Preparing for Joint Replacement

The Roadmap

What happens after we decide on surgery?

Once we have decided together that joint replacement is the right next step, there is usually a period of preparation before the operation.

Some patients are healthy and move through this process quickly. Others need additional testing or optimization before it is safest to proceed.

The basic roadmap looks like this:

1. We decide that joint replacement is appropriate.
2. Your surgery is scheduled.
3. You complete the required medical evaluation and preoperative testing.
4. We identify any health issues that should be improved before surgery.
5. You receive instructions about medications, surgery, and recovery.
6. You prepare your home and arrange the help you will need.
7. We confirm that you are ready to proceed.
8. You arrive for surgery with a clear plan.

The purpose is not to create unnecessary hurdles. It is to avoid preventable surprises.

Medical Readiness

What does medical clearance involve?

Before elective joint replacement, we need to make sure you are medically ready for surgery and anesthesia.

This does not mean that you have to be perfectly healthy. Many people having hip or knee replacement have high blood pressure, diabetes, heart disease, sleep apnea, or other medical conditions.

The goal is to make sure those conditions are understood and reasonably controlled.

Who provides my clearance?

Depending on your health and the surgical facility, your preoperative evaluation may be completed by your primary care physician, an internal medicine provider, an anesthesia preoperative clinic, or another clinician involved in your care.

Some patients may also need input from a specialist such as a cardiologist, pulmonologist, endocrinologist, or another physician who manages an important medical condition.

What testing will I need?

The exact testing depends on your age, medical history, medications, and where your surgery will be performed.

Preoperative testing may include:

• Blood work
• Glucose testing
• A blood count
• Kidney and electrolyte testing
• An electrocardiogram, or EKG, when appropriate
• Additional testing based on your medical history
• Screening required by the surgical facility

Not every patient needs every possible test. Testing should have a reason behind it.

What if something abnormal is found?

An abnormal test does not automatically mean your surgery is canceled.

Sometimes it simply needs to be reviewed. Other times, we may need to adjust a medication, repeat a test, obtain another evaluation, or improve a medical condition before proceeding.

Reducing Risk

What do we try to improve before surgery?

Some surgical risks cannot be changed. Your age, previous operations, and much of your medical history are already part of who you are.

Other factors can sometimes be improved. These are often called modifiable risk factors.

Nicotine

I require patients to be nicotine-free before elective hip or knee replacement.

That includes cigarettes, vaping, chewing tobacco, nicotine pouches, and other nicotine-containing products.

Nicotine interferes with blood flow and tissue healing and is associated with a higher risk of wound problems, infection, and other complications after orthopedic surgery.

If you currently use nicotine, tell us. The goal is not to judge you. We need to know so that we can help you stop and safely prepare for surgery.

Blood sugar and diabetes

Good glucose control matters because elevated blood sugar is associated with wound-healing problems and infection after joint replacement.

In my practice, I use a blood test called fructosamine as part of evaluating glucose control before surgery.

Many patients are familiar with hemoglobin A1C. A1C gives us an estimate of average blood sugar over roughly the previous two to three months.

Fructosamine looks at a shorter period of glucose control — roughly the previous two to three weeks. That makes it useful when we are trying to understand how well blood sugar has been controlled recently as surgery approaches.

If your fructosamine is elevated, we may need to improve glucose control and repeat the test before proceeding with elective surgery.

This applies even if you feel well. High blood sugar does not always cause obvious symptoms.

Why not just use A1C?

A1C is still a useful test, and your other physicians may use it to manage diabetes. I use fructosamine because it gives us additional information about more recent glucose control.

We are not treating a laboratory number simply for the sake of the number. We are trying to reduce avoidable risk around your joint replacement.

Nutrition

Your body needs adequate nutrition to heal an incision, recover from surgery, and rebuild strength.

In the weeks before surgery, focus on regular meals with adequate protein and a balanced diet unless another physician has given you different dietary instructions.

Significant unintentional weight loss, poor appetite, or known nutritional problems should be discussed before surgery.

Weight

Body weight can affect the risk of wound problems, infection, blood clots, anesthesia complications, and other issues around joint replacement.

Weight is not the only thing that determines surgical risk, and this conversation should not be about blame. It is one of several factors we consider when deciding how to make surgery as safe as reasonably possible.

Anemia and other medical conditions

If testing shows significant anemia or another medical problem that can reasonably be improved, we may address that before surgery.

The same is true for uncontrolled blood pressure, active medical illness, or other conditions that could unnecessarily increase the risk of an elective operation.

Active infections and skin problems

Tell us if you develop an infection, draining wound, open sore, significant rash, or skin problem near the operative leg before surgery.

Also let us know if you become sick shortly before the operation.

Because a joint replacement introduces permanent implants, an active infection may be a reason to delay surgery until it has been appropriately treated.

What about dental work?

Routine dental health is important, but you generally do not need to undergo unnecessary dental procedures simply because you are having a joint replacement.

If you have an active dental infection, painful tooth, abscess, or dental procedure already planned around the time of surgery, let us know so we can coordinate the timing.

Medication Planning

Which medications need attention before surgery?

One of the most important parts of your preoperative visit is making sure we have an accurate medication list.

Bring or provide a complete list of:

• Prescription medications
• Over-the-counter medications
• Blood thinners
• Diabetes medications
• Weight-loss medications
• Vitamins
• Herbal products and supplements

Blood thinners

Medications that affect blood clotting require a specific plan before surgery.

Examples include warfarin, apixaban, rivaroxaban, clopidogrel, aspirin, and other anticoagulant or antiplatelet medications.

The plan depends on why you take the medication and your individual risk of bleeding and blood clots.

Diabetes medications

Insulin and other diabetes medications may need to be adjusted around the time you are fasting for surgery.

Some diabetes medications require specific instructions before an operation, so follow the medication plan given to you by your surgical and anesthesia teams.

GLP-1 medications

Medications used for diabetes or weight management — including GLP-1 medications — deserve specific attention because they can affect stomach emptying and anesthesia planning.

Recommendations for these medications have evolved over time and may differ depending on the medication, your symptoms, your dose, and the anesthesia plan.

Do not guess when to stop them. Follow the instructions provided for your specific medication and surgery.

Anti-inflammatory medications and supplements

Certain anti-inflammatory medications and supplements may affect bleeding or interact with other medications.

You will receive instructions about which products should be continued and which should be held before surgery.

Getting Ready

How should I prepare myself and my home?

You do not need to turn your house into a hospital.

A little planning, however, can make the first several days after surgery much easier.

Keep moving before surgery

Within what your arthritic joint allows, try to remain active before surgery.

Walking, cycling, basic strengthening, and your usual activities can help maintain strength and endurance.

You do not need to make yourself miserable trying to "train" for a joint replacement. The goal is simply to arrive at surgery as active and functional as reasonably possible.

Plan who will help you

Arrange for someone to drive you home and make sure you have appropriate help available during the early recovery period.

The amount of help you need depends on your age, overall health, home environment, and how independently you are moving after surgery.

Make the important areas easy to reach

Think about the places you will use most during the first few days:

• Where you will sleep
• The bathroom
• The kitchen
• Where you will sit during the day
• The path from your entrance to those areas

You usually do not need to move downstairs permanently or avoid every staircase. We simply want a safe plan for getting around.

Remove obvious fall hazards

Loose rugs, cluttered walkways, cords, poor lighting, and excited pets can all become more challenging when you first come home using a walker or cane.

Clear the main paths through your home before surgery.

Do I need special equipment?

Most patients will use a walker initially and then transition to a cane as balance and confidence improve.

Some patients benefit from additional equipment depending on their home setup and mobility.

Do not feel that you need to buy every piece of equipment you see online. We can help you determine what you actually need.

Plan ahead for meals and daily tasks

Having simple meals available, prescriptions organized, and routine household tasks handled ahead of time can make the first week less stressful.

If you live alone, tell us. Living alone does not automatically prevent joint replacement, but it makes planning ahead more important.

Almost There

What should I expect in the final days before surgery?

By this point, most of the major decisions should already be made.

You should know where your surgery is taking place, when to arrive, which medications to take or hold, and what your plan is for getting home afterward.

Follow your bathing and skin-preparation instructions

You may receive specific instructions about showering or cleansing your skin before surgery. Follow the instructions provided by your surgical facility.

Do not shave the operative area immediately before surgery unless you have specifically been instructed to do so.

Check your skin

Look at the leg that will be operated on.

If you have a new cut, scrape, wound, rash, bite, or other skin problem near the surgical area, contact the office rather than assuming it will be fine.

Tell us if you become sick

Fever, significant respiratory illness, a new infection, or another major change in your health shortly before surgery should be reported.

Sometimes surgery can proceed normally. Sometimes the safer choice is to delay it. We would rather make that decision before you arrive for the operation.

Follow your fasting instructions

You will receive instructions about when to stop eating and drinking before surgery.

Follow those instructions carefully. They are important for anesthesia safety.

What should I bring?

Keep it simple. Bring the items requested by the surgical facility, your identification and insurance information, and any medication information you have been asked to provide.

Wear comfortable clothing that will be easy to put on after surgery.

What if I am nervous?

Most patients are.

You can understand why you need the operation, feel confident in your decision, and still be nervous the night before. Those things can all be true at the same time.

By the time surgery day arrives, our goal is that there are very few surprises left. You should understand the plan, know what comes next, and know who to contact if you have a question.

What comes next?

After surgery, the focus shifts from preparation to getting you moving safely, controlling pain and swelling, and gradually rebuilding strength and function.

Learn what to expect during recovery →

Common Questions

Frequently asked questions

Why do I need medical clearance if I feel healthy?

Surgery and anesthesia place stress on the body, and some medical conditions do not cause obvious symptoms. The preoperative evaluation helps us identify issues that may affect the operation or recovery before they become a surprise.

Why do you check fructosamine?

Fructosamine gives us information about your recent blood glucose control over approximately the previous two to three weeks. I use it as part of evaluating glucose control before elective joint replacement because poor glucose control is associated with higher surgical risk.

What if my fructosamine is too high?

We may need to improve your glucose control before elective surgery. Once that has been addressed, fructosamine can respond more quickly than A1C because it reflects a shorter period of time.

Can I vape instead of smoking before surgery?

Not if the vape contains nicotine. My requirement is that patients be nicotine-free before elective joint replacement, not simply cigarette-free.

Can I use nicotine patches or gum?

Because my surgical requirement is nicotine-free status, nicotine-containing replacement products still contain the substance we are trying to avoid. Talk with us about your cessation plan so we can help you choose an appropriate strategy.

Do I need to see a cardiologist?

Not everyone does. Whether you need specialist evaluation depends on your medical history, symptoms, previous testing, and the recommendations of the clinicians performing your preoperative evaluation.

Do I need dental clearance?

Not every patient needs routine dental clearance simply because they are having a joint replacement. An active dental infection or significant dental problem should be addressed and discussed before elective surgery.

Should I exercise before surgery?

Yes, within what your joint can reasonably tolerate. Maintaining strength, motion, and general conditioning is helpful, but you do not need to push through severe pain in an attempt to prepare.

What if I live alone?

Tell us early. Many patients who live alone can still recover successfully at home, but transportation, mobility, meals, medications, and early support need to be planned in advance.