Orthopedics and
Sports Medicine Center

The following information will help guide you in preparation for your total knee or hip replacement surgery . Please review this information carefully to ensure that you have taken the necessary steps weeks in advance of your surgery .

Preoperative Risk Assessment Center (PRAC)

A comprehensive physical exam, along with a focused anesthesia evaluation, will occur in the Preoperative Risk Assessment Center (PRAC) . This will help to prepare you and your family for the upcoming surgery (please see page 12 for further information on how to prepare for this appointment) .

Medical Risk Assessment for Surgery

You will need a formal evaluation from your primary medical doctor (PMD) . If you do not have a primary medical doctor, please ask your surgeon for a recommendation . This medical clearance for surgery is for your safety . Depending on your underlying medical condition, your surgery may be cancelled if your PMD hasn’t provided this medical clearance form for your anesthesiologist to review .

Total Joint Replacement Class

A comprehensive Total Joint Replacement class is offered and must be attended at NewYork-Presbyterian Queens . At this class, important information will be reviewed . If scheduling permits, we will arrange for you to take this class the same day as your appointment for the preoperative comprehensive physical exam and anesthesia evaluation in the PRAC .

Home Preparation

Before your surgery, you should begin to evaluate what your needs will be after you are discharged from the hospital . Most knee replacement patients will need help at home for the first few weeks including assistance with bathing, dressing, meal preparation, medications and transportation .

In the weeks before your surgery, please do the following:

Exercise (as directed by your surgeon)

Discuss with your surgeon, exercises appropriate for you to increase your overall body strength and possibly lessen recovery time, including the option of walking at least 15 to 20 minutes daily.

Blood Transfusions

After surgery, you may need a blood transfusion . The use of a medication called Tranexamic acid (TXA) has decreased the need for a blood transfusion by decreasing the loss of blood.

Dental Examination

Poor dental hygiene may contribute to the risk of infections related to joint replacement surgery. It is recommended that you practice good oral hygiene by brushing your teeth and using mouthwash at least twice a day. We recommend a visit to your dentist for any outstanding dental problems or procedures that need to be addressed before undergoing joint replacement surgery.

Lung Exercises

A spirometer is a device we provide that helps you breath deeply and will help prevent potential problems with your lungs after surgery (see page 21 for directions).

Medications

Provide your surgeon with a full list of medications and over-the-counter items including herbal supplements and vitamins you are currently taking as well as any allergies you may have . A complete list of prior surgeries and hospitalizations should also be provided . Discuss with your doctor which medications you should stop taking before surgery as some medications may cause problems during or after surgery.

Smoking

Smoking of any kind should be stopped prior to your replacement surgery . This is important to help lessen the risk of postoperative lung problems, as well as to decrease healing complications which smoking can cause . If you need help with smoking cessation, ask your doctor for information.

Review Your Insurance Coverage

Your surgeon’s office will speak to you about your insurance. However, it is also important for you to contact your insurance provider before surgery to better understand your insurance coverage.

Watch Your Weight

If you are overweight, plan to lose some weight before your surgery but at the same time, make sure you are well nourished. This will be beneficial to you and to the new implant in your knee or hip.

SURGERY PREPARATION CHECK LIST

Approximately 10 Days Before Surgery

• PRAC
• Joint Replacement class
• Review insurance coverage with your case manager

Two Days Before Surgery

• Wash surgical site (hip or knee) with soap and water two times per day

The Day Before Your Surgery

• Wash surgical site (hip or knee) with soap and water two times per day
• Do not eat after midnight
• Do not drink after midnight (a sports drink e .g ., Gatorade may be consumed)
• Review this guide
• Get a good night’s rest

The Day of Your Surgery

• Take a shower during the morning of the surgery with soap and water
• Take routine medications with only a sip of water, as instructed by your doctor
• Brush your teeth and rinse
• Wear comfortable clothing
• Leave valuables at home or with a family member

APPOINTMENT: PREOPERATIVE RISK ASSESSMENT CENTER (PRAC)

Your surgeon’s office will help you schedule this appointment that must be completed before your surgery . You will receive a comprehensive physical exam that will provide important information to the surgeons and nurses preparing you for surgery . The multidisciplinary team of caregivers is comprised of physician assistants (PAs), patient care associates and medical technicians . Besides a blood test, EKG, urine specimen, nasal culture, chest X-ray and/or other X-rays, a complete medical history will be obtained from you .

• The appointment may take up to two hours, so please plan accordingly .
• If you need to change or cancel your appointment, please call your surgeon’s office directly. The surgeon’s office will notify the PRAC.
• If you are running late for your appointment, do not call your surgeon . Please call the PRAC directly at 718-670-1990.

Prepare for Your PRAC Appointment

• On the day of your appointment with PRAC, please remember to bring a complete list of your medications with the correct dosage, including over-thecounter medications you are currently taking at home.
• You can eat normally the day of your appointment.
• Take your usual medications you normally take.
• Wear comfortable clothing, such as a shirt or blouse that buttons down the front and has sleeves that you are able to roll up.
• For your convenience, and that of the staff administering your tests, please do not wear pantyhose or long underwear.

What to Bring to the PRAC Appointment

• Identification and insurance cards.
• A written list of all the medications you take, including herbal supplements, vitamins and over-the-counter drugs with dosage and frequency.
• A list of all prior surgeries, hospitalizations and illnesses you have had, with approximate dates.
• A list of all allergies, including medications, and whether or not you are allergic to latex and metals.
• All letters and information from your doctor.
• Reading glasses and hearing aids (if you use them) .

Note: If scheduling permits, we will arrange for you to take the Total Joint Replacement class on the same day.

TWO DAYS BEFORE SURGERY

Please Document Your Cleansing Process and Bring This with You to Surgery

Two Days Before Surgery: Date: ________ Time: (1st Shower) ________ (2nd Shower) ________

The Day Before Surgery: Date: ________ Time: (1st Shower)________ (2nd Shower)________

The Day of Surgery: Date: ________ Time: (1st Shower) ________ Not Required

• Take a shower and wash your entire body.
• Wash your hair using normal shampoo; make sure you rinse the shampoo thoroughly from your hair and entire body.
• Wash your body with your regular soap or cleanser.
• Rinse your entire body thoroughly with clean water.
• This is very important.
• Use a fresh, clean towel to dry your body.
• Dress in clean clothes, preferably freshly washed ones.

ONE DAY BEFORE SURGERY

You will receive a telephone call between 12 p .m . and 6 p .m . on the last business day before surgery to notify you of your arrival time and answer any further questions you may have about your surgery . It is very important that you provide a number where you can be reached at this time . If you are not going to be home, or you miss our call, please call us . The options for hours and phone numbers to call are:

12 p.m. to 6 p.m.: 718-670-1053

6 p.m. to 9 p.m.: 718-670-1438

After 9 p.m.: 718-670-1442

It is important that you arrive on time the day of your surgery. If you are late, your surgery may have to be rescheduled.

Food

• You may eat normally the day before surgery.
• Do NOT eat food (including gum or candy) after midnight.

Fluids

• Do NOT drink alcohol.
• You MAY drink clear liquids after midnight until two hours before arriving to the hospital.
• Clear liquids include: sports drinks (EX: Gatorade, Powerade), water, juice without pulp, coffee or tea without milk.
• Medications ordered on the day of surgery should be taken as directed with water.

Please call the PRAC to speak to a physician if you have any questions.

Medications

• Take medications as directed, with a small amount of water (unless otherwise directed by your surgeon)

Activities of Daily Living

• You should shower and wash your hair the night before or the morning of your surgery.

What to BRING, and NOT BRING, to the Hospital

BRING to the Hospital

• This booklet
• Cane, crutches or a walker (if your surgeon has asked you to)
• Eyeglasses (not contact lenses)
• Dentures and/or hearing aid (a container will be provided for these items - do not place them on your bed, food tray or anywhere else)
• A list of your medications (including any you have recently stopped taking at your surgeon’s request)
• Small amount of money for items that may interest you, such as newspapers, etc .
• Relaxation items such as a book or magazine
• Identification
• Insurance cards
• Completed Advance Health Care Directive (optional)
• Telephone number for your pharmacy
• Emergency contact name and telephone number
• Your telephone number
• Your email address

DO NOT BRING to the Hospital

• Medications (please do NOT bring in your medications unless asked by your surgeon)
• Valuables (jewelry, large amounts of cash or credit cards)

We understand that this may become overwhelming. Please feel free to contact the surgeon’s office with any questions you or your caregivers may have.

SURGERY DAY

The Day of Your Surgery

• Brush your teeth and rinse your mouth without swallowing any water.
• Wear comfortable, loose-fitting clothing and flat, non-slip walking or athletic shoes that you can easily put on your feet.
• Leave valuable possessions at home or give them to a family member for safekeeping.

Directions

For directions to the main campus of NewYork-Presbyterian Queens, please see pages 33-35 of this guidebook.

Once You Arrive at the Hospital (Enter the Main Lobby)

• Upon arrival, you will be directed to the appropriate waiting room (holding area) for your surgery.
• From the holding area, a nurse will greet you and take you to a private area where you will be provided with a disposable gown.
• You will be asked to change into your disposable gown and will be given a warming blanket to use during your surgery.
• Your regular clothes and private belongings will be secured and given back to you on your way to your regular hospital room.
• Your surgeon, or the physician assistant assigned to your case, will go over the informed consent (in the language of your choice) and ask you to sign and date it . The orthopedic surgeon will mark the correct knee or hip that is going to be operated upon with his/her initials . This is an extra precautionary measure to ensure that the correct site is selected.
• You will also meet your anesthesiologist who will explain the type of anesthesia that you’re going to receive . A separate anesthesia consent form will also be given to you to sign.
• Once all of the formalities are completed, and the operating room (OR) is prepared, a nurse will take you into your OR.
• Any friends and/or family members who have accompanied you to the hospital will be provided information on where they can wait in the hospital . If they wish to leave the hospital during your surgery, they should leave a call back telephone number where they can be reached . Upon completion of your surgery, a limited number of family members will be allowed to visit you in the Post Anesthesia Care Unit (PACU) . With your permission, your surgeon and/or designee will gladly answer any questions they may have.