Before Joint Replacement Surgery
Do I need to make a pre-operative appointment myself?
No. About six weeks prior to surgery you will receive a mailing with information regarding your surgery, including the date and time of your pre-operative appointment. The date of this appointment is usually two weeks before your surgery date.
Is it necessary to donate my own blood before surgery?
Note that donation of your blood before your operation is used only if you need a blood transfusion during or after your surgery.
Donating your blood, called an autologous blood donation, is not necessary. Even though blood from donors is tested to eliminate all known risks, a transfusion of your own blood is the safest course because it eliminates any risk of acquiring diseases that may be transmitted by blood transfusion.
Age, weight, medications and medical conditions such as heart disease usually do not preclude autologous blood donations. However, conditions may exclude you or may require you to obtain a clearance from your doctor. You should discuss your individual circumstance with a specialist at our Neely Cell Therapy and Collection Center (617-636-6453) to determine whether or not you are a good candidate for autologous blood donation.
Must I get vaccinated before my joint replacement surgery?
Yes. Please make sure you are up to date on your flu and pneumonia vaccines. However, some people should not get an inactivated influenza vaccine or should wait before getting it. Tell your doctor if you have any severe (life-threatening) allergies. A severe allergy to any vaccine component is also a reason to not get the vaccine. For example, while allergic reactions to influenza vaccine are rare, the influenza vaccine virus is grown in eggs so people with a severe egg allergy should not get the vaccine.
If you have had a severe reaction after a previous dose of influenza vaccine, tell your doctor. Tell your doctor if you ever had Guillain-Barré Syndrome (a severe paralytic illness, also called GBS). You may be able to get the vaccine, but your doctor can help you make the decision.
People who are moderately or severely ill should wait until they recover before getting flu vaccine. If you are ill, talk to your doctor or nurse about whether to reschedule the vaccination. People with a mild illness can usually get the vaccine.
Am I allowed to eat and drink the night before my surgery?
It is extremely important that you neither drink nor eat anything the night before your surgery, but you can have clear liquids up until midnight. After midnight, no food or liquids can be consumed.
The Day of Joint Replacement Surgery
On the day of my surgery, is there valet parking?
Yes. There is valet parking right in front of our South Building. The cost of valet parking is the same as at our parking garage.
How long does the surgery last?
Joint replacement surgery lasts about three to four hours.
Do Drs. Baratz and Zarin use sutures (stitches) or staples for the joint replacement?
Drs. Baratz and Zarin use sutures. Most of their stitches are done underneath the skin, though there may be a few on the outside. If you see any loose threads after surgery, it is important that you do not pull at them. If the loose threads become bothersome, they may be trimmed with scissors.
Which day is considered "post-op day one?
The day of your surgery is considered day zero, so post-op day one would be the day after your surgery, post-op day two would be two days after your surgery, and so on.
What is femoral nerve blocker anesthesia and how does it work?
A femoral nerve block is considered a regional anesthesia. In regional anesthesia, a numbing medication is injected around the nerves that transmit pain signals from the area involved in the surgery. The procedure “blocks” the nerves, ensuring that you will not feel pain during or immediately after surgery.
Depending on the specific numbing medicine (local anesthetic) used, the effects of the block can last even longer, ranging from hours to days. For some types of surgery, you may receive an infusion catheter, a very thin tube which can continuously bathe the nerve area in numbing medicine for an average of two to three days. When the medication runs out, the catheter is removed, a simple procedure that you or your caretaker can perform. The femoral block will be removed 48 hours after surgery.
When is the femoral nerve blocker administered?
Before your surgery, the regional anesthesiologist will locate the relevant nerves using ultrasound or electrical stimulation to determine the optimal injection site. The numbing medication can then be injected with precision, without irritating or injecting the nerves themselves. This is generally done one half hour to one hour before your surgery.
Getting this nerve block is no more painful than getting an IV. Your skin will be numbed before the procedure, and you may also receive mild sedation.
Regional anesthesia can be used by itself or with conscious sedation, meaning you are drowsy but do not require an airway device to assist in breathing as you would during general anesthesia. If you prefer, we can also combine regional anesthesia with either intravenous sedation or general anesthesia, both of which allow you to “sleep” during surgery. You will have the opportunity to discuss your preferences with your anesthesiologist prior to surgery.
Where is the femoral nerve blocker administered?
For surgeries involving the knee, nerve blocks are most commonly performed at the groin (femoral block).
After Joint Replacement Surgery
Will I be provided with a list of rehabilitation centers? Will my insurance cover the costs?
We are glad to provide you with a list of rehabilitation centers in your area for you to review prior to your admission. Alternatively, you can get a list of rehabilitation centers on your own.
Visit massgov.org and search for “skilled nursing facilities.” If there is a particular place you’re interested in, use the Internet to search and retrieve ratings, comments and any other information for that center.
Whether or not your insurance covers the costs of your rehabilitation center depends on your insurance carrier. If you have any questions regarding coverage please call your insurance company.
How long, on average, are patients in rehabilitation centers following joint replacement?
The length of stay at a rehabilitation center varies by individual. Factors such as your level of functionality prior to surgery and your rate of recovery help determine your length of stay.
Are there risks of having dental work done after a joint replacement?
The reason we recommend that all your dental work be up to date prior to your surgery is because it is possible, in some situations, for bacteria from the mouth, teeth or gums to travel through the bloodstream and settle in an artificial joint and infect the joint. In an attempt to prevent this occurrence, representatives from the American Dental Association and the American Academy of Orthopaedic Surgeons developed recommendations for people with joint replacements who are planning on having certain dental procedures done.
These are guidelines only. Because your dentist knows the extent of any dental work you may require, he or she is the best person to determine whether a course of antibiotic treatment is appropriate for you. If antibiotics are necessary, your dentist should write the prescription for you. Routine cleaning of your teeth should be delayed for several weeks after surgery.
For what dental procedures do I need preventative antibiotics?
You won’t need to get preventive antibiotics for most dental procedures, though, because you have an artificial joint your risk of contracting a blood borne infection is higher than normal. Preventive treatment is advised if the procedure involves high levels of bacteria. You should get preventive antibiotics before dental procedures if: you had a joint replacement, have had previous infections in your artificial joint or you have an inflammatory type of arthritis, such as rheumatoid arthritis.
Do I need to take an antibiotic every time I go to the dentist?
Whether or not you need an antibiotic for a dental appointment depends on what you will be having done. You should consult your dentist prior to your appointment to find out. If you do need an antibiotic, your dentist should write the prescription for you.
This precaution is for the dentist, but if you happen to cut yourself and it looks infected, consult a doctor immediately.
How soon can I fly on an airplane after hip or knee replacement surgery?
As soon as you are comfortable with sitting down, you can fly. Usually, three to four weeks is the minimum time. During flying or driving on long trips, exercise your calf muscles and ankles frequently. Also, get out of the car or walk the aisle of the airplane to avoid the possibility of blood clots. Take the blood-thinners prescribed after surgery to reduce the risk of blood clots and wear your white anti-embolism stockings.
Do I need a letter to carry in order to get through airport security with an artificial hip or knee?
We will write a letter on letterhead for patients that travel out of the country or do not speak English. With heightened security measures however, be prepared to have the security personnel at airports screen you more thoroughly. In some cases, patients have been escorted to a private area and have been asked to show security personnel their surgical scar.
How soon can I resume sex after a hip or knee replacement operation and what positions re safe?
You can resume sexual activity as soon as you are comfortable, in any position that does not cause discomfort or break your joint precautions.
Are hip precautions for life?
Yes, the precautions are for life and should be strictly adhered to for the duration of the healing and muscle strengthening. However, hip precautions can be relaxed once the hip is strong and healed.
Can I drive after getting a joint replacement?
For a replacement operation on the right leg, hip or knee, it is wise to wait a four to six weeks and after you have stopped taking medications that impede your driving ability. By that time, you have control of your reflexes, making driving safe.
For replacements on the left side, with an automatic transmission, usually you can drive two to three weeks with a pillow on the seat and after you’ve stopped taking medications that impede your driving ability. Also make sure you are able to safely get into and out of the car.