Preparing for Surgery

Once you and your surgeon decide that surgery is appropriate for you, you will need to learn what to expect from surgery and create a plan to achieve the best results. Preparing mentally and physically for surgery is a very important step for successful outcomes. Understanding the process and your role in it will help you recover more quickly and have fewer problems.

Working with Your Doctor

Before surgery, your primary care physician will perform a complete physical examination to make sure you don’t have any conditions that could interfere with the surgery. Routine tests and X-rays will be obtained. You may also be asked to provide dental clearance.

• Discuss any medications you are taking with your primary care physician to see which ones you should stop taking before surgery.
• If you are taking aspirin or anti-inflammatory medications or warfarin or any drugs that increase the risk of bleeding, you will need to stop taking them one week before surgery to minimize bleeding.
• If you are overweight, losing weight before surgery will help decrease the stress you place on your new joint. However, you should not diet during the month before your surgery.
• If you smoke, you should stop to reduce your surgery risks and improve your recovery.
• If you are on prescription opioids, you should reduce your use or wean off completely to minimize your surgery risks and improve your recovery.
• Have any tooth, gum, bladder or bowel problems treated before surgery to reduce the risk of infection later.
• Eat a well-balanced diet, supplemented by a daily multivitamin with iron.
• Report any infections to your surgeon. Surgery cannot be performed until all infections have cleared up.

Hip Replacement

Unlike knee replacement, recovery from a hip replacement is usually faster and a formal rehabilitation program is often not necessary. Things you should keep in mind:

• Surgery replaces only the “ball and socket”. Your chronically weakened hip muscles are not replaced and as a result, you are likely to experience a feeling of leg length inequality and have a limp. These will improve as your hip muscle strength and coordination recover.
• The most important activity for recovery is walking. Practice to walk naturally with the help of your rolling walker. Walk slowly but confidently, resisting the temptation to limp.

Knee Replacement

Unlike hip replacement, knee replacement requires substantial rehabilitation as a result of pain, stiffness, and swelling that commonly develop after surgery. That is because the knee is a superficial joint. Your quadriceps muscles (those responsible for straightening your knee) are also likely to be weak and atrophied from chronic pain and underuse. Things you should keep in mind:

• Motion: Your knee range of motion after surgery will be close to your knee motion before surgery.
• Pain is expected after knee replacement and will normally improve.
• Stiffness means difficulty in moving the knee. Most patients with severe arthritis have some form of stiffness. The amount of stiffness you have before surgery predicts the amount of stiffness you will have after surgery. Stiffness is difficult to treat because it indicates contractures and shortening of your knee connective tissue. No amount of surgical release will adequately correct this problem, and hence the importance of knee exercises after surgery by working on straightening and bending your knee regularly.
• Swelling results from surgery itself but it is also influenced by your overall health and the health of your operative leg. For example, if your leg veins are not good or you retain water in your legs, you will likely have more knee swelling after surgery. Swelling usually takes several weeks to months to resolve depending on your activity and health. You will be provided with compressive socks to wear and are expected to exercise and walk regularly.

Get Your Home Ready

Rearrange your furniture at home so it is easy to navigate with a walker. Make sure there are no tripping hazards and all items you regularly use are easy to reach. It may be helpful to obtain a grabber so you don’t have to bend deeply if something is too low or drops to the floor. Having handle bars in the bathroom is good for safety. Stock up on essentials items (food, water, personal hygiene, etc.). Run your important errands before surgery. If you are having a hip replacement and your toilet seat(s) at home are low, consider obtaining a toilet seat riser.

Ask for help

Having someone around to help you the first two weeks is very helpful (preparing meals, assisting with stairs, bringing you to your follow-up appointment, etc.). Your helper does not need to be with you 24/7, but should be available if you need them.

Final Words

It takes a team to have a successful hip or knee replacement. That team consists of the patient, a loved one, and the surgeon. A physically and mentally prepared patient is important to recovery. You are encouraged to bring anyone who will be involved in your care (spouse, parent, sibling, friend, etc.) to your visit so all are on the same page. Ask questions!  Stay positive! Remember surgery is only the first important step to recovery and understanding the process and your role in it will help you recover more quickly and have fewer problems.