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)

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.
• Information handout
• Pre-op handout
• Post-op handout

During Surgery

Antibiotic Prophylaxis

• Will be given within one hour of incision.

Standardized Anesthesia Care

• 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.

After Surgery

Post-operative Pain Management

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

Activity

• 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.

Eating and Drinking

• 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.

Education Materials

• Nutrition
• Incentive Spirometry
• Deep Breathing Exercises
• Patient Education Packet
• BAIR Paws Peri-operative Warming Therapy Gown
• CHG Instructions
• Hibiclens Intsructions
• Theraworx Instructions

Our Team



Leroy M. Schmidt, MD
Physician Champion



Dominick A. Lanzo, MD
Physician Champion



Kara Douglas, MSN, APN, CRNA
Program Director



Rachel Hellmann MSN, RN, CNOR
Clinical Program Manager

• 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)