PRE-OP: Preparing for your surgery
Your surgical journey will start after you and one of the highly skilled total joint surgeons at UNOVA Hip and Knee Center have exhausted all the appropriate conservative measures to address your hip arthritis. At this time, you will undergo a pre-surgical evaluation to determine how best to optimize you for your surgery. Your primary care physician and your specialists will work diligently with the UNOVA Hip and Knee Center team to get you to your optimal medical condition. Occasionally testing will indicate a potential problem that may delay surgery while it is evaluated and addressed.
At UNOVA Hip & Knee Center, although we believe every patient is unique, there are a few HARD STOP RULES that we must abide by before we can undertake your surgery. These rules exist to ensure your safety and to give us the best opportunity to help you achieve your desired outcome with the lowest possible chance of encountering a complication. The Parameters Linked to Hard Stops Are Non-Negotiable.
There are a few general health issues and medical conditions that give us greater concern and as such these must be dealt with prior to your being scheduled for surgery.
Before we get into specific medical conditions, as a patient, you must understand that YOUR SAFETY IS OUR PRIMARY CONCERN. As such any break in the skin with a surrounding blanching red area at the time of your surgery will constitute grounds for postponement of your surgery. Avoid any work in the garden or outdoors that may cause cuts or punctures of the skin. Any evidence of infection in any system in your body at the time of your surgery will also be grounds for postponement of your surgery. The two most common culprits are dental and urinary tract infections.
• Dental Issues such as painful teeth or excessively bleeding gums to the attention of the Hip and Knee Center team. All must be fully resolved prior to surgical scheduling.
• Urinary Tract Infection symptoms, such as discomfort or burning during urination, increased frequency of urination or malodorous urine must also be brought to the attention of the Hip and Knee Center team. ALL SYMPTOMATIC patients will undergo a screening urinalysis and, if positive, a urine culture. You will begin a five-day treatment plan and be rescreened two days after its completion.
Please complete tending to any dental issues at least six weeks prior to your surgical date. THESE TWO ISSUES CONSTITUTE HARD STOPS!!
Please review the following three videos for information regarding the action steps you will have to take prior to your surgery
Pre-Op
Peri-Op
Post-Op
We recommend that you set up appointments to see any specialists caring for you, such as cardiologists, pulmonologists, hematologists/oncologists, as soon as you and your surgeon make the decision to undergo surgery. Our surgery scheduler will help facilitate this. This guarantees to the best of our ability that your primary care physician will have the specialist’s clearances when he or she sees you.
Now let’s get on to more specifics. Below you will find a series of write-ups and videos on specific medical conditions that can impact your surgical preparation:
General Well-Being
Pre-Op Pain Tolerance
Obesity
Diabetes
Pulmonary/Lung Disease
Renal/Kidney Disease
Cardiac/Heart Disease
Hematology/Blood Disease
Nutrition
General Well-Being
We are providing this information to you to serve as a guide through your pre- and post-op process. Your particular journey may involve many or none of these steps. At UNOVA Hip & Knee Center, we strive to personalize each patient experience, we understand that every patient we encounter is an individual with unique concerns. This video is not meant to be used to diagnose or treat any medical condition, those decisions should only be made after consultation with your treating surgeon and primary care physician.
Selecting A Coach
Because your safety is our primary concern, you must have a coach selected prior to your surgery. This person may be a spouse, adult child, sibling, or close friend. Your coach must accompany you to your pre-op visit and your Bone Camp class. Your coach is there to assist you in the immediate post-operative period and must stay with you in your home for the first week after surgery. The Hip and Knee Center will need the contact information for your coach to add to. Your HIPPA document to allow us to discuss your care with your coach. You and your coach will sign an agreement stating that they agree to the above conditions. We must have this document signed prior to scheduling your surgery.
This addition to our process is necessary due to the recent Medicare guideline changes that now classify Total Hip and Total Knee Replacement procedures as outpatient procedures. Medicare will only cover the first 23 hours of inpatient hospital care without prior written approval. Your coach is the first thread in your post-operative safety net. You and your coach will work with a specially trained network of home health providers to coordinate your post-operative experience. Failure to set up a coach prior to surgery will lead to the cancellation of your surgery.
THIS IS A HARD STOP!!
As always, your safety is our primary concern and your patience is greatly appreciated.
Smoking
The chemical nicotine has a potent effect on multiple systems in the body. It can affect your lungs, keeping much-needed oxygen from healing tissues, it can affect newly forming blood vessels causing them to collapse and again disrupting healing. This in addition to all the other lung and heart issues it has been linked to such as emphysema, asthma, lung cancer, and heart disease.
If you are a smoker you must Stop Smoking For 6 Weeks Prior To Your Surgery.
Believe it or not this short period of time will allow your lungs to reacclimate to more normal functional levels. Ignoring this will increase the likelihood of not only delayed wound healing that can increase your chances of infection, but also heart and lung complications that can increase your chances of pneumonia and possibly death.
You must have a nicotine level of < 0.1ng/ml to safely undertake joint replacement surgery. Your nicotine level will be tested 72 hours prior to your surgery a Nicotine Level > 0.1ng/ml, will lead to the cancellation of your surgery until your level is below the threshold. THIS IS A HARD STOP!!
As always, your safety is our primary concern and your patience is greatly appreciated.
Narcotic Use
The opioid epidemic is a serious national concern. Recent changes to the federal guidelines for narcotic prescribing have set limits on the amount of narcotic medication that can be prescribed in the post-operative period.
You must stop all narcotic pain medication use prior to your surgery. Any pre-op narcotic use will need to be managed by a pain management physician. Your pain management physician will be responsible for managing and prescribing your narcotic pain medication after surgery. We will need documentation from your pain management physician stating they will manage your post-op narcotic pain prescriptions.
Failure to produce the documentation in the form of a letter from your pain management physician will constitute a hard stop.
Pre-Op Pain Tolerance
We are providing this information to you to serve as a guide through your pre- and post-op process. Your particular journey may involve many or none of these steps. At UNOVA Hip & Knee Center, we strive to personalize each patient experience, we understand that every patient we encounter is an individual with unique concerns. This video is not meant to be used to diagnose or treat any medical condition, those decisions should only be made after consultation with your treating surgeon and primary care physician.
At UNOVA Hip & Knee Center, although we believe every patient is unique, there are a few HARD STOP RULES that we must abide by before we can undertake your surgery. These rules exist to ensure your safety and to give us the best opportunity to help you achieve your desired outcome with the lowest possible chance of encountering a complication. The Parameters Linked to Hard Stops Are Non-Negotiable.
There are a few general health issues and medical conditions that give us greater concern and as such these must be dealt with prior to your being scheduled for surgery.
Your pain management in the peri and post-operative periods surrounding your surgery is something your team at UNOVA Hip & Knee Center take very seriously.
Your UNOVA team has spent many years perfecting their multi-modal pain management program:
- Developed proprietary regional block techniques for both Partial and Total Knee Replacement surgery.
- Developed and introduced the first Opioid-Free Anesthesia program for Total Hip and Knee Replacements in the region. This aids in reducing any potential changes in our patient’s mental acuity post-operatively, allowing our patients to immediately engage in therapy in the recovery room.
- Perfected our use of minimally-invasive approaches to the hip and knee that preserve tendons, ligaments, and muscles which have resulted in our ability to greatly reduce our post-surgical pain profiles. This allows our patients to utilize our express recovery process.
You will be asked to answer 13 questions on your intake called a PCS survey, these questions are related to how well you manage your pain. Should your answers score greater than 30, we will have you see a clinical specialist specifically trained in pain-coping mechanisms. The specialist will train you in techniques that will give you the tools necessary to participate fully in your post-operative rehabilitation to ensure that we achieve our desired outcome.
Obesity
We are providing this information to you to serve as a guide through your pre- and post-op process. Your particular journey may involve many or none of these steps. At UNOVA Hip & Knee Center, we strive to personalize each patient experience, we understand that every patient we encounter is an individual with unique concerns. This video is not meant to be used to diagnose or treat any medical condition, those decisions should only be made after consultation with your treating surgeon and primary care physician.
At UNOVA Hip & Knee Center, although we believe every patient is unique, there are a few HARD STOP RULES that we must abide by before we can undertake your surgery. These rules exist to ensure your safety and to give us the best opportunity to help you achieve your desired outcome with the lowest possible chance of encountering a complication. The Parameters Linked to Hard Stops Are Non-Negotiable.
There are a few general health issues and medical conditions that give us greater concern and as such these must be dealt with prior to your being scheduled for surgery.
If you are overweight, this can have a significant impact on your post-operative complication risk. There are many ways to approach this issue since your safety is our primary concern. Studies have shown that people with a body mass index (BMI) less than or equal to 40, tend to have lower post-operative complications than patients with a BMI greater than 40. That being said, there is ample proof that decreasing your body weight by 5-10% leads to measurable health benefits. We will strive to get your BMI as close to 40 as possible, but our main goal is to achieve this 5–10% weight loss. This is 10–20lbs for a patient weighing 200lbs. We will assist you with a 12-week wellness, nutrition, and exercise program to accomplish this. It will involve coaching on nutrition and exercise.
Our goal is not to involve you in a crash diet to get your weight down, but instead to help you develop habits that last you a lifetime. We recognize the difficulty of dealing with this issue and our goal is to work with you through the process.
Diabetes
We are providing this information to you to serve as a guide through your pre- and post-op process. Your particular journey may involve many or none of these steps. At UNOVA Hip & Knee Center, we strive to personalize each patient experience, we understand that every patient we encounter is an individual with unique concerns. This video is not meant to be used to diagnose or treat any medical condition, those decisions should only be made after consultation with your treating surgeon and primary care physician.
At UNOVA Hip & Knee Center, although we believe every patient is unique, there are a few HARD STOP RULES that we must abide by before we can undertake your surgery. These rules exist to ensure your safety and to give us the best opportunity to help you achieve your desired outcome with the lowest possible chance of encountering a complication. The Parameters Linked to Hard Stops Are Non-Negotiable.
There are a few general health issues and medical conditions that give us greater concern and as such these must be dealt with prior to your being scheduled for surgery.
Poorly controlled diabetes has been linked to a significantly increased probability of complications in the post-op period. Uncontrolled diabetes has been linked to poor tissue healing and immune system suppression. This can increase the likelihood of infections and other adverse events in the post-operative recovery phase of your surgery.
Your diabetes must be well controlled prior to surgery. The team will monitor certain blood parameters to track your diabetes control. The most common of these parameters are the Hgb A1c (Hemoglobin A1C, a diagnostic test that measures your average level of blood sugar over the past 2 to 3 months) and the fructosamine level. Your Hgb A1c must be equal to or less than 8.0 to proceed with your surgery. If your Hgb A1c is greater than 8.0 your surgery will be rescheduled until your Hgb A1c is at or below 8.0. AN ELEVATED Hgb A1c IS A HARD STOP!!
Pulmonary/Lung Disease
We are providing this information to you to serve as a guide through your pre- and post-op process. Your particular journey may involve many or none of these steps. At UNOVA Hip & Knee Center, we strive to personalize each patient experience, we understand that every patient we encounter is an individual with unique concerns. This video is not meant to be used to diagnose or treat any medical condition, those decisions should only be made after consultation with your treating surgeon and primary care physician.
At UNOVA Hip & Knee Center, although we believe every patient is unique, there are a few HARD STOP RULES that we must abide by before we can undertake your surgery. These rules exist to ensure your safety and to give us the best opportunity to help you achieve your desired outcome with the lowest possible chance of encountering a complication. The Parameters Linked to Hard Stops Are Non-Negotiable.
There are a few general health issues and medical conditions that give us greater concern and as such these must be dealt with prior to your being scheduled for surgery.
If you have been diagnosed with COPD—a group of lung conditions that include Asthma, Emphysema, and Sleep Apnea—you will need to see your pulmonologist. These conditions can significantly impact your post-operative recovery if they are not managed properly.
Patients with unmanaged COPD are at increased risk of pulmonary or lung-related complications post-operatively such as pneumonia and breathing difficulty needing ventilator support. Your UNOVA Hip & Knee Center team will work closely with your primary care doctor and pulmonary specialist to maximize your lung function.
If you have been diagnosed with COPD, you will need clearance from your pulmonologist. Untreated sleep apnea can lead to increases in pulmonary, cardiac, and neurological complications, such as stroke in the period surrounding your surgery. They will need to document your compliance with the use of your CPAP machine and document the machine parameters so we may have them available. You will need to bring your CPAP machine to the surgery center or hospital on the day of surgery. NON-COMPLIANCE WITH YOUR CPAP MACHINE IS A HARD STOP!!
Renal/Kidney Disease
We are providing this information to you to serve as a guide through your pre- and post-op process. Your particular journey may involve many or none of these steps. At UNOVA Hip & Knee Center, we strive to personalize each patient experience, we understand that every patient we encounter is an individual with unique concerns. This video is not meant to be used to diagnose or treat any medical condition, those decisions should only be made after consultation with your treating surgeon and primary care physician.
At UNOVA Hip & Knee Center, although we believe every patient is unique, there are a few HARD STOP RULES that we must abide by before we can undertake your surgery. These rules exist to ensure your safety and to give us the best opportunity to help you achieve your desired outcome with the lowest possible chance of encountering a complication. The Parameters Linked to Hard Stops Are Non-Negotiable.
There are a few general health issues and medical conditions that give us greater concern and as such these must be dealt with prior to your being scheduled for surgery.
If you suffer from chronic renal failure, your surgical preparation may be slightly longer than usual. Your creatinine level must be equal to or less than 1.5. If it is elevated above this level, it will need to be optimized by your nephrologist. The UNOVA Hip and Knee Center team will help to develop a care plan with your nephrologist to minimize the surgical impact on your kidney function during your planned surgery. We will work closely with your nephrologist to manage your renal function in the postoperative period.
If you are on dialysis prior to your surgery, we will work very closely with your nephrologist to determine the best time to schedule your surgery around your dialysis treatments. This is necessary due to the significantly increased risk of electrolyte or blood chemistry abnormalities as well as bleeding, both of which can lead to adverse cardiac and metabolism events or complications.
Cardiac/Heart Disease
We are providing this information to you to serve as a guide through your pre- and post-op process. Your particular journey may involve many or none of these steps. At UNOVA Hip & Knee Center, we strive to personalize each patient experience, we understand that every patient we encounter is an individual with unique concerns. This video is not meant to be used to diagnose or treat any medical condition, those decisions should only be made after consultation with your treating surgeon and primary care physician.
At UNOVA Hip & Knee Center, although we believe every patient is unique, there are a few HARD STOP RULES that we must abide by before we can undertake your surgery. These rules exist to ensure your safety and to give us the best opportunity to help you achieve your desired outcome with the lowest possible chance of encountering a complication. The Parameters Linked to Hard Stops Are Non-Negotiable.
There are a few general health issues and medical conditions that give us greater concern and as such these must be dealt with prior to your being scheduled for surgery.
If you have had a recent Heart Attack or Myocardial Infarction (MI), Coronary artery Bypass Graft (CABG) or Heart Catheterization for ballooning or stents, your surgery may need to be delayed up to a year in order to allow your heart to heal. Any of these conditions will necessitate a clearance by your cardiologist.
Any pre-existing High Blood Pressure (Hypertension) must be well controlled prior to surgical scheduling. Atrial Fibrillation (A-fib) must be controlled.
If you are on any anticoagulation medications or blood thinners for your A-Fib, they must be well managed prior to your surgery. Your Primary Care Physician (PCP) will inform the Hip and Knee Center team of any special instructions for their management.
All anticoagulants will need to be stopped prior to surgery to allow your blood to get back to its normal clotting capacity. Your primary care physician or cardiologist will need to inform your UNOVA Hip & Knee Center team in the clearance letter whether an Anticoagulation Bridge is necessary. Depending on the bridging protocol, you may need to have your surgery in the hospital and be admitted to the hospital a few days before your surgery to ensure that we can get your anticoagulation parameters to normal in the safest manner possible. You may also need to remain in the hospital for a period of time after your surgery to re-establish a therapeutic level for your blood anticoagulation.
Hematology/Blood Disease
We are providing this information to you to serve as a guide through your pre- and post-op process. Your particular journey may involve many or none of these steps. At UNOVA Hip & Knee Center, we strive to personalize each patient experience, we understand that every patient we encounter is an individual with unique concerns. This video is not meant to be used to diagnose or treat any medical condition, those decisions should only be made after consultation with your treating surgeon and primary care physician.
At UNOVA Hip & Knee Center, although we believe every patient is unique, there are a few HARD STOP RULES that we must abide by before we can undertake your surgery. These rules exist to ensure your safety and to give us the best opportunity to help you achieve your desired outcome with the lowest possible chance of encountering a complication. The Parameters Linked to Hard Stops Are Non-Negotiable.
There are a few general health issues and medical conditions that give us greater concern and as such these must be dealt with prior to your being scheduled for surgery.
With all surgeries there is blood loss and the potential for unexpected blood loss. As a precaution, we want our patients’ blood counts to start at a level high enough to accommodate any unexpected blood loss. Our cut-off for the Hgb or hemoglobin level is a minimum of 10g/dl with a preferred range from 12 – 18g/dl.
Since an elevated white blood cell count is a possible sign of infection, any elevation in white blood cell count will need to be evaluated prior to surgery. Please inform your UNOVA Hip & Knee Center team of any family history of blood-related diseases such as Sickle Cell, Thalassemia, or Leukemia. The team will work closely with your hematology-oncology specialist to address any issues with scheduling and to minimize the impact on any treatment regimens you may be undertaking.
Nutrition
We are providing this information to you to serve as a guide through your pre- and post-op process. Your particular journey may involve many or none of these steps. At UNOVA Hip & Knee Center, we strive to personalize each patient experience, we understand that every patient we encounter is an individual with unique concerns. This video is not meant to be used to diagnose or treat any medical condition, those decisions should only be made after consultation with your treating surgeon and primary care physician.
At UNOVA Hip & Knee Center, although we believe every patient is unique, there are a few HARD STOP RULES that we must abide by before we can undertake your surgery. These rules exist to ensure your safety and to give us the best opportunity to help you achieve your desired outcome with the lowest possible chance of encountering a complication. The Parameters Linked to Hard Stops Are Non-Negotiable.
There are a few general health issues and medical conditions that give us greater concern and as such these must be dealt with prior to your being scheduled for surgery.
The role that nutrition plays in post-surgical healing cannot be overstated. The body must have a reservoir of fuel, nutrients, vitamins, and minerals to heal itself after surgery. We will test for many of the nutritional component levels and correct those that we deem necessary prior to your surgery.
Your Albumin level, a gauge of your body’s protein supply, should be as close to 3.5 mg/dl as possible.
Your Vitamin D, a vitamin essential to wound and body healing, should be at a level greater than 40 ng/ml. Regularly walking or sitting in sunlight improves your body’s ability to make Vitamin D.
Modifying your diet, incorporating more fruits, dark berries, and vegetables, green leafy veggies, prior to surgery will also enhance your recovery.