Surgical Pathway

Pre-operative Preparation

After your consultation with Dr. Lee, through shared decision making, you may have both agreed that your arthritic hip or knee pain has not been adequately relieved by non-operative treatments, and joint replacement is a reasonable option for you.

Now what?

Proceeding with surgery is an important decision to make and one that you should spend as much time as is needed to reach a definitive conclusion.

If you have chosen that is the best option for you, you will have been in touch with the office scheduler to find a surgery date.

Pre-operative Clearance

You will need to consult with your regular doctor to make sure you are in a state of health to undergo a hip or knee replacement. This should be a pre-operative clearance letter made available to our office.

If you see a heart specialist (cardiologist), you will need to obtain a clearance letter from this doctor as well.

Other specialists who you see on a regular basis should also provide their clearance for you to proceed with surgery.

1-2 Weeks Prior to Surgery Date

You will see Dr. Lee at least one more time, one to two weeks before your scheduled operation. At this visit, we will go over the details of the surgery and an informed consent process.

You will also attend a pre-operative joint replacement class at the hospital, a group session with other joint replacement patients, to go over the peri-operative days work flow and do's and dont's before and immediately after the surgery. It is important that you bring your "coach" to this pre-operative education class.

Night before the Surgery

Prior to midnight, on the night before your surgery, drink plenty of fluids. This has been shown to accelerate your recovery process.

*Do not eat or drink anything after midnight the night before your surgery. The anesthesiologist may refuse to proceed with your case if he/she feels there is material at risk for aspirating and blocking your airway.

Behind the Scenes

If you are curious about the surgical planning behind the scenes, we've outlined the process below. Based on your pre-operative x-rays, surgical planning begins. If your case is a complex one (ie, not a routine first-time hip or knee replacement), your case will be discussed with and presented to a group of Harvard-trained joint replacement surgeons, where the best treatment plan will be agreed upon and described to you.

Total Hip Replacement

The dimensions of your pelvis and hip are carefully examined, and pre-operative templating of how the implants will be placed in your bones is overlayed onto your x-rays.

Considerations are made for the size of the implants, their geometry, where they are placed, what the resulting forces are across your new joint, what your range of motion will be, risk of impingement, and ultimate leg length.

Hip Intra-operative Fluoroscopy

During your surgery, low-dose x-rays are obtained to visualize the positioning of the implants, and to see how they match up to our pre-operative templating plan.

Total Knee Replacement

Careful attention is placed on the alignment of your knees. Standard knee replacements with Dr. Lee are cemented components, but your x-rays are thoroughly reviewed and consideration is given to whether your bone density, along with your age, makes you a candidate for cementless implants. Templating of the implant sizes allows for smooth intra-operative work-flow.

Day of Surgery

The morning or day of the surgery, the anesthesiologist will meet you in the pre-operative holding bay. A pre-operative nurse will be taking care of you and collecting your history, reviewing your allergies, placing an IV, and providing you with pre-operative medication. Dr. Lee will come meet you here, and place a marking on your operative site.

If no contraindications exist, you will be given a cocktail of medication to help you relax and to provide enhanced analgesia through the operation and the post-operative period. These include tylenol, a non-steroidal anti-inflammatory pill (Celebrex), a nerve-blunting pill (gabapentin), and a narcotic pill oxycodone.

You will then be taken to the operating room (OR), where if deemed appropriate, you will be given a spinal anesthetic injection by the anesthesiologist. Often times, patients request to not be conscious for the actual operation, and additional sedatives can be administered to help you fall asleep during the procedure.