• Preparing for Surgery

  • What You Can Do to Ensure the Safest Possible Surgery

    Weight Maintenance
    Excess weight makes your surgery more difficult and places you at an increased risk of complications. Speak to your primary physician about weight loss programs.

    Eating as healthy as possible, with the right amount of fruits, vegetables, protein, whole grains, and low-fat dairy, is important for surgery. Iron is important, too. Good sources of iron include lean red meat, fortified cereals, and leafy green vegetables.

    If you have diabetes, it is important that your blood sugar is under control. Check your blood sugar daily. Also ask your doctor about having an A1C test, if you haven’t had one recently. This test measures your average glucose level over the previous few months.

    Smoking increases your risk of complications. Consider stopping now. If you would like help quitting, you can contact the California Smokers Helpline at 1-800-NO-BUTTS.

    Dental Care
    Bacteria that cause infections in the teeth or gums can travel through the bloodstream and settle in your new joint, so you should have a dental exam before surgery. You should also wait at least six months after surgery before having any dental procedures done, including cleaning. Speak to your surgeon and dentist about preventive antibiotic treatment before any procedure.

    Alcohol may interfere with anesthesia and pain medications. Don’t consume alcohol within one week of surgery.

    Signs of Infection
    If you develop a fever, infection, skin rash, cut, bite, or openings in your skin prior to surgery, contact your surgeon immediately.

    Blood Clots
    Hip and knee surgery increase your risk of developing blood clots. Tell your surgeon if you have a history of blood clots. Also let your surgeon know if you smoke, use birth control pills, or have any type of cancer.

    Use of NSAIDs
    Stop using anti-inflammatory medications (NSAIDs) 10 to 14 days prior to your surgery. These increase your risk of bleeding. Examples of NSAIDs are aspirin, Ecotrin, Advil, Motrin, ibuprofen, Aleve, and Naprosyn. You may continue to take medications that contain acetaminophen as ordered by your doctor. These include Tylenol, Vicodin, Norco, and Percocet.

    Blood Thinners
    If you are currently taking blood thinners (anticoagulants), consult your physician about how far in advance of your surgery you should stop taking them. Anticoagulants include Coumadin, Pradaxa, Plavix, Ticlid, and others.

    Presurgical Exercises

    Your leg muscles help support your knees and hips. Making them strong aids recovery. The exercises on these pages strengthen your muscles. They also increase range of motion and flexibility. Do each of these 10 times with each leg, twice a day until your surgery.

    Ankle Pumps

    1. Bend ankles to move foot up and down, alternating feet.

    Quad Sets

    1. Lie on your back with your legs extended.
    2. Tighten the muscles in the front of your thighs (the quadriceps).
    3. Keep them tight for five seconds, then relax.

    Hamstring Sets

    1. Lie on your back.
    2. Keep one leg straight, and bend the other to a height of about six inches.
    3. Tighten the bent leg by digging down and back with the heel.
    4. Hold for five seconds, then relax.
    5. Repeat with the other leg.

    Gluteal Sets

    1. Lie on your back.
    2. Squeeze your buttocks together as tightly as possible.
    3. Hold for five seconds, then relax.

    Heel Slides

    1. Lie on your back.
    2. Bend your knee.
    3. Slide your heel up toward your buttocks. Go as far as you can and hold for five seconds.
    4. Then slide your heel back down until your leg is straight.
    5. Repeat with the other leg.

    Short Arc Quads

    1. Lie on your back with a rolled towel under your knee.
    2. Keeping your thigh on the towel, straighten your knee to lift your foot off the bed.
    3. Hold for three seconds, then slowly lower your foot.
    4. Repeat with the other leg.

    Straight Leg Raises

    1. Lie in bed. Bend one leg. Keep your other leg straight on the bed.
    2. Tighten your thigh muscle and lift your straight leg as high as you can, but not higher than 12 inches. Hold for a few seconds. Slowly lower the leg.
    3. Repeat with the other leg.

    Knee Extension/Flexion:

    1. Sit in a chair with both feet flat on the floor.
    2. Slowly straighten your one leg as much as you can. Hold for five seconds.
    3. Then slowly bend your leg under the chair, bringing it back as far as you can. Hold for 10 to 20 seconds. Return your leg to the starting point.
    4. Repeat with the other leg.

    Upper Body Strengthening Exercises

    These exercises help build upper body strength. This will make using a walker or crutches easier on you.

    Seated Push-Ups

    1. Sit in a sturdy chair with armrests.
    2. With palms flat on the armrests, press down to lift your buttocks from the chair. Hold for a few seconds.
    3. Bend your elbows to slowly ease back down.

    Arm Curls

    1. Sit in a chair, with your back straight. With a dumbbell in each hand, keep your arms at your sides. Your palms should face forward.
    2. Keeping your elbows close to your sides, curl the dumbbells up toward your shoulders.
    3. Slowly, bring the weights back down

    NOTE: Use small bottles of water or cans of food if you don’t own weights.

    Pre-Hospitalization Checklist

    This checklist will help you prepare for your total joint surgery. Your surgeon and/or primary physician will decide which diagnostic tests you should have.

    • I have made appointments with other physicians if requested to do so.
    • I have made appointments to collect and store my own blood.
    • I have called San Antonio Regional Hospital for my pre-admission appointment and completed my home medications sheet.
    • I have completed pre-op labs and tests as ordered by my surgeon and/or physician.
    • I have started my presurgical nutrition and exercise program.
    • I will STOP taking aspirin, NSAIDs, or any anti-inflammatory medications on _______________________________ (date) as instructed by my doctor.
    • I will STOP taking Coumadin, Plavix, or any blood thinner (anticoagulant) medication on ___________________________ (date) as instructed by my doctor.
    • I will STOP smoking cigarettes.
    • I will bring this handbook to all surgery-related appointments, pre-admission, and on the day of my surgery.
    • I will NOT bring any valuables to the hospital.
    • I will NOT bring any of my medications to the hospital.
    • I WILL bring the following items to the hospital:
      • Glasses, dentures, and hearing aids with containers
      • Personal toiletries
      • Closed-toe, non-skid slippers or shoes
      • Loose-fitting clothes, including socks and undergarments
      • Extra clothing if I am going to a rehabilitation facility. I will be dressing each morning in my own clothing.

    Home Survey Checklist

    • Be aware of and repair any uneven surfaces inside and outside your home.
    • Remove throw rugs, phone cords, and extension cords from walkways.
    • Remove clutter and furniture so that you have clear walkways in your home that will accommodate you and a walker.
    • Prepare an area for yourself where your essentials will be close by.
      These might include:
      • A chair with armrests and a firm, raised cushion.
      • A small table for a cell phone and/or cordless phone, pitcher and glass of water, medications, reading glasses, books and magazines, television remote, tissues, laptop, etc.
    • Provide a space where your pets can be confined when you arrive home and when you are walking around your house.
    • Provide good lighting in all rooms, including nightlights in bathrooms and hallways.
    • Install safety rails in tubs, showers, and wherever additional support is needed.
    • Install safety mats inside and outside tubs and showers.
    • Use a raised commode chair over the toilet, or a raised toilet seat.
    • Choose shoes or slippers that stay securely on your feet, fit well, and have non-skid soles.
    • Avoid unnecessary and unsafe reaching by moving frequently-used items to shelves and counters that are easy to reach.
    • Make meals ahead of time and freeze; warm in microwave or toaster oven after you get home. Prepare simple meals using countertop appliances or the stovetop.
    • Purchase bed risers, if necessary, to raise the height of the bed so that the top of the mattress will be at or above your knee level.

    Blood Donation

    Donating Your Own Blood
    If your surgeon advises you to donate blood for yourself, you should schedule an appointment with the blood bank three to four weeks prior to your surgery date. If you are donating more than one unit of blood, wait about one week between donations. The phone number for the Upland Donation Center is 909.920.0625.

    Community Blood Supply
    The blood bank keeps an available supply of blood donated by community volunteers. New methods for screening donors and testing blood mean that blood is safer than it has ever been.

    Directed Donation
    If you are unable to donate your blood, you may have a friend or family member donate for you. Blood that is compatible will be set aside for your surgery. The processing and testing takes approximately seven days.

    Before Surgery

    Several Days Before Surgery
    All of these tips will help you be better prepared for surgery. They will also make returning home easier.

    • Pay bills so they are up to date through a few weeks after you return home.
    • Clean up the house, including vacuuming the carpets. Do laundry.
    • Go shopping. Buy food items and supplies that can be used after you return home.
    • Confirm how you will get to and from the hospital. You are not allowed to drive yourself home from the hospital. Assure that the passenger seat can move fully backward.
    • Confirm who will be staying with you after you return home.
    • Pack an overnight bag for the hospital. Include loose-fitting clothes, toiletries, and any personal items you will be taking with you.
    • Notify your surgeon’s office right away if you think you may have an infection of any kind (bladder, skin, tooth), or any illness or fever.
    • Do not shave your legs or cut your toenails for one to two weeks before your scheduled surgery.

    The Day Before Surgery
    Follow these instructions on the day before surgery. They’ll help to ensure that everything goes smoothly.

    • Eat small, light meals. Avoid heavy, greasy foods.
    • Shower the night before your surgery with the special soap you will be given, and put clean sheets on your bed.
    • Do not drink fluids, eat food, chew gum, or use mints after midnight before your surgery. Take any blood pressure and heart medications as directed by your doctor with a small sip of water in the morning.
    • You may brush your teeth, but do not swallow any water.
    • Have a bowel movement the night before or the morning of surgery.

    The Day of Surgery

    On the day before surgery you will receive a call from the hospital. You’ll be told the time that you are scheduled to arrive. It is important that you arrive on time. This allows the nurses and other staff to complete the necessary preparations for your surgery. Here are some DOs and DON’Ts for the day of your surgery.

    • DO take your medications with a small sip of water as instructed by your physician.
    • DON’T take your insulin unless instructed to do so by your physician.
    • DON’T take other diabetes medications unless instructed by your doctor.
    • DON’T bring anything of value to the hospital. Leave your cell phone/charger and other electronic devices with the person who brings you to the hospital.
    • DO bring respiratory inhalers for the control of asthma. If you have sleep apnea and use a CPAP at home, bring it with you.
    • DO bring your eyeglasses, contact lenses, hearing aids, and dentures if you wear them. You will be able to wear them after surgery. Please bring a case for each item. The case should be labeled with your name and phone number.
    • DO bring an overnight bag with toiletries and personal items as well as loose-fitting clothing and closed-toe shoes for your ride home.