Contents:
information improves results
understanding what is awaiting you
asking your surgeon
other sources of knowledge
preparing your body
weight reduction program
fitness program
stop smoking
infection eradication program
stabilizing your medical condition
pre-admission testing
three stages in preoperative preparation
making lists /notes
medicines to take before the surgery
medicines to stop before the surgery
how shall you pack for the hospital
" On Monday I will have my total hip
surgery. Believe me, I am scared, apprehensive, and excited at the same time. But most of
all, I’m informed and encouraged, thanks to your advice. I was always healthy before,
no contact with doctors there, so I felt only frustration and confusion the way medical
people spoke to me."
Stephen.
Many patients made the same experienced as
Stephen. Sometimes, it may be hard to know what is awaiting you.
This page is about the preparation for your
oncoming surgery. What follows are only general suggestions that may help you to make
plans for the time period before your surgery and for the recovery period thereafter.
Please feel free to adapt them to suit your needs and the routines of the hospital where
you will have your surgery performed.
In short, you should prepare both your soul
and your body for the future total hip surgery. Knowing more about what
is awaiting you will prepare your soul , being fit physically will prepare
your body for the operation.
Then you should also be medically fit for the
operation and for this purpose you will have pre-admission testing done.
1
Do the informed
patients have better operation results?
Yes!
Several studies demonstrated that patients who completed
group education classes have had less signs of stress (high pulse rates, chemical
markers of stress in blood) during their total hip and knee replacement operations than
unprepared patients.
The rehabilitation and recovery was speedier in
psychologically well prepared patients.
2
UNDERSTANDING
WHAT IS AWAITING YOU
The most important thing in the preparation for your
oncoming total hip / knee surgery is understanding what is awaiting you.
- First of all, make sure that you are inwardly ready for the
operation. If you are not prepared to go through with the surgery now, don’t. Wait
until you are sure that you really need the total hip / knee surgery. Only when you are
fully prepared and committed to go through the surgery will you achieve the best results.
Consider your oncoming total hip / knee surgery and
subsequent rehabilitation as teamwork. All modern total joint surgery is teamwork. You,
your surgeon, and the other members of his staff are all members of one great team.
Everybody in this team has a piece of work to do, you too. The responsibility for the best
result of your total hip / knee surgery is shared between you and the members of the
team.
3
Asking your
surgeon
Each patient is an individual. Even if the joint disease
is identical, osteoarthritis, e.g., the impairment vary from patient to
patient. There are questions about the operation that only your surgeon can answer
reassuringly.
If you wish to know more about the questions to ask your
surgeon, please
4
Other
sources for more knowledge:
Group education classes -
Group education sessions are usually a practical solution
to your need of preoperative education before a total joint surgery. Here is how one
patient described it:
"On this education session our teachers explained
to us what will be happening and they wanted me and all others to speak if we
don't understand something or want something. What a difference! We have not only had a
2-hour class to have the whole procedure explained, we get several informational booklets
to read and make annotations, we have had a 15 minute VCR tape, and we get a fanny pack to
carry things in when we will be on crutches. We also get numbers to call at the hospital
if we will think of any question to ask. We get food and juice and were encouraged to eat
and drink more because some of use were giving blood this morning. After this
session I felt like a "significant" part of the entire process of my
rehabilitation.
The entire atmosphere of the class was pleasant, caring
and relaxed. I am now feeling in charge of my own destiny and as if no question was too
small or stupid to ask. Now I know that I can get through my surgery" .
In my opinion, you should attend, if possible, an
education class.
Books
" There are a couple of great books to read -
available at the library - on total hip and knee replacement. I felt, after reading these,
that I could have performed the surgery myself, and it gave me the feeling of having great
control over what was happening. My total hip surgery has been complete success "
Marianne
Go to the library or a good friend and loan a good book on
total joint surgery, such as
Arthritis of the Hip and Knee: The active Person's Guide to
Taking Charge, by RJ Allen, D Stulberg, and VA Brander
A Patient’s Guide to Knee and Hip Replacement:
Everything You Need to Know, by I. Silber and E. Wolf.
Information on Internet
Other sources of easy information on total joint operation
are the web sites. One thing about these sites is sure: whereas their numbers increase
steadily, their quality does not.
Besides, when you punch a keyword like "total hip
replacement" on the popular seeking machines (yahoo, google) you will get more than
100 000 hits. Can you ever evaluate such information avalanche?
The web sites owned by big manufacturers of artificial
joints provide often good patient information about the products and about the surgeons
who work with them. Remember, however, that the information is highly selected in favor of
the advertised product.
The web sites set up by patient support organizations.
You will get not only the personal opinions of other patients there but also a
compassion from the fellow patients who were through it.
What about the enthusiastic recommendations for a new total
joint model made by patients on these web sites?
Remember, that every patient is an individual. There is no
guarantee that a total hip model that is performing so well in your neighbor will perform
equally well in your case. In every case, it is worth to discuss the pros and cons of such
total joint models with your surgeon.
For more facts about the patient information on Internet,
please
5
PREPARING
YOUR BODY
the goal is to make you maximally fit for the
surgery. There is, however, one problem: your aching joint may not allow you too much
preoperative exercise. In that case, don't torture yourself.
There are several areas, where you may improve
your fitness.
6
Weight reduction program, do I need it?
There is one obvious reason for weight-reduction - reducing
body weight decreases the load on the newly operated joint. Remember that the load acting
on your hip or knee joint surface during walking is about three times your body weight,
and this force increases with the walking speed. So every kilogram less of body weight
reduces the load on your hip or knee joint with between three and eight kilograms.
If you wish more information on overweight and its
influence on the total joint replacement please
7
Fitness and condition program, do I need it?
You should establish a regular exercise routine to
increase the general strength and fitness and the strength of the muscles
across the damaged joint. Ask your doctor and your physiotherapist for a program adapted
to your needs and also to your capabilities.
Remember: surgery put stress on your body, the better
preoperative condition you are in, the better you will be able to withstand this stress.
Better preoperative condition will also make any post-surgical rehabilitation you will
have to do far easier than it would be starting from scratch.
Patients with arthritic joints usually avoid to use the
joint which causes them great pain when it is moved. Over time, the muscles acting across
such painful joint become weak to the point that moving of the joint becomes pure torture
and the patients then consequently avoid to use painful joint - a vicious cycle is thus
established. There is no idea to torture such painful joints with exercise just
before your total joint surgery.
The total joint operation that relieves the joint pain will
also break this vicious cycle. Only after such operation you can start a consequent and
vigorous postoperative exercise program.
8
Stop smoking
Smoking produces more complications after the total hip and
knee surgery. Statistics demonstrated that:
Smokers have had three time more failures of total hip
replacement than non-smokers. Smokers also have had up to ten times more heart and lung
complications after the total hip and knee surgery, and about six times more wound healing
complications than non-smokers
Studies have shown that smoking patients who ceased
smoking 6-8 weeks before the surgery experienced much less postoperative complications
compared with patients who continued to smoke until the day of the surgery (Moller 2002)
9
Infection eradication program, what is it?
If you have any known focus of infection in your body, it
is now time to eradicate it. Otherwise, bacteria from this focus may travel in your blood
and infect the newly operated artificial hip.
The focus may be a chronic infection in the urinary bladder
from enlarged prostate, teeth infection, or deep infected leg ulcers.
Consult your doctor to start a program to eradicate the
centers of infection in good time before your surgery.
All dentistry work that produces bleeding should be
finished in good time before the contemplated surgery.
There are also certain preoperative precautions that can
help you to reduce the risk of post-operative infection. It is mostly common sense: avoid
doing anything that could produce open wounds on your legs and arms that are always
potential gateways for infections.
For example, take extra care when you are trimming
toenails, so that you don’t nick the skin and produce a small bleeding wound. Through
such small wounds the bacteria may wander uphill and produce postoperative infection in
the newly operated joint. And don’t prune the rosebushes the week before your
operation.
10
Stabilization of your medical condition, what is
it?
The two medical conditions which most often force the
anesthesiologist to postpone a scheduled total hip replacement are high blood pressure and
high blood sugar values. So if you have one of these diseases, arrange for continuing
control and treatment in good time so that the conditions will be stabilized at the time
for your surgery.
11
PRE-ADMISSION
TESTING
Many hospitals have
pre-admission testing programs. You should be brought for testing usually two weeks before
the scheduled surgery to check your blood, urine, and general physical condition.
All these tests should tell your surgeon and your
anesthesiologist whether you have any condition that might increase the risk of your
surgery. This is called "pre-admission testing".
Abnormal tests do not necessarily mean that your surgery
will be cancelled. Your surgeon has two weeks for further evaluation, for repeated
testing, or for a short term treatment. This is for your safety.
An anesthesiologist will have time to perform tests and
evaluate which kind of anesthesia is appropriate for you.
All patients aged 50+, and all patients below that age with
any history of cardiac or respiratory disease, are usually required to have a chest X-ray
and electrocardiogram examination done less than 4 weeks before the surgery. With abnormal
findings, there is time for further evaluation.
The same applies for cases of bad flu and other seasonal
respiratory infections that may occur just one or two weeks before the scheduled surgery.
The symptoms may disappear just in time before the surgery, but it depends on your surgeon
and anesthesiologist to assess the risks.
12
STAGES
IN YOUR PREPARATION
You may divide the time period for your surgery into
stages:
3 - 6 months before the operation
Start to learn what to expect before, during, and after
surgery
Start Weight reduction program
Start Fitness and condition program
Start Infection eradication programs
Start Stabilization of your medical condition (diabetes,
blood pressure)
Start accommodation of your house/flat
6 - 2 weeks before the operation:
Arrange autologous blood donation
Make concrete plans for recovery period after discharge
from hospital Arrange for transportation to and from the hospital
Set up a "recovery station" at home
Prepare things to take with you to the hospital
2 weeks before the operation:
Definitive / Last pre-operative check -up. This check
includes:
X-ray, EKG, Laboratory tests, Medical assessment, last
control and changes in your current medication.
Some of the lab examinations should not be older than 2
weeks when you come in the hospital, so you need your "2
weeks" control. Other examinations, such as X-ray pictures, EKG, etc, may be older.
Ask always your surgeon.
13
MAKING
LISTS
Already months before your surgery, you should make plans
for your hospital stay and for the recovery period after your return home.
I will suggest that a very good approach to this planning
is making lists. Written annotations and check lists will help to organize your activity.
You will probably need at least four check lists:
On this list you just write all questions regarding your
pre-admission care (what you should do and prepare before you will be admitted to the
hospital)
questions about your oncoming surgery and recovery at the
hospital,
questions about your care after returning home.
Keep these questions conveniently in a notebook with you.
- List of your medicines and previous diseases.
Throughout your preoperative care and in the hospital,
nurses and doctors will be repeatedly asking you what medicines you take. Thus make a list
of all medicines you take just now - be generous and include also over the counter
medicines, vitamins, and nutritional supplements. Prepare also a directory of all
medicines you have ever taken that caused allergies (rashes, breathing, and bowel
problems). Have this list handy.
- Appointment schedule list
You will have several appointments for pre-admission lab
tests, X rays, blood donations, preoperative education classes. Keep yourself organized
and include these appointments in a list or a diary. Of course, you include also all your
appointments with your doctors (rheumatologist, anesthesiologist, and any other doctor
that will see you before the surgery).
Plan ahead for your care after surgery. This list should
include people who will be able to assist you for your travel to the different
appointments, to the hospital admission, who will be able to stay with you and help you
after the discharge from the hospital.
14
Which medicines should I take before my surgery?
You will usually need to take iron supplements prior to
your surgery if you have donated your blood. These are usually non-prescription
preparations.
15
Which medicines should I stop taking before my
surgery?
You will be inquired by your surgeon and your
anesthesiologist about the medicines you are currently taking. You will be instructed
which medicines you should stop and how many days prior to your surgery you should do it.
Some of the medicines that should be stopped before total joint operation:
Anti-inflammatory medicines, such as NSAIDs or aspirin,
increase bleeding in the operation wound and should, generally, be discontinued two weeks
prior to surgery. Always check, however, with your surgeon. At the same time , ask
your surgeon for prescription of pain relieving medicines that you may use until the day
of your surgery
Blood thinning medications such as Coumadin should be also
discontinued prior to surgery because they may cause excessive bleeding.
Observe, however, that some patients need permanent
medication with blood thinning medicines. In these patients, the Coumadin medication
is usually replaced by other substances (heparin like substances), with better
controllable blood thinning effect, for the time of surgery. The whole procedure must be
supervised by your doctor.
16
How shall I pack for the hospital stay?
Clothing
Most hospitals supply the patients with gowns, robes,
non-skid slippers, and usually a personal hygiene pack with soap, tissues, comb, and a
toothbrush. If you still wish to have your own clothes, be sure that they are comfortable
and loose fitting. Remember that they should allow easy access to the hip / knee since
this area is checked frequently. For physical Therapy sessions shorts are popular. Use
cotton made clothing, avoid all clothing made of nylon - they are uncomfortable when you
are in bed.
Footwear
Tennis shoes are ideal, but any flat shoe, closed back,
with a non-skid sole is appropriate for the post-operative period.
Toiletries
Take with you deodorants, combs and other items according
to your personal wish
Other equipment
Bring with you all crutches, walkers, and other items that
you will use post-operatively
Before you take any action, please read
carefully the Disclaimer.
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