Plan your surgery

4 weeks

• Become familiar with your joint anatomy. You may find it helpful to understand your joint anatomy and read answers to common questions.

3 weeks

• Store frequently used items in easy to reach cabinets, such as cleaning supplies and canned foods. Avoid very high or very low shelves as these may require you to use a step stool or kneel.
• Make and freeze meals or stock up on frozen dinners before surgery so that meal preparation is easier and requires less effort. You may want to make a list of items you will need to prepare meals and go to the supermarket. You should plan on making enough meals for one week or so.
• Contact friends/family for support. Friends/family may be needed to assist with activities such as driving and moving items in your home for safety. The Arthritis Foundation also has a support network that can provide emotional support. You can contact your local chapter or go to the Arthritis Foundation web site (www.arthritis.org) for more information.
• Check the safety of your home to prevent falls or tripping. Move long electrical and telephone cords against the wall, remove rugs, and place a non-skid mat in your bathtub. You may want to prepare a bed in the downstairs level of you home to reduce climbing stairs. Have an elevated chair or high seated chair with arms in every room if possible.

2 weeks

• Anti-inflammatory medications - your physician may not want you to take any aspirin or non-steroidal anti-inflammatory medications (Advil, Ibuprofen, Motrin, etc.) for the 14 days before surgery. You may be able to take Tylenol or medicines with acetaminophen. Be sure to discuss this with your physician.
• Purchase or borrow the special equipment your physician recommends. This may include an elevated commode and small devices such as a grabber. You can find these items at most hospital supply sections of large drug stores or in mail order catalogues from department stores. Practice using the items at home.

1 week

• Anti-inflammatory medications - your physician may not want you to take any aspirin or non-steroidal anti-inflammatory medications (Advil, Ibuprofen, Motrin, etc.) for the 14 days before surgery. You may be able to take Tylenol or medicines with acetaminophen. Be sure to discuss this with your physician.
• Write down all of the medication you take, the dose, and how often. You will want to take this with you when you pre-admit at the hospital.
• Pre-register at the hospital. Your surgeon may suggest that you pre-admit to the hospital typically three to nine days before your surgery. Your insurance will be verified and depending upon your surgeon's instructions, you may have lab work, x-rays, and an EKG. You may want to plan at least 2 1/2 hours to complete the visit. Check with your surgeon to see if an appointment is necessary. You may receive a breathing exerciser. The nurse will review written directions for the exerciser with you. Bring a list of the medicines you are currently taking; this includes the name(s) of the medicine, the dose(s), and how often you take the medication. If you have blood slips from blood you or your family have donated, bring the slips with you and give them to the nurse in the Admissions Area. You may also see someone from the anaesthesia department to discuss anaesthetic.
• Manage finances. You may want to balance your cheque book, pay bills, make arrangements to board pets, and stop the delivery of your newspaper. If you are going to a rehabilitation facility after being discharged from the hospital, you can ask you local post office to hold your mail until you return home.
• Contact local supermarkets and pharmacies. Some supermarkets and pharmacies provide delivery services to your home. This may make mobility after surgery more convenient. Call supermarkets and pharmacies to see if they provide delivery services and if they charge a fee.
• Go to the supermarket. Make a list of the items you may need once you return from the hospital and purchase these items or arrange for the supermarket to deliver these to your home. If you are going to a rehabilitation facility after your hospital discharge, you will need to make arrangements for someone to drive you to the supermarket or do your shopping for you.

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• Anti-inflammatory medications - your physician may not want you to take any aspirin or non-steroidal anti-inflammatory medications (Advil, Ibuprofen, Motrin, etc.) for the 14 days before surgery. You may be able to take Tylenol or medicines with acetaminophen. Be sure to discuss this with your physician.
• What to bring to the hospital. Below is a list of things you may want to bring with you to the hospital in preparation for your surgery. Talk with your physician as he/she may have additional information about preparing for your hospital stay.
• Your personal belongings should be left in the car until after surgery. Tell your family that your room will be assigned when you are in surgery or in recovery, at which point they can bring your personal items to your room.
• Personal grooming items that you may want to pack include a toothbrush, toothpaste, hairbrush, eyeglasses/contacts, comb, deodorant, shaving cream/electric razor, shampoo, lotion, undergarments, and a robe.
• Bring slippers or flat rubber-soled shoes for walking in the hallways.
• Bring loose fitting clothing for your trip home.
• Bring any medications you are currently taking. You should also write down your medication information to be given to the hospital staff. Be sure to include the name, strength, and how often you take the medication. Please communicate any allergies you might have to your doctors and the nursing staff.
• If you use a breathing exerciser (IBE), be sure to bring it with you from home, as you will probably need this right after surgery. Check with your physician about this.
• Leave jewellery, credit cards, car and house keys, cheque books, and items of personal value at home. Bring only enough pocket money for items such as newspapers, magazines, etc.
• Eating or drinking after midnight may or may not be allowed by your surgeon (not even water) the night before your surgery. Check with your physician about this. Your anaesthesiologist may prescribe a medication for you to take the evening before surgery.
• Arrival at the hospital - you should report to the hospital at least two hours before your scheduled surgery. The nurses will complete your preparation for surgery and will likely review your care following surgery.
• About your surgery - you may want to read an overview of your procedure.

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• How you will feel after surgery - be sure to ask your physician how you may feel after surgery. You may be nauseous, dizzy, weak, experience loss of appetite, and have constipation. You will probably experience a level of pain, and patients usually have marked improvement in a few days after surgery.
• First meal after surgery will likely be ice chips and clear liquids and will progress to solid foods as tolerated. Check with your physician about your first meal.
• Self-care after surgery - a catheter may be in place after surgery. It is normally removed when you can get out of bed to the bedside commode or rest room; you can feed yourself, and can bathe your face and upper body. Your bandage will probably be changed once or twice a day.
• Visitors after surgery - typically you are allowed visitors once you have been moved from the recovery room and into your own room. If you would prefer not to have visitors, please tell the nursing staff so they can communicate this to potential visitors.
• Your hospital stay - your surgeon will visit you and your physical therapist will begin post-op exercises. Your pain may be managed with shots or pills.
• Self-care - a bedside commode will probably be available until you are able to walk to the restroom. Walking to the restroom will build your strength and prepare you for discharge home. You can bathe yourself with a little help around your surgery area.

Discharge from the hospital

• You will be discharged from the hospital when your physician feels the time is right, this is typically five days after surgery. You will need to make arrangements for someone to drive you home from the hospital, as you will not be able to operate an automobile. You will also want to wear comfortable, loose clothing to avoid pressure on the incision area. Your therapist will review how to get in and out of a car.
• Transfer to a rehabilitation facility. Depending on your situation, your physician may recommend that you be transferred to a rehabilitation facility after you are discharged from the hospital. You may be there a few days so you can begin physical therapy and your health can be monitored.
• Fill pain medication prescription. Your surgeon will probably give you a prescription for pain medication. You will probably need less each day but you may need them at night for a few days. Check with your physician. Do not drink alcoholic beverages while you are taking pain medication. Some people find that Tylenol and aspirin will relieve their pain. A local pharmacy may deliver these to your home.

Once you are home

• It is very important that you follow your surgeon's instructions. The following suggestions should be discussed with your surgeon before your hospital discharge:
  • If you will be using a walker or crutches to assist with walking, ask your doctor how much weight you may put on your operated joint.
  • Remember that you will probably tire more easily than usual. You may want to plan a rest period of 30 to 60 minutes mid-morning and mid-afternoon.
  • It is safer and easier to get in and out of chairs using both arms and you should avoid low or overstuffed furniture. To increase your comfort, use a cushion or pillow to raise your body while seated.
  • An elevated toilet seat may reduce stress to your hips and knees as you sit and stand.
  • A shelf placed in the shower at chest height may reduce having to bend to retrieve items.
  • A bathtub seat (bench) allows you to sit while bathing for increased safety and comfort. A long-handled bath sponge may be used to reach lower legs. Women can also purchase razor extenders to shave their legs.
  • Avoid sweeping, mopping, and running the vacuum cleaner. Use long-handled feather dusters for dusting high and low items. Your doctor will tell you when it is okay to sweep, mop, and vacuum.
  • You may ride in a car, but you must follow your doctor's instructions for how to get in and out of the vehicle. You can raise the height of the car seat with pillows to protect your hips and knees as well.
  • Your doctor will talk with you about when you can drive, typically within four to six weeks after surgery. If you have a car with manual transmission, talk with your doctor about driving limitations. Make sure you can brake the car without discomfort before you attempt to drive in traffic.
  • Constipation is a common problem for patients following surgery. This is usually due to your limited activity and any pain medications you may be taking. Discuss your diet with your doctor. It should include fresh fruits and vegetables as well as eight full glasses of liquid each day, unless you doctor tells you otherwise.
  • Your doctor will probably give you a prescription for pain medication. Please follow your doctor's instructions concerning these medications.
  • Some swelling around the incision is normal. You will find it more comfortable to wear loose clothing to avoid pressure on the incision. Ask you doctor or other qualified health professional about appropriate wound care.
• Eat well-balanced meals for healing purposes.
• Wound care - in some cases, when you are discharged your bandage will be removed and may be replaced with a smaller bandage. You will want to change your bandage as recommended by your physician, which is typically once a day. Call your physician if you notice any signs of infection.

1 Week

• Visitors - you may want to wait a few days after you are home from the hospital/rehabilitation facility to give yourself an opportunity to rest and become comfortable in your home setting.
• Schedule post-op appointment - if your post-op appointment has not already been scheduled, call your surgeon's office a day or two after you are home from the hospital to set up your post-op visit, which is typically two weeks after your surgery.

3 Weeks

• Post-op appointment - the nurse or physician's assistant will take your blood pressure and temperature. Your surgeon will examine the surgery area checking for any signs of infection. Your stitches/staples will likely be removed as well. Your range of motion will also be examined and you will review your physical therapy instructions. You will want to wear comfortable, loose clothing. You will likely return for follow-up appointments at three months, six months, and one year post-op. You will probably return once a year thereafter.

4 Weeks

• May be able to resume driving a car - you will need to talk with your physician, but normally, you can resume driving four to six weeks after surgery. If you have had a knee replacement, it may be longer before you can drive. If you have a car with manual transmission, talk with your doctor about limitations on driving. Make sure you can use the brake of the car without discomfort before you attempt to drive in traffic.

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