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Smoking and Alcohol Use
Smoking - Smoking causes breathing problems, increases the risk of medical complications, and slows recovery. Smoking also increases the risk of infection and blood clots after surgery. If you smoke, we encourage you to quit at least a few weeks before surgery. Cleveland Clinic Tobacco Treatment Program offers a variety of methods to help people who want to become nonsmokers. For more information and locations, please call 216.448.8800. Please be aware that smoking is strictly prohibited at all Cleveland Clinic hospitals. Alcohol Use - Before surgery, it is important to be honest with your health care providers about your alcohol use. Tell your health care provider how many drinks you have per day (or per week). This information helps determine if you are at risk for alcohol withdrawal or other alcohol-related problems that could occur after surgery and affect your recovery. We are here to help you prepare and recover from your surgery as quickly and safely as possible.
Diabetes Guidelines and Blood Glucose Management
Managing your blood glucose is always important, but it is extremely important before surgery. In fact, managing your blood glucose before surgery can help reduce the risk of problems after surgery, such as infection and other complications. Surgery can affect your blood glucose control in many ways. Stress before and after surgery can cause your body to release hormones that may make it more difficult to manage blood glucose levels. Surgery can also affect your normal diet, and may change your usual medication routine. Your diabetes will be managed throughout the entire surgical process, starting with a thorough review during the pre-operative testing and continuing through the post-op period.
Medications
Some medications thin your blood, increase the risk of bleeding after surgery, or interfere with healing. These medications may need to be stopped before surgery. If you take medications that contain aspirin, anti-inflammatories (such as ibuprofen, [Motrin®, Advil®], naproxen [Aleve®]), blood thinners (such as warfarin, [Coumadin®]) or arthritis medications, ask your surgeon when to stop taking these medications. Because blood-thinning medications affect clotting and bleeding, these medications (plus all your other medications) will be reviewed with you either at your pre-admission visit or by your surgical team. If you have any questions about your medications, please contact your surgeon’s office.
Home Safety Preparation
Setting up your home for your return before you have surgery will help keep you safe, make your life easier, and aid in your recovery. Listed below are suggestions for preparing your home for a safe recovery.
Traffic pattern
Move obstacles – such as throw rugs, extension cords, and footstools – out of your walk way. Create a wide, clear path from your bedroom to your bathroom and kitchen so you can easily move about with a walker or crutches.
Bathroom
Ask an occupational therapist how to adapt your bathroom to meet your needs during recovery. You will likely need an elevated toilet seat or commode and a shower chair. (Read more about Bathroom readiness in the Adaptive and Durable Medical Equipment Section)
Sitting
Sit in chairs that keep your knees lower than your hips. Choose a firm, straight-back chair with armrests. A dining room chair may work if you don’t have other chairs. Add a foam cushion or folded blanket if you need to raise yourself up, but avoid sitting on a soft pillow. Also, avoid sitting in rolling chairs or recliners.
Children and Pets
Small children and pets can pose a safety hazard. Small children may need to be taught how to interact with you in ways that keep you safe. If you have pets, make arrangements to keep pets in another area of the house when you arrive home.
Access to Items
To avoid reaching or bending, keep frequently used items within easy reach, especially in the kitchen, bathroom, and bedroom, for example, food, medications, phone. It’s a good idea to carry a cell phone or portable phone with you at all times during your recovery.
Stair climbing
It’s okay to climb stairs without assistance, if you are able. However, you may need help with climbing stairs when you first get home. Consider installing handrails or make sure existing handrails are secure.
Laundry and cleaning
Get help with cleaning and laundry. Have a few weeks’ of clean clothes available.
Arrange for somebody to collect mail or place delivery on hold (same with newspaper).
Meals
Arrange for help with your meals and perishable foods (milk, salad, and fruits and vegetables). Freeze pre-made dinners before your surgery. Stock up on non-perishable foods (boxed, canned, and frozen) to make it easier to prepare meals after surgery.
Driving
Arrange for someone to drive you to your after surgery appointments. Do not drive until your surgeon tells you it’s okay to do so. Absolutely do not drive while taking narcotic medications. Do not drive until you have regained the range of motion, strength, and reaction time needed to drive safely.
Adaptive or Durable Medical Equipment (DME)
A walker, crutches, or cane are standard equipment used by all patients recovering from joint replacement surgery. It is highly recommended that you contact your insurance company to find out what is covered under your policy.
For patients with hip replacements, an elevated toilet seat or bedside commode may be needed for safety. Both provide increased height, while the bedside commode also has arms and can usually fit directly over your home toilet. It may also fit in the shower.
Below is a list of suggested items that can make your life easier and keep you safe. Most of the items can be found at a medical supply store or at pharmacies, home improvement stores, or thrift stores. These items should be purchased before your surgery, however before buying; we suggest you talk to either a physical or occupational therapist about your specific needs.
• Walker (with 5 inch wheels, not a Rollators or walker with seat)
• Cane
• Reacher (or grabber)
• Crutches
• Sock aid
• Long-handled shoehorn
• Elastic shoe laces
Bathroom• Elevated commode seat
• Toilet seat riser
• Shower chair
• Grab bar for shower / tub
• Hand-held shower head
• Long-handled bath sponge
Before Your Surgery
Checklists
The following checklists are guides to help you prepare for surgery and recovery. Careful preparation improves the chance of a complication-free recovery. To complete before surgery:
I have verified with my insurance company that I have coverage for my surgery.
I have attended the total joint replacement education class.
I have received my pre-admission testing schedule. If I have not received my schedule with in two weeks before my surgery, I will contact the surgery scheduling office.
I have completed all lab work requested from my surgeon’s office.
I will call my Specialty Care Coordinator if I have questions or concerns about my surgery.
I have talked to my Specialty Care Coordinator or surgeon about discharge options.
I have completed a Living Will or Health Care Power-of-Attorney to have on file in my chart.
I have not shaved my legs 3 days before my surgery.
I have arranged for someone to drive me home when I’m discharged from the hospital.
I have arranged for someone to drive me to my follow-up appointments.
To improve my health before surgery:
I quit smoking to improve healing and reduce the risk of infection after surgery.
I had a dental check-up to make sure all my dental needs are taken care of before surgery.
I received a flu vaccination (if during flu season -- October through March).
I am eating lightly the week before my surgery to help reduce the risk of constipation. I have increased fluids and fiber in my diet as well.
I had my diabetes checked, and it is under control (if applicable).
What to Bring to the Hospital Current list of medications and supplements, noting which ones have been stopped Loose pajamas or short nightgown and short robe if desiredUnder garments
Loose shorts, jogging suit, sweats, tops
Slippers with backs and rubberized sole or walking sneakers/shoes with Velcro® closures or elastic shoe laces
Socks
Personal toiletries (toothbrush, toothpaste, denture cleanser/cup, deodorant, electric or other razor, shaving cream, comb, NO powders)
Eyeglasses
Hearing aid and batteries
CPAP machine settings, tubing, and machine Cell phone or calling card
Driver’s license or photo ID, insurance card, Medicare or Medicaid card
Copy of your Advanced Directives
Important telephone numbers (include person bringing you home)
Any hand-carry equipment you may have such as a reacher, sock aid, long-handled shoe horn
This guide booklet so you can review items with your health care team
Do not bring a walker. The person driving you home should bring it at the time of your discharge.
Do not bring valuables - no jewelry, credit cards, checkbooks, or cash.
Do not bring your own medications.
Pre-Admission Testing
A pre-operative work-up is mandatory for all joint replacement patients. At this visit, you will be asked about your medical history, previous surgeries, illnesses and current state of health. You will also undergo a series of tests, such as lab work, urinalysis, nasal swab, X-ray, EKG and / or stress test.
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