Orthopaedic Pre & Post-Op Guide

• Follow your pre-operative physiotherapy and activity advice

This may be prescribed for you because it can be vital in reducing pre-operative swelling and ensuring your muscles are strong enough for the recovery process.

• Stop smoking (including nicotine products)

Smoking has a significant impact on healing and outcomes, so your surgeon will likely advise you to stop for at least six weeks before and after your operation. Seeing your GP, pharmacist or smoking cessation adviser early could help you get support.

• Ensure good nutrition

Keep a balanced diet and one that keeps you well-hydrated. Aim to reduce your alcohol consumption for overall optimal health.

• Arrange home support

Consider the need for help with childcare, household tasks, pets, driving and shopping for your recovery.

• Request time off work

The amount of time you need to recover will vary depending on the type of job you have and your personal circumstances. In some cases, it may be useful to discuss with your work's occupational health or HR department to alter some of your duties while you fully recover.

• Plan your diary

Try to reschedule any appointments to fall before your surgery so you can focus on your recovery without feeling pressured to attend.

• Continue to follow your physiotherapy guidance.

Ensuring your muscles are strong will improve your recovery

• Review your pre-operative instructions

Make sure you are clear on what to do about fasting (eating and drinking before an operation), jewellery/piercings, medications, nail polish (or artificial nails) and your plan for the day of your surgery.

• Confirm your transport and post-operative plans.

You will need to have someone to take you home (unless told otherwise for minor procedures), and they are also likely to need to stay with you for the first night / 24 hours after discharge from the hospital.

• Purchase or prepare meals in advance

Cooking can be difficult when you are recovering from surgery or using a mobility aid (i.e. crutches). You will likely find it helpful to ensure your freezer and cupboards are well stocked, and essentials are in easy-to-reach places (e.g. plates and bowls not in the top cupboards).

• Taking care of housework

Again, it may not be possible to do many household chores after surgery. Doing as much as you can in advance can help make your recovery as relaxing as possible.

• Pack your bag

Consider packing loose-fitting clothing and comfortable shoes that are easy to get on and off. Remember toiletries, paperwork, medication and things you feel you may need after surgery. Try to limit valuables, but you may want to bring some entertainment, such as a tablet or a book. In some locations, you may need a credit/debit card for services like television.

• Follow your fasting guidance.

If you are receiving a general anaesthetic, you will usually be advised not to eat or drink for a period of time before surgery. Not following guidance may result in the cancellation of your operation, so make sure your plan is clear. Small sips of water are usually allowed to continue your usual prescribed medication. Ensure you know which medication you are meant to take in the lead-up and on the day of your surgery.

• Relax

Ensure you get plenty of rest.

• Bath or shower

You may be given instructions on when to wash before surgery, either on the day or the night before. Follow any instructions given.

• Dress comfortably

It’s best to wear comfortable and loose clothing that you can easily change in and out of. Usually, you cannot wear jewellery (other than a wedding band), no makeup, body piercings or nail polish.

• Relax

We’re here for you at every step of your journey.

Some medications can cause dangerous effects during or after surgery. Examples of this include slowing down your body's ability to stop bleeding and changing how fast your body heals. This may be caused by some medications that are prescribed to you or even those that can be bought easily in a supermarket.

Before your procedure, it is vital you tell your surgeon about all the medications you take. Your list should include those prescribed to you, those bought over the counter or the internet, herbal or homoeopathic preparations and any recreational drugs.

You will be given a clear plan of which, if any, medication you need to stop before your surgery. It will also be made clear when and for how long you need to stop taking your medication. Do not stop or start taking any medication without confirming with your surgeon.

Some of the medications you may be advised to stop include:

• Anticoagulant medication (also known as blood thinners) - including warfarin, apixaban, rivaroxaban, dabigatran, and edoxaban. These medications increase the time it takes for you to stop bleeding.
• Immunosuppressants - including methotrexate, and biologics (etanercept, infliximab etc.).
• Non-steroidal anti-inflammatories (NSAIDs) - including Aspirin, Ibuprofen, Naproxen any other NSAIDs (i.e. Nurofen and Advil).
• Other prescribed medications - this could include the contraceptive pill, steroids, certain painkillers, and certain injections.
• Homoeopathic and herbal medications - including those containing ginger, ginkgo, cod liver oil, St John's Wort and certain multivitamin preparations.

The decision to stop any medications for surgery is tailored to each individual, so even if someone you know stopped taking a certain medication prior to surgery, it may not be the case for you.

• Rest and sleep

It is normal to feel more tired than usual for a period after surgery. Ensure you take your recommended pain medication regularly to support your comfort, especially in the early days after surgery. It’s common to be given specific positions to sit and sleep in; this will be demonstrated to you before heading home from the hospital.

• Nutrition and hydration

Aim to increase your intake of high-protein, low-sodium foods as well as fresh fruits and vegetables. It is also recommended to keep well hydrated with water and caffeine-free beverages.

• Wound care

Keep wound(s) clean and dry and avoid touching it wherever possible. Crepe bandages are usually removed by you at home, but ensure you check before you leave the hospital. You will likely be given extra waterproof dressings to keep your wound(s) covered until stitch/staple/tape removal.

• Driving

If you have received a general anaesthetic, you will likely not be able to drive for at least 48 hours after surgery; you may need support from friends or relatives to get yourself and those you care for around. It is also worth checking with your insurance company and DVLA as they might have specific timelines on when they allow you to return to behind the wheel. For larger procedures such as a hip replacement or knee replacement, it can be advised to not drive for at least six weeks.

• Mobility

Many procedures will impair your ability to have full function for the first few weeks following surgery. It is essential not to overexert yourself and to be patient with yourself as you recover. It is vital to follow your surgeon’s and physiotherapist’s instructions. If you require any mobility aids, you will be given them before being discharged, shown how to use them, and told how long to use them.

• Physiotherapy

For most procedures, this will be a large part of recovery. Specific exercises tailored to you and your treatment will be given, with some being performed at home and others in outpatient appointments with your physiotherapist. This will generally be very structured. The physiotherapy will last for weeks to months for larger procedures, gradually increasing your strength and movement until you have reached your new baseline. Your physiotherapy will begin before you are discharged from the hospital and usually consists of stretching and strengthening exercises.

• Returning to work

If you have a desk job and the ability to work from home, returning to work can generally be sooner than commuting and working in an office. Despite this, it is important to take time off work to focus on rest and recovery and not rush back into working. The surgery takes its toll on the body, and rest is vital to a good recovery. For more active and physical work, expect to take longer periods off. For larger procedures, it may be months before it is advisable to return to work. A clear guideline on when you can return to your job will be discussed with your surgeon. It’s best to be open with your employer about what you can and can’t do, so adjustments can be made while you recover.

• Sports and activities

Returning to sports and activities - how and when you return to physical activity will be centred on your own circumstances and fitness. For larger procedures, your physiotherapy program will typically start with lower-impact (i.e. swimming or static bike) and then gradually build towards more intensive exercise. It’s important not to overdo it by returning to sports too soon and expect that contact sports will likely have a longer recovery time than non-contact sports.

• Surgeon appointments

For smaller procedures under local anaesthetic, you may only need one or two follow up appointments with your surgeon to check everything has healed well and you have recovered well. For larger procedures, it's common to have multiple appointments with your surgeon over the course of a few months to ensure you are recovering well and are hitting the milestones expected.

• Physiotherapy appointments

These are vital to ensuring you recover well. In these appointments, you will focus on strengthening and stretching your muscles and ensure that you gain as much mobility as possible. A good recovery depends on how well patients follow their physiotherapy.

• Post-op nurse appointment

These may be arranged to ensure your wounds are healing well, and the nurse may also change your bandages. This is a good opportunity to discuss post-op wound care.

This appointment is essentially a health check to ensure patients are medically fit for surgery. Many parts of the assessment are undertaken over the phone a week or more prior to your surgery date, and a face-to-face appointment is usually three to seven days before. It is vital to attend the pre-operative appointment.

What happens at a pre-operative assessment?

This can vary depending on your surgery, but it will generally consist of:

• A questionnaire on physical and mental health, including any medication
• Height and weight measure
• Blood tests
• Blood pressure measure and sometimes a physical examination

Occasionally, patients will have an MRSA screen; this consists of taking swabs from parts of the body to check if you are an MRSA carrier. If you are, you are likely to need to use a special soap to remove MRSA from your skin before your operation.

The aim of the assessment is to confirm that you are fit enough for the operation. Typically, patients will only hear back about their results if there is an issue.