Requirements Before Surgery

Patients must complete these steps before having joint replacement surgery at CHA.

1. Dental Clearance
• Infections in your mouth can lead to higher risks during joint surgery.
• You will need to visit a dentist to ensure you are not at risk for infection.
• We will give you a clearance letter to be signed by your dentist.
• You can turn this in at our front desk or at your next appointment with your surgeon or PA.
2. Primary Care Clearance
   • Make an appointment for a pre-op physical to make sure you are healthy enough to have this surgery.
   • If you have other medical issues (i.e. heart conditions), you may need to see other providers for additional tests/clearance.
     
     
3. Attend Total Joint Class
   • Attend one online or in-person class to learn about the total joint surgery process. You must sign up ahead of time.
     • Please note: Due to ongoing COVID-19 concerns, our total joint replacement class is currently being held virtually and individually.
     • Include family/friends who will be helping you after your surgery. Interpreters are available if English is not your primary language. Call 617-665-1566 and ask to speak with your surgeon’s staff to request an interpreter.
     • You need access to an email account to be able to participate in the online class.
     • If you do not have access to an email account, you will be scheduled for an in-person class at your orthopedic clinic.
       
       
4. Physical Therapy Evaluation
   • Hips/Knees: Attend one appointment with physical therapy to evaluate your ability to walk. They will also show you how to use a walker after surgery.
   • Shoulders: Attend one appointment to prepare for using one arm after surgery.
     
     
5. Get Medical Equipment
   • Hip Replacement: You need a walker and a raised toilet seat (or commode) in your home before you have surgery. Sock aids and reachers, etc. are optional.
   • Knee Replacement: You need a walker in your home before you have surgery. A raised toilet seat (or commode) is optional for knee support.
   • Ask For A Prescription
     • If your insurance does not cover these items, you can find them at pharmacies, home improvement stores, and online.
     • If you can’t afford to buy these items, you can go to the Mason’s Loan Program in Woburn. They loan out used hospital/medical equipment for free. Open on Saturday from 9 am to 12 pm at 500 West Cummings Park Suite 1150 in Woburn, MA
       
       
6. Body Mass Index (BMI) Less Than 40
   • We will measure your BMI (based on your height and weight)
   • If your BMI is 40 or over, you will need to lose weight before surgery.
   • CHA Nutritionists are available to help with weight management.
     
     
7. Quit All Nicotine Products (Cigarettes, Vape, Patches, Gum, etc.)
   • You must quit at least 1 month prior to surgery. A urine test will confirm this.
   • We can help you quit. Please ask us about this.
     
     
8. If Diabetic, You Must Have Well-Controlled Blood Sugar Levels
   • Your Hemoglobin A1C (a blood test to check your glucose levels) must be less than 8.
     
     
9. Nasopharyngeal Swab For COVID-19
   • The test must be performed within 96 hours prior to your scheduled surgery.
   • If the test is negative, you can proceed with your surgery as planned.
   • If positive, you will need to quarantine for 10 days before having your surgery.
     
     
10. Nasal Swab For MRSA
    • This painless test will check for bacteria that have been linked to infection.
    • If your test is positive, we will prescribe a nasal ointment to use before surgery.
      
      
11. Chlorhexidine Body Wipes
    • To use the night before surgery and the morning of surgery.
    • If your nasal swab is positive, you will need to use the wipes for 5 days.
      
      
12. Pre-Admission Testing Appointment (PAT)
    • You will have a tele-visit with an anesthesia team member and have blood tests 1-2 weeks before your surgery.
    • You must attend this appointment or your surgery will be canceled.
      
      
13. Telephone Call With Case Management
    • A nurse or social worker from the Case Management team will call you to discuss your insurance benefits and your plan of care after your surgery.

***Your total joint surgery cannot be done until you fulfill all requirements***