What to Expect Before, During, and After Surgery

As an orthopedic surgeon specializing in hip and knee replacement surgery, I'm often asked about what patients can expect throughout their surgical journey. I'll walk you through the key stages of joint replacement surgery, from pre-operative preparation to post-operative recovery.

The Pre-Operative Period

Consent and Understanding Risks

Before surgery, you'll need to sign a consent form acknowledging the risks associated with joint replacement. It's crucial to discuss any concerns with your surgeon and ensure you fully understand the procedure.

Preparing Your Body

Getting in the best possible shape before surgery can significantly improve your outcomes:

• Nutrition: Eat a healthy, diverse diet. If you're overweight, try to lose some weight before the operation.
• Diabetes Management: If you have diabetes, work on controlling your blood sugar levels.
• Smoking: Try to quit or at least reduce smoking before surgery.
• Medications: Inform your surgical team about all medications you're taking, especially blood thinners.
• Get in the best shape possible to reduce complications - complete a pre-hab program like the one offered in Joint Recovery.
• Past medical history: Disclose all allergies, medications, and medical conditions 

Medical History and Conditions

Be sure to disclose:

• Any allergies
• Recreational drug use, including alcohol
• Previous medical conditions
• Auto-immune conditions
• Use of steroids

Understanding Anesthesia

The Pre-Operative Period

Before your surgery, it's crucial to take several steps to ensure the best possible outcome:

1. Sign the consent form after thoroughly understanding the risks
2. Get in the best shape possible to reduce complications
3. Manage your diet, especially if you have diabetes
4. Quit or reduce smoking
5. Inform your surgical team about any blood thinners you're taking
6. Disclose all allergies, medications, and medical conditions
7. Discuss any autoimmune conditions with your rheumatologist
8. Inform your surgeon if you're taking steroids
9. Consider losing weight if you're overweight
10. Control blood sugar levels if you have diabetes

Nutrition and Lifestyle

Eating a healthy and diverse diet is essential. If you're overweight, try to lose as much weight as possible before the operation. This can significantly improve your recovery time and reduce the risk of complications.

For smokers, it's crucial to quit or at least cut down before surgery. Smoking can interfere with healing and increase the risk of complications.

Medications and Medical History

Be sure to disclose all medications you're taking, including over-the-counter drugs, herbal supplements, and recreational substances. This information is vital for your anesthesiologist to ensure your safety during the procedure.

If you have any allergies, even if they seem unrelated (like eggs or soy), mention them to your surgical team. Some anesthesia medications contain ingredients that could trigger allergic reactions.

Types of Anesthesia

There are two main approaches to anesthesia for hip and knee replacement surgery:

1. General Anesthesia

• You're completely asleep during the procedure
• Medication is injected through an IV or inhaled
• A breathing tube may be inserted to ensure proper oxygenation
• You wake up when the medication is turned off
• The anesthesiologist monitors you closely throughout the entire procedure

Risks: Tiredness, nausea, dry mouth, shivering, sore throat, itching, and rarely, confusion

2. Regional Anesthesia (Spinal)

• Numbs you from the waist down
• A local anesthetic is injected into your spine
• You may still be given medication to sleep during the procedure if desired
• Numbness lasts 2-5 hours
• You breathe on your own throughout the procedure

Risks: Headache, low blood pressure, dizziness

Pain Management Techniques

In addition to the primary anesthesia, your anesthesiologist may use other pain management techniques, especially for knee replacements:

• Nerve blocks: Local anesthetic is injected around specific nerves to provide longer-lasting pain relief
• Catheters: Sometimes, a small tube is left in place to continuously deliver pain medication

The Day of Surgery

On the day of your operation, you'll typically be asked not to eat anything for about 12 hours before the scheduled surgery time. However, many anesthesiologists allow clear fluids up to 4 hours before the operation. Always check with your surgical team for specific instructions.

What to wear and bring with you:

I’d recommend wearing loose-fitting clothes on the day of surgery. That could be sweatpants and a T-shirt, or maybe a skirt.  Whatever makes you comfortable. And shoes that are easy to take off and on.

Even if you are not planning on staying overnight, it’s a good idea to bring an overnight bag with a change of clothes and some toiletries.

You may be asked to come with a walker, crutches, or canes. 

Getting to and from the hospital:

You need to plan a ride to take you to the hospital and home afterward. You should have someone with you overnight on the first night at home.

One question we get a lot from patients is, “I live alone. Surely I won’t cope on my own.” Many patients DO live alone and can do really well on their own by pre-planning at home. 

Prep you home:

Stock the kitchen with pre-made meals and ice. Make sure the fridge has milk, eggs, bread, and other necessities.

Pick up and move any trip hazard like loose mats or rugs, loose wires, piles of clutter, or unstable furniture.

Plan for visitors to come over, and maybe have a loved one stay with the for a day or two. 

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Some people also worry about having to climb the stairs. And about whether the bathroom, bedroom, and kitchen, are all on the same floor.

But remember, we will make sure you are safe to climb stairs before you leave. We actually like stairs. They help as part of your rehab, so by and large, you won’t need to move your bedroom. Keep climbing those stairs!

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The pain is obviously worse for the first two or three days. It will go down day by day after that, and of course, we will give you painkillers to cover that process. When you get home, go through your different painkillers. Many find it useful to write down a plan and tick off the tablets as you take them.

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Ice will become your best friend - use it to help with pain management and swelling. it is especially useful to ice after your exercises each day, many times a day. Remember, never put the ice directly on the skin. Use a towel to cloth between the skin and ice/ frozen veg.

After Surgery

Post-surgery, you'll be monitored in the recovery room until you regain feeling and movement. Your pain will be managed with various medications, and you'll work with a physiotherapist to practice moving safely before going home.

Recovery Room

In the recovery room, the medical team will monitor your vital signs, including blood pressure and pulse. They'll ensure you're comfortable and not experiencing any nausea or other side effects from the anesthesia.

Physiotherapy

Before leaving the hospital, you'll meet with a physiotherapist who will:

1. Help you practice getting up and moving around
2. Teach you how to use support aids like walkers, crutches, or canes
3. Show you how to navigate stairs safely
4. Demonstrate how to get in and out of a car

Discharge

Before you're discharged, whether it's the same day or after a short hospital stay, make sure to:

1. Voice any concerns or fears you may have
2. Get prescriptions for pain medications and blood thinners
3. Obtain contact information for your physician's office and after-hours support
4. Ensure you have someone to drive you home and assist you initially

Remember, your comfort and safety are our top priorities. Don't hesitate to ask questions or voice concerns throughout the process. With proper preparation and care, you'll be on your way to a successful recovery from your hip or knee replacement surgery.

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