The process of preparing for hip replacement surgery begins with your first diagnostic visit to The Leone Center for Orthopedic Care. The Center is located at the Holy Cross HealthPlex facility, just 1.5 miles from Holy Cross Hospital. If Dr. Leone feels that a need for hip surgery is indicated, a Nurse Liaison will be available to schedule your surgery at that time. Once you have been given a date for surgery, there are a number of simple steps to be taken in preparation.
Before Your Surgery
Once a decision is made to proceed with surgery, we will make every effort to help you navigate the pre-operative education and medical clearance processes as efficiently as possible. My entire team will be available and involved in every step of the process to assist you. This may include completing all medical forms, managing preoperative clearance, helping you create an optimal discharge plan and arranging for private rooms and VIP meals and other enhanced services if desired.
You will be given a pre-operative packet of materials including a hard copy of my “Preparing For Your Total Hip Replacement” booklet which you can also review and download from this website. We ask that you bring this packet to the hospital with you for your pre-surgical appointment and on the day of your surgery. This helps ensure that all necessary steps have been completed pre-operatively and that your surgery and hospitalization will go smoothly.
The Orthopedic Patient Pre-Surgical Agreement Form
This form, included in your packet, details the steps that must be taken in preparation for your surgery:
Obtain Medical Clearance prior to your surgery. Our staff will help you make an appointment, either with your own physician or a different physician who has privileges at Holy Cross Hospital (HCH), who will then be available to see you after your surgery. (If a non-HCH doctor clears you, we still will arrange for a medical doctor to see you in the postoperative period.) It is best that this appointment be made as soon as possible after surgery is scheduled. This helps prevent your surgery from being delayed or cancelled.
Stop taking blood-thinning medications, according to your physician’s/surgeon’s instructions, to reduce the risk of bleeding during surgery. A member of our team will advise you if any medications you are currently taking are blood thinners. (Be certain to inform your nurse of any Over the Counter medications and supplements you are taking.)
The need for a blood transfusion is much less common than only a few years ago. Our surgical and anesthetic techniques and specialized medications, including those which decrease bleeding, are administered during and after surgery. Also, the prior threshold for transfusion has been lowered as traditional benchmarks have been challenged and refuted in medical literature. I emphasize maintaining the volume of fluid in the vascular system with fluids other than transfused blood. The old thinking was that autologous blood (blood donated before surgery by a patient) was safer than blood donated by another person. This no longer is the case and the change in thinking has largely come about by our ability to test for potential specific diseases that sometimes contaminate blood, such as HIV or hepatitis. We discourage our patients from pre-donating because the percentage of people who need a transfusion is very small. If a transfusion is necessary, one is made available through our blood bank. Read more on my blog.
Stop or start other medications as advised by your physician/surgeon.
Follow your surgeon’s recommendation regarding flu vaccination. While the hospital supports the Centers for Disease Control’s advice that individuals receive an annual flu shot between October and March, in an effort to prevent influenza and pneumococcal infections, your surgeon may recommend that you not be vaccinated during your total joint replacement surgery admission process. If so, he may suggest an alternate time for your flu vaccination.
Begin the Home Exercise Program included in your packet. Do the exercises as illustrated, performing ten repetitions of each exercise three times per day. This will increase your range of motion, strengthen your muscles and improve your endurance in preparation for surgery and rehabilitation.
Make an appointment for the pre-operative class at least two weeks prior to surgery. Ask you Nurse Liaison for assistance.
Attend a pre-operative class (details below).
An important part of our consistent success at the Leone Center of Orthopedic Care is to have each patient’s medical condition fully evaluated before their surgery. This allows us to better understand and optimize any medical concerns pre-operatively. It also allows us to more safely plan for your surgery and post-operative care. This Medical Clearance is often provided by each patient’s own physician. My staff will help arrange for you to see another physician who is associated with Holy Cross Hospital if you don’t have a regular physician who follows your care or you prefer. That individual will also be available to see you after your surgery if appropriate. If your own physician clears you for surgery but does not have privileges at Holy Cross and you need other medical specialist to help manage your care post-operatively, then we will make arrangements for appropriate specialist to see you.
Please schedule your appointment for surgical clearance 2-3 weeks prior to your scheduled surgery in case more studies or the need to see another medical specialist should be required. This helps prevent your surgery from being delayed or canceled. Your Medical Clearance for surgery will include a note from the physician who evaluated you “clearing you” to proceed with surgery, blood studies, chest X-ray report, EKG and any other studies which were required. Note: lab studies must be conducted within 30 days of your scheduled surgery. My staff will help you coordinate this. This information is Faxed to our office 954-489-4584 at least 7 days prior to you scheduled surgery. Because it is so important, we encourage you to be fully involved in this process by calling the physician’s office who cleared you and our office to confirm all necessary information has be received. Once again, my staff will be fully engaged and will help.
You will return to our office approximately a week prior to your scheduled surgery. We will review you pre-operative clearance, post operative discharge plan and any specific concerns or needs you might have. You will also be given specific instructions about which medicines to take and which to stop taking pre-operatively.
Many of our patients travel from throughout the USA or internationally for they’re surgery. Our staff will work with you to customize to preoperative process to meet your needs.
The Pre-Operative Class
The Center has created a very popular and informative pre-operative class. We’ve learned that if our patients are admitted for surgery with more and better information, they feel empowered, are more confident and have a better hospital experience. That is our goal.
At the class, you will meet key members of our team with whom you will be interacting once admitted for surgery. We will review the entire process, from admission to discharge, using personal stories to make it real. We will explain the details of the surgery itself, discuss various methods of implantation, and likely show you an actual prosthesis. We will describe the location of the incision and explain how you can expect it to heal after your surgery. We will cover patients’ concerns about anesthesia extensively.
Therapists and nurses will outline the post-surgical rehabilitation process. Social workers will help you understand exactly what your insurance will cover and all of your care options after discharge.
The day of class is also a perfect time to “pre-admit” so that you will not need to worry about additional logistics on the day of your surgery.
Home Exercise Program
You will be encouraged to preform exercises prior to your surgery which we’ve outlined in the Hip Booklet. Our goal is to improve your strength, endurance and the joints range of motion prior to your surgery. These are the same exercises you will be asked to do after your surgery. We see that patients that go into surgery more physically fit tend to get well faster. We don’t want you doing any exercise or activity that causes pain and aggravates your underlying condition.
Vitamin C, 1000mg, once a day, will improve iron absorption and the ability of your tissues to heal.
Iron, Slow Fe is recommended, twice a day with meals.
Please note: iron may cause constipation or diarrhea and your bowel movements may appear black. If this occurs, you may need to decrease or stop the iron.
Do not eat dairy products one hour prior to or after taking iron because dairy hinders iron absorption.
If you regularly take a blood thinner, you will be given specific instructions by your medical physician and by our team when to stop taking this medication and also instructed if a different, shorter-acting blood thinner needs to be substituted until your surgery. This will reduce the risk of increased bleeding during your surgery, while still keeping you safe.
DO NOT TAKE Vitamin E, fish oil, NSAIDs, or other aspirin-like anti-inflammatory medicines for at least 14 days prior to hospitalization. You may continue to take Tylenol if needed.
There are many natural herbs, bioceuticals and even vitamins including Vitamin K that also can increase bleeding and affect bioavailability and the metabolism of other drugs and should be stopped 14 days pre-operatively.
DO NOT EAT OR DRINK LIQUIDS AFTER MIDNIGHT THE DAY PRIOR TO YOUR SURGERY.
Morning of the Surgery
If you routinely take medications, our team will instruct you which to take and which to discontinue the morning of your surgery. You may take any approved medications with a sip of water.
You will be instructed to wash using a special surgical soap called Hibiclens the night before and morning prior to your surgery. Use regular soap first and thoroughly wash. Then again wash your entire body from neck down with Hibiclens paying special attention to the area around your hip but don’t scrub. Allow to remain on your skin for 5 minutes before rinsing.
Other Important Information
It also is very important to maintain a healthy diet rich in fruits, vegetables, lean proteins, such as chicken or fish, and whole grains. This helps build up your blood levels and nutritional strength prior to surgery and helps the healing process.
DO NOT neglect routine dental work, including oral cleaning. If a dental problem develops, correction is preferable prior to your hip surgery.
We hope that you do not smoke; however, if you do, it is important to stop 3 weeks prior to your surgery. This will make the operation much safer for you and improve your healing.
The need for a blood transfusion is much less common than just a few years ago. Surgical and anesthetic techniques continue to be refined, which has resulted in much less blood loss during and after surgery. Specific medications are administered just prior to surgery and during the post-operative period which decrease bleeding. Further, patients who have their surgery with a regional or spinal anesthetic tend to bleed less and are less likely to need a transfusion than those cared for with general anesthesia. Also, the threshold for when to transfuse has been lowered, as traditional benchmarks have been challenged and refuted in the medical literature.
Maintaining the fluid volume in your vascular system with fluid other than transfused blood is emphasized. This begins with you receiving IV fluids in the pre-operative area to improve hydration even before your surgery starts.
Autogenous blood transfusion (blood which the patient donates for themselves before surgery) is no longer recommended because the risks do not outweigh the benefits.
What to Bring to the Hospital
˜ Current list of medicines (name, dosages, frequency)
˜ Insurance information
˜ Living Will or advanced directives
˜ Comfortable clothing, such as a workout outfit or tee shirt and shorts
(plan on getting dressed the morning after your surgery) ˜ Shoes with a rubber soul and a closed heel
˜ Personal toiletry items
˜ Leave all jewelry and other valuables at home
The Day of Admission for Surgery
Arrive the Holy Cross Hospital Main Entrance
4725 N Federal Highway (next to the Chapel and Cancer Center) at the time instructed by Dr. Leone’s team (please be early)
Registration process will be completed (first floor) You will be escorted to the preoperative holding area
Preoperative holding Area (third floor)
I will see you the morning of surgery and ask you to confirm on which hip I will be operating and then I will place my initials and the word “yes” on that hip.
You will meet with your anesthesiologist, who will discuss different types of anesthesia and their part in your care.
An IV will be started and you will receive fluids, antibiotics as well as a number of other medicines to minimize post-operative pain and make you more comfortable.
You will experience many checks and re-checks to confirm all important information is correct. This consistent attention to detail makes the entire procedure safer for you.