Preparing for Surgery & Procedure

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 the role you and your support network play in it will help you recover more quickly and have fewer problems.

Working with Your Doctor

Before surgery, Dr. Melvin may recommend that you be evaluated by your primary care physician and/or your treating medical specialists. You may be asked to obtain routine pre-operative tests, such as blood tests, EKG’s and X-rays. These are typically best performed approximately 3 weeks prior to your joint replacement.

• Discuss any medications you are taking with your doctor and your family physician to see which ones you should stop taking before surgery
• Adhere to a healthy diet prior to surgery. If you are overweight, Dr. Melvin may discuss a weight-loss program.
• If you are taking a prescription blood thinner such as warfarin, Xarelto, Eliquis, Pradaxa, Plavix, etc. you should discuss a plan with Dr. Melvin or your primary care physician to stop these medication 3-5 days prior to surgery.
• If you smoke, you should stop or cut down to reduce your surgery risks and improve your recovery and decrease your risk of infection.
• Have any tooth, gum, bladder or bowel problems treated before surgery to reduce the risk of infection.
• 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 been adequately treated.
• Arrange for someone to help out with everyday tasks like cooking, shopping and laundry.
• Create a recovery hub where most of your time will be spent. A comfortable chair, phone, television, reading materials and medications should all be within arm’s length.
• Remove all loose carpets and tape down electrical cords to avoid falls.
• Bathroom modification can make a large difference. A raised toilet, shower chair or gripping bar will assist in your mobility following hip or knee replacement.
• Make sure you have a stable chair with a firm seat cushion, a firm back and two arms.
• If it is expected that your mobility will be greatly compromised during recovery, it is recommended that you get a temporary handicapped parking permit.. Dr. Melvin’s office can assist you with this.

The night Before...

• Take a bath or shower the night before surgery. Follow any other specific bathing instructions provided in Dr. Melvin’s surgery packet,
• Do not shave the surgical site. If this is necessary, it will be taken care of in the operating room.
• Do not wear any nail polish, lipstick or makeup.
• Do not eat or drink anything after midnight unless instructed otherwise.
• If you are expected to have a brief stay in the hospital, bring a bag with the following items:
  • Comfortable bedroom slippers with non-skid soles.
  • A robe or gown.
  • A comfortable shirt to wear under the hospital gown.
  • Reading material or laptop for entertainment.
  • Copies of insurance cards and medical history.
  • Medications you regularly take.
  • Items for personal care, such as toothbrush, eyeglasses, hairbrush, etc.
  • A comfortable change of clothes and comfortable shoes to wear home.
  • Please make sure to ask a friend or family member for help. This may simply include checking in on you daily, but it is important to have support during recovery.

If you are having outpatient 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
• If you had surgery on an extremity (leg, knee, hand or elbow), keep that extremity elevated and use ice as directed. This will help decrease swelling and pain

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.

What to Expect After Surgery

Hip and knee replacement are extremely effective at improving or eliminating hip and knee pain and dysfunction. While some patients will experience these tremendous improvements in pain and function very quickly, the typical recovery period is more modest occurring over a 6-12 week timeframe. Having appropriate recovery expectations can help to avoid set-backs from “over-doing it” and can actually lead to a more efficient recovery.

Immediately following surgery

Directly following surgery, you will arrive in the recovery room (PACU). Most patients are very comfortable at this time due to the numbing medication injected in the joint during surgery, but pain medication will be available if needed. You will likely notice the sequential compression device on your leg to promote blood circulation and prevent blood clots. For primary, uncomplicated hip or knee replacements, Dr. Melvin does not routinely use a urinary catheter.

It’s very possible the hospital or surgery center staff will want you standing and bearing weight on your joint replacement later today, and you’ll be walking with support before you go home. The faster you mobilize your joint after surgery, the faster your recovery. However, remember, recovery is a process, and it will take time for your joint to heal; so be patient.

During the first few days following surgery, you will still be taking medication to help with any pain that is lingering. Try to minimize or avoid narcotic pain medication if possible as there are many side effects associated with these medications. Dr. Melvin’s multi-modal pain regimen will help you to minimize or avoid these medications. Additionally, you may work with a physical therapist or follow instructional videos to ensure the hip or knee is being moved and exercised appropriately. Mobilization following a hip or knee replacement is crucial, as it allows your body to adapt to the new implant. The primary goal of mobilization is to allow your hip or knee to perform daily activities such as walking, climbing stairs and getting in and out of a car.

Following joint replacement surgery, patients may go home the same day or have a short hospital stay. Dr. Melvin is able to minimize or eliminate the hospital stay through his minimally invasive procedures and muscle sparing technique, multimodal pain control regimen, and his thorough preparation and recovery pathway. This applies to both hip and knee replacement. Once patients go home, the recovery process continues.

At home

Long-term use of your new hip or knee implant depends greatly upon the care that is taken in the months following surgery. Dr. Melvin will provide specific instructions for care, helping you to ensure that your joint reaches its maximal potential.

Once you go home, keep an eye on your bandage. Prior to discharge from the hospital or surgery center, Dr. Melvin or the hospital staff will instruct you on how to care for your incision and Aquacel bandage. Most of the time, you should leave your bandage in place until you return to the office and you may shower if the bandage is completely sealed. If the bandage peals up, becomes dislodged or saturated, you may remove it and cover with sterile gauze or an appropriately sized (20cm or 30cm) Primapore dressing (these can be purchased on Amazon).

Rehab and physical therapy will continue with a therapist or, in some cases via instructional video, once you go home. This will continue until you have regained maximum range of motion of your knee or hip and are able to operate completely independently. Most patients achieve maximal rehabilitation within several months following surgery. In addition to therapy, you should take part in short walks and other mild activities. If there is any soreness, you should cut down the gradient and apply a cold pack, but don’t stop completely. Continued movement is vital to a full recovery.

Most importantly, the office of Dr. Melvin is always available during your recovery period. If there is any trouble, we want to know about it. Any questions or concerns will be addressed rapidly, and if you even want to come by and see us, that will be encouraged. However, we will not simply wait for complications to see you—after your surgery, you will be asked to schedule follow-up appointments so Dr. Melvin can monitor the recovery process.

Longer Term

Even once you have returned to your full physical capacity, it is important to remain active. Rarely does Dr. Melvin replace “official” restrictions on your activity, although Dr. Melvin would prefer low impact exercises over high impact exercises or contact sports going forward. Dr. Melvin will continue to see you over the years to ensure that the joint is wearing and functioning properly. At any point following your surgery, his office will be available as a resource for any questions or worries that may arise. At the office of Dr. Melvin, our first priority is our patients’ well-being. Please call us if you have any questions or concerns.