Before & After Orthopedic Surgery

What you need to know

With caring hearts and capable hands, Lee Health strives to provide first-class care to all of our patients to help restore you to a higher quality of life.

We also maintain a team atmosphere in our joint center, whether it is our highly skilled staff members working together to help you or patients joining forces to help one another excel during the recovery process.

You will be involved in your comprehensive planned course of treatment every step of the way.

This begins with a Pre-Op education class that helps you understand what to expect, and continues through your discharge from the hospital and recovery at home or in a skilled nursing facility for rehabilitation.

The Joint Center is the largest orthopedic program in Southwest Florida and one of only a handful of wellness-based joint replacement centers in the country.

The Joint Centers are within three of Lee Health hospitals—Lee Memorial Hospital, Gulf Coast Medical Center, and Cape Coral Hospital.

In addition to our talented orthopedic surgeons who will perform your surgery, our joint center team members include navigators, nurses, therapists, case managers, and patient care technicians with decades of experience caring for joint replacement patients.

You are in caring hands and your safety is our No. 1 concern!

Before surgery

Joint Center Pre-Op Education Class
Before surgery we highly recommend that you take the time to attend one of our Pre-Op education classes, which will provide valuable information regarding your upcoming surgery and hospital stay.

The class is generally 90 minutes long. The Pre-Op education classes take place at Lee Memorial Hospital on Wednesday; at Gulf Coast Medical Center on Friday and at Cape Coral Hospital on Tuesday.

To register, please call 239-343-1999.

What You Will Learn:

• Preparing for surgery
• What happens the day of surgery
• What happens after surgery
• Effects of anesthesia
• Pain management
• Pre- and Post-Op exercises
• Use of a walker/assistive devices
• Physical therapy/ Occupational therapy
• Review of potential complications and preventive measures
• The role of your “coach” (family member, patient support person, friend)
• Infection prevention
• Important contact names and numbers

Pre-Op Checklist

• After your surgery has been scheduled, you will need to provide information for pre-registration. You will be asked to supply the following information:
• Full legal name as it appears on your insurance card
• Your local home address
• Your local home phone number or cell number
• Social Security Number
• Driver’s license or photo ID
• Insurance card with the name of the insurance company, mailing address, policy and group numbers. If you are not the primary insured, the policy holder’s name.
• The name of your current employer, if applicable
• Your emergency contact name, phone number, and address

Billing For Services
After your procedure, you will receive separate bills from the anesthesiologist, the hospital, the radiology and pathology departments (if applicable), the physical therapist and the surgical assistant. If your insurance company has specific requirements regarding participation status, please contact your company.

Start Pre-Op Exercises
Many patients with arthritis favor their bad joints. This causes the bad joints to become weaker, which interferes with recovery. It is important that you begin an exercise program before surgery. Our staff will provide you with a full list of exercises for your specific condition.

Contact Nurse Navigator with Questions

• The nurse navigator guides patients through the entire surgical process from preadmission to discharge.
• Facilitates preoperative education about the procedure, recovery, and rehabilitation.
• Maintains communication with the patient and family before, during and after the hospital stay.
• Answers any questions a patient might have about the procedure, recovery and rehabilitation.
• Call 239-343-3341 to contact the Lee Memorial Hospital orthopedic nurse navigator.

10 Days before Surgery Pre-Op Visit to Surgeon
You should have an appointment with your surgeon 7-10 days before your surgery. This will serve as a final checkup and a time to ask any questions that you might have.

Prepare Your Home for Your Return
We suggest that you take a few steps to prepare your home before your surgery. Preparing early will help make things easier for you upon your return from the hospital.

• Be sure there is plenty of food, supplies and medication.
• Store your important items at waist level so you do not have to bend over to reach them.
• Arrange furniture to allow easy access for walking.
• Clean and wash the laundry and put it away.
• Put clean linens on the bed.
• Prepare meals and freeze them in single serving containers or stock up on healthy, prepackaged frozen meals.
• Cut the grass, tend to the garden and finish any other yard work.
• Remove throw rugs and tack down loose carpeting.
• Remove or tape down electrical cords and other obstructions from walkways to allow enough room for your walker.
• Be sure your house is well lit and use night lights.
• Arrange to have someone collect your mail and take care of pets or loved ones, if necessary.
• If you have stairs inside or outside your home, make sure you have a sturdy handrail to grab.
• If you have a two-story home make plans to sleep on the first floor.
• Make sure that you have an appropriate chair to sit in, at least knee high with arm rests—a sturdy recliner works well.
• Arrange for your transportation to home, follow-up appointments and any errands.

What to Bring to the Hospital

• For your comfort we suggest you bring some personal items from home: 
• Personal hygiene items, such as a toothbrush, powder, deodorant and electric razor
• Loose-fitting, elastic waist shorts and T-shirts—exercise or gym clothes (one set for each day)
• Dentures, glasses, hearing aids and their cases—please remember it is your responsibility to keep them safe
• Your guidebook to the hospital with your medication sheet filled out
• A copy of your advance directives
• If you bring a cell phone, cell phone charger or computer, please remember it is your responsibility to keep it safe

Seven Days before Surgery
Seven days before surgery, stop all anti-inflammatory medications, such as Motrin, Aleve, vitamin E, Naproxen and Ibuprofen. These medications may increase bleeding.

Check with your surgeon to see if you should continue Celebrex® or Mobic®. If you are on blood thinners, you will need special instructions.

The nurse from the preprocedure testing will instruct you about what to do with your medications.

Day before Surgery
The day before surgery the hospital will call you to tell you what time your procedure is scheduled. You will be asked to come to the hospital two hours before the scheduled surgery so the nursing staff has sufficient time to get you ready for surgery and answer questions.

Your surgery could start earlier than scheduled. If you are late, it could create a significant problem, and in some cases, tardiness could result in moving your surgery to a much later time.

Night before Surgery
Your surgeon may recommend an antibacterial soap to reduce the number of germs on your skin before your procedure -- depending on the kind of surgery. 

Shower before surgery the night before and the morning of with the cleansing product provided to you by your surgeon. Follow the instructions carefully to decrease your risk of infection.

Eat or Drink
Certain surgeries will require your stomach needs to be empty. Do not eat or drink anything after midnight, INCLUDING WATER, unless otherwise instructed. Your doctor will give you full instructions.

What to expect surgery day

The Pre-Op surgery nurse will greet and prepare you for surgery. This includes changing into a gown, reviewing medical information, starting an IV into your arm to keep you hydrated with fluids and removing the hair from the operative area.

The operating room nurse and anesthesiologist will review your medical history. Your anesthesiologist will explain the types of anesthesia you will receive, the risks involved and will answer any questions. 

Once your nurse has completed your preparation, a family member can sit with you until it is time for surgery. Your surgeon will ask you what type of surgery you are having and will initial the area with a marker. This makes sure that we perform the correct procedure.

After your surgery is finished, the surgeon will go to the waiting area to let your family know the procedure is completed. You will be transferred to the Post Anesthesia Care Unit (PACU).

Upon arrival to your room, you will be evaluated by a multi-disciplinary team to determine your plan of care.

Going directly home

You will need someone to drive you home. You will receive written discharge instructions concerning medications, physical therapy, activity, etc. Your physician will write orders for you to have home health. Our case managers will work with your insurance company to make these arrangements before you are discharged.

The name and phone number of your Home Health Agency will be written on your discharge paperwork.

Going home with Home Health

You will need someone to drive you home. You will receive written discharge instructions concerning medications, physical therapy, activity, etc. Your physician will write orders for you to have home health. Our case managers will work with your insurance company to make these arrangements before you are discharged.

The name and phone number of your home health agency will be written on your discharge orders.

Going to a Skilled Nursing Facility

The decision to go home or to a skilled nursing rehabilitation facility will be made collectively by you, the care manager, your surgeon, therapist and your insurance company. You will be asked for your preferences early in your hospital stay. It is wise to visit 2-3 facilities prior to surgery.

Check with the insurance company for preferred facility coverage.

Transportation costs to facilities are not covered by insurance or Medicare. However, case managers can make arrangements for you with a local nonemergent transportation company. If you have family or friends, they can provide transportation to the skilled nursing facility. 

Case management will prepare a transfer packet to be taken to the facility.

A physician from the skilled nursing facility will care for you in consultation with your surgeon. Expect to stay seven to 21 days, based on your progress. When you are discharged to go home, the rehabilitation staff will give you instructions. 

Caring for yourself at home

When you go home, there are a number of things you need to know for your safety, recovery and comfort.

Controlling Your Discomfort

• Take your pain medicine with food at least 30 minutes before physical therapy.
• Gradually wean yourself from prescription medication to Tylenol®. You may take two, extra-strength Tylenol in place of your prescription medication up to four times per day. Do not take extra Tylenol plus your pain medicines that contain Tylenol together or any additional over-the-counter products containing Tylenol.
• Change your position every 45 minutes throughout the day.
• Use ice for pain control. Applying ice to your affected joint will decrease discomfort, but do not use the ice for more than 20 minutes at a time each hour. You can use it before and after your exercise program. A bag of frozen peas wrapped in a kitchen towel makes an ideal ice pack. Mark the bag of peas and return them to the freezer to be used as an ice pack later.

Body Changes

• Your appetite may be poor. Drink plenty of fluids to keep from getting dehydrated. Foods may taste different. Your desire for solid food will return.
• You may have difficulty sleeping. This is normal. Do not sleep or nap too much during the day.
• Your energy level will be decreased for the first month.
• Pain medication that contains narcotics promotes constipation. Increase your fluid and fiber intake. Eat a lot of fruits. Prunes and prune juice will help. Use stool softeners, Miralax, or Milk of Magnesia if necessary.

Potential complications

Call your doctor if you experience any signs of infection:

• Increase swelling and redness
• Change in color, amount, and odor of drainage
• Fever greater than 101.5 

Post-Op exercises 

Exercise is important. Your therapist will set goals and work with you so you can achieve them. The therapist will also remind you of important safety tips for sitting, standing, using a walker, lying in bed, sleep position, transfering to the care or toilet, and more.