Orthopaedic - Enhanced Recovery Surgical Innovation

Before Surgery (At Home)

Activate your MyChart at GBMC

• Click here to visit MyChart at GBMC

Register for your Pre-op Joint Replacement Class

• Click here to register online.

Pickup your Pre-op Joint Replacement Supplies

• Joint Replacement Guidebook
• Preop Skin Prep: CHG Wash Kit
• Incentive Spirometer

Enhanced Recovery – Surgical Innovation Patient Education Packet

• Prior to leaving the surgeons office, you will receive your patient education packet.
• Bring your packet to every appointment regarding your surgery.
• For qualified ERSI patients, view the introductory video here.
• Download Enhanced Recovery Patient Education Packet

Pre-Admission Testing

• You will need to undergo a history and physical and have blood work completed in order to be cleared for surgery.
• We highly recommended GBMC’s pre-admission testing department; otherwise, this can be done by your primary care physician.
• Visit GBMC's Ambulatory Testing Center for your MSSA/MRSA Surveillance Nasal Swab Test and your COVID-19 test.

Prehabilitation

• We recommend you increase your exercise by at least 10% prior to surgery. You can do this by simply walking 30 minutes a day.
• Your doctor may refer you to a physical therapist or an exercise program depending on your diagnosis and procedure.
• An in-home pre-surgical assessment should be completed by a physical therapist prior to your admission.
• Visit ActiveLife website.

Nutrition

• A nutrition supplement or nutrition education resources may be recommended depending on your diagnosis or procedure.
• Try to increase your protein intake with supplements, dairy, meat, beans, legumes, soy products, and eggs.
• Having good nutrition all the way up to the date of surgery will ensure adequate healing afterwards.
• Visit the Geckle Diabetes and Nutrition Center at GBMC
• Visit Milton J. Dance, Jr. Head and Neck Center at GBMC 

Nasal Swab

• During your visit in the surgeon’s office, a nasal swab screening will be completed to determine if you are positive for s. aureus.
• If your test is abnormal, MRSA+, you will be given two intravenous antibiotics during the perioperative phase of the day of your surgery.
• If you are allergic to orange fruit, please notify your doctor or the Joint & Spine Center as soon as possible.
• Mupirocin 2% intranasal ointment, every 12-hrs, beginning 5-days before your surgery for a total of ten applications inside your nose.

CHG/Hibiclens Wash or Theraworx Wash

• You will be instructed to shower using CHG/Hibiclens wash three days prior to surgery and up to seven days after surgery.
• If you are allergic to CHG/Hibiclens wash, you will be instructed to use a product known as Theraworx.
• The solution kills bacteria on the skin that could cause a wound infection after surgery.
• CHG Instructions
• Hibiclens Intsructions
• Theraworx Instructions

Deep Breathing Exercise and/or Incentive Spirometry

• You will be instructed to complete deep breathing exercises and/or use an incentive spirometer prior to surgery to keep your lungs healthy.
• Deep Breathing Exercise
• Incentive Spirometry

Before Surgery (Pre-Operatively)

Medication List

• Review list of medications that can and can't be used prior to surgery

CHG/Hibiclens or Theraworx Wipes

• You will be instructed to use CHG/Hibiclens wipes or Theraworx wipes (if allergic to CHG) at the hospital in pre-op before surgery.
• The solution kills bacteria on the skin that could cause a wound infection after surgery.

Pain Management

• Pain will be addressed using oral medications that target several different pain receptors.

Warming Gown

• You will receive a purple warming gown to keep you comfortable and help maintain your temperature through the surgical process.

Nozin Nasal Sanitizer

• The nose is a reservoir for bacteria that escape typical hygiene protocols such as hand washing. Nozin® Nasal Sanitizer® antiseptic equips health professionals, patients and individuals with a safe and effective nasal shield that helps decrease bacteria on nasal vestibule skin. Importantly, Nozin Nasal Sanitizer antiseptic is clinically shown to reduce nasal bacteria carriage without antibiotics
• On the day of your surgery, GBMC's pre-op staff will give you your first treatment and show you how to clean the inside of your nose before you go into surgery. After surgery you will be given a bottle of Nozin, first application an hour after surgery and then 9 pm that same day. You will clean the inside of your nose with Nozin 9am and 9 pm, twice a day, every day until the bottle is empty.
• If you are allergic to orange fruit, please notify your surgeon or the Joint & Spine Center, you will not be able to participate in the Nozin program.
  • If you are allergic to orange fruit and you are MSSA+ or MRSA+ in the nares, you will need an intranasal antibiotic ointment to begin five days before your surgery.
    • Mupirocin 2% intranasal ointment, every 12-hrs, beginning 5-days before your surgery for a total of ten applications inside your nose.
• Will be given within one hour of incision.
• Evidence-based, best practice recommendations will be used throughout surgery.
• These standardized anesthetics will be focused on non-narcotic pain medications, and often utilizes local anesthetic pain blocks for the best possible pain relief.
• Pain will be addressed using oral medications that target several different pain receptors.
• You should be out of bed and walking the day after surgery.
• Daily ambulation goals will be set by the medical team and their completion encouraged by nursing staff.
• The day after surgery, we will place you on a clear liquid diet and encourage gum chewing as well as high protein supplements.
• We will advance your diet with solid food as tolerated. Proper nutrition will allow for improved recovery and reduce your risk for surgical infection.
• The goal is to get your diet advanced to solid food as quickly as we can, once you are medically able to.
• Nutrition
• Incentive Spirometry
• Deep Breathing Exercises
• Patient Education Packet
• BAIR Paws Peri-operative Warming Therapy Gown
• CHG Instructions
• Hibiclens Intsructions
• Theraworx Instructions
• James C. Johnston, MD
• Stewart L. Koehler, MD
• Todd M. Melegari, MD
• Peter Jay, MD
• David P. Buchalter, MD
• James L. Huang, MD
• Gurminder S. Ahuja, MD
• April Asuncion Higgins, RN (Joint Program Manager)
• Brittany Boyce (ECIP Program Manager)