What to expect pre-operatively

Scheduling Your Surgery

Based on the surgical schedule, you may either receive:

• A confirmed date
• A general month for planning ahead

If your surgery is scheduled for a later month, a clinic nurse will contact you closer to that time to confirm your date and review preoperative instructions.

If you need to cancel or reschedule, please notify us at least one month in advance. Operating room time is limited, and late cancellations prevent other patients from being scheduled.

Pre-Surgery Checklist

• Schedule and complete your Primary Care Provider (PCP) clearance and any specialist evaluations.
• Complete all required blood work and EKG.
• Stop restricted medications as directed (see pre-op packet for detailed list).
• Use a simple nasal treatment and special body wash to clear away common skin germs, which is one of the safest and most effective ways to protect you from getting a surgical infection.
• Arrange transportation and 24-hour assistance for the first day after surgery.
• Avoid eating after midnight before surgery. You may drink only water up to 2 hours before your arrival time.
• Bring your ID and necessary paperwork on the day of surgery.

Before Surgery

You must receive surgical clearance from your Primary Care Provider (PCP), which includes an EKG and a review of your medications and overall health.

If you see any specialists (such as cardiology, pulmonology, or endocrinology), they should also provide clearance if you are currently under their care.

You will have a preoperative appointment with your surgeon within 30 days of surgery to review your paperwork, surgical plan, and any final questions.

Testing and Labs

We will order preoperative tests which may include: CBC, CMP, Hemoglobin A1c, fructosamine, Vitamin D, EKG, CRP and ESR (for revision cases), and a chest X-ray only if you have a history of lung issues or prior abnormal findings.

Most results are valid for 45 days before surgery.

Medication Instructions

In general: Stop certain medications (blood thinners, aspirin-based drugs, NSAIDs, and GLP-1 agonists) prior to surgery. Some medications, like diabetic drugs, may need to be held the morning of surgery. You will receive detailed medication instructions in your preoperative packet or at your PCP/Anesthesia appointment.

Day of Surgery

• Do not eat after midnight the night before surgery.
• You may drink only clear liquids until 2 hours before your arrival time.

Many joint replacements can be performed as same-day procedures, meaning you will go home the same day.

Recovering at home promotes better rest, nutrition, and lowers infection risk. You must have someone drive you home after surgery and ideally stay with you for 24 hours.

If you have certain medical conditions, an overnight stay may be arranged in advanced.

After Surgery

Some pain after joint replacement surgery is expected. Most patients do well with a multimodal pain control plan, which includes acetaminophen (Tylenol) on a scheduled basis, anti-inflammatory medication (NSAID) such as ibuprofen (Motrin) or celecoxib (Celebrex) if permitted, gabapentin for nerve-related pain (typically avoided in patients over 70 due to risk of drowsiness and falls), a short course of opioids (like tramadol) and non-opioid (like journvax) prescription pain medication for breakthrough pain.

Opioids like tramadol can cause constipation quickly, so eat well, stay hydrated, and use a stool softener daily while taking narcotics. Use narcotics only as needed and taper off as soon as possible, ideally within the first 1–2 weeks after surgery.

Avoid alcohol and driving while taking pain medications (tramadol and gabapentin).

If pain remains severe after 2 weeks, contact the office to discuss adjustments.

Postoperative Appointments and Follow-Up

Our office will schedule your first postoperative appointment at your preoperative visit. We may also schedule your second postoperative visit if the schedule allows. If not, you can schedule it after your first appointment.

Additional follow-ups may occur at 3 months, 1 year, and 2 years depending on the type of surgery performed. X-rays may be obtained at certain visits to monitor healing and implant position.

Appendix: Surgical Risks and Factors to Consider

The goal of total hip or total knee arthroplasty is to reduce pain and improve function. All surgeries carry risks. Understanding these risks helps you make an informed decision and recognize problems early.

General Surgical Risks

• Infection: superficial skin infection or deep joint infection. May require antibiotics, additional surgeries including irrigation and debridement, or staged revision.
• Bleeding/hematoma: some bleeding from surgery is expected. This rarely requires return to the operating room or need for blood transfusion.
• Blood clots (DVT/PE): can develop in your legs and risk traveling to your lungs, resulting in pulmonary embolism, difficulty breathing, and even death. Prevention includes early mobilization and medication.
• Nerve or vessel injury: usually temporary irritation; rarely permanent injury.
• Stiffness: may require extended physical therapy; in rare cases, manipulation or arthroscopic release.
• Wound-healing problems or drainage: may prolong recovery and increase infection risk.
• Complex Regional Pain Syndrome (CRPS): rare, characterized by prolonged pain and swelling; treated with therapy and medications.
• Anesthesia risks: nausea, sore throat, dental or lip injury, medication reactions; rare serious events (heart attack, stroke, pneumonia, death).
• Persistent pain or incomplete symptom relief: some patients have ongoing discomfort despite a well-performed surgery.
• Reoperation: occasionally required to address complications or persistent symptoms.

Total Hip and Knee Arthroplasty–Specific Risks

• Instability/dislocation: more common early after surgery or with certain positions of the hip.
• Infection: may require staged revision and prolonged antibiotics.
• Component loosening or wear over time (polyethylene wear): may require revision surgery in the future; less common with modern polyethylene.
• Periprosthetic fracture: during or after surgery; may require immobilization or additional fixation.

Patient-Specific Factors That Increase Risk

• Chronic anticoagulation or bleeding disorders: higher bleeding and hematoma risk; medication plans are individualized.
• Diabetes or elevated A1c: higher infection and wound-healing risk; good glucose control improves outcomes.
• Smoking or nicotine exposure: worsens blood flow, increases infection risk, and impairs healing.
• Chronic opioid use: makes postoperative pain more difficult to control; tapering plans may be recommended.
• Obesity or poor conditioning: increases risks of anesthesia, infection, component malpositioning, and poor wound healing; may prolong rehab.
• Osteoporosis/low bone density: higher risk of fracture or fixation loosening.
• Metal sensitivity (e.g., nickel) or adhesive allergies: alternative materials and dressings may be used.
• History of lymphedema or prior infection: requires special precautions and may limit IV placement or blood pressure cuff use.
• Autoimmune disease or immunosuppression: higher infection risk; medication timing may need coordination with your specialists.
• Sleep apnea: higher anesthesia risk; bring your CPAP the day of surgery if instructed.

Most patients do very well after joint replacement surgery. Clear communication, good nutrition, nicotine avoidance, glucose control, and adherence to restrictions and therapy improve the odds of a smooth recovery.

Thank you for trusting us with your care. Please reach out if you have any questions before or after surgery — we’re here to help every step of the way.