Joint Replacement Guide - Before Surgery

Medical Clearance

You may be required to complete a medical clearance form by your family physician or other specialists if necessary. Your surgeon’s office will discuss and explain paperwork requirements. Your surgery could be postponed if medical clearance is not completed before surgery.

Dental Clearance

Please inform your surgeon if you experience any pains or other symptoms in your mouth. Dental clearance may be required depending on your surgeon's assessment. Practicing good oral hygiene is important to prevent infection. Following your surgery, antibiotics must be taken one hour before each dental appointment for at least one year.

Stop Smoking

Smoking is not allowed on campus. Smoking affects healing and can cause breathing problems. If you are interested in quitting, please talk to your primary care provider.

Healthy Weight

Weight loss can be difficult when your joints hurt. Excessive weight puts more stress on your joints and can affect your health in general. If weight loss is a goal before surgery, we can help with a referral to an appropriate resource. Please discuss this with your primary care provider or surgeon.

Medications

After surgery, medication will be prescribed to reduce the risk of blood clots.

The use of some medications may need to be stopped before surgery. Aspirin products, as well as NSAIDS (Aleve®, Motrin®, Advil®, Ibuprofen®, Naproxen, Mobic®, Celebrex®), should be discontinued one week before surgery. The exception is 81 mg of Aspirin, or “baby aspirin.” Do not stop taking this medicine if you are currently taking this dose, unless directed by your doctor. Other things to stop before surgery are over-the-counter herbs and supplements. If you are taking blood thinners and over-the-counter herbs and supplements, please discuss with your surgeon.

Nutrition

Getting enough nutrition is always important but even more so for healing. Follow a healthy diet before and after surgery to heal properly. If you would like to schedule an appointment with a clinical dietitian, please ask your doctor.

• Dairy Products - Two to three servings of low-fat dairy foods daily
  • This provides calcium, vitamin D, and phosphorus to help your bone tissue adapt to the new joint
• Fruits and Vegetables - Five or more servings daily
  • This provides Vitamins A and C, and zinc that help wound healing
• Meat, Fish, and Poultry - Two to three servings daily
  • Each serving should consist of two to three ounces
  • High-protein foods include eggs, tofu, peanut butter, cheese, yogurt, dried beans, lentils, and nuts
  • Protein promotes wound healing
• Breads, Cereal, Pasta, and Whole Grains - Six or more servings daily
  • This provides energy and essential vitamins and minerals
• Fluids - At least six to eight cups of fluids daily
  • Water and decaffeinated beverages are the best choices

Planning Ahead

It is very important to be prepared before surgery. When it's time for you to go home, we want to make sure you have the right plan. Some people return home as quickly as the day of surgery. Most return home after one to two nights in the hospital. Our goal is to safely discharge you so that you can return home. Once you can successfully perform these tasks by yourself or with your caregiver’s help, you are ready to go home:

• Walk with an assistive device
• Get in and out of bed
• Get in and out of the shower
• Get on and off the toilet or commode
• Go up and down stairs if needed in your home

Helpful Tips

• We do not expect you to clean, do laundry, mow grass, shovel snow, etc. for several weeks.
• Find a family member or friend to be your “coach” and help you in the first few days or weeks after surgery. Share this booklet with your coach to learn how they can help.
• Make sure your pathways are clear to walk with a walker or crutches. Ensure that the room is clear of extension cords, throw rugs, and other items that might cause you to fall.
• Arrange to stay on the main level of your home or rearrange things to avoid numerous trips up and down stairs.
• If you live alone, try a first-floor setup. If you must climb steps, you may need a second walker. Your insurance usually covers one item like a walker every five years.
• Other equipment such as a bath bench, extra walker, leg lifter, or raised toilet seat may not be covered by insurance. Borrowed equipment may be available from family, friends, churches or other organizations. Used equipment can be found in retail stores, thrift shops, and yard sales.
• Determine the safest and easiest way to enter your house. An entrance with no steps or one step is the easiest.
• If you have stairs without a railing, it is highly recommended that you install one. It is much easier and safer to walk up and down stairs with a railing.
• Have things you need daily within reach.
• Having adequate lighting and nightlights are important for safety.
• Plan for easy-to-prepare meals. Stock your pantry with the basics. If you are considering Meals on Wheels, contact them as soon as possible.
• Do not be afraid to ask for help from family and friends.
• If you have pets, consider having someone feed them, walk them, and change litter and bedding for the first few weeks. The day you come home, arrange for someone to corral your pets so that you can safely enter the house.
• We recommend not allowing pets into bed with you until your wound heals.
• Transportation should be planned before you go to the hospital. You will need someone to drive you to therapy, the lab, and doctor's appointments for the first few weeks. If you are alone, talk to your family and friends to schedule as many drivers as possible. If you plan to use public transportation but do not have a pass, begin the process as soon as possible. It takes several weeks to process an application.
• If there are any areas in your home that are causing you concern, take a picture of that area to show your therapist. They will work with you to resolve problems before discharge.
• If you are borrowing a walker, crutches, or cane that has not been sized for you, please make certain it is taken to the hospital and shown to the therapist before you are discharged. If you own one of these items and have not loaned it to anyone, nor have you had any changes in your height, it does not need to be brought in. Be sure to have assistive devices brought to the hospital on the day of discharge. This will be used when you get into and out of the car. If you do not have equipment, our therapists will ensure you have the devices you need before discharge. Walkers are covered by insurance.
• Outpatient therapy should be arranged before your hospital stay.
• Home health therapy can be arranged if you are safe for home discharge but not ready for travel to and from outpatient therapy. A therapist will come to your house three times a week. After two weeks, outpatient therapy will begin. This is dependent upon your insurance plan and may include copays and deductibles.
• If you are unable to safely care for yourself at home, our case manager will discuss skilled nursing facilities with you and your family. Options will be based on your insurance plan, available choices, and your preferences. Acute rehab settings are usually not covered by insurance.
• If you need an extended nursing home stay, our case manager or social worker will work with your insurance company. If your first-choice facility is not available, you will be asked for a second choice. The case manager or social worker can help you and plan the best discharge plan. If you have questions, please discuss with your care manager.

Discharge Predictor

If you prefer to not return home, use this scoring sheet can help you determine which plan is best.

How to evaluate your score:

• Less than 6: You may need skilled nursing after hospital stay. Your team will help you with options.
• Six or above: Plan to return home. You may need home health services.

The more prepared you are before surgery, the better your recovery after surgery.

Pre-Admission