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Orthopaedic - Enhanced Recovery Surgical Innovation

Orthopaedic ERSI

Before Surgery (At Home)

Activate your MyChart at GBMC

Register for your Pre-op Joint Replacement Class

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

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

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

Before Surgery (Pre-Operatively)

Medication List

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)