What to do Before you Check In

Preparing for total joint replacement begins weeks before the actual surgery. In general, you may be told to:

1. Donate blood –While some total joint procedures do not require blood transfusion, you may need blood before or after surgery. You may use donor blood or plan ahead to make an autologous donation of your own. You may also have a family member or friend with the same blood type as you designate a donation specifically for you.
2. Exercise under your doctor’s supervision – It’s important to be in the best possible overall health to promote the best possible surgical experience. Increasing upper body strength is important to help you maneuver a walker or crutches after surgery. Strengthening the lower body to increase leg strength before surgery can reduce recovery time.
3. Have a general physical examination – You should be evaluated by your primary care physician to assess overall health and identify any medical conditions that could interfere with surgery or recovery.
4. Have a dental examination – Although infections after joint replacement are not common, an infection can occur if bacteria enter the bloodstream. Therefore, dental procedures such as extractions and periodontal work should be completed before joint replacement surgery.
5. Review medications – Your orthopaedic surgeon can tell you which over-the-counter, prescription medications and herbal supplements should not be taken before surgery.
6. Stop smoking – Breaking the habit is particularly important before major surgery to reduce the risk of post-operative lung problems and improve healing.
7. Lose weight – For patients who are overweight, losing weight helps reduce stress on a new joint.
8. Arrange a pre-operative visit – It’s important to meet with healthcare professionals at the hospital before surgery to discuss your personal hospital care plan, including anesthesia, preventing complications, pain control and diet. Bring a written list of past surgeries and medications and dosages you normally take at home.
9. Get laboratory Tests – Your surgeon may prescribe blood tests, urine tests, an EKG or cardiogram, and chest X-ray to confirm you are fit for surgery. These tests should be performed within 14 days of the scheduled surgery in order to be acceptable.
10. Complete forms – You will need to fill out a consent form for your surgeon confirming that you agree to have the operation and that you know the risks involved, as well as hospital forms about your past history, medications, previous operations, insurance and billing information.
11. Prepare meals – You may want to prepare meals in advance and freeze them so they’re ready when you return.
12. Confer with physical therapist – The physical therapist will record a baseline of information, including measurements of current pain levels, functional abilities, the presence of swelling, and available movement and strength. You will also practice post-operative exercises using either a walker or crutches.
13. Plan for post-surgery rehabilitative care – Total joint replacement recipients may need help at home for the first few weeks, including assistance bathing, dressing, preparing meals and with transportation. If you can’t arrange for someone to help you at home, you may need to stay in a rehabilitation or skilled nursing facility. A medical social worker can assist with arrangements. Home therapy visits should end when you can safely leave the house and outpatient physical therapy should begin.
14. Fast the night before – No eating or drinking after midnight before surgery; however, you may brush your teeth or have a few sips of water if you need to take medicines. Discuss the need to take medications such as insulin, heart or blood pressure pills with your doctor or nurse to make sure you don’t miss them.
15. Bathe surgical area with antiseptic solution – Use antiseptic scrub brushes supplied by your health team the night before and morning of to reduce the risk of infection. Tell the nurse if you are allergic to iodine or soap. If possible, shampoo your hair. You must remove all nail polish and make-up. Do not shave your legs within 3-4 days of surgery.

The Day of Surgery

What to Expect Throughout

Your hospital stay will progress something like this:

Pre-Op

1. Arrive at the hospital at the appointed time.
2. Complete the admission process.
3. Have final pre-surgery assessment of vital signs and general health.
4. Remove all personal belongings – dentures, hearing aids, hairpins, wigs, jewelry, glasses, contact lenses, nail polish, all underwear – and leave them with your family or friends during surgery. You will be dressed in a hospital gown and nothing else.
5. There will be several checks to make sure the correct joint is being replaced: your surgeon will review your X-ray and mark the area to be operated on; nursing staff will check the consent form you signed to make sure it agrees with the procedure on the operating room list.
6. Final meeting with anesthesiologist and operating room nurse.
7. Start IV (intravenous) catheter for administration of fluids and antibiotics.
8. Transportation to the operating room.

In Surgery

Many people will be with you in the operating room during your one to three-hour surgery, including:

• Orthopaedic surgeon(s) – your doctor(s) who will perform surgery.
• Anesthesiologist or nurse anesthetist – the doctor or nurse who gives you anesthesia.
• Scrub nurse – the nurse who hands the doctors the tools they need during surgery.
• Circulating nurse – a nurse who brings things to the surgical team.

Your surgeon and the anesthesiologist or nurse anesthetist will help you choose the best anesthesia for your situation. No matter what type of anesthesia you have, be assured you will not feel the surgery. Options include:

• General Anesthesia – You are put to sleep. Minor complications such as nausea and vomiting are common, but can usually be controlled and settled within 1-2 days.
• Epidural – You are numbed from the waist down with medicine injected into your back. (This is also used for women giving birth.)
• Spinal – Much like the epidural, you are numbed from the waist down with medicine injected into your back.

You may have any of the following inserted:

• An Intravenous Tube (IV) – This is placed in your arm and used to replace fluids lost during surgery, administer pain medicine, or deliver antibiotics and other medications.
• A Catheter Tube – This may be placed in your bladder to help your healthcare delivery team keep up with your fluid intake and output. It is most often removed the day after surgery.
• A Drain Tube – This may be inserted in your bandage site to help reduce blood and fluid buildup at the incision.

Elastic stockings will be put on your legs to help the blood flow. You may also have compression foot pumps wrapped around your feet and connected to a machine that blows them up with air to promote blood flow and decrease the possibility of blood clots.

What to Expect, What to Watch For, & How to Recover Safely

When you leave the hospital, your family will need to bring extra pillows for you to sit on in the car. It will be most comfortable to sit in the front seat. Your physical therapist will show you how best to get in and out. All of the tubes will be out. All that should remain is a bandage on your wound site. If you have been instructed to use an abduction wedge you will still need to use this at night when you are sleeping. You’ll need to continue taking medications as prescribed by your doctor. You may be sent home with prescriptions for preventing blood clots, some of which require monitoring through blood draws two times per week. Make sure to take pain medication 30 minutes before exercises—it’s easier to prevent pain than to chase it later. Your surgeon may recommend taking a multi-vitamin with iron daily for a month. You may also be advised to take 1-2 enteric-coated aspirin daily for 6 weeks and non-steroid anti-inflammatory medication for pain and swelling unless you are on blood thinners such as Coumadin or Lovenox. Check with your doctor about special precautions while on these bloodthinning medications.

Hip Precautions

After hip replacement, you will need to observe some important safety rules to help prevent dislocation. Here are some of the most frequently advised precautions. Review them with your surgeon and discuss how many months you will need to follow these, or any other safety rules prescribed after surgery:

• Don’t bend your hip past 90º
• Don’t cross your legs; keep knees 12-18 inches apart
• Don’t lean forward while sitting in a chair
• Don’t sit on a chair that does not have arms
• Don’t lean forward while sitting in bed
• Don’t sit more than 60 minutes at a time; get up and walk frequently
• Don’t sit on a toilet or commode that does not have handles or side arms
• Don’t let your knee move inward past your navel
• Don’t turn your feet in or out
• Do use pillows between your legs at night to keep your hips properly aligned

Special Equipment

Ask your occupational therapist about special equipment to help you do routine things for yourself without placing your hip in danger of dislocation. These tools include:

• Dressing sticks – to help you put on and take off your pants or underwear
• Long shoe horns – to help you put on your shoes
• Elastic shoe laces – to make your laced shoes into slip-ons
• Grabber – to help you pick up things without bending over, reach items from high and low shelves, get clothes in an out of front loading washers and dryers, etc.
• Long-handled sponge – to help reach without stretching inappropriately
• Soap on a rope – to prevent bending to retrieve items in the shower
• Extender for woman’s razor – for shaving legs safely
• Raised commode seat – to put your knees in proper position below hips
• Bathtub benches and handrails – to improve bathroom safety
• Handheld shower – for washing while seated
• Long-handled feather duster – for dusting low and high items
• Long handled Johnny Mop – for cleaning out the tub or shower

1. Is joint replacement the best option for me now, or should I wait?
2. If I have joint replacement surgery, how much of my pain will be relieved?
3. How physically active can I be with a new joint?
4. How do joint replacements compare?
5. What are the risks or complications of joint replacement surgery?
6. How long will I be in the hospital, and how soon after having the procedure can I get back to normal daily activities?
7. Is joint replacement covered by my health insurance?
8. After the procedure, will I see you or my regular doctor for follow-up care?
9. How many of these procedures have you performed?

Getting physically and psychologically ready for joint replacement surgery can be an intense process. Those who are better prepared tend to achieve better results. Here are 20 tips for achieving optimal results: *

1. Find an experienced surgeon – Your orthopaedic surgeon will become an important person in your life for years to come. Make sure you are comfortable with your doctor’s approach, level of experience and personality.
2. Educate yourself about your surgery – Learn as much as possible about pre-op preparations, the procedure, post-op care, precautions and possible complications. Ask your doctor to go over your surgical plan, outcomes and long-term care in detail.
3. Seek a second opinion – Your surgeon should honor your right to confer with another, well-respected orthopedist if you have any doubts.
4. Plan ahead – Schedule surgery when you can afford to take time off from work, and when it will be least disruptive to your family.
5. Weigh risks versus benefits – Reconcile the big picture in your mind so you don’t go into surgery dwelling on risks or potential complications.
6. Have a positive attitude – Be encouraged and focus on the high rate of success for total joint procedures.
7. Talk with past patients – Hearing about other’s successes can help you gain perspective and ease your mind.
8. Visualize getting your life back – The pain and deterioration of your joint severely diminished your quality of life. Think about how much things will improve after surgery.
9. Realize feeling tense or anxious is normal – Don’t fight it!
10. Actively participate – Make a commitment to do your part to ensure a positive outcome and assume responsibility for your own care (i.e., follow precautions, do exercises daily, etc.). Consult with your orthopaedic surgeon with questions or concerns.
11. Practice on crutches – If you have spent time on crutches before, reacquaint yourself with them so the awkwardness won’t be overwhelming after surgery.
12. Don’t view the recovery process as time lost – This is time to rest and recuperate. Time invested in rehabilitation is necessary for better health.
13. Prioritize physical therapy – Realize your physical therapy and postop exercise regimen are critical for a successful outcome. Think of each exercise as a stepping-stone toward improved strength, range of motion and function.
14. Prepare for downtime – Remember you will be laid up for about 6 weeks. Organize, schedule appointments and take care of as much business as possible before surgery.
15. Take multi-vitamins and eat well-balanced meals – Be particularly health conscious during the weeks and months leading up to surgery to promote better healing.
16. Be conscious of infection – If you have any sign of any kind of infection anywhere in your body you must postpone surgery.
17. Donate autologous units of blood – You can donate your own blood in the weeks prior to surgery to be held for your operation.
18. Ask about current medications – Find out if you need to stop taking any prescription, over-the-counter or herbal remedies before surgery.
19. Adapt your environment – Get ready for homecoming before you go to the hospital by having a raised toilet seat, reachers and other adaptive equipment already available.
20. Arrange for help – Plan for someone to be with you, especially for the first week or two at home. If no one is available, make arrangements to enter a post-op inpatient rehabilitation facility until you are independent enough to care for yourself at home.

Never Lose Sight of Your Goals

The surgeon and surgical team do their work in the operating room. The rest is up to you. With inspiration and hard work, you will achieve great success throughout your rehabilitation, recovery and beyond.

References: *Adapted from an excerpt of “Arthritis of the Hip & Knee,” by Allen, Brander M.D., and Stulberg M.D., as it appeared on http://arthritis.about.com/od/surgicaltreatments/a/tipsforsurgery.htm.