Lower Extremity Joint Replacement Pre-Surgery Checklist

o I have attended my preop physical exam with my (PCP) primary care provider.

• I know which medications to hold or continue before surgery. If I do not know, I can ask my PCP or the optimization nurse.
• I will inform the Optimization RN if I am taking any of the following medications: GLP-1, blood thinners, Estrogen or HRT, Chemotherapy, and Immunosuppressive drugs including biologics.
• I had my blood drawn and MRSA nasal swab.
• I will call my PCP and surgeon if I have any skin concerns (i.e. rash, open wound, skin redness) or if I become ill (i.e. fever, shortness of breath, productive cough, vomiting/diarrhea etc.) prior to surgery.

o I have attended one preop physical therapy appointment for education, walker and stair training before surgery.

• I understand my pre and post-surgery exercises (upper body and lower body strengthening).
• I have all the equipment that I need for after surgery as advised by the physical therapist (i.e 2-wheeled walker and if needed crutches, cane, leg lifter, toilet riser with handles, long handle shoe horn, shower chair etc.).
• Practice walking in your home with your walker before surgery. Learn where obstacles are such as rugs, tight corners and cords. Plan a clear safe path. Test your daily routine and rethink logistics to make changes before surgery if needed.
• If I do not have a walker before surgery, one will be provided and billed to insurance on the day of surgery, and I will own it.
• I am scheduled for my 1st post op physical therapy appointment if needed.

o Prior to surgery

• My support person should be willing and physically able to assist with driving to post op appointments/physical therapy, help with meals, assist with leg positioning if needed, coach and encourage me to do my exercises, keep track of medications, assist with physical hygiene if needed etc. An adult will stay with me 24/7 for at least 72 hours at home.
• I will sign up for my surgeon’s automated educational texting program (STREAMD) using the card found in my surgery folder from the clinic at the time of scheduling, this will start 13 days before surgery and continue daily until approximately 6-7 weeks after surgery.
• I will not drink alcohol, smoke/vape/chew tobacco or do recreational drugs including but not limited to marijuana/THC gummies 1 week before surgery or longer if directed by the optimization nurse or surgeon. If I do not follow these instructions, surgery could be cancelled.
• If ordered by my surgeon, I have my CPM (continuous passive motion) machine (for knee surgery) and cooling machine. The equipment company will contact me 7-10 days before surgery. They will go over cost, deliver to my house, and instruct me how to use the equipment.
• I will not shave my surgery site 7 days before surgery.
• I have my skin prep soap with an instruction sheet and understand how to use it.
• I will pick up my post op medications the day before surgery and leave them at home (i.e Tylenol, stool softener/laxative, blood thinner and prescribed pain medication).
• I will receive a text message or phone call from the surgery center 1 business day before surgery with my registration arrival time and when to stop eating/drinking.
• I should drink a serving of Gatorade prior to the clear liquid cut off time.

o Day of surgery:

• I will walk into the main entrance and go to the left for registration.
• I will bring my photo ID, insurance card, walker, and extra set of loose comfortable clothes (elastic waist bottoms).
• I will wear non-skid shoes that allow room for post op swelling. Lace up tennis shoes work best. Do not wear pull-on boots or open-toed backless shoes.
• I will not bring any controlled substances (i.e. narcotics).
• I will not bring money or valuables to OSI unless I have been told I have a copay.
• My support person should wait at OSI the whole time if possible. Let the registration staff know if the support person is leaving to get lunch etc. and communicate when they should return. The support person must be present for home instructions and the stair demonstration. If there is more than one support person, one person will be allowed back in recovery at a time.
• The nurse will be going through home instructions on the day of surgery including incision care and dressing changes, showering, activity level instructions, infection prevention, etc.
• After surgery, the goal is to be out of bed within 1 hour or as soon as physically capable. Anticipate being discharged on average 2-4 hours after surgery.
• I will be discharged to home the same day of surgery after I meet the following criteria:
  • Urinate (without symptoms of urinary retention)
  • Eat/drink well
  • Adequate pain control
  • Demonstrate safe walking with the walker, nurse and a gait belt
  • Demonstrate I can do the stairs (if applicable)

o A few reminders once I am home:

•  I will use the walker until my follow up appointment with my surgeon and/or as advised by my physical therapist post op.
• My support person should walk with me and utilize the gait belt every time I get up for a minimum of 24 hours to prevent falling.
• It is not uncommon to feel dizzy or lightheaded after surgery. Lie down slowly and elevate your legs above heart level. Place a cool compress on the forehead. Once symptoms improve, gradually rise to a seated position. Be sure to drink adequate fluids (i.e sports drink, electrolyte drink, broth or soup). Avoid bearing down with bowel movements.
• I can call my surgeon’s clinic (920-560-1000) 24/7 if I have a concern that cannot wait until normal business hours.