Preparing for Surgery

Optimize Yourself Before Surgery

Athletes do not go into a big game expecting to win without putting in significant effort BEFORE the big game. The same is true for total joint replacement! To set yourself up for success, follow these steps:

1. Achieve a healthy weight to height ratio (BMI). I do not clear patients for surgery if their BMI is over 40 because studies show that the risk of infection is 3.3 times greater than average.
2. Get your blood work normalized. I require patients to have a hemoglobin A1c of less than 7.5. Male patients must have a hemoglobin (blood count) greater than 13, and female patients should have a blood count greater than 12; patients lower than these levels are anemic and have greater infection risk. Additionally, albumin must be at least 3.5 and ideally 4.0 or higher. Kidney function should also be optimized.
3. Take multivitamins with Vitamin D and Zinc. Low levels of Vitamin D and Zinc are associated with greater infection risk. I typically recommend a daily dose of Vitamin D 2000 International units OR a Centrum multivitamin with Vitamin D.
4. STOP SMOKING. Patients are not eligible for elective joint replacement if they are smoking. You should stop smoking a minimum of 6 weeks before surgery through at least six weeks after surgery. If you are able to stop smoking for 3 months, why not stop altogether? Smoking doubles your infection risk and causes cancer. Please stop smoking.
5. Get your blood pressure under control. Uncontrolled blood pressure increases your risk of heart attack and stroke and makes it harder to do your knee replacement without a tourniquet. If a tourniquet is needed, you may have a slower and more painful recovery.
6. Get evaluated by your primary care doctor to determine if you need special heart or lung testing.
7. Enlist a friend or a spouse to help coach you through the recovery process. Having someone go through this process with you increases your likelihood of a great outcome and decreases complications.
8. Watch my video to learn your 4 simple recovery exercises prior to going into surgery.
9. See a physical therapist BEFORE surgery. Learn how to approach activities like walking up and down stairs, getting into and out of a car, etc. before you actually have a sore knee. Practicing ahead of time decreases your risk of problems after surgery.

Prepare Your Home for Recovery

Make simple modifications to your home life to make it easier for you to get around in recovery. These steps should be completed a week before surgery.

1. Remove throw rugs and any other items that may pose a fall risk, such as electrical cords.
2. Make sure you have night lights in your bathroom and hallway so that you can see clearly if you go to the restroom during the night.
3. Consider non-slip surfaces for your bathtub and shower, such as a non-slip mat or stick-on safety treads.
4. Consider short-term pet care.
5. Have loose-fitting clothing and non-slip shoes ready for post-op.
6. Plan out where you will be recovering in your house. Consider where you will have your meals, where you will sleep, where and how you will elevate your leg, how you will get to the bathroom, and how you will entertain yourself while recovering. If possible, try to stay on one floor and have everything in as close proximity as possible until you are able to get around more easily.
7. Get your medications and assistive devices ahead of time when possible.

Create Your Pre-Surgery Plan

I work with patients to plan for the following:

• Preventing deep vein thrombosis (DVT)
• Prescriptions – Both current prescriptions and medications needed after surgery
• Whether or not the procedure will be tourniquet-free
• Urinary retention plan – The right plan can help you avoid the need for unexpected catheterization.
• Addressing potential nausea and vomiting in recovery
• Sleep apnea evaluation – This is VERY IMPORTANT, as undiagnosed sleep apnea combined with anesthesia and narcotics is potentially life-threatening.
• Diabetes management (if needed)
• Whether or not the procedure will be outpatient. In general, the sooner you are out of the hospital, the better.
• Pain control techniques
• Reducing blood loss – Tranexamic acid, a medicine that helps reduce blood loss, may be recommended

Understand Hospital Discharge Goals

Patients must meet 5 goals to be discharged from the hospital:

1. Need to be adequately recovered from anesthesia—not too sleepy, not too numb, not in terrible pain
2. Need to have blood pressure not too high or too low
3. Need to be able to fully empty your bladder
4. Need to be able to keep food down
5. Need to pass physical therapy: transfers, stairs, walking, getting dressed, going to bathroom

Take your time getting up after surgery. Patients tend to get lightheaded when going from lying flat to walking, especially in the first 48 hours. When sitting up, count to ten, then stand. Count to ten again, then slowly start walking. This will reduce your risk of lightheadedness and falling.