Prepare for Success with PreHab.
Tips For Success When Preparing For Total Joint Replacement Surgery
“In addition to improving the strength and range of motion of the joint to be replaced, consider improving your core strength, as well as the strength of joints above and below. For example, when having knee replacement, target the strength and range of motion of the hip and ankle.”
The Basics of Proper Preparation – A Quick Look
The first step is to choose your surgeon. This is a very personal decision, which goes beyond the scope of this article, however, the key qualities of the surgeon you choose will likely include: reputation, communication style, and convenience. Ultimately, choose the surgeon you are most comfortable with.
Please, do not stop there. There is so much more you can do to impact your results and overall experience. Preparation is key! Consider the factors below for a smooth and easy recovery for joint replacement surgery.
Exercise: Prepare your body. Improve your strength and flexibility prior to surgery. The concept of pre-habilitation (simplified as “prehab”) has been around for a while but is finally catching on. A stronger you before surgery will translate to a stronger and better you afterward.
Diet: Prepare your gut. Commit to better food choices prior to surgery. Follow a smart diet that controls blood glucose and eases digestive strain. This will enhance your healing process.
Game Plan: Prepare your brain. Take the time before surgery to learn joint protection techniques, use of adaptive equipment, or post-operative exercise routines. Have a game plan for physical therapy, grocery shopping, and rides to any appointments.
Equipment: Gather all the equipment that you will need prior to surgery and prepare your home. Barriers such as stairs, toilet height, and bed height should be addressed in advance.
Taking these actions will promote a greater sense of control and responsibility and will improve your confidence. Improved confidence and decreased anxiety are key characteristics of patients with successful outcomes. Practice other ways to decrease your stress and anxiety levels including meditation or other breathing techniques, and getting the proper amount of sleep.
Sounds simple, right? So, are you ready to report to the surgical center with a clear head knowing you have done all you can to properly prepare? If not, details on how to prepare for a successful outcome following joint replacement surgery can be found below.
Prepare your body for joint replacement surgery
Painful and swollen joints prior to surgery are often weak and stiff. Obviously, this is not the ideal state to undergo surgery. Thankfully, there is something you can do about it. Improvements in range of motion, strength, and swelling prior to surgery may lead to a significantly easier experience after surgery.
A proper prehab program designed specifically for your condition is best prescribed by your physical therapist. At least six weeks prior to your surgery is the optimal time for an effective prehab program.
Your physical therapist will teach you a customized exercise program that is safe and effective. There is no one exercise program that fits everyone, however a good exercise program should contain these characteristics:
A warm up activity.
Specific exercise routines tailored to your needs.
A cool down activity that helps manage swelling, flexibility, and range of motion.
Following this simple formula may also result in a dramatic decrease in your preoperative pain. Serendipitously, your new habit of exercise may lead to better overall health!
In addition to improving the strength and range of motion of the joint to be replaced, consider improving your core strength, as well as the strength of joints above and below. For example, when having knee replacement, target the strength and range of motion of the hip and ankle as well. Additionally, performing core strengthening exercises in the standing position may help your balance and gait stability after surgery.
Discuss your prehab plan with your surgeon. Your surgeon understands that it is unwise to go into surgery with a weak, stiff, or swollen joint. In some circumstances, your surgeon may even require a specific program of exercise and weight loss prior to surgery.
Prepare your gut: Nutrition and healthy eating habits
The pre-operative diet is often cited as the most commonly overlooked detail in surgical preparation. Indeed, healthy eating habits boost your immune system and aid in the process of tissue and wound healing. Conversely, poor eating habits and food choices may lower your body’s ability to fight infection and heal properly.
Choosing the quality, quantity, and consistency of the food you eat is a personal choice you make every day. A habit of smart daily choices is critically important for successful recovery. Most of us can begin by making small changes such as eating more vegetables and drinking more water, Start with these simple changes. Further diet changes should be based on your specific needs, your existing good/bad habits, and your preferences. Patients who are unsure of how to properly adjust their eating habits prior to surgery should seek the advice of a registered dietitian or nutritionist.
Start early. Not only will it benefit your recovery process, it may change the quality of your life! Supplementing your body with the proper balance of calories, macro nutrients, and hydration options will ease your body’s stress response after surgery. Begin your diet adjustments well before surgery and get into a good habit. It is not as hard as you think.
Maintain a consistent and healthy diet according to your needs before and after surgery. To minimize distress to the system, do not make drastic last minute changes in your diet. However, two weeks prior to surgery, you will be required to make a few important adjustments. Please find this summary below. These guidelines should not replace the individualized recommendations and instructions from your surgeon and/or your registered dietitian or nutritionist.
Two weeks prior to surgery, avoid foods, drinks, and supplements that may interfere with blood clotting ability. In general, avoid fish during this time period as it is high in Omega 3 fatty acid which can interfere with blood clotting ability. Likewise, you should also avoid fish oil supplements. Garlic and ginger spices should also be avoided during the pre-operative period as they are also known to interfere with blood clotting. Some recent studies suggest that vegetables known as nightshades may adversely affect metabolism of anesthesia or other pain medications. Other guidelines also suggest limiting foods such as potatoes, tomatoes, and eggplant two weeks prior to surgery.
In addition to the foods noted above, all vitamins and supplements should be stopped between one and two weeks prior to surgery. This includes vitamins E, K, C, and B and your multivitamin, as they may adversely affect your response to anesthesia and interfere with blood clotting.
Constipation following surgery is one of the most common complaints. The anesthesia during surgery and oral pain medications used after surgery are known to cause slower gut motility. Therefore, one to two days prior to surgery, avoid high fiber foods and supplements. Although foods in this category (fruits and vegetables) are considered highly nutritious and part of your healthy eating plan, you should avoid high fiber foods just prior to surgery because they pass very slowly through the gut causing constipation. Likewise, avoid fiber supplements. Experts generally agree that a low fiber/low residue diet is a healthy, short-term diet adjustment that most patients should practice prior to surgery.
Your doctor will give you instructions about proper hydration during the 24 hour period prior to surgery. Proper hydration is key for blood pressure stabilization, gut motility, and pain medication tolerance following surgery. The better hydrated you are, the better you will feel. Today, most surgeons and anesthesiologists allow drinking clear liquid beverages up to two hours prior to surgery.
If you live alone, grocery shop prior to surgery. Keep in mind that your post operative diet needs to be as nutritious and balanced as your preoperative diet. Avoid highly sweetened beverages and snacks as these raise your blood sugar. Resist the temptation to eat poorly just because you are bored, tired, or in pain. Whether or not you are a diabetic, maintaining a healthy diet with a stable blood glucose level will support the important functions of your immune system and other vital organs.
Medication and supplement use prior to surgery
The bottom line: Follow your doctor’s instructions about discontinuing certain medications and supplements prior to surgery as this vary. Your full medication and supplement profile should be examined well before surgery to determine your specific instructions. Your surgeons objective is to halt the effects of the medications or supplements that thin your blood. The ability to control bleeding during surgery will be hampered if blood thinning medications have not been discontinued on a timely basis before surgery.
If you take any of the types of medications below, please consult your physician about their use prior to surgery:
Anti-inflammatory medication or NSAIDs. (Non-steroidal anti-inflammatory drugs) If you take prescription or over-the-counter medicine for your arthritic condition, they should be stopped 7 days before surgery.
Aspirin. Please consult your physician about the use of aspirin. Aspirin is a medication with multiple uses including pain management and blood thinning. Clear instructions on when to discontinue aspirin should be discussed with your surgeon and physician.
Blood thinning medicines. If you take Plavix, Coumadin, Xarelto, Eliquis or any other similar medicine, please discuss if and for how long you are to stop taking them prior to surgery.
Vitamins and supplements. As previously discussed, these should be stopped one to two weeks prior to surgery as many of them have blood thinning properties.
Other medications. Steroid medications such as Prednisone will likely be stopped as well. Immunosuppressant medication should also be discussed with your doctor. Cardiovascular and other heart medications which regulate your blood pressure and heart rate should be discussed as well.
Prepare your home to promote a safe and simple recovery
Prior to your surgery, make a game plan to address potential safety issues in your home. Your physical therapist can perform a home safety evaluation to help you identify potential barriers. Below is a list of important questions to consider about your home:
Are there stairs leading into your home and or bedroom, and do those stairs have handrails?
Is the toilet seat too low?
Is the bed too high?
Are there loose rugs throughout the home?
Are there handrails in key areas? (showers, tubs, garage steps, surface level changes like breezeways or a sunken living room).
The amount of assistance you will need when you come home from surgery will depend on the following factors: your strength and mobility prior to surgery, the surgical procedure and its postoperative rules/precautions, and your overall home accessibility.
Another variable for the need of extra assistance after surgery is your weight-bearing status. In most cases, patients are allowed to bear full weight (as tolerated) on their operative leg. However, in some cases, the joint will need to be protected and a limited weight-bearing requirement may be imposed after surgery. With limited weight-bearing rules, patients should be prepared for increased challenges with stairs, steps, meal preparation, and bathing. Adherence to joint protection and weight-bearing restrictions are critically important to your postoperative recovery.
Finally, please consider the following questions related to your first several days after surgery:
Do I have a ride home from the surgery center in an easily accessible car?
Do I have easy-to-prepare meals and a strategy for healthy eating after surgery?
Do I have enough assistance available until I am steady on my feet?
Gather needed equipment
The most common piece of equipment needed after undergoing hip or knee replacement is a rolling walker. For stability and mobility, the walker should have two front wheels and solid rear legs. Some patients prefer putting tennis balls on the back legs to decrease noise and eliminate scuff lines on soft flooring. To assist with going up and down stairs, a cane is used alongside a sturdy handrail. However, if your doctor gives you a restriction on your weight-bearing, you may need crutches instead of a cane. If you are using crutches, there are techniques to use them safely on both level floors and on stairs. For patients who have never used crutches before, it is highly recommended to master the techniques for crutch walking on level surfaces, curbs, and stairs prior surgery.
An apparatus that elevates your toilet seat height is also highly recommended after any lower extremity replacement surgery. In fact, most posterior hip replacement precautions require some type of seat elevation. A three-in-one commode or a toilet seat extender are popular choices.
Optional equipment to consider include the contents of a hip kit such as a reacher, a sock aide, a long handled shoe horn, and a dressing stick. If you have a restriction not to reach below the level of your knee, the contents of the hip kit are priceless.
Have the proper footwear you will need for walking around your home. Footwear should be non-slip and cover the heel and be fully affixed to your foot. Sandals or flip flops are not recommended, nor should you walk with socks on hardwood floors. Consider owning a shoe that’s easy to slip on and off.
Prepare your brain
The best time to learn something new is when your head is clear. Why wait until after surgery to learn and practice the important keys to successful recovery? Your surgeon will give you a guide of what to do following surgery. In most cases, this is given to you in the recovery room. However, you can ask for this information prior to surgery so you can begin to learn the protocols and procedures. Learning this information prior to surgery will clarify your post operative expectations and enhance your compliance with the plan.
For example, if your surgeon is planning a posterior approach hip replacement, learn the postoperative precautions your surgeon requires. Precautions and instructions following surgery are usually given a time basis. Weight-bearing restrictions and hip precautions may be limited between two and six weeks. Be advised the one surgeon’s precautions may differ from another’s. Again, it is critical to follow your specific surgeon’s precautions. These rules are typically based on the individual surgeon’s operative choices when performing surgery and factors based on your surgical outcome, bone structure, or other incidental findings during surgery. In the recovery room, your surgeon will provide you with any additional instructions not included in your postoperative guide or paperwork.
Skills you can practice prior to surgery include:
Using a walker or crutches.
Going up/down stairs.
Getting in/out of your car.
Getting in/out of your tub or shower.
Your post operative exercise routine.
Miscellaneous instructions prior to surgery
Below is a list of other common instructions patients should adhere to prior to surgery:
Do not have dental work within six weeks before or after your joint replacement surgery.
Do not shave 48 hours prior to surgery.
Avoid alcohol 48 hours prior to surgery.
Try to avoid skin cuts or lacerations prior to surgery.
Try to quit smoking at least six weeks prior to surgery.
Inform your surgeon of any active infections you may have developed prior to surgery.
A final word
Total joint replacement surgery in the United States boasts a very high success rate. Positive outcomes are improving the lives for many patients suffering from pain and mobility loss. In decades past, patients would have to wait a long time for their joint replacement surgery. Today, the average age of patients undergoing joint replacement continues to decrease as surgeons agree that it is no longer prudent to wait excessively for this restorative procedure.
Each year, we continue to improve and innovate total joint replacement procedures. As we continue to transition toward the outpatient surgery model, it is critically important to have patients well educated and prepared to do their part for successful outcomes. Our instructions and teaching methods need to continually evolve as well, giving patients the most clear and individualized instructions available. As innovation and technology continues to transform the process, it is easy to loose sight of the patient’s responsibility and control of their surgical outcomes. Preparation, education, and guidance will continue to be an essential key to success. Together, we can make sure that you enjoy the road to complete recovery after your joint replacement surgery.
The intent of this publication is to educate and inform prospective patients about their part required for successful outcomes following total joint replacement surgery.
