Based on the results of the pre-operative evaluation and tests by the orthopedic surgeon, clearance is or is not given for the surgery. The pre-op evaluation appointment will allow you to ask questions about the procedure, as well as pre- and post-surgical expectations, so be sure to come prepared.
Pre-operative visit
Not long before the date of the hip arthroplasty (replacement) surgery, the orthopedic surgeon will perform thorough physical, mental, and emotional examinations, as well as evaluate your loved one's post-op support at home. The surgeon will likely:
Ask about medical history and current medications (be sure to bring a list of ALL medications - with names, doses, and times - including over-the-counter)
Examine the problem hip, noting the range of motion in the joint and strength of the surrounding muscles
Order blood tests
X-ray of the hip and pelvis to assess the status and structure of the hip joint, and occasionally advanced imaging (CT or MRI) may be needed to assist in surgical planning
Order an electrocardiogram ("ECG" or "EKG") to establish heart rhythm
Review what is required in the 24 hours before surgery
The surgeon will also work closely with other providers, like your loved one's cardiologist, to determine what medications they may need to stop taking before surgery (and when) to decrease the risk of complications, as well as when it will be safe to resume taking these medications. This may include stopping blood thinners, aspirin, or supplements like fish oil, as these medications slow blood clotting, which could lead to an increased risk of blood loss during surgery or bleeding after surgery.
Before surgery, medical risk is assessed. The surgeon needs to make sure that the risks of hip arthroplasty (replacement) don’t outweigh the benefits. They will check for:
Anxiety and stress levels around the surgery
How well your loved one's body may tolerate blood loss
How well your loved one tolerates anesthesia
How your loved one will manage the rehabilitation process (making appointments, participating in the program, performing the recommendations)
How other medical problems may affect their healing
How active they are
How their current weight will factor in
Their lower extremities will also be evaluated before surgery. The surgeon will conduct the following:
Muscle testing
Nerve and vascular status testing
Palpation testing
General inspection
Range of motion testing
Straight leg raise test
Measure leg length
Trendelenburg sign ("positive" when, while standing on one leg, the pelvis drops toward the unsupported side, and "negative" when the pelvis remains level - it indicates weakness in the hip abductor muscles)
Trendelenburg Sign
Visit the dentist before surgery
It’s better to have any dental work done either well before surgery or no less than three months after. The surgeon may recommend antibiotics before any dental procedure once your loved one has had a joint replacement.
