Patients usually arrive on the morning of the scheduled surgery, usually two or three hours before the scheduled time of surgery in order to allow enough time for check-in, getting an IV started, and checking over necessary preoperative lab work and information. The process is similar for all types of joint surgeries, including joint replacement and resurfacing.
Early Admission
Some patients have to be admitted a day or two before surgery because of special medical conditions. The most common cause for this is usually anticoagulation that cannot be stopped (such as for a patient with a mechanical heart valve, who must have the blood thinned at all times). In that case, the patient arrives and is placed on heparin while the warfarin wears off, and then the heparin is shut off a few hours before the surgery.
Patients who require admission prior to the day of surgery typically have a serious co-existing medical condition that necessitates the early admission. This typically also requires prior approval from their insurance company for the early admission.
Same Day Admissions
The majority of elective hip and knee surgery patients arrive the morning of surgery. After checking into the surgery area, a nurse will meet with you and escort you to the preop holding area. Friends and family can visit with you there up until it is time to actually go to surgery.
In the holding area, the nurse will help you get changed into a hospital gown and collect your belongings. These are usually rounded up and placed into bags so that clothing and belongings will be waiting for you upstairs in your room after surgery. It is generally a good idea to leave any valuables, such as rings, watches, or jewelry, at home or with a family member.
Dentures are collected and placed into a container right before surgery, so that they will not be lost and also because it is important that dentures be removed so that they will not interfere with anesthesia (even if you are having a spinal, in case intubation is needed).
If you normally wear contacts, leave them out on the day of surgery and use your glasses instead.
It is also a good idea not to wear any nail polish, because it can interfere with oxygen monitors that may be fitted over your finger.
Please do not shave or wax any surgical sites prior to surgery. Some patients try to do this before arriving, and it actually increases the risk of infection through tiny breaks in the skin. I have had to cancel surgeries when patients (trying to be helpful) waxed their surgical site the day before surgery. If necessary, the nurse will use electric clippers for the surgical area. The side that is being operated on usually will also be painted with an anesthetic scrub.
Preoperative Holding Area Interviews
The nurse will have a short interview with you to go over medications and any recent changes in your health. Do not be surprised if multiple people ask you why you are here and what joint is being operated on; it is not that they forgot or did not know, but there are several check-points scripted in to double-check on the surgery and surgical site. In fact, at our hospitals we ask all patients to mark the surgery site themselves with a marker just prior to surgery.
Next the anesthesiologist will meet with you to discuss the anesthesia and answer questions. The anesthesiologist will have some questions as well in a short interview. In general, we prefer spinal anesthesia if possible for joint replacement surgeries as it is safer and usually more comfortable for the patient, and this is discussed in the next chapter. As the anesthesiologist will explain, a spinal does not mean that you have to be awake for the procedure, and there is almost no chance of neurologic injury from most spinals despite many misconceptions that exist about spinals and epidurals.
Finally, the surgeon comes by to answer any last minute questions and check to see that your health has not changed since you were last seen. If the surgical consent form has not yet been signed, this will be filled out at this time. It is a good time to ask any questions that you might have remembered or formed in the day or two before surgery.
Surgery
After everything has been checked several times and patients are ready (including a quick trip to the bathroom in the preop area if needed), patients are then taken to the operating room on a gurney.
Most patients are surprised that the operating room is such a bright place. Contrary to what is sometimes portrayed on television, the operating room is usually very brightly lit. Patients slide over to the operating table and warm blankets are usually used to keep them comfortable. If general anesthesia is being used, or if a patient does not want to be awake during the time of the surgery, a sedative is given through the I.V. If you have never had intravenous sedation, it is quite rapid, and most patients are next aware of waking up in the recovery room with the surgery complete. It is a good idea to try to relax and think of something pleasant rather than try to fight the sedative, and drifting off is usually quick and pleasant.
If a spinal is being performed, patients may be asked to sit up briefly or lie on their side while the spinal is administered. Again, some patients request medication before this step and often have little memory of it, unless they want to remain awake. The spinal is typically no worse than getting an I.V. placed, and the skin in that area is usually anesthetized with a local anesthetic first.
If a urinary catheter is to be used, it is typically placed in the operating room after anesthesia is established, so most patients do not feel or remember catheter placement. In our practice, catheters are usually only used for bilateral or revision surgeries.
The time required for a particular surgery varies widely depending on the surgeon, surgical approach used, and the size of the patient. Some joint replacements require an hour or less in thin patients, and complex joint replacements, revision surgeries, or those in obese patients may take significantly longer. We are usually back in the operating room longer than the duration of the surgery for other additional reasons, to allow 20 minutes or so for the anesthesia and similar time at the end of the case to get to the recovery room.
Note that surgery may not always begin as scheduled. Sometimes surgeries in progress may run late, and at a busy hospital that also handles trauma, surgeries are sometimes "bumped" if a more urgent case requires use of the next available operating room. Sometimes the anesthesiologist may order an additional blood test the morning of surgery, and this can sometimes cause a short delay as well.
Recovery Room
After surgery, there is a short stay in the recovery room (also called the PACU, or post-anesthesia care unit) until you are fully awake and blood pressure and other vitals are stable. We generally also wait until toes and feet start moving, to signify that the spinal is wearing off. In our practice, all of our patients get xrays in the recovery room to check on the hip or knee replacement and ensure that there are no problems before starting weightbearing in the evening or next morning.
Usually there cannot be visitors in the recovery room area, but visitors are certainly welcome once you get upstairs to your room.
There is usually some discomfort the first evening. It is expected after major surgery, but there are pain medications available, and you should ask your nurse if you need them. Most patients undergoing joint replacement use intravenous pain medications (such as morphine) the first evening in order to remain reasonably comfortable, and the majority are taking oral pain medications the next day.
Most joint replacement and resurfacing patients can walk and bear weight as soon as the spinal wears off, but it is important to have your nurse or a physical therapist help you the first day or two so that you do not get dizzy or fall. Each time you get up, it gets progressively easier and you will find you can walk farther.
Please remember the information on this site is for educational purposes only and should not be used to make a decision on a condition or a procedure. All decisions should be made in conjunction with your surgeon and your primary care provider.
