IN THE BEGINNING...............

It is important to be as prepared as possible prior to undergoing a hip or knee replacement. After surgery is scheduled, we ask all of our patients to see their primary care physician for a routine pre-operative evaluation approximately two to four weeks prior to their operation. You will need to contact your physician regarding this pre-operative evaluation. If you do not have a primary care physician, our office staff can assist you in finding one.
Additionally, we ask that most of our patients donate autologous blood (your own blood) prior to the operation. You will be given an information sheet with the phone number to the Carter Blood Bank. It is important to call this number and schedule an appointment at a facility closest to your home. No matter which location you choose, autologous blood donations may not be made sooner than 30 days prior to your surgery.
You will be scheduled for an appointment in our office within one to two weeks prior to your surgical intervention. At that visit, you need to have the following:

• A list and dosages of all medications you take on a routine basis.
• Be ready to give a complete medical history, including all previous surgeries.
• Any problems that you may have had in the past from an anesthetic standpoint.

Some of the hospitals do provide pre-operative information, including a visit to physical therapy and a discussion with the orthopedic nurses. You can ask one of our nurses if the hospital where you are undergoing surgery provides this information.

PRIOR TO SURGERY

DO I NEED TO CONTACT MY INSURANCE COMPANY TO LET THEM KNOW I AM SCHEDULED FOR SURGERY?
Once the date of your surgery has been determined, our office will precertify your surgery with your insurance company. It is not necessary for you to contact your insurance company. You will need to provide our office with your current insurance information and a referral from your primary care physician if your insurance plan requires one.

WHEN SHOULD I BEGIN TO DONATE BLOOD FOR MY SURGERY?
As soon as you receive your pre-operative information, find the Carter Blood Bank information form. There are a number of facilities locally at which you can donate blood. Call the main number to locate the facility closest to your home to set up the appointment to donate blood. The normal number of units needed for total joint replacement is as follows:

• One unit for primary knee replacement
• Two units for revision knee replacement
• Two to three units for bilateral knee replacement
• Two units for primary hip replacement
• Two to three units for revision hip replacement

These are recommended units to be donated; however, more or less may be required, depending on your specific surgical requirements.

You may be instructed by the blood bank to take an iron supplement. Check with your primary care physician if he/she advises you to do so. Many different iron supplements are available. Your pharmacist can assist you regarding the different brands.

Also, if you have any history of heart problems, check with your cardiologist or primary care physician prior to donating blood.

If you are having surgery due to an infected prosthesis, you are not permitted to donate blood for surgery.

ARE THERE CERTAIN MEDICATIONS I SHOULD DISCONTINUE BEFORE MY SURGERY?
Never discontinue any medications prescribed by your primary care physician without his or her approval. If you are taking aspirin or anti-inflammatory medications (arthritis medication), you will need to stop them two weeks prior to your surgery. If you are taking medications to thin your blood, please let us know, so that we can determine the proper time to stop these medications.

IF I NEED DENTAL WORK, SHOULD I HAVE IT DONE BEFORE MY SURGERY?
Schedule an appointment for a complete dental checkup well in advance of your surgery. If you are in need of any major dental work, have it done immediately, and well before your surgery. Routine cleanings may be scheduled prior to surgery. However, we do not recommend that any major dental work be performed within two weeks prior to your surgery.

ARE THERE CERTAIN PREPARATIONS I SHOULD MAKE PRIOR TO MY ADMISSION TO THE HOSPITAL?
Depending on your situation at home, there are certain things you should do prior to your admission to the hospital.

If your spouse will be caring for you at home, talk to them about your concerns. It may be beneficial to prepare meals and freeze them prior to your hospitalization so you have nutritious meals available for you when you arrive home from the hospital.

Following your surgery, your physical therapist will be instructing you on how to go up and down stairs. If your bedroom is on an upper level in your home, you may want to make arrangements to have a bed on the lower level if you think you would prefer not going up and down stairs following discharge.

Prepare as much as you can prior to the surgery so you don't have to rely on your spouse, family, or neighbors to do unnecessary running around after your surgery. Look around your house and make sure you can access the rooms in your home with a walker or crutches. Remove throw rugs that could potentially cause you to slip or trip. If you have pets that might get in the way after surgery, you may want to make arrangements for them to spend a few days with a neighbor or other family member until you are more comfortable.

If your spouse is taking care of you after surgery, you may want to take into consideration that this is a role that may be new to them.

WHAT HAPPENS IF I DON'T HAVE ANYONE AT HOME TO TAKE CARE OF ME AFTER SURGERY?
If you do not have a spouse who is capable of caring for you following surgery but have family members in this area, check with them to see if arrangements can be made to care for you following discharge from the hospital. If you have children, they may be able to cover certain days and work out a schedule to be available for meals, bathing, etc. Some patients may require an extended stay in rehabilitation for one to two weeks after surgery.

SURGERY AND POSTOP QUESTIONS

WHEN DO I ARRIVE AT THE HOSPITAL FOR MY SURGERY?
Unless your physician should inform you differently, you will arrive at the hospital the morning of your surgery. YOU SHOULD HAVE NOTHING TO EAT OR DRINK AFTER MIDNIGHT THE NIGHT BEFORE YOUR SURGERY. If you are on medications, check with your primary care physician and ask him whether or not you are to take your medications on the morning of your surgery.

WHAT SHOULD I BRING TO THE HOSPITAL?
You should bring a robe, toiletries, and slippers or gym shoes to the hospital. You may wear your own pajamas or gown after your IV and catheter are discontinued. You should bring loose comfortable clothes for exercise if you are going to rehabilitation. The hospital gown you will be wearing allows easy access for the medical staff to assess your incision. Your slippers should fit snuggly on your feet so you can walk comfortably and not have to worry about them coming off and possibly tripping you in the course of your therapy. Do not bring your medications from home.

WHAT HAPPENS THE DAY OF SURGERY?
When you arrive at the hospital, you will be taken to the Surgery Department. There will be surgical consent forms for you to sign, and the nurse will explain what will be taking place. You will change into a hospital gown and be taken to the holding area where you will be placed on a cart. The anesthesiologist will talk to you and may ask questions regarding your past experiences with general anesthesia. An I.V. will be started.

The length of your surgery will depend on the procedure you are having done. Primary hip and knee procedures take approximately 1 1/2 to 2 hours. Revision hip and knee procedures take longer.

After surgery, you will be placed on a hospital bed. Normally, you are still quite drowsy from the anesthetic, so you may not even be aware that this is taking place. Most knee patients will have a knee immobilizer on the operated knee. Hip patients will have a special pillow placed between the legs.

You will then go to the recovery room. The nurses will make sure that you are comfortable and after a couple of hours, you will be transferred to your room.

You will have a catheter in your bladder so you will not have to get up to use the bathroom. You will need to use the bedpan if you have a bowel movement. Some patients have what is called Patient Controlled Analgesia (PCA). This means that the patient can control their pain medication. The medication is injected into the I.V. and goes directly into the bloodstream. The machine is set up in such a way that only the designated amount of medication can be given at a certain time, thus eliminating the possibility of overdosing on pain medication. If you do not have PCA, the nurse will bring you medication as indicated by the doctor's orders.

You may also have a device wrapped around your legs that will inflate and deflate periodically. This is called a sequential compression device and will assist in the prevention of blood clots and help with your circulation. There will be a device for you to breathe into a number of times throughout the day in order to expand your lungs.

Your I.V. fluids will continue and you will be on a liquid diet for a day or two following surgery. Your G.I. system needs time to "wake-up" after surgery, and introducing solid food too soon may cause problems. Foods will be introduced slowly and, after a few days, you will be back to your regular diet.

Depending on how you are doing, the nurses will probably have you sitting on the side of your bed by the end of your first day in the hospital. The therapists will be coming in to see how you are doing and isometric exercises are usually started soon after surgery. Knee patients will be started on a machine that will help with their range of motion as well as isometric and muscle strengthening exercises. All joint patients will have therapy on a daily basis. You will also have Occupational Therapy so the therapist can assist and advise you in performing activities of daily living. The therapist will stress certain precautions, and it is important to maintain these precautions as instructed.

Some hip revisions require a brace after surgery to assist in recovery. This will be applied before your therapy is initiated. If a brace is required, it is typically utilized for four to six weeks from the date of surgery.

WHEN WILL I BE DISCHARGED FROM THE HOSPITAL?
Barring any unforeseen complications, the normal length of stay is 4-5 days. Most patients are sent home following surgery. If you are not ready to go home and need additional rehabilitation, the discharge planning nurses will make arrangements for your transfer to a rehabilitation facility. Where you are sent depends on whether or not there is space available or whether or not your insurance covers that particular facility. Not all patients automatically go to rehabilitation facilities following surgery. If you will be discharged to your home, the discharge planning nurse will make arrangements for nursing and physical therapy personnel to see you at home.

WHEN DO I RETURN TO SEE THE DOCTOR TO HAVE MY STAPLES REMOVED?
The doctor will inform you as to when you should return to the office for follow up. Please call and make your follow-up appointment as soon as you get home.

Sometimes, patients can have wounds that become irritated from the staples, especially if it is near the time for the staples to be removed. Do not apply salves, topical antiseptic, or anything else to the wound. The wound should be kept dry and bandaged until your staples are removed.

If you develop night sweats or a fever greater than 101°F following discharge, please call our office. This may be indicative of a postoperative infection, and we would need to make arrangements to see you in the office for a wound check.

WHAT SHOULD I DO IF I HAVE ANY DRAINAGE FROM MY WOUND AFTER MY STAPLES ARE REMOVED?
Following staple removal, it is normal to have some drainage. This may be from fluid trapped beneath the surface of the wound. Removing the staples allows an outlet for the fluid to escape. If you notice an odor or an unusual amount of fluid being discharged from the wound, call our office. Also, if you are having night sweats, fever, or the wound becomes red and feverish, CALL OUR OFFICE IMMEDIATELY.

WHEN DO I STOP TAKING THE COUMADIN?
Your surgeon will determine when you stop taking Coumadin. You are at increased risk of developing blood clots following surgery so it is important that you stay on this medication until your medical doctor advises you to discontinue taking the medication. Blood tests may be ordered periodically while you are on the Coumadin. These can be done on an outpatient basis, or a nurse will come to your home if you are home-bound. Adjustments to your medication may be made, depending on the results of your lab work. YOU SHOULD NOT TAKE ASPIRIN OR ANTI-INFLAMMATORY MEDICATION WHILE ON COUMADIN. Also, if you take Vitamin E supplements, discontinue the supplements until you stop taking the Coumadin.

If you should have calf pain, leg cramping, or an excessive amount of swelling in your leg, do not hesitate to call our office. Sometimes, even though you are