Surgery

Pre-Admission Clinic

Once your date for surgery has been set, you will have an appointment at the hospital prior to surgery in the Pre-Admission Clinic. The purpose of the Pre-Admission Clinic visit is to help you prepare for your surgery. Here we will talk to you about what will happen to you while you are in hospital and what you are to expect when you return home.

The Pre-Admission Clinic visit is your opportunity to discuss any questions or concerns that you may have about your surgery, hospitalization and discharge home.

For more information about the Pre-Admission Clinic, visit What to expect in your Adult Pre-Admission Clinic appointment.

Day before surgery

  • You must call your surgeon’s office between 2:30PM and 4:00PM to confirm your time of surgery.
  • You must remove finger and toenail polish.
  • You must not eat anything after midnight the night before or the morning of your surgery.
  • You must not chew gum, candy or smoke after midnight the night before or the morning of your surgery.
  • You must bathe or shower the night before and the morning of the surgery.

When you wash, both the night before and the morning of the surgery, you must also wash with the special cleansing sponge given to you in the Pre-Admission Clinic visit. You should:

Hip surgery

  • Use the sponge to wash from your waist to your knee on the leg having surgery.
  • Rub the sponge over the skin until it becomes foamy and rinse away with water.
Diagram of pre-hip surgery washing area
​ Diagram of pre-hip surgery washing area

 

Knee Surgery

  • Use the sponge to wash from the middle of your thigh to your ankle on the leg having surgery.
  • Rub the sponge over the skin until it becomes foamy and rinse away with water.
Antiseptic Sponge
Diagram of pre-knee surgery washing area

 

If you are feeling unwell, or there are any changes to your health in anyway, you must immediately contact your surgeon’s office.

What to bring to hospital

In a small overnight case or bag, pack:

  • One set of clothes to go home in.
  • A bath robe.
  • One or two sets of night clothes (if you prefer over using a hospital gown).
  • Slippers or sandals that are easy to slip on and have a closed heel.
  • My Guide to Total Joint Arthroplasty.
  • Personal items such as toothbrush and paste, razor, comb, deodorant, lotion, tissues and feminine hygiene products.

You should also bring in crutches if you have them so they can be sized and you can be taught how to use them correctly. Please do not bring in any walkers or canes.

Day of surgery

On the day of your surgery, you:

  • Will arrive at the hospital at least 2 – 2 ½ hours before the time of surgery.
  • Report to the Pre-Admission Clinic area.
  • Be directed to the Surgical Preparation area where you will wait and be prepped for your surgery.

For more information, visit What to expect on the day of your surgery.

Pain Management

The goal of pain management after surgery is to provide best possible pain control and improve rehabilitation. Your ability to do activities necessary for a full recovery improves outcomes for you. Early activity prevents scar tissue formation in joint surgery and helps to reduce the risk of problems that can occur if you stay in bed too long. Walking and coughing reduce your risks of developing blood clots in your legs and chest infection.

We cannot promise that you will have no pain. Every attempt will be made to keep you as comfortable as possible. Please remember that it is better to treat pain early than to delay treatment until it is severe. So, if you have pain, let your nurse or doctor know.

For more information, please visit Anesthesia and You and Managing Your Pain.

Preventing Blood Clots:

For the first few days after surgery, you will not be getting up as often as you were prior to surgery. As a result, you are at a higher risk of developing blood clots. To prevent this, you will be given a medication once a day to thin your blood. Your surgeon will make the recommendation as to the type of blood thinner that is best for you.

Fragmin®

One blood thinner you may receive is Fragmin® (dalteparin). This medication:

  • Will be given to you using a small needle in your stomach.
  • You will be taught how to give the injections yourself starting on the first day after surgery.
  • You will need to continue this medication at home, for a total of 10 to 14 days after surgery.

Your surgeon may choose to shorten or lengthen the duration of this therapy based on other risk factors.

Please note: Fragmin® (dalteparin) is not a paid benefit under the Ontario Drug Benefit Program for preventing blood clots. This affects you if you are senior citizen (age > 65) and/or receive:

  • Social assistance
  • Trillium program
  • Home care drug card

Alternative drug plans (i.e., benefits through employer) may cover this drug.

If you already take a medication for blood thinning such as Coumadin® (warfarin), you will resume this drug after surgery. The day after surgery you will be put on a combination of Fragmin® and Coumadin® initially because the Coumadin® will take a few days to start working again.

Rivaroxaban/Xarelto®

Rivaroxaban/Xarelto® is another blood thinner that is now being used in our orthopaedic population. It is a tablet that is taken once a day. This may be covered in a drug benefit plan or can be covered by limited use code prescription for Total Knee and Total Hips patients (for a specific time limit for each procedure).