Steps to Take Before Orthopaedic Surgery

Preparation for Surgery and Medical Clearance

Because we have a waiting list for surgery, you must confirm your intent to go ahead with surgery 4 weeks before the planned date. If we do not hear from you, we will attempt to contact you, and leave a message if possible. If you do not respond within 3 business days, we will have to cancel your procedure. Re-scheduling will then be arranged as soon as a place becomes available.

Hospital rules require that all patients undergoing surgery must have a medical evaluation and 'clearance' prior to the surgery, as well as pre-admission testing. Pre-admission testing can be done at the hospital or at your primary care doctor's office. If you do not have a doctor, we can refer you to one. Pre-admission testing includes a complete history and physical examination, and often includes blood tests, urine tests, chest X-ray and electrocardiogram. These results must be at the hospital 2 business days before the surgery or the procedure is automatically cancelled (by the hospital). The cancellation policy is rigid and there are no exceptions to this.

Therefore, all the results should be in our office preferably at least 3 business days before the surgery to allow us time to make sure it is complete and pass it on to the hospital on time. It may take more than one visit at your doctor's office to complete the necessary tests. If you need to have more testing, such as a cardiac stress test or pulmonary function test, you must allow extra time for these results to be sent to us.

Remember that this is not just our office policy, but rather a hospital rule. Failure to comply unfortunately will result in postponement of the planned procedure. If the operation is cancelled, please be aware that it can take several weeks to re-schedule since our surgical schedule is fully booked for 2-3 months in advance.

Patients scheduled for total joint replacement are encouraged to attend our preoperative class at the hospital. It will provide you with the opportunity to meet some of your nurses and therapists who will take care of you in the hospital and prepare you for what to expect during your 2 day stay in the hospital. At the class you may inquire about private rooms, private duty nurses and our luxury suites with individualized attention, gourmet food, large screen HD TV and wireless internet access. A bed is provided for a friend or family member if they wish to stay with you. The suite is available at extra cost.

About Stopping Certain Medications

• Stop all ANTI-INFLAMMATORY medication at least 10 days before your operation including Naproxen (Naprosyn, Aleve), Ibuprofen (Motrin, Advil), Diclofenac (Voltaren, Arthrotec) and others. Celecoxib (Celebrex) and Nabumetone (Relafen) do not affect bleeding and may be taken.
• Stop ASPIRIN, VITAMIN E, and all HERBAL SUPPLEMENTS that affect blood clotting (garlic, ginkgo, ginseng, kava, St. John's Wort, valerian, echinacea and ephedra, etc.), at least 10 days before your surgery
• Stop ANTI-COAGULANTS (blood thinners) such as Coumadin, Plavix, Persantine, Ticlid, Aggrenox, etc., from 5–10 days before your surgery. Check with your primary care doctor to make sure it is safe for you to stop. If you cannot stop it, let us know right away.
• In some cases a drug must be stopped 2 weeks or more before your surgery. Ask your primary care doctor, rheumatologist or oncologist and let us know if there is a problem.
• You may take certain medications on the day of surgery (like medication for blood pressure, your heart and our recommended dose of Celebrex)… see below.
• If you are a smoker, quit or cut down before your surgery to help wound healing.

The Days Before, The Night Before and the Day of Surgery

In preparation for your operation, to minimize any potential complications of anesthesia, you must not have anything to eat or drink after midnight before your surgery. The exception to this rule is that you should take essential medications (such as for blood pressure, your heart, etc.) in the morning with the smallest amount of water. Because you are not eating, diabetics who take insulin or oral medications should not take their usual diabetes medication the morning of surgery.

It has been shown that taking the anti-inflammatory drug Celebrex for a few days before your surgery will help to reduce the amount of pain of surgery. Therefore we recommend that you take one capsule (200mg) two days before, one capsule the day before and one capsule on the day of surgery, in the early morning with a very small amount of water, along with your other essential medications. Taking this very short course of Celebrex is unlikely to cause any significant side effects. If you have any reservations about this, speak with Dr. Harwin or your family doctor.

In the days before the surgery, if you notice any evidence of infection on your body, such as boils, skin or mouth sores, rash, toothache or other such problems, you must call us. Surgery cannot be done if infection is present. For two weeks before surgery, begin to shower daily using Hibiclens soap (chlorhexidine) available without prescription at your pharmacy. It will remove bacteria on the skin that can cause infection.

You will be asked to arrive at the hospital at least 2 hours before the start of the planned procedure. Please understand that while the procedures are scheduled for a certain time, the time is an estimate. The first operation starts at 7:30 AM on Tuesdays and Fridays and 8:30 AM on Thursdays. The hospital will call you the day before your surgery between 2 PM and 4 PM to advise you of the time to arrive. Therefore, you must provide us with the number where you can be reached the day before the procedure. If you do not hear from the hospital by 4 PM, you must call the Admitting Department at (212) 420-4557 and ask what time to arrive.

If your surgery is ambulatory, you will go home the same day and you must arrange for someone to escort you home. This is for your own safety and is a hospital rule. An escort is mandatory. If this is not arranged, the surgery must be cancelled.

Family members or friends may wait in the Surgical Waiting Room during your procedure. If you would like me to call someone after your procedure, please give their cell phone number to my assistant or nurse. If your surgery was ambulatory, I will call you after surgery, either that night or the next day. If you want to hear from me, please be sure to give the number where you can be reached.

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