Pre-operative Evaluation

Pre-operative Evaluation Day

At this visit, the medical team will obtain your medical history and perform a physical examination, including an EKG, chest X-ray, urine sample and blood work, to identify your health risks. If these risks are high, your doctor will discuss whether you should have surgery. He or she might recommend that you have additional tests, which may or may not delay your surgery, or that you don’t have surgery until the risks are brought under reasonable control. If you have specific concerns about your health, you can also consult with your primary care doctor or other specialists prior to this appointment and make your concerns known to Dr. Maratt's team if you haven't already done so.

Preparation Phone Call

Prior to your pre-operative visit, you will receive a phone call from the staff at the pre-op clinic. This call normally takes about 15 to 20 minutes and shortens the actual time you have to spend at your visit. This phone call helps determine what testing will be needed for your visit and also directs us on what medical records we need to obtain prior to your visit with the physician. Here is some information to have ready for this phone call:

• Dates and places of any past cardiac, pulmonary or vascular testing.
• List of all your current medicine names and doses. This includes vitamins, supplements and any over the counter medicines you take.
• Dates and places of most recent EKG or labs.
• Date of most recent visit with your primary care doctor or any other specialists such as cardiologist, rheumatologist, gastroenterologist, pulmonologist, neurologist, etc.
• Whether or not you have any advance directives, and if not, if you would like to complete one before surgery.

What To Bring With You

When you attend your pre-operative evaluation day appointment, make sure to bring:

• A list of all home medicines with dosages.
• Any advance directives you may have.
• If you already have them, any walking devices you plan on using after surgery. We will provide you will prescriptions for these if you do not have them.

Joint Replacement Education

You will likely have an education session with our physical therapist either before or after the internal medicine specialist. This will include a therapy evaluation and also education about the surgery and recovery. This can be scheduled on a different day based on your preference.

Scheduling

These appointments typically happen 3-4 week prior to surgery. You will typically receive a call to schedule these appointments within 6 weeks of your surgery date. In some cases the pre-op evaluation will be scheduled in advance if there are medical concerns that we know will need to be evaluated and addressed earlier in the process. These appointments can also be scheduled in advance if you will be away in the weeks prior to your surgery date. Please contact our office if you have any questions about scheduling.

What Can I Do To Get Ready?

There are some things you can do, so you’ll have a better outcome from your surgery.

Tobacco

• Smoking cigarettes or using other tobacco products can increase your risk of heart attack, infection and death. You may also heal more slowly after your surgery because of the nicotine reducing the blood flow to the area and skin. This is a major concern in joint replacement surgery because of the risk of infection.
• The sooner you stop using tobacco products before surgery, the better.
• You may be required to stop smoking prior to surgery.
• Please let us or the pre-op clinic know if you need help to quit smoking.

Diabetes

• If your blood sugar is elevated at your pre-operative visit, you may require further lab work.
• If you are diabetic, you can have a better surgery outcome with good blood glucose control. This will help you heal better with less chance of infection.

Managing Your Medications

• Some medicines should not be taken before surgery. We will review these medications with you during your pre-operative evaluation.
• Please take only the medications we have instructed you to take on the day of surgery and the week leading up to surgery.

Dental Work

We do recommend that you continue with regular dental visits. However, the dental visits should take place greater than 1 week prior to surgery or greater than 4 months after surgery. If your dental work involves something more significant than a routine cleaning (e.g. tooth extraction) this should be done 2 weeks or more before surgery. If you have not seen a dentist regularly prior to surgery, it is a good idea to have a check-up as it is especially important to make sure there are no infections in your mouth prior to surgery.

Exercise

• Exercise can shorten your hospital stay, reduce your chance of getting an infection, and improve your mental health.
• Walking daily is a good way to improve your health. Start slowly and work up to 30 minutes of walking every day. If walking has become too difficult, consider using an eliptical, stationary bicycle or doing an upper body workout.
• In the Exercise Program section if this book you will find exercises to begin prior to your surgery. The main goal is to be very familiar with your exercise routine so that after the surgery you know how to perform the exercises. If beginning the exercise program before surgery substantially increases your pain, please reduce the number of repetitions or hold off on exercising the affected joint until a few days before surgery.
• The physical therapist that does your pre-operative education can also help guide you to the best plan for your joint and overall health.

Deep breathing

• Deep breathing can reduce your chance of getting pneumonia.
• Practice deep breathing by taking 8-10 deep breaths, several times a day.
• You will be given an Incentive Spirometer after surgery that you will use in the hospital and at home.

Bathing/showering

• Using a special body wash (chlorhexidine) before your surgery can reduce the number of germs on your body. This will reduce your chance of getting an infection.
• We will provide this body wash and instructions for use during your pre-operative visit.

MRSA testing and treatment

• There are bacteria that normally lives on our skin, in our mouths and nose without causing any problems.
• We will test you to determine if you are a carrier of a drug resistant bacteria called MRSA.
• If you are found to be a carrier, we will add an additional antibiotic to help reduce your risk of infection.