How to Prepare for Knee & Hip Replacement Surgery – What the Patient Can Do

Introduction
There are many things a patient facing knee or hip replacement surgery can do for themselves in preparation for surgery to increase their odds of a favorable outcome and a smooth rehabilitation. Some of the things listed below are easy to accomplish, while others require a great deal of effort. Knee and hip replacements are major surgeries and require strong patient dedication to achieve maximum outcome. The more guidelines the patient is able to accomplish, the more likely they are to be happy with the knee or hip for decades to come.

Long Term Advance Preparation

• • The more fit a patient is going into surgery, the less chance there is of post op complications. Even upper body fitness can help with crutches and/or a walker after surgery.
  • Having toned muscles (especially the quadriceps and hamstring muscles of the thigh) helps speed the rehab process. Patients do not need formal (and expensive) physical therapy to accomplish this preoperatively. A combination of walking, leg lifts, elliptical machines, light resistive exercises, and use of an exercise bike depending on what is tolerated can suffice.
  • For overweight patients, a weight reduction program helps minimize risks.
  • Eat a very well-balanced diet in the months and weeks leading up to surgery. Even overweight patient’s oftentimes have paradoxical malnutrition. Consuming a healthy level of protein and vitamins and a low level of carbohydrates and sugars can optimize your nutrition levels and decrease the perioperative risk.
  • Diabetic patients can more carefully manage blood sugar levels. The better the long term glucose control the less the risk of infection. Keeping tight control of your blood glucose levels in the months leading up to surgery is very important, but of even greater importance is having your blood glucose controlled tightly in the days leading up to and especially the day of surgery. Uncontrolled glucose levels can lead to infection and wound healing problems.
  • If you are a smoker, quitting smoking months/weeks before surgery can greatly reduce your perioperative risk.
  • All health issues such as heart, pulmonary, or kidney disorders should be brought to their optimum condition via proper medical consultation. If you have a history of significant heart, pulmonary, or kidney disease, a clearance letter from your specialist may be required prior to surgery.
  • Patients with skin disorders affecting the operative area (such as psoriasis) should take appropriate measures to have their skin as healthy as possible before surgery. Any skin lesions in the area of surgery could potentially cause your surgery to be canceled.
  • While after surgery you will be mobile, you will need some help around the home. Having this arranged prior to surgery can alleviate much of the worry and concerns of recovery.
  • Take care of any minor medical or dental procedures prior to surgery. After knee and hip replacement, medical and dental procedures should be strictly avoided for at least 3 months and ideally 6 months to minimize risk of complications.

Immediate Pre Op Preparation

• Stop blood thinning medications such as aspirin, plavix, eliquis, xeralto, other more potent blood
  thinners, non-steroidal anti-inflammatory medications (NSAIDS), and dietary supplements that might
  have a blood thinning effect prior to surgery under physician supervision.
• Do not shave or trim the hair in the area of your surgery for at least 48 hours prior to surgery. Any hair
  removal will be done in the hospital. Shaving can lead to small cuts in the skin that can increase infection
  risk.
• Patients with Autoimmune diseases such as rheumatoid arthritis, psoriatic arthritis, Sjogren’s, Lupus, and
  others may be taking certain disease modifying medications (DMARDS or Biological Agents) that can
  lower your immune system. There is a list of these medications and the recommended stop time prior to
  surgery that you will be given.
• Protecting the skin from scratches or abrasions, especially on the operative leg, is crucial. Wear
  protective clothing around pets that scratch or when gardening/performing manual labor prior to
  surgery. Scratches on the operative leg can potentially cause your surgery to be canceled.
• Typically the surgeon will prescribe an antibiotic that is absorbed through the nasal membranes
  (Bactroban) to prophylax against staph infections. It is to be used the night before and the morning of
  surgery
• Often an antibacterial soap is recommended to use on the knee or hip the evening before and morning
  of surgery. Ensuring that the entire extremity is well cleaned including behind the knee, between the
  toes, and even the pelvic area is crucial to minimizing the bacterial load on your skin prior to surgery.
• If you develop any symptoms of a cold, fever, rash, or any medical problems close to your surgery date
  you should immediately notify your surgeon.

  EAT/DRINK NOTHING AFTER MIDNIGHT BEFORE SURGERY