Preparing for Surgery

Preparation is one of the keys to success. Preparing yourself physically and mentally is important for a healthy recovery. Here are a few steps to help you get ready for your surgery.
It’s important to reach out to family and friends to build your support system and identify a “coach” to help you through your recovery.

Preoperative Education Classes

Education is another key to success. Newton-Wellesley Hospital provides preoperative education classes to help you and your family prepare for hip replacement surgery. These classes are designed to provide information on the surgery, the postoperative course, and rehabilitation after hip surgery.
During class, the surgical procedure will be discussed, you will have the opportunity to see an example of a prosthesis and ask questions about your surgery and hospital stay. 
You are strongly urged to attend a preoperative education class. These classes can be booked by contacting Nancy Hiltz at The Kaplan Joint Center:

• By phone: 617-243-5597
• By email: nhiltz1@partners.org

Surgery Pre-Registration and Pre-Surgical Assessment

Before you come to Newton-Wellesley Hospital for surgery, you must complete your pre-registration. We encourage you to call us at 617-243-6122 before your preadmission visit. Otherwise, a member of our registration staff will call you three to five days before this appointment.

Pre-Admission Visit

Once your surgery has been scheduled, your surgeon’s office will arrange a pre-admission testing appointment. The average pre-admission visit is about two to three hours long. You will meet with or receive a call from the Orthopedic Pre-op Coordinator.

This visit will be scheduled as many as four weeks before your surgery. This is a separate appointment from your visit with your surgeon or PCP. The purpose of this visit is to make sure you are healthy and prepared for your surgery. You may eat normally and take your usual medications before this visit.

For Kaplan Joint Center patients, you will have a thorough evaluation by the Kaplan Joint Center internist.

On the day of your pre-admission visit, be sure to bring the following information:

• A list of your medications, vitamins, herbs, and any other over-the-counter medications – and please include dosages 
• A list of any allergies you may have 
• Names, addresses, and phone numbers of all the doctors, including specialists, that you see
• Any previous problems or reactions to anesthesia
• Results of recent tests at other hospitals 

During the pre-admission visit, we will:

• Order tests that may include blood work, an EKG, a chest X-ray, and a nasal swab test for bacteria
• Conduct an assessment that includes your past medical conditions, previous hospitalizations, and a review of your medications
• Confirm any allergies you may have to drugs, food, or latex 
• Review your bathing instructions before surgery
• Review your arrival time for the day of surgery

Anesthesia

You will have the opportunity to speak with a member of our Anesthesia Department. He or she will review your medical history and medications. You will be given instructions regarding the medications you should take before your surgery, and if any medications need to be stopped before surgery. Anesthesia options will be discussed, and there will be time for you to ask questions.

Informed Consent

Before surgery you will be asked to sign consent forms. You have the right to an explanation of your health condition and treatment options in words you can understand. Your doctor will also tell you about the risks and benefits of each treatment. Please feel free to ask questions.

Preparing Yourself for Surgery

Having surgery can be stressful. It may help to learn as much as you can about the procedure and to share this information with family and friends who will be involved in helping you with recovery. 

Here are some tips that will help you focus on a smooth recovery:

• Stay as active as possible.
• Continue your normal activity and exercise programs.
• If you smoke, stop.

Stopping your use of tobacco, even for a short time, can be helpful. For help, you may contact the Quit Smoking Programs at our partner hospitals:

• Brigham and Women’s Hospital, 617-732-8983
• Massachusetts General Hospital, 617-726-7443

For further information, you may also call 1-800-TRY-TO-STOP or visit www.trytostop.org.
Smoking can cause complications with anesthesia. So if you smoke, try to stop or cut back on the number of cigarettes you smoke each day.

Planning for Your Return Home

Before the day of your surgery, you, your “coach,” and your support team will discuss plans for discharge from the hospital after your operation. Your health care team will be evaluating your progress and will make recommendations. This is a decision that will be made together with you.

A nurse case manager will meet with you to assist in planning your discharge. He/she can arrange services from a home care agency if they are needed. Most patients return directly to home after a one-night hospital stay.

Your eligibility for home services or extended care facility is determined by a number of factors, including your medical and rehabilitation needs and your insurance coverage. Your insurance company will need to authorize any services for home care or a stay at an extended-care facility.

If you have specific questions about planning for discharge prior to surgery, you may contact the Care Coordination Department at Newton-
Wellesley Hospital at 617-243-6695.

Here are the goals we will help you achieve prior to being discharged from the hospital:

• You are able to get in and out of bed by yourself.
• You are able to stand up and sit down by yourself.
• You are able to walk safely on level ground with crutches or a walker over a distance of 150 feet or more.
• If you have stairs at your home, you can go up and down the stairs using crutches.
• You are able to complete self-care tasks (such as dressing, bathing, and toileting) safely by yourself or with minimal assistance.

Please note: You will need to have a ride available the day of your discharge from the hospital.

Here are some tasks you should anticipate needing support for at home:

• Transportation
• Meal preparation
• Laundry
• Household chores
• Driving

Home Safety Checklist

The Newton-Wellesley Occupational Therapy Department has prepared a Home Safety Checklist and general post-operative tips to help you prepare yourself and your home for your recovery from joint-replacement surgery.

We encourage you to review this list with family and friends and make any needed changes BEFORE your surgery. These recommendations can help you safely manage at home during your recovery period.

• Remove all loose rugs and electrical cords from areas where you walk in your home, as they can easily become caught under walkers or crutches.
• Make sure carpet edges are tacked down to reduce the risk of falling.
• Be sure all walking areas are free of clutter and well lit.
• You will need a stable chair with a firm back. Seat height can be built up with a firm pillow or folded linens. A chair with arms is recommended.
• Place a lamp or light switch within reach from your bed.
• Place needed items in the bathroom, bedroom, kitchen, and living areas within easy reach (not too high, and not too low).
• Keep a cordless phone or cell phone with you during the day.
• Place rubber mats or non-slip decals in your tub or shower.
• If you have equipment such as a commode or tub seat, check it out before your surgery to make sure it is in good working order.
• Consider having grab bars installed in your tub or shower wall and near your toilet for added safety when toileting or bathing.
• Put nightlights in your bathroom and in the hallway leading from your bedroom to bathroom.
• Ensure that stair handrails are securely fastened and extend the full length of the stairs.
• Be sure that outdoor walkways, steps, and porches are free of rocks, loose boards, and other tripping hazards.
• If you have young children or pets at home, be sure to arrange for assistance with their care prior to coming in for surgery.
• Depending upon your surgical approach and your level of flexibility, you may need longhandled equipment (a “hip kit”) to help with getting dressed after surgery. Your occupational therapist will make recommendations regarding equipment needs once you are evaluated postoperatively. If you feel that you may benefit from having a “hip kit” or home use prior to surgery, they can be purchased at most medical supply stores and pharmacies, as well as at Newton-Wellesley Hospital’s Gift Shop.

Tips for using a walker or crutches

• Always use your walker or crutches when walking until cleared by your home therapist.
• You will not be able to carry things in your hands while using crutches. Wearing an apron with pockets or a belt pack is a good way to  transport items from room to room when walking with crutches.
• If you are using a walker, consider buying a walker bag or basket for use in carrying items.

Kitchen tips

• If possible, move your kitchen table close enough to the counter so you can easily pass food items back and forth without twisting.
• To move an item from one part of the counter to the other, simply slide it along the countertop. If the item is hot, place a potholder under it.
• If you must set your crutches aside temporarily while preparing food at the counter, make sure they are within reach in a safe place where they will not fall to the floor.
• Frequently used refrigerated items should be within easy reach (between your waist and shoulder level). Arrange kitchen cabinets so that frequently used items are within easy reach, to avoid excessive bending or stretching.
• Keep your freezer stocked with ready-to-eat foods.
• Lighter-weight and single-serving items are easier to handle than large containers.
• Use only stovetop or counter-level appliances to prepare food. Do not use low ovens or attempt to load or unload the bottom rack of the dishwasher.

Bathroom tips

• Do not use towel bars, soap-dish handles, shower curtain rods, or toilet paper dispensers for support when getting in and out of the shower or on and off the toilet.
• It is important that you can reach your soap, shampoo, washcloth, and long-handled sponge in the shower without too much bending.
• Always make sure there is no water on the floor when stepping in and out of the tub or shower. If necessary, get help to dry the area before getting in and out of the shower.
• Sitting down to dry off after showering is recommended.

Assistive equipment frequently used following joint replacement

• A raised toilet seat or 3-in-1 commode chair to increase the height of a low toilet is helpful, with grab bars to assist with getting on and off your toilet.
• A tub bench or shower chair is helpful if you have weight-bearing restrictions following surgery or if you do not have good balance.
• A hand-held showerhead can also be helpful when bathing after surgery.