Preparing for orthopaedic surgery

Register with the hospital

Once your surgery has been scheduled, Great Plains Health or your surgeon's office will contact you with instructions.

Get lab tests

You will need to schedule a time for lab tests to be done. Your surgeon will give you a letter that tells you which tests you need before your surgery.

Get medical and anesthesia clearance

Your surgical team needs to be aware of any health conditions you have in order to avoid potential problems during surgery. So you'll need a brief checkup by your primary care doctor to get medical and anesthesia clearance for surgery. Your surgeon's office will help you make the appointment.

Be sure to ask your primary care doctor if you need to make any changes to your medications. Some may increase your chance of bleeding. If you are currently taking a blood thinner, like Coumadin, Xarelto, Plavix, Pradaxa, Lovenox or Aggrenox, your doctor will give you special dosing instructions for stopping the medication. Don't stop taking any medication unless told to do so by your doctor.

Get your home ready

Preparing now for your homecoming will make your days after joint surgery much more relaxed.

Help at home

Although you'll be well on your way to recovery when you leave the hospital, arrange to have someone help you with meals, medications, dressing and other daily tasks, for at least one or two weeks. If you go directly home from the hospital, the joint care team can arrange to have a home health nurse visit you if needed.

To make the transition to home easier, plan ahead. Before coming to the hospital, take care of things like:

• Getting prescriptions filled.
• Changing the beds.
• Doing the laundry.
• Washing the floors.
• Arranging for someone to cut the grass or walk the dog.
• Stocking up on groceries.

Your job after surgery is to focus on recovering, not household tasks.

Attend a joint class

Every patient must take a class before joint replacement surgery at Great Plains Health. It's designed to give you the opportunity to meet staff and other patients. You'll receive valuable information to help prepare you for the days and weeks to come. And the staff will be able to answer any questions or concerns you have.

Your surgeon's office will give you the date and time to attend the class. If you aren’t given a date, call Great Plains Health Orthopaedics at 308.568.3800 or the Joint Replacement Patient Navigator at 308.660.1191.

We strongly recommend that you attend the class with your coach. Your coach can be a spouse, friend or family member who will help care for you after surgery. They will be at your side, helping you with your exercises, keeping you motivated and generally doing whatever is necessary to get you back on your feet again and enjoying life.

Start your pre-op exercises

Over the years, joint pain prevents many people from exercising. This lack of activity tends to weaken the muscles. It is important to start strengthening your muscles before surgery in order to get a jumpstart on your recovery. The better condition your muscles are in before surgery, the easier and faster your recuperation may be. Starting to exercise now will build muscle tone and pave the way to a quicker recovery.

Start other healthy habits

How you treat your body in the weeks before and after surgery has a direct effect on how fast you will heal. A little preparation now will make a big difference later. For example:

• If you smoke, try to quit—or at least cut back.
• Avoid alcohol, especially 48 hours before surgery.
• Eat a balanced diet rich in iron, protein, vitamin C and calcium.

Donate blood

During surgery, you will lose some blood. In most cases, your body can replace the blood on its own without a transfusion. If a transfusion is needed, the blood is usually supplied by a blood bank.

Some people prefer to use their own blood, which they donate before surgery. Using your own blood ensures a perfect blood type match and decreases the risk of infection.

If you decide to donate this way, your blood will not be used by anyone else. And there may be a charge for the service. Contact your local American Red Cross center to learn more.

Stop medications that increase bleeding

Follow your doctor's directions. You may need to stop taking certain prescription drugs, over-the-counter pain medications or even some vitamins. These include blood thinners, aspirin, ibuprofen, naproxen, glucosamine, chondroitin, MSM and vitamin E. If you need pain relief during this time, you can use acetaminophen.

Pack for your stay

Leave jewelry, valuables and large amounts of cash at home. Bring the following items with you to the hospital:

• Photo ID.
• Insurance card.
• Contact phone numbers.
• Your current medications or a list of what you normally take.
• Personal hygiene items (toothbrush, deodorant, comb, brush).
• One change of clothes (underwear, socks, loose-fitting top and bottoms).
• Shoes with good support and tread (no sandals or flip-flops).
• Sleepwear.

Shower carefully

Shower using the antibacterial soap given to you at your joint class. Pay special attention to the hip, knee or shoulder that will be operated on. The directions for showering will be provided during your class.

Do not shave or remove any hair from the surgical area before surgery. This may cause small raised bumps and could cause your surgery to be delayed or canceled.

Be sure to use a clean washcloth, towel, pajamas and bed linens.

Don't eat or drink after midnight

Take any recommended medications before bed. Do not eat or drink anything after midnight, including water, chewing gum or medications. Eating or drinking after midnight could postpone your surgery.

The surgery nurse will call you the day before surgery to let you know what medications to take the morning of surgery.

If you have diabetes, the surgery nurse will let you know which of your diabetes medications you should take before coming to the hospital.

Have a question about getting ready for surgery?

Call Great Plains Health Orthopaedics in North Platte at 308.568.3800 to speak with one of our experienced staff members.

All the planning you've done is about to pay off! Here's what you can expect to happen on the day of your hip replacement, knee replacement or shoulder replacement surgery.

Checking in for your surgery

Check in at the main lobby registration area of Great Plains Health for all orthopaedic surgeries.

Getting ready for surgery

After checkin, you'll have a chance to speak with your anesthesiologist, operating room nurse and surgeon. They can answer any last-minute questions you may have.

You'll be given a surgical gown to wear and asked to remove any makeup. (Nail polish is OK.) After confirming which hip, knee or shoulder is to be operated on, the nurse will start an IV. The IV will give you fluids and medications during and after your surgery. Your hip, knee or shoulder will be thoroughly scrubbed with antibacterial soap, and the nurse may remove hair around the area.

Pain control during surgery

During surgery, an anesthesiologist will give you an anesthetic that provides pain relief. There are different types: A general anesthetic will put you into a deep sleep, while a regional anesthetic (spinal block or nerve block) will numb specific areas only. You and your anesthesiologist will discuss which method is best for you.

For hip and knee replacements, we usually use regional anesthetics along with another medication to make you very relaxed and put you in a light, dreamlike state.

For shoulder replacements, we typically use a general anesthetic.

Out in the waiting area

While you're in surgery, your loved ones can stay in the waiting area. They will be notified of your condition during surgery. Once you're out of surgery, the surgeon will contact them and let them know how you're doing.

In the recovery room

Right after your surgery, you'll be taken to the recovery room, also called the Post-Anesthesia Care Unit (PACU). You'll remain there for one or two hours while the anesthesia wears off.

The staff will monitor your blood pressure and other vital signs. They'll start pain control measures. And you may have an x-ray taken of your new hip, knee or shoulder.

If you are discharging home the day of surgery, you will return to a room in Same Day Surgery. You will be given a pain medication and something to eat and drink. When the spinal block has worn off and you are ready to get up, the nurse will take you the bathroom and help you get dressed. The physical therapist will evaluate your walking and test how easily you can go up and down the stairs. If you are able to do this and feel comfortable, you will be able to go home and sleep in your own bed or a recliner that night.

If the plan is to stay overnight, then you will be taken a room usually located on the fourth floor of the hospital. You will begin walking that afternoon or evening with the nurse. You should be walking back and forth to the bathroom and possibly into the halls.

Remember to do your deep breathing exercises and ankle pumps. These exercises are very important to help prevent pneumonia and blood clots. Compression stockings and sequential compression devices may also be used to help prevent blood clots.

The nurse will periodically check your circulation and may apply ice to your incision.

If you've had a knee replacement, don't use pillows under your knee that would cause it to bend or flex. It needs to remain straight.

Pain control after surgery

There are several pain control methods that can keep you comfortable and allow you to be up and moving shortly after surgery. Your doctor will help choose the method right for you. It may include:

• Oral medications. These may be started before surgery and continue throughout your hospital stay and recovery at home.
• IV pain medications. These are given through a vein in the arm. They may be used for severe pain or before oral medication has taken effect.
• A nerve block. This is a regional anesthetic injected in the thigh or neck area. Nerve blocks prevent the pain signals from reaching the brain.

You may be asked to use a pain scale to help describe your pain level. Don't try to tough it out. Let your healthcare team know if:

• Your pain medication is not working well enough.
• Your feel your pain increasing.
• You feel nauseated.
• You're not as alert as you want to be.

Adjustments can be made to your medications to make you more comfortable.

Repositioning and applying ice to the area for 15-minute intervals may also help. And relaxation techniques, such as soft music or deep breathing, can help with pain control too.