Pre-admission testing

For some, pre-admission testing may be done all at once at the hospital per your surgeon’s request. Your surgeon’s office will give you instructions for all pre-admission assessment/pre-admission testing required, including:

  • Health history and physical exam. There may be other testing needed, such as blood work, EKG or X-rays.
  • Other medical clearances (e.g., dental/cardiac). Refer to the list provided by your surgeon.
  • A list of medications, allergies and prior surgeries. The medication list should include prescription and over-the-counter meds. You will need this information for both the nursing assessment phone call and pre-admission testing visit.
    • Use the Medication Tracker (see page 15 of the booklet).
    • Make a list of your current medications, including: name of medication, dosage in milligrams or milliliters, how often you take it, when you take it (am/pm).
    • Write down any allergies or side effects you have had from medication or anesthesia.
    • List all food restrictions/preferences (e.g., vegetarian, gluten-free, kosher).

Staphylococcus/MRSA swab screening

What if I test positive for staph/MRSA?

If you test positive for staph, the office will call and give you special instructions that include taking a series of pre-operative showers with antiseptic soap (Hibiclens/Bactoshield) and applying an antibiotic ointment to your nose.

The office will call in a prescription for two percent Mupirocin nasal ointment (Bactroban).

  • Dab a small amount of ointment, about the size of a match head, onto a Q-tip.
  • Apply ointment to the inside front part of both nostrils.
  • Press the nostrils closed to spread the ointment throughout the nostrils.
  • Do this twice a day (morning and before bed) for five days.

Begin pre-operative showers protocol five days before your surgical procedure is scheduled. Follow instructions as outlined in the patient education pre-operative showers section (see page 44 of the booklet).

  • Bathe or shower every day with Hibiclens/Bactoshield.
  • On the morning of your surgical procedure, shower or bathe again with Hibiclens/Bactoshield. You should have completed six showers or baths with this antiseptic.
  • Use the enclosed grid (page 44) to keep track of your skin decolonizing protocol and bring it to the hospital on the day of your surgery.

Insurance and copay information

Call 484.580.1825 for assistance. Financial counselors are available if needed (see page 2).

Pre-op considerations

During the weeks before your surgery, many people will be asking you about your insurance coverage, medical history and legal arrangements. The following may help:

  • Arrange for a “coach,” a family member or friend who will be taught how to assist you with planning, recovery and rehabilitation. This person will act as your first contact to receive information from the doctor and health care team.
  • If you have a power of attorney for medical affairs or a living will that indicates your health care decisions, you must provide copies of these documents in advance.

Dental work such as extractions or periodontal treatments should be scheduled well in advance.

  • DO NOT schedule dental work, including routine cleanings, for 60 days after your surgery.
  • The current recommendation is that one dose of an antibiotic must be taken prior to dental care for the rest of your life following joint replacement surgery. Your surgeon will give you direction at your first follow-up appointment.
  • Dental work should be avoided for two weeks before surgery.

High blood sugar, smoking, and obesity all increase the risk of infection and poor wound healing.

  • If you are a diabetic, talk with your doctor about controlling your blood sugar and managing your health to improve the healing process.

Warming up: How exercise can prepare you for surgery

We know your knee or hip pain has slowed you down and most likely kept you from being as active as you could be. But less pre-op activity often means less muscle strength—something you’re going to need in order to be ready for joint replacement surgery. All of your muscles need to be strong to support you during your recovery. Just staying active helps a lot.

Start off slow

On the following pages are detailed instructions and photos for each exercise. Get started by doing your pre-op exercises once a day (see the grid below). Make sure you do the exercises correctly and be sure to do them on BOTH legs.

Listen to your pain

If you experience an increase in pain or symptoms while doing these exercises, STOP! Listen to what your body is telling you.

Participate in physical therapy

Consider taking part in a pre-op physical therapy program. A therapist can help you with your exercises and make sure you’re moving your body safely and effectively.

Pre-op exercises

Pre-surgery exercise is an important part of the joint replacement journey.

Note: The five exercises below are the most important to do consistently up to the day before surgery.

You will perform each of the leg and ankle exercises while lying down on a flat surface, such as a couch or bed, with your legs out straight. Repeat each exercise one to two times per day. If there is any one exercise that hurts, skip it.

Remember to breathe:

  • Inhale just before you start the exercise
  • Exhale while you perform the exercise
  • Do not hold your breath. Count aloud when performing holding (isometric) exercises

Gluteal sets

  • Squeeze buttocks together
  • Hold for 10 seconds, remembering to breathe
  • Relax your buttocks
  • Repeat 10 to 20 times

Hamstring sets

  • Dig your left heel into the bed or couch. By doing so, you will feel the muscle on the back of your thigh tighten.
  • Hold for 10 seconds, remembering to breathe.
  • Relax your leg.
  • Repeat 10 to 20 times.
  • Repeat exercise with other leg.

Quad sets

  • Press the back of one of your knees down, into the bed or couch. By doing so, you will feel the muscle on the front of your thigh tighten.
  • Hold for 10 seconds, remembering to breathe.
  • Relax your leg.
  • Repeat 10 to 20 times.
  • Repeat exercise with other leg.

Ankle pumps

  • Point toes towards ceiling.
  • Bend your ankle up and down, as if you are pumping a gas pedal. You may do this with both feet together or alternating feet.
  • Repeat 20 times.

Strengthening your arms

This exercise helps strengthen your arms for walking with crutches or a walker. It makes getting out of a chair easier and is especially helpful for patients who are having bilateral knee replacements.

For this exercise you will start from a seated position in an arm chair.

  • Sit with your knees bent and feet flat on the floor.
  • Place hands on armrests.
  • Straighten arms by pushing down and raising your bottom up off the chair (if possible).
  • Hold for five seconds.
  • Slowly lower yourself back into the chair.
  • Repeat 10 to 20 times.

Seven to 10 days prior to surgery

Stop medications if necessary

Sometimes medications need to be stopped prior to surgery.

  • Refer to your surgeon’s pre-op checklist regarding your medications.
  • You CAN take Tylenol for pain.
  • If you take a blood thinner, such as Coumadin, Pradaxa, Plavix, Xarelto or Arixtra, check with the physician who prescribed your medication about stopping these medications.

Plan for at-home care after surgery

Ask yourself, who will…

  • Help me prepare meals?
  • Take me home from the hospital?
  • Take me to my doctor appointments after surgery?
  • Drive me to outpatient physical therapy sessions?
  • Have my prescriptions filled upon discharge?
  • Care for my pet while I am in the hospital?

Modify your home

  • Consider securely attaching bars or handrails in shower or bath.
  • Have a stable chair with a firm seat cushion and arm rests.
  • Consider a raised toilet seat (your social worker can help with this).
  • Physical therapist (PT)/occupational therapist (OT) will talk about any handheld items needed for individual patient discharge.
  • Remove throw rugs. They can be a tripping hazard when using a walker.
  • Place items used on a daily basis within arms’ reach.
  • Prior to discharge from the hospital, your physical and occupational therapists will advise you on what home modifications and aids you may need during your recovery.

Keep in mind that insurance does not always pay for assistive devices.

Plan for physical therapy after discharge to home

Most everyone will need to use outpatient physical therapy at some point. Talk with your surgeon about your physical therapy needs after surgery. Be sure to choose a physical therapy location that is convenient and close to home.

  • Call your insurance company for therapy coverage copay information.
  • Plan for rides to therapy until you are cleared to drive yourself.

What to bring to the hospital

Bring these items to the hospital on the day of your surgery.

  • Photo identification and insurance cards.
  • Hospital copay (if you have one).
  • Glasses with a case.
  • Copy of power of attorney documentation (if applicable).
  • CPAP or BiPAP machine with mask, if you use one at home. Write down your settings if you can.
  • Your favorite personal hygiene products.
  • Shoes with a good heel (sneakers, loafers); no flip-flops.
  • Loose fitting pants (sweat pants or shorts) to accommodate dressings/bandages.

What to leave at home

  • Tight-fitting clothes
  • Jewelry, credit cards, valuables
  • Large amounts of cash
  • Flip-flops (safety hazard)
  • Medications
  • Walkers (bring for sizing purposes only if your walker was not purchased and sized for you)

Evening before surgery

Use the pre-surgical soap as directed by your surgeon:

  • The evening before your surgery
  • The morning you come in for surgery

Review the patient education for pre-operative showers in the next section.

Patient education for pre-operative showers

Frequent hand washing and daily skin cleansing promote good health and hygiene by removing microbes (germs) that may cause infections. This is especially important if you are having a surgical procedure.

Before showering or bathing, be sure to read the instructions provided by your health care provider. If you have a dressing or cast, follow the directions for keeping that area dry.

To prepare for your surgery you will be washing with a special antiseptic soap. Hibiclens and Bactoshield are two common ones available at your local pharmacy.

These soaps consist of four percent chlorhexidine gluconate, an antibacterial compound. If you are allergic to chlorhexidine gluconate or any other ingredients listed on the bottle, do NOT use these products. Talk to your provider about an alternative.

The night or two before and the morning of your procedure, shower or bathe with Hibiclens/Bactoshield as per surgeon request.

Hibiclens/Bactoshield should replace your regular soap. Use this product as a liquid soap, applying directly to the skin and washing gently. Do not rub or scrub skin. Rinse thoroughly with warm water.

DO NOT:

  • Use Hibiclens/Bactoshield on your head, face, ears or mouth. If you plan to wash your hair, do so with your regular shampoo. Then, rinse your hair and body thoroughly to remove any shampoo residue. Wash face with regular soap and water only.
  • Use Hibiclens/Bactoshield in the genital area. Use your regular soap and rinse thoroughly with warm water.
  • Wash with your regular soap after applying and rinsing Hibiclens/Bactoshield.
  • Apply any lotions, powders, or perfumes to the body areas that have been cleaned with Hibiclens/Bactoshield.
  • Use hair removal products or shave at or near the surgical site 48 hours before your procedure.

DO NOT USE HAIR REMOVAL PRODUCTS OR SHAVE AT OR NEAR THE SURGICAL SITE 48 HOURS BEFORE YOUR PROCEDURE.