Preparing For Surgery

Your orthopaedic surgeon has the expertise to replace your worn and damaged joint, but you have the most important role to play in your surgery and recovery.

You must prepare to achieve the best possible outcome from your surgery. Here is what you can do to get ready for that big day:

Follow your orthopaedic surgeon’s recommendations
- Your surgeon and his office give you specific instructions to follow that are important to your health and safety leading up to and including your surgery. Not following these recommendations can cause your surgery to be cancelled at the last minute or unnecessary complications to happen.
Maintain or improve your fitness level and your joint range of motion – maintain strength and mobility.
- The healthier you are going into the surgery, the more efficient your recovery will be.
Maintain or attain a healthy weight.
- People who are overweight have a higher risk for complications after surgery.
Have any dental work done.
- Having dental work done before surgery reduces the risk infection after surgery. This is especially true for major dental procedures.
Learn about your surgery.
- Seek out information and ask questions, however, be careful to ensure that the information you review is credible.
Talk to people who have had a similar surgery (visit Orthoconnect).
- People’s experiences can ease your mind or worry, but be sure to remember that everyone is different and that not all people have the same interpretation of their experiences.
Prepare yourself and your home:
- Stock the freezer with quick and easy to prepare meals.
- There are many things to do around your home in preparation for surgery, making easy meals for yourself, and setting up a bedroom on a main floor are some examples of things that are helpful in easing your transition from hospital to home. Your therapist will assist you in determining what needs to be done to get your home environment ready ahead of time.
Quit smoking at least two weeks prior to surgery to reduce complications and aid soft tissue and bone healing.
- Smoking is a lifestyle habit that is difficult to change, however your risks of complications are greatly reduced if you do not smoke. Consider your options and talk to your family doctor about quitting smoking as there are many methods to help you succeed.
Find out how long you may require outpatient physiotherapy and locate a physiotherapy facility close to home. (Manitoba Physiotherapy Association website)
- In Manitoba, access to physiotherapy services beyond those offered to you in the hospital is variable. However, there are many ways to obtain the rehabilitation you require. Be sure to discuss your needs and services with your therapist before and during your hospital stay.
Find out what, if any, assistive equipment you’ll need to rent/purchase.
- Things you can do now and will be able to do again may be difficult for a while after surgery. You will need an assistive walking device such as a cane or walker and other equipment such as a shower chair, grab bars and raised toilet seats. Talk to your therapist about these devices and how to arrange to get them.
If your recovery involves not bearing weight on your limb, consider practicing using crutches or a walker to test your ability to comply with the requirements during your recovery. If you are not able to remain off of your affected leg, you may need to prepare to have more help, such as a wheelchair or assisted-living environment to recover until you are told that you may put full weight on your leg again.
Arrange any supportive care (including a driver), if needed, in preparation for discharge from hospital.

There are a variety of non-surgical treatment options that should be considered before proceeding with a joint replacement.

Weight Loss

For both the hip and the knee, the forces acting across the joint are a combination of body weight pressing down on the joint and the muscles pulling up to stabilize the joint. As these values combine, the hip and knee experience 3-4 times the body weight in pressure with each step. Loosing excess weight reduces the pressure on damaged joints and can relieve pain.

Physical Therapy

By stretching, strengthening and re-balancing the muscle- forces across the joint, the movement and control of the joint can be improve. Pain can also be improved with therapy in addition to the mobility of the joint.

Acetaminophen

Acetaminophen (Tylenol) containing products can be very useful analgesics in arthritis. Given its low cost and good side effect profile, it is a good first-line drug for treating arthritis. It should be avoided in some patients with a history of liver disease and care should be taken not to exceed the total daily dose of 4gm per day. This is especially true when a patient takes multiple different medications that contain acetaminophen.

NSAIDs

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are medications that block the COX receptors on cells and reduce inflammation which can play a significant role in both osteoarthritis as well as other inflammatory arthridities such and rheumatoid arthritis and lupus. Different versions of this type of drug have different side-effect profiles, but, in general, NSAIDS, when taken for extended periods, can play a role in stomach irritation, ulcers, and bleeding and kidney problems with elevated blood pressure. While these can be very helpful medications, their prolonged use should be done under the guidance of a physician.

Steroid Injections

Steroid injection (often referred to as a “cortisone shot”) is generally performed with a depot version of a corticosteroid that remains within the joint. Once in the joint, the steroid blunts the inflammation within the joint and can reduce the pain of the arthritis. This effect can last from a few days to 6 months. There is a small risk of infection with an injection which can be very debilitating and destructive if it were to happen. The risk of infection is less than 1%. There is no agreed upon number as to how many times an injection can be repeated if the most recent injection had benefit for multiple months. Most agree that multiple injections can be offered, the whether a limit should exist or how high the limit may be is unknown.

Unloader Bracing

As arthritis progresses in the knee and joint space is lost, the leg becomes more bow-legged or knock-kneed. As this collapse occurs, increased load is applied to the already diseased and damaged section of the joint. By applying and unloader brace, the leg can be straightened and the load shifted back onto the more healthy area of cartilage remaining. This can reduce pain and suffering during activities such as walking, shopping and yard-work.

Viscosupplement Injection

Viscosupplement injections inject a purified, viscous fluid into the joint. The injection frequently includes components of normal healthy joint fluid known to be reduced in arthritis. While the exact mechanism of benefit is not known, many patients, especially with early arthritis, can benefit from these injections for a variable period of time.

Walking Aid

Many patients find the use of a cane, walking stick or walker to reduce their pain. By transferring weight to the walking aid, the effected joint can be off-loaded reducing the pain experienced and improving the distance that a patient can walk.