Preparing for Surgery & Procedure

Preparing for Surgery

Once you and your doctor decide that surgery will help you, you will need to learn what to expect from the surgery and create a treatment plan for the best results afterward. Preparing mentally and physically for surgery is an important step toward a successful result. Understanding the process and your role in it will help you recover more quickly and have fewer problems.

Working with Your Doctor

Before surgery, your doctor will perform a complete physical examination to make sure you don’t have any conditions that could interfere with the surgery or the outcomes. Routine tests, such as blood tests and X-rays, are usually performed a week before any major surgery.

Discuss any medications you are taking with your doctor and your family physician to see which ones you should stop taking before surgery

Discuss with your doctor about options for preparing for potential blood replacement, includes donating your own blood, medical interventions and other treatments, prior to surgery

If you are overweight, losing weight before surgery will help decrease the stress you place on your new joint. However, you should not diet during the month before your surgery

If you are taking aspirin or anti-inflammatory medications or warfarin or any drugs that increase the risk of bleeding you will need to stop taking them one week before surgery to minimize bleeding

If you smoke, you should stop or cut down to reduce your surgery risks and improve your recovery

Have any tooth, gum, bladder or bowel problems treated before surgery to reduce the risk of infection later

Eat a well-balanced diet, supplemented by a daily multivitamin with iron

Report any infections to your surgeon. Surgery cannot be performed until all infections have cleared up

Arrange for someone to help with everyday tasks like cooking, shopping and laundry

Put items that you use often within easy reach before surgery so you won’t have to reach and bend as often

Remove all loose carpets and tape down electrical cords to avoid falls

Make sure you have a stable chair with a firm seat cushion, a firm back and two arms

Cardiac Clearance before Outpatient Procedures

Cardiac Clearance before Outpatient Total Joint Surgery: FAQ’s

Who needs cardiac clearance before surgery?

Anyone with a history of heart disease, including heart arrythmias, stents, or hear surgery
Anyone 70 years and older

Why do I need a stress test if I’m 70 years old and have a normal EKG and my doctor says I am healthy?

Approximately 10% of people over 70 who have no symptoms or EKG abnormalities have underlying heart disease
The main symptoms of heart disease are shortness of breath with walking, chest pain with activity and abnormal heart beats
Patients with arthritis often are unable to do activities that cause the heart symptoms because of the pain they have with walking

When did Dr. Swank start requiring his patients to have a preoperative stress test or cardiac clearance?

In the late 1990’s, Dr. Swank had approximately 5% of the patients he operated on have a cardiac related event in the first 90 days after surgery. When he reviewed the medical history of these patients, they all had been seen by their primary care physician and had normal EKGs and had been appropriately cleared for surgery
Dr. Swank discussed these cases with the head of cardiology, Dr. Don Wayne and the head of cardiac surgery Dr. Russel Vester to figure out how to detect the underlying heart disease in these asymptomatic patients
Their recommendation was to perform stress tests on every 70 and over in otherwise asymptomatic patients
Dr. Swank immediately implemented this protocol around 1999

What has been the outcome since instituting this protocol?

In over 15,000 surgeries since that time, Dr. Swank has not had a single cardiac death in asymptomatic patients who passed the cardiac stress test
The screening continues to identity 1-2 patients a month who had no symptoms and a normal EKG who fail a stress test and are found to have significant cardiac issues that we treat before the elective joint replacement surgery
Dr Swank’s medical complication rate remains substantially lower than national and local averages

Why does Dr. Swank want the cardiac clearance before he schedules your surgery?

Scheduling surgery involves a significant time commitment for you and your families

You may have to arrange for home care, for family members to take off work, drive them to doctor appointments, lab work, physical therapy, etc., many of these things have a cost associated with them that you must pay for
If a scheduled surgery gets canceled because of cardiac reasons, then all of these things need to be rescheduled- creating a major inconvenience and often significant cost to you
Obtaining cardiac clearance beforehand prevents you from incurring these costs and streamlines the surgical process for you

How do I obtain cardiac clearance?

We recommend you call your primary care physician for a referral
If you are having difficulty making an appointment with a cardiologist, Dr. Swank’s staff will help you with this process

What happens once you have obtained your clearance for surgery?

You can call Dr. Swank’s surgical scheduler to begin the surgical planning process

Physical Therapy before Outpatient Procedures

Physical Therapy for Outpatient Joint Replacement Surgery

Why do I need physical therapy before surgery?

Almost every insurance requires 6 weeks of physical therapy before surgery or they will not cover the cost of surgery
Physical therapy can be very beneficial in preparing you for your upcoming joint replacement surgery

What are the benefits of physical therapy Before surgery?

Physical therapy can improve your strength to help facilitate your postoperative recovery
Physical therapy can help improve the motion in your joint to make it easier to regain your motion after surgery
Physical therapy can help you address mobility issues that occur after surgery like stair climbing, getting in/out bed, on/off the toilet, bathing, and getting in/out car
Physical therapists can make recommendations about how to arrange your home to make your recovery easier

What about physical therapy After surgery?

Physical therapy after surgery can help you recover your range of motion and strength after surgery
The timing of physical therapy is different for hip patients and knee patients though because the surgeries are fundamentally different

How often will I go to Physical therapy after knee replacement surgery?

For the first six weeks, you will go to physical therapy once a week to regain the range of motion of your knee
This therapy will not be comfortable but should not be significantly painful.
If therapy is very painful, you should contact Dr. Swank’s office
After 6 weeks, when you see Dr. Swank in the office, he will order another 6-12 weeks of physical therapy to work on strengthening your muscles

Why is Dr. Swank’s protocol different than other doctors?

Swank does not cut the muscle during surgery so it is usually easier to achieve range of motion after surgery requiring less therapy in the early postoperative period
Even though the muscles are not cut, they are still very inflamed after surgery and not ready for significant isolated strengthening even if the range of motion has been achieved
Over strengthening early on can lead to unnecessary pain and swelling of the knee and can actually interfere with the recovery process

Why doesn’t Dr. Swank order physical therapy for the first 6 weeks after hip replacement surgery?

Swank performs hip replacement surgery with an implant that requires the bone to grow into it like a broken bone
For the first 6 weeks, you are essentially walking around on a broken leg even though it generally feels pretty good after a couple of weeks.
Falling on the leg and manipulating the leg, particularly while twisting it can actually cause the bone to break requiring another surgery
Once the bone has healed, when you see Dr. Swank in the office for your 6 week postoperative visit, he will order physical therapy to work on your hip motion and strengthening

Preparing for Procedure

On the day of surgery, remember the following:

Have someone available to take you home, you will not be able to drive for at least 24 hours

Do not drink or eat anything in the car on the trip home

The combination of anesthesia, food, and car motion can quite often cause nausea or vomiting. After arriving home, wait until you are hungry before trying to eat. Begin with a light meal and try to avoid greasy food for the first 24 hours

Take your pain medicine as directed. Begin the pain medicine as you start getting uncomfortable, but before you are in severe pain. If you wait to take your pain medication until the pain is severe, you will have more difficulty in controlling the pain.

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