Day of Surgery

Patients usually arrive on the morning of the scheduled surgery, usually two or three hours before the scheduled time of surgery in order to allow enough time for check-in, getting an IV started, and checking over necessary preoperative lab work and information. The process is similar for all types of joint surgeries, including joint replacement and resurfacing.

Early Admission

Some patients have to be admitted a day or two before surgery because of special medical conditions. The most common cause for this is usually anticoagulation that cannot be stopped (such as for a patient with a mechanical heart valve, who must have the blood thinned at all times). In that case, the patient arrives and is placed on heparin while the warfarin wears off, and then the heparin is shut off a few hours before the surgery.

Patients who require admission prior to the day of surgery typically have a serious co-existing medical condition that necessitates the early admission. This typically also requires prior approval from their insurance company for the early admission.

Same Day Admissions

The majority of elective hip and knee surgery patients arrive the morning of surgery. After checking into the surgery area, a nurse will meet with you and escort you to the preop holding area. Friends and family can visit with you there up until it is time to actually go to surgery.

In the holding area, the nurse will help you get changed into a hospital gown and collect your belongings. These are usually rounded up and placed into bags so that clothing and belongings will be waiting for you upstairs in your room after surgery. It is generally a good idea to leave any valuables, such as rings, watches, or jewelry, at home or with a family member.

Dentures are collected and placed into a container right before surgery, so that they will not be lost and also because it is important that dentures be removed so that they will not interfere with anesthesia (even if you are having a spinal, in case intubation is needed).

If you normally wear contacts, leave them out on the day of surgery and use your glasses instead.

It is also a good idea not to wear any nail polish, because it can interfere with oxygen monitors that may be fitted over your finger.

Please do not shave or wax any surgical sites prior to surgery. Some patients try to do this before arriving, and it actually increases the risk of infection through tiny breaks in the skin. I have had to cancel surgeries when patients (trying to be helpful) waxed their surgical site the day before surgery. If necessary, the nurse will use electric clippers for the surgical area. The side that is being operated on usually will also be painted with an anesthetic scrub.

Preoperative Holding Area Interviews

The nurse will have a short interview with you to go over medications and any recent changes in your health. Do not be surprised if multiple people ask you why you are here and what joint is being operated on; it is not that they forgot or did not know, but there are several check-points scripted in to double-check on the surgery and surgical site. In fact, at our hospitals we ask all patients to mark the surgery site themselves with a marker just prior to surgery.

Next the anesthesiologist will meet with you to discuss the anesthesia and answer questions. The anesthesiologist will have some questions as well in a short interview. In general, we prefer spinal anesthesia if possible for joint replacement surgeries as it is safer and usually more comfortable for the patient, and this is discussed in the next chapter. As the anesthesiologist will explain, a spinal does not mean that you have to be awake for the procedure, and there is almost no chance of neurologic injury from most spinals despite many misconceptions that exist about spinals and epidurals.

Finally, the surgeon comes by to answer any last minute questions and check to see that your health has not changed since you were last seen. If the surgical consent form has not yet been signed, this will be filled out at this time. It is a good time to ask any questions that you might have remembered or formed in the day or two before surgery.

To learn more about Joint Replacement Surgery or to make an appointment, please call us at 203.598.0700.

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