Day of Surgery
Unless you have to be admitted a day or two before surgery because of special medical conditions, you will need to arrive on the morning of surgery two to three hours before your scheduled procedure time. Leave any valuables, such as rings, watches, or other jewelry, at home or with a family member.
If you normally wear contacts, leave them out on the day of surgery and use your glasses instead. You will also have to remove your dentures right before surgery. In addition, you should refrain from wearing nail polish because it can interfere with oxygen monitors that may be fitted over your finger.
Finally, you should not shave or wax any surgical sites prior to surgery, as this increases the risk of infection through tiny breaks in the skin.
After checking into the surgery area, a nurse will meet with you and escort you to the pre-op holding area, where you will change into a hospital gown. He or she will collect your belongings, which will be waiting for you in your hospital room after surgery.
The nurse will review your pre-operative lab work, current medications, and any recent changes in your health. He or she will start an IV.
Next, the anesthesiologist will meet with you to discuss the anesthesia, ask you some questions, and answer any questions you might have.
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.
In general, we prefer spinal anesthesia (also known as a spinal block) if possible for joint replacement surgeries as it is safer and usually more comfortable for the patient. A local anesthetic will be injected into the lower portion of the spine, which numbs and paralyzes the lower half of the body.
Spinals are effective for surgeries lasting several hours or less, which is usually more than enough time for most hip and knee replacement surgeries.
Having a spinal does not necessarily mean that you will be awake during surgery. You will be offered the opportunity to receive a mild sedative with the spinal so that you are asleep during surgery and wake up in the recovery room.
Revision and complex surgeries usually last longer and may require a different type of anesthesia. An epidural is similar to spinal anesthesia except for the placement of the injection and the length of time it lasts. A catheter may be left in place to allow for continuous anesthesia for as long as needed.
Not all patients are good candidates for spinal or epidural anesthesia. Certain patients may require general anesthesia, or going “completely under,” which requires the placement of a breathing tube and having the ventilator machine breathe for them while they are asleep.
When it is time for surgery, you will be taken from the pre-op holding area to the operating room. If you are having spinal anesthesia and have elected to receive sedation, it will be administered through the IV prior to the spinal block. If a urinary catheter is to be used (typically only for bilateral or revision surgeries), it is inserted after anesthesia.
The time required for a particular surgery varies depending on the surgical approach used and size of the patient. Some joint replacements take an hour or less in thin patients while joint replacement for obese patients, complex joint replacements, or joint revision surgeries may take significantly longer.
After surgery, you will be taken to the recovery room, or PACU (post-anesthesia care unit), until you are fully awake, moving your toes and feet, and your blood pressure and other vitals are stable. You will also have X-rays to check on the hip or knee placement before being taken to your hospital room.