Your Support Team & Care Coach

We ask all of our patients to identify a support team (care coach) before their surgery date. Your support team could be a friend, family member, or neighbor—someone who you know and trust, who is willing to help you for your first few days at home after surgery. This can be one person, or it can be several people; it does not matter as long they communicate any needs you may have. 

Most importantly, your support team will help you with daily activities as you recover. 

We encourage your support team to accompany you to Joint Academy. They can:

  • stay with you in the hospital,
  • attend your physical therapy sessions,
  • help you get food and medication, and
  • perform other basic household tasks after your surgery.

They will also help remind you of the exercises you will be doing during recovery, and should be available as an extra set of eyes and ears to support you during your first days back home.

After your joint replacement surgery, you will be able to bathe and use the bathroom independently, but be sure to communicate with your support team if you do decide that you need an extra hand. Include your support team in your home preparations, if possible. The more communication you have with them prior to surgery, the better equipped they will be to assist you when you return home with your new joint. 

Choosing Your Care Coach

Insurance

Our surgical coordinator will notify your insurance organization of your upcoming surgery. We will make every effort to pre-authorize your surgery and provide any requested information to your insurer. Please call our coordinator if you have questions about the authorization or need to change the surgery date.

It is your responsibility to communicate with your insurance provider to determine what charges you may be responsible for. We are not authorized to inform you of your co-pay or other financial responsibilities. A University of Utah Health patient financial advocate can tell you an estimated cost for the surgery based on the current procedural terminology. They may be contacted at 801-587-5374.

All scheduled surgery dates are subject to change pending insurance authorization.

Plan for Post-Surgical Care

Physical Therapy

You may begin outpatient physical therapy (physical therapy after your hospital stay) soon after you are released from the hospital. It is a good idea to identify a physical therapist you would like to see and schedule an appointment before surgery. This way you can have your first physical therapy appointment on or after your first follow-up with your joint replacement surgeon.

We can help you identify good physical therapy services before your surgery.

 

Prepare Your Home for Recovery

It is important to consider the layout and organization of your home in preparation for your joint replacement surgery. We want your return home to be as smooth and comfortable as possible. We recommend you try moving around your house with a walker or crutches before you actually need them to help you get a sense of possible challenges or barriers that you may not have noticed otherwise.

Here is a list of things you may want to think about:

  • Consider your floor plan/stairs. If possible, arrange for a bed, a place to sit, and a bathroom all on the same floor of your home.
  • Rearrange your furniture to make space for crutches and/or a walker, if necessary.
  • Have firm pillows available to raise low seats, and keep extras on hand to help elevate your leg while you're in bed.
  • Throw rugs can be a trip hazard, especially in the bathroom. If you have any, pick them up and put them away.
  • Consider installing safety bars in the shower or near the toilet.
  • Prepare and freeze meals ahead of time to make cooking easier.

For more information on how to prepare for your return home with your new joint, be sure to watch our Joint Academy video series.

There is also equipment you will need for your safe recovery. A list and prescription will be provided for you. Please obtain these items before surgery. Safety bars are helpful and increase your safety at home. Install them ahead of time, especially in the bathroom, if you are able. Shower chairs and raised toilet seats are also useful during recovery. A raised toilet seat is required for the first six weeks after a total hip surgery.

If you will not have help available, or you live alone, please plan on a brief stay in an additional facility (care facility or rehab) until it is safe for you to return home.

Optimize Your Health

Being in the best health possible decreases your risk of complications both during and after surgery. To optimize your health, we recommend the following:

  • Quit smoking at least six weeks before and six weeks after surgery. Nicotine decreases the blood supply to your surgical site and slows down the healing process. Your surgery will be canceled if you're using products containing nicotine (gum, patch, vaping, or smoking).
  • Exercise. We understand  that you may be limited by your arthritis pain, so we encourage you to strengthen your upper body. This will help you use the crutches/walker following surgery. We also recommend low impact exercises like walking and swimming.
  • Try not to injure your skin. Cuts or lacerations can cause a delay of your surgery.
  • Avoid alcohol for 48 hours before surgery.
  • Decrease your use of narcotic pain medications as much as possible. This allows us to use effective medications to control your pain after surgery. If your body is tolerant of high doses of pain medication, your pain may be more difficult to control.

Medical Clearance by Primary Care Physician

We recommend that you visit your primary care physician (PCP) six months before surgery for a general health check-up to ensure that any health concerns are addressed before proceeding with your surgery. If you have other significant medical conditions, you will need to see relevant specialists for medical management prior to surgery.

  • All medical clearances must be received by our office at least two weeks prior to surgery, or your procedure may be postponed.
  • If you have multiple medical problems, you may need to obtain these medical clearances prior to obtaining a surgery date.

Diabetes

Be sure that your blood sugar is well controlled before and after surgery. If you are diabetic, your Hemoglobin A1C must be well controlled (goal 7.0) keeping your daily blood sugar at or below 150.

It is also important that you continue controlling your glucose levels after surgery to have a good recovery.

Injections Before Surgery

DO NOT get a steroid injection in the joint that we will be replacing within 12 weeks of your surgery. Injections to close to your surgery will increase your risk of infection in the joint.

Procedures/Dental Work

Bacteria from some procedures and dental work place you at higher risk for joint replacement infection. These include any invasive procedures (through the skin) such as:

  • a biopsy,
  • Moh’s surgery for skin cancer, or
  • a colonoscopy.

They should be done six weeks prior to your surgery date. Dental cleaning, especially root canals, extraction, and crowns, need to be taken care of six weeks before surgery.

Medications & Surgery

You will need to stop taking certain medications prior to surgery. Questions regarding all medications should be directed to your surgeon’s staff as soon as possible.

Seven Days Before Surgery, STOP:

  • Non-steroidal anti-inflammatory drugs (NSAIDs): Ibuprofen, Motrin®, Advil®, Naprosyn®, Aleve®, and the like. (These medications also cannot be taken with warfarin after surgery.) Topical NSAIDs, including topical creams, are okay to continue.
  • Any over-the-counter herbal medications that may thin your blood, such as St. John's Wort, Tumeric, fish oil, or Omega-3 supplements.
  • Aspirin®: If you take Aspirin for a cardiac condition, continue your dosage through your surgery date. If you have not been prescribed Aspirin by your doctor, please stop taking it seven days before surgery.

Other Medications:

You may be taking a variety of medications, and we place a high priority on ensuring that your prescriptions are aligned appropriately to ensure the best possible outcome for your surgery. If you are taking any of the following medications, please contact our office for instructions:

  • Plavix,
  • Coumadin,
  • Eliquis,
  • Xarelto,
  • Aggrenox,
  • hormone replacement therapy,
  • immunosuppressant medications (such as methotrexate, Enbrel), and
  • prednisone/steroids.
Do not get a steroid injection into the joint we will be replacing within six weeks of your surgery date. It increases your chance of an infection in the joint.

You may continue taking Celebrex (celecoxib) and/or Tylenol (acetaminophen), but do not exceed 3,000 mgs of Tylenol in a 24-hour period. 

Medications List

Please write down all your current medications with dose, frequency you take them, and the reason you take them. Include any:

  • over-the-counter medications,
  • herbal supplements, or
  • vitamins.

Bring this list to all visits, including surgery.

Pre-Operative Lab Work & Assessment

Pre-operative nurses will collect medical history information from you before surgery.

Surgery at University Orthopaedic Center:

If you are having surgery at the University Orthopaedic Center, a pre-op nurse will call you to discuss your medical history over the phone. You will also need to have your blood drawn within 30–90 days of surgery. Generally this is completed at your appointment with your surgeon; however, if you are not sure, please contact our offices to confirm.

Supplies for the night before surgery are provided by our surgery coordinator. If you are having a total knee replacement, you can watch an educational video on the safety and procedure of a femoral nerve catheter.

Surgery at University of Utah Hospital:

If you are having surgery at University of Utah Hospital, you may be scheduled for an appointment at the surgical pre-admission clinic (SPA). Be on time to your appointment, but also bring a book. Your appointment may take up to three hours. Bring a copy of any medical clearances we asked you to obtain, especially an echocardiogram report if applicable, so our anesthesiologists can clear you for surgery.

Bring a list of your medications so the nurses can get accurate names, dosages, and times you take your medications. Your visit will include evaluation of your vital signs, height and weight, a possible EKG of your heart and/or a chest X-ray, blood work, and a detailed history and physical exam.

You may meet with a member of our anesthesia team as well. If you are having a total knee replacement, you will watch an educational video on the safety and procedure of a femoral nerve catheter. You will take home instructions and supplies for the night before surgery.

We will provide you with educational materials designed to help you understand the surgical and recovery processes as well as how to care for your joint. We encourage you to share this information with the important people in your life who will be assisting you throughout this process.

Staph Aureus Screening

We currently screen all patients for staph prior to elective joint surgery to reduce the possibility of infection.

What is Staph Aureus?

Staph Aureus is a common type of bacteria that lives on the skin or in the nasal passages of about one in four healthy people. The apparent bacteria do not always cause problems or infections, but those affected we consider “colonized” with staph. If the staph bacteria enters a person’s body through a surgical incision, cut, sore, catheter, or breathing tube, it may cause an infection.

MRSA (Methicillin Resistant Staphylococcus Aureus) is a bacterium from the staph family that can also be identified by this screening. It is resistant to commonly used antibiotics. It is typically harmless to healthy people; however, carriers of MRSA are at an increased risk of the bacteria getting into their wound during surgery and possibly causing an infection. Up to one in 20 persons can carry MRSA on their skin or in their nose. MSSA (Methicillin Susceptible Staphylococcus Aureus) is readily treated by common antibiotic but also has the potential to cause infections.

What does the screening entail?

When you schedule your surgery, you will have a nasal swab done in clinic. A cotton swab will be placed in your nose to get a sample. The process is painless and only takes a few seconds. The sample will then be sent to the lab to have cultures done, with results returning to your provider in five to seven days.

What if I test positive?

Many people are carriers of MRSA/MSSA. This does not mean you are not clean, ill, or a risk to other healthy people. It means that you are a carrier of the staph bacteria and "decolonizing" will help reduce the number of bacteria, which helps reduce the chance of infection.

If your culture results come back positive, we will contact you and send additional instructions, including a decolonization process. This process will involve the use of a nasal ointment and a "chlorhexidine" body wash daily for five days prior to surgery. You can also minimize your risk of becoming recolonized by using clean linens, clothing, and other hygiene precautions.

What if I test negative?

We will only contact patients with a positive result prior to surgery. If we do not contact you, continue the following hygiene routines:

  • Bathe regularly.
  • Clean your hands with soap and water or an alcohol-based hand sanitizer.
  • Avoid reusing or sharing personal items, such as disposable razors, linens, towels, and the like.
  • Maintain clean sheets, clothing, and home.
  • Wear clean, washed clothing for the five days leading up to surgery.
  • Wash all eating utensils after each use.

In addition, you will be given an anti-bacterial wash to use prior to surgery. Instructions for this will be explained at your pre-op appointment.