours, prior to driving where other automobiles or pedestrians may be present.
3. You may wish to consider discussing with your auto insurance company as to their “rules”. Some insurance companies will not cover you if you drive while using a sling, cast, splint or brace or while “impaired”, as after surgery.

1. This depends on your job and the specific surgery that you have had. If we have not discussed your expected restrictions, you may wish to call and speak with me or my assistant. Sometimes the exact restrictions are more accurately determined after surgery when the particular diagnosis and procedure is known.
2. For most procedures, sedentary type work is permitted and possible within several days.
3. If a work release note is needed, please contact our nursing staff at 703-970-6424
4. If you have disability paperwork or other restriction paperwork that needs filling out after your surgery, you can either fax it to our office at 571-472-0451 or bring it with you to your first post-operative visit. Please be aware that it can take up to 7-10 business days to complete.

He performs surgery at both Fairfax Hospitals Professional Services Building Surgery Center and Loudoun Ambulatory Surgery Center. More information, the addresses and days of the week I operate at each one can be found here.

While this is not an all inclusive list, I commonly perform the following surgeries:

• ACL reconstruction
• Knee arthroscopy
• Meniscus surgeries
• Knee cartilage repair/reconstruction: i.e, Carticel, Osteochondral Allograft and Autograft Transplantation Surgery (OATS)
• Patellar tendon repair
• Quad tendon repair
• Achilles tendon repair
• Patellar instability surgeries
• MPFL reconstruction
• Tibial Tubercle Osteotomies (TTO)
• Hip arthroscopy
• Hip labral repair & reconstruction
• HIP osteoplasty for CAM/Pincer deformity or FAI
• Total Shoulder Arthroplasty (TSA - Shoulder Replacement)
• Reverse Total Shoulder Arthroplasty (rTSA)
• Rotator Cuff repair
• Labral repair
• Distal biceps repair
• Clavicle ORIF
• Acromioclavicular (AC) joint reconstruction
• General fracture care: shoulder, clavicle, forearm, ankle

If you are in need of a surgery that you don't see on this list, please call our office at 703-970-6464 or email my athletic trainer Kendall Robinson at [email protected] to see if Dr. Giuliani performs the surgery you are seeking so he can evaluate you and discuss further in the office.