Before you come to the Medical Center, you will have seen your orthopedic physician in their office and made the decision to have your joint replaced. Their office will have contacted the Medical Center with the date of your surgery. You will need to get medical clearance from your primary family physician as well as any other physicians you may need to see.
You will come to the Joint Care Center on either Wednesday or Thursday of the week prior to your surgery for pre-op education. At that time, we will:
- Pre-register you in the Medical Center’s computer system
- Verify your health history
- Obtain a list of the medications you are currently taking
- Perform an EKG
- Draw blood for lab work, and cross match you in case you need a blood transfusion
- Perform a urinalysis
You will be seen by a case manager to begin the discharge planning. He or she will discuss your home situation (are there stairs in your home, is there someone at home to help you with your care, etc.) and get an idea if you plan to return home after surgery or if you may need to go to a rehabilitation center for more therapy.
An anesthesiologist will also see you and review your health history, current medications, and spend some time talking with you. He or she will discuss the different types of anesthesia available and together you will make the decision about which type is right for you.
Finally, a physical therapist or a physical therapy assistant will meet with you. He or she will go over some of the exercises that you will be doing after surgery. We want you to start doing these exercises as soon as possible so that you strengthen specific muscles and are familiar with the exercises.
We will talk to you about pain control and set personal goals for tolerable pain. We use a pain scale to rate pain, with zero being “no pain” and 10 being the worst pain you have ever felt. Typically, we like to keep pain at or below a level four. We will have different types of pain medication to keep your pain at an acceptable level. After surgery you will have some pain, but we want to keep it at a level that allows you to be active on the unit. We will work with you and the physician to find the right pain medicine and the right amount for you. It is a good idea to request pain medication about 30 minutes before physical therapy.
You should stop medications that increase bleeding. Seven days before your surgery, stop all anti-inflammatory medications such as aspirin, Motrin, Naproxen, Vitamin E, etc. These medications may cause increased bleeding. You may continue Celebrex. If you are on Coumadin, Plavix, Pradaxa, Xarelto, Eliquis or any other anti-coagulant, you will need special instructions for stopping the medication.
If your surgery is on Monday, take a shower or a bath on Saturday, Sunday and Monday using Chlorhexidine Gluconate 4% provided during training day. If your surgery is on Tuesday, take a shower or bath with Chlorhexidine Gluconate 4% on Sunday, Monday and Tuesday. This reduces the amount of germs on your skin prior to surgery.
Do not eat or drink anything after midnight the night before your surgery, not even water, unless otherwise instructed to do so. No chewing gum.
Day of Surgery
When you have your pre-op visit to the unit, you will be instructed to come to the unit at a certain time for your surgery. Once on the unit, we will prepare you for surgery. You will wear a hospital gown, but this is the only day you will wear hospital clothes. Since we are very concerned about your safety, you will have the correct surgical site marked by you and the physician and then be taken to the operating room for your procedure.
The first few hours after surgery are the most painful. We will keep a very close eye on you and make sure that your pain is at a comfortable level. The first night is usually the worst, but it soon gets better. Getting out of bed and walking are some of the best things you can do to help decrease the pain.
After surgery, you will spend a short period of time in the PACU (Post-Anesthesia Care Unit, or recovery room) before returning to your room in the Joint Care Center. We will check your vital signs often and make sure your pain is under control. You will also have sleeves on your legs that help blood flow back to your heart. After a few hours you will be helped out of bed and walked to the bathroom, then you may sit in a recliner for the remainder of the day.
On the first day after surgery, and for the remainder of your stay, you will have help getting in the shower, usually around 6:00 or 7:00 am. After that you will be able to order your breakfast, sit in your recliner and watch TV until the first of two physical therapy sessions around 9:00 am. The second session is usually around 1:00 pm. You will attend two physical therapy sessions each day, except the day you are discharged when you will only have physical therapy in the morning.
Once your shower is complete, you will be free to walk the hallways, but we require that during your first few trips around the unit that a staff member walks with you. After that, you are free to walk whenever you feel like it and as much as you feel like it. In fact, we would rather see you out walking than staying in your room.
Caring for Yourself at Home
When you go home, there are a few things you need to know for your safety, recovery and comfort.
Make yourself comfortable:
- Continue to take your pain medicine 30 minutes before physical therapy if not driving.
- Slowly wean yourself from the prescription medication. You may take two extra strength Tylenol up to four times per day. This will be discussed with you before you leave the Medical Center.
- Change your position every 30 to 45 minutes throughout the day.
- Use ice for pain control. Applying ice to your affected joint will decrease discomfort, but do not use for more than 20 minutes at a time each hour. You can use it before and after your exercise program. A bag of frozen vegetables wrapped in a kitchen towel makes an ideal ice pack.
- Continue to do the exercises that you learned in your pre-op orientation at the Joint Care Center.
Monitor your body changes:
- Your appetite may be poor, so drink plenty of fluids to keep from getting dehydrated. Your desire for solid food will return soon.
- It is normal that you may have difficulty sleeping. Try not to sleep or nap too much during the day.
- Your energy level will be decreased for the first month.
- Pain medication that contains narcotics promotes constipation. Use a stool softener such as milk of magnesia, if necessary.