On The Day Of Surgery
Medication and Hygiene
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 or knee. Do not scrub. Allow the Hibiclens to remain on your skin for 5 minutes before rinsing.
What To Bring
- 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
- Shoes with a rubber soul and a closed heel
- Personal toiletry items
- Leave all jewelry and other valuables at home
Where To Go
Your surgery will take place at Holy Cross Hospital, 4725 N Federal Highway. The hospital is next to the Chapel and Cancer Center. Enter at the Main Entrance which is on the east side of the building facing Federal Highway. Dr Leone’s team will give you an arrival time. Please arrive early!
You will complete the Registration process on the first floor and then you will be escorted to the preoperative holding area on the third floor.
Pre-operative Holding Area
In the preoperative holding area, you will be asked to remove contact lenses and glasses and put on a surgical gown. If you wear dentures or use a hearing aid, we suggest that these be removed. An IV will be started and you will receive fluids, antibiotics as well as a number of other medicines which minimize post-operative pain and make you more relaxed and comfortable. A member of our healthcare team will make sure all consent forms are signed.
Dr. Leone will personally visit with you just prior to surgery. He will ask you to confirm which hip he will be operating on. He will then initial that hip with a special marking pen and write the word “yes” on that hip. Your anesthesiologist will also meet with you to review your record and examine you. Together you will discuss and agree to an appropriate anesthetic plan. If you wish, a member of our Spiritual Care team will also be available to see you.
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.
The Surgical Waiting Room
Once you are transferred to surgery, family members, caregivers, and/or special friends will be escorted to the Surgical Waiting Room. During surgery and post-surgical recovery, every effort will be made to reassure and communicate with these individuals and let them know when they can expect the doctor to visit.
Once the surgery has been completed, Dr. Leone will come to the Surgical Waiting Room and speak to any family members, caregivers or friends. When you are ready to be transferred to your hospital room, guests can accompany you. If someone important is not able to be at the hospital, Dr. Leone will be happy to call them after the surgery and report on your surgery and care.
Cell phone use is permitted in the Surgical Waiting Room, and there is free wireless internet access. The Surgical Waiting Room has a television and vending machines. On the first floor are both the hospital cafeteria and Heart Healthy Café, serving meals, snacks and refreshments. Additional outdoor seating can be found in the Mercy Courtyard.
In the Surgical Suite
You are wheeled from the pre-operative holding room to the surgical suite and given either regional (spinal) or general anesthesia. You will be comfortable and unable to recall the surgery from this point on.
All surgery is performed by Dr. Leone. The surgery is not delegated to anyone else.
At the conclusion of your surgery, Dr. Leone injects a combination of different medicines into tissues around your new hip which further decrease post-operative pain. Your tissues are irrigated with a solution containing different antibiotics and betadine which further decreases the risk of an infection.
Your incision is meticulously closed with a running suture (as opposed to conventional staples). In our experience this suturing technique provides a superior seal and extra protection against infection. It is performed like plastic surgery, using a single stitch. Some studies have reported a decrease infection rate with this technique. We apply a sterile surgical dressing that has antiseptic properties and allows the incision to breathe.
We take every precaution to prevent a post-operative infection and take great pride in our track record. This process begins pre-operatively through nutritional health and hygiene. Before surgery, we encourage you to optimize your nutritional health, with a diet of rich in fruits, vegetables, lean protein, such as chicken or fish, and whole grains. You are also asked to supplement your diet with Vitamin C and iron which help the healing process and improve your body’s ability to prevent an infection.
We recommend that you wash using a special soap the night before your surgery and again the morning of your surgery. Refer to our Hip Booklet for more specific instructions. During surgery, we wear body exhaust suits (that look like space suits) to completely isolate our breathing which further reduces the risk of infection. You receive IV antibiotics before the incision is made and after your surgery. Even the surgical dressing has special antiseptic properties.
The need for a blood transfusion has decreased markedly in recent years due to improved surgical and anesthetic techniques, such as the use of tranexamic acid which helps stabilize blood clots, reducing the need to transfuse. Also the prior threshold for transfusion has been lowered as traditional benchmarks have been challenged and refuted in medical literature.
What that means is that the percentage of people who require a transfusion post-surgery is very small. Dr. Leone emphasizes maintaining the volume of fluid in the vascular system with fluids other than transfused blood.
If a transfusion is necessary, however, we recommend using donated blood from our blood bank rather than autologous blood, which is blood donated before surgery by patients for their own use. Improvements in screening donated blood for diseases such HIV or hepatitis coupled with its benefits make it a better choice. For this reason, we discourage our patients from pre-donating for themselves.
Here’s why. The red blood cells in transfused blood must be alive and function normally to deliver oxygen to our body tissues. Blood cells removed from our own body (autogenous) and then frozen do not deliver oxygen to the tissues as optimally as we thought in the past. Also, donating blood for oneself lowers the pre-operative hemoglobin level which increases the need for a post-operative transfusion. You can read more about blood transfusions on my blog.
Post Anesthesia Care Unit (Pacu):
After your surgery, you will awaken in our PACU. Your nurse will monitor your vital signs, give you IV fluid and other medicine and make sure you are stable and comfortable. An ice bag is also place against your surgical dressing which helps decrease swelling, bleeding and pain. You will then be transferred to our specialty orthopedic unit on the 4th floor where any family and/or friends may join you.
We use medication to prevent and down modulate pain as well as to pre-empt potential post-operative complications, such as nausea or vomiting. Our protocol includes the type of anesthesia you will be administered, injecting the tissues around the surgical reconstruction with a combination of different meds prior to incision closure, and giving you different medicines from different families of medicines, other than just narcotics, on a specific schedule once your surgery is complete. Everyone’s care is individualized for their unique needs.
Medications administered the morning prior to or during surgery include:
- Tylenol to lower your sensitivity to pain as well as decrease the amount of pain.
- IV Toradol which is a NSAID and has proven remarkably effective at decreasing pain via alternate pathways in our bodies.
- Neurontin which also helps to decrease postoperative pain by affecting chemicals and nerves in your body that are involved in pain pathways.
- Medicines which decrease anxiety and make you drowsy.
- A long-acting narcotic to dull pain receptors before pain sets in as well as medication to prevent nausea following surgery.
- An IV steroid just prior to the start of your surgery and postoperatively.
- After implanting the components, the tissues around the new joint are injected with a “cocktail” including a long-acting local anesthetic, and an NSAID. This combination has greatly reduced post-operative pain and the need for narcotics. This has resulted in our patients feeling remarkably comfortable immediately after their surgery and allowing them to get out of bed the day of surgery and walk.
- Tranexamic acid is also given just prior to making the incision and postoperatively. This medication decreases intra- and post-operative blood loss by stabilizing the blood clot which mitigates the need for post-operative blood transfusion.
- IV antibiotics are also administered before and after surgery to lower the risk of infection.
Medicines prescribed for use at home
You will be given very specific instructions regarding what medicines to take and when to take them to manage pain and prevent common post-op problems like constipation. We often prescribe a combination narcotic/Tylenol medicine.
We make arrangements for your medication to be filled by a local pharmacy before you leave Holy Cross Hospital and deliver it to you at the time of discharge. For many patients, having the pain medication in hand before they leave is very reassuring, even if they do not have to use it. We also verify that arrangements have been made for delivery of specified supplies to your home, such as walkers or elevated toilet seats.