Joint Replacement Process
Two weeks prior to scheduled surgery, patients attend a pre-operative, educational class. In a separate, optional pre-habilitation class, physical therapists and occupational therapists meet with patients to teach basic exercises that will be used during group therapy sessions and at home after surgery.
Pre-operative educational classes must be taken the Wednesday before your surgery date. Patients will also learn about:
- Safety precautions
- Deep vein thrombosis(blood clots) prophylaxis
- Transfer techniques (from the car)
- Training in daily activities
- Ensuring a safe home environment
- Potential post-operative complications
- Pain management
- Weight-bearing status
- Stair training
- Fall prevention
During the pre-operative education patients view a video explaining the details of the surgery and rehabilitation process. This pre-operative education helps alleviate fear and stress commonly associated with surgical procedures.
Classes are scheduled and confirmed in advance and typically follow this order:
- 7 a.m. : Business office paperwork
- 8 a.m. : Pre-admittance, lab work and ECG
- 9:30 a.m. : Education - anesthesia, pharmacy, physical therapy, home health and discharge planning, The Mind/Body Wellness Institute
- 11 a.m. : Tour of the Total Joint Replacement Center
Pre-Operative Office Evaluation
You should receive this medical history questionnaire from your physician. Please complete it in order to gain admission to the hospital. Bring the completed form with you to the hospital on the day of surgery.
Night Before Surgery
DO NOT EAT OR DRINK ANYTHING AFTER 9 P.M. This includes water or coffee. Do not smoke, chew gum or eat mints. If you are taking prescription medications, these should be taken with a small sip of water at the same time that you usually take them.
Stop taking aspirin and all anti-inflammatory medication 10 days before surgery. These include but are not limited to the following medication:
These medications increase the bleeding that occurs during surgery. If you are taking blood thinners, MAO inhibitors or diet pills, please notify your surgeon immediately.
Continue taking all other medication that has been prescribed for you. This includes heart, asthma, blood pressure, seizure, diabetic medications and prednisone/cortisone. You should take these medications on the day of surgery in the same manner that you would normally take them, but only with a small sip of water. If you use an inhaler, please bring it with you.
Diabetic patients: Do NOT take insulin the morning of surgery. If you are taking oral diabetic medication, bring it with you. When you come to the hospital, the nurse will check your blood sugar and the anesthesiologist will regulate your insulin accordingly.
Bring a list of your current prescription medications, dosages or the pill bottles with you for review by the nurse. You will not be taking your own medications in the hospital. These have to be recorded by the pharmacist and administered by the nurse in accordance with hospital policy.
Most patients are admitted the morning of the operation. Your surgeon's office will call you the day before your surgery to tell you what time to arrive. If you have not been called by 2 p.m. the day before surgery, you should call your surgeon's office.
Please notify your surgeon if you develop any of the following problems prior to surgery:
- Sore throat
Also, report any other problems that may interfere with your scheduled surgery. If you are unsure, call and check with your physician.
Where You Arrive
Please take the elevators in the Professional Office Building I located at 7777 Southwest Freeway (across from Professional Pharmacy) to the second floor, Day Surgery.
Check in at the registration desk. Be prepared with your I.D., doctor's name and type of procedure being done. If you have not already made payment during pre-registration, collection of deductibles and co-payments will be requested.
Duration of Surgery
The average operation takes about one to two hours. A revision could take as long as four hours. After your operation is completed, you will be taken to the Post Anesthesia Care Unit (PACU). This is the recovery room. You will be kept there approximately one to two hours until you are ready to return to your room in the Joint Center on the ninth floor.
While You're in the Hospital
- Leave all jewelry and valuables at home. Bring a storage case for your contact lenses or glasses and for your dentures if you wear dentures.
- You will be measured for surgical hose called TEDS. These are elastic stockings that you will wear to surgery and during your hospitalization.
- Pain medication will be ordered after surgery and given to you only when you ask your nurse for it. The pain medication does not take the pain away entirely, but should keep you comfortable enough to rest.
- You will have blood drawn each morning.
- Nursing staff will get you out of bed the very next day after surgery and perform an initial physical therapy evaluation after breakfast.
- Some knee replacement patients are fit with a special machine in the recovery room. This is a Continuous Passive Motion (CPM) machine. It bends and straightens your knee for you.
- You will wear a hospital gown the day of surgery, but after surgery you will dress in everyday clothes. If you have loose-fitting clothing that you would like to wear, bring it with you. Sweats or exercise outfits work nicely.
- You will always have a nurse assigned to you. You will receive a sponge bath the first day. Your TEDS need to be removed daily for bathing and at other times during the day for a few minutes. There is a "charge nurse" on duty every shift. If your concerns are not being met, ask to talk with her/him.
- Your normal expected stay in the Joint Center is three days after surgery. We recommend that a relative or friend (coach) that will be helping you after surgery at home accompany you to the hospital. The therapist will teach you and your coach the correct exercises and techniques to help you at home. You will need to do these exercises everyday at home.
Anesthesia for Total Joint Surgery
On the day of your pre-operative class, your anesthesiologist will discuss the type of pain management appropriate for you. You can reduce your risk for anesthetic complications by taking steps now. Avoid non-prescription drugs and alcohol. Stop smoking for as long as possible before your surgery and after.
Most knee replacements do not need a blood transfusion. Donating blood for yourself is an excellent idea prior to your operation. This is called "autologous blood donation."
To help your body quickly replenish your blood, you should take iron supplements. Iron pills can be purchased at any drug store without a prescription.
It is also wise to take one good multiple vitamin everyday. You should begin taking your iron and vitamin pills a few days before your first blood donation and continue right up to the day before your operation.
While in the hospital, the doctor monitors your blood count and condition daily. Decisions on blood utilization are made on an individual basis.
If you are concerned and want to donate blood before surgery for you own use, contact your physician for more information.
Discharge Information and Planning
You will be discharged from the hospital three days after your surgery. For example, if your surgery is on Monday, you should plan to go home Thursday.
You will need to make arrangements for someone to pick you up to take you home. Your doctor will let you know on the second day after surgery if there are any different plans for your discharge.
You will need help at home after you leave the hospital. Most patients do not need formal visits from a physical therapist. You will most likely be doing the exercises with the help of a friend or family member. You will need help for bathing, shopping, housework and putting on clothes.
You will need schedule your outpatient physical therapy sessions.
If you anticipate needing long-term care in a nursing home or extended care facility, start these plans prior to admission. The case manager can provide you with a list of approved, available facilities. You should visit the facility in advance of your surgery and make arrangements for admission there on discharge from the hospital.
You will be discharged from the hospital with prescriptions for pain pills and blood thinner. The prescriptions can be filled before discharge.