Richard W. Vanis, MD

Pre-op Instructions: Preparing for Knee or Hip Replacement Surgery

Preparing for total joint replacement begins weeks before surgery.

There are instructions that are important for you to follow:

1. Stop medications that increase bleeding – 2 weeks before surgery stop all herbal supplements, weight loss aids, vitamin E and all anti inflammatory medications, such as ibuprofen (Motrin) and naproxen (Aleve). Celebrex and Tylenol are ok to take. Coumadin and Plavix need to be stopped but require special instructions for stopping these medications.
2. Have a general physical examination – Some patients should evaluated by their primary care physician preoperatively. This would include patients with serious medical conditions and/or patients taking certain prescriptions drugs.
3. Get laboratory Tests – Your surgeon may prescribe blood tests, urine tests, an EKG or cardiogram to confirm you are fit for surgery. These tests should be performed within 30 days of the scheduled surgery in order to be acceptable. These test are usually performed at the our laboratory or at your primary care physician's office when you have a physical.
4. 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.
5. Plan for your recovery and rehabilitation – Total joint replacement recipients may need help at home for the first week, including assistance bathing, dressing, preparing meals and with transportation. Arrange for someone to help you at home. If you need to stay in a rehabilitation or skilled nursing facility, a medical social worker from the hospital can assist with arrangements. A physical therapist will come to your home initially — usually about two weeks. You will then begin water therapy and come to the office for physical therapy.
6. Typically, blood donations are not necessary for total joint replacements. There is minimal surgical blood loss. Dr. Vanis harvests blood loss during surgery for possible reinfusion at the end of the procedure. The blood collected may be given back to you at the at the end of your knee or hip replacement.
7. 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.

Make Sure to Take These Things With You to the Hospital:

• Exercise shoes with closed-in heel and non-slip soles
• Knee length robe or cover-up for walking in the halls
• Grooming items such as shampoo, toothpaste, deodorant, etc.
• A list of medications you are currently taking at home, including the name, strength and how often you take each medication
• A list of allergies (to food, clothing, medicine, etc.) and how you react to each one.
• A copy of your Living Will and Health Care Power-of-Attorney, if you have either one. Hospital personnel are required by law to ask for these when you are admitted. They will make a copy for your medical record and return the original.
• A copy of your insurance card
• A walker if you already have one, and a list of other adaptive equipment you may have at home with your name on all equipment you take to the hospital
• Glasses, hearing aid, and any other items you use every day
• Short gowns, pajamas or workout shorts, underwear, socks/stockings and one set of street clothes to wear home v
• Leave jewelry, credit cards, keys and checkbooks home. Bring only enough money for items such as a newspaper, magazine, etc.

What You Can Expect During Your Hospitalization:

1. Arrive at the hospital at the appointed time. Please be patient while waiting, most surgeries are performed within the hour of the scheduled time, but due to unexpected changes a delay can occur.
2. There will be several checks to make sure the correct joint is being replaced. Your surgeon will 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.
3. You will meet with the anesthesiologist and operating room nurse.
4. They will start an IV in your arm for administration of fluids and antibiotics
5. You will be moved from the pre-op area to the operating room.

Changes You May Notice After Surgery:

1. Your appetite may be poor because of surgery, fatigue and narcotic pain medication. Drink plenty of fluids to avoid dehydration.
2. You may have difficulty falling asleep or staying asleep. Do not nap too much. Call for prescription medicine if needed. Trouble sleeping may continue for 4-6 weeks.
3. Narcotic pain medication promotes constipation. Use a combination of stool softeners and laxatives. (Dulcolax suppositories, Metamucil, and Milk of Magnesia.)
4. Pain will commonly increase as you become more active at home and during rehab. You may experience groin pain in the operative leg. Medication has been prescribed for you. Take 1 or 2 tablets every four hours if needed. The oral pain medication may cause nausea, constipation and a light-headed sensation. If symptoms occur, call the office, and the medication can be changed. You should not drink alcohol while on this medication.

Postoperative Precautions

Knee Replacement

• Never rest with a pillow under your knee – you may lose the ability to straighten your knee.
• Walk putting full weight on your foot.
• Weight bearing as tolerated – as much as comfortable
• Use common sense to decide when to stop using walker.
• After the walker, use a cane or crutch in the opposite hand of the knee operated on until you are steady and safe. Most patients are walking freely in 2 weeks.

After your surgery, you will be asked to observe certain precautions for the first 6 weeks to prevent the ball from popping out of the socket (dislocation).

• You should not bend your hip beyond 90° (a right angle), and you should not bring your legs or knees together.
• You should not sit straight up in bed or bring your operative leg up toward your chest.
• Use a pillow between your legs in bed to help maintain the proper position and to keep your legs apart.
• Do not rotate your operative leg inward. Use a reacher to pick objects off the floor without bending over.
• Swelling in the operative leg is a normal part of the postoperative course after surgery. Normal swelling is reduced in the morning, and gradually accumulates throughout the day. This can be reduced by elevating your legs or lying down for 30 minutes or an hour during the day. Any activity that leaves your feet on the floor, such as sitting in a chair, standing or walking can lead to swelling. If the swelling is severe in the morning when first arising or if accompanied by leg pain, you should contact your surgeon.
• We do several things to reduce the risk of blood clots forming in the veins of your legs. We may place you on either Aspirin or Coumadin to thin your blood again to reduce the risk of clot formation. In addition, you should continue the exercises and walk as tolerated to maintain the blood flow. Pump your feet up and down 20 times each hour while awake and perform the tightening exercises of the thighs and buttocks.

Keep your incision clean and dry and check it daily. Call your doctor if you notice any of these symptoms:

• Your temperature may be slightly elevated for several days after surgery. However, if fever persists above 101°F and is accompanied by chills, sweats, increased pain or drainage at the incision, you should call the office. These may be signs of infection or blood clots.
• Chest pain
• Chest congestion
• Problems with breathing
• Calf pain or swelling in your legs
• Worsening knee pain and decreasing knee motion

• Drainage from incision is normal
• Redness around incision, increased swelling around incision is normal
• Warmth of the incision is normal
• Please shower daily. Keep you incision as dry as possible until the first post-op visit. Put alcohol on the incision after showering.
• Your incision will heal, and the swelling and bruising will get better over the next few weeks.