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Your hospital journey
Pre-assessment Clinic - nurse
The Pre-assessment Nurse will ask you about your
general health, medical history, previous anaesthetics and if there
were any problems. Please bring this book and all your current
medications in their original packaging with you.
It is important that you are assessed prior to your operation to
minimise the risks associated with your surgery. Most people will
have their first assessment for their fitness for surgery with the
Pre-assessment Nurse in a specialist pre-assessment clinic. This
clinic typically takes place soon after you have seen the
Specialist (Surgeon) in the clinic. It may even occur the same
A record will be made of any family history of anaesthetic
problems, medicines, pills, inhalers or alternative medications
that you use allergies, smoking, alcohol and whether you have any
loose, capped or crowned teeth. You may have investigations such as
blood tests, a heart trace (ECG), urine tests and X-rays. This
helps your anaesthetist consider any medical problems which may
either affect the risks to yourself or the likelihood of
complications from the anaesthetic or surgery.
The Pre-assessment Nurse will give you time to ask questions
about any possible problems and give advice and education on your
hospital stay and activities following your surgery.
The National Joint Register
The New Zealand Orthopaedic Association has a National Joint
Register which records all the technical data on all joint
replacement surgery performed in New Zealand. This provides
independent data on the performance of these joints over the
years. The data will be used in future audits of joint
replacement outcomes and will identify factors which will provide
the best long term surgical results for all New Zealanders.
You are asked for your consent to allow your name, address, date
of birth, National Health Index number along with the technical
data on your joint surgery to be forwarded to the registry.
Pre-assessment Clinic -
anaesthetist (if required)
The anaesthetist will see you before your operation
to discuss your health, the types of anaesthetic and pain relief
that can be used and their risks and benefits. Consent for your
anaesthetic will also be sought at this time.
Nothing will happen to you until you understand and agree with
what has been planned for you. You have the right to refuse if you
do not want the treatment suggested or if you want more information
or more time to decide.
Types of Anaesthetics:
Produces a state of controlled unconsciousness during which you
feel nothing. You will receive anaesthetic drugs, strong pain
relieving drugs, oxygen to breathe and sometimes a drug to relax
your muscles. You will need a breathing tube in your throat once
you are unconscious, and will be put on a breathing machine
(ventilator) during your operation. When the operation is finished
the anaesthetic is stopped and you regain consciousness.
You will be unconscious during your operation.
Common side-effects (<1 in 100) include headache, sore
throat, feeling sick or vomiting, dizziness, bladder problems,
damage to the lips or tongue, temporary confusion or memory loss,
aches and pains and bruising/soreness.
Uncommon side-effects (<1 in 1000) include chest infection,
muscle pains, damage to teeth, becoming conscious during your
operation, slow breathing and existing medical conditions getting
Rare side effects (less than 1 in 10,000+) include damage to the
eyes, serious drug allergy, nerve damage, equipment failure, heart
attack, stroke or death.
A measured dose of local anaesthetic is injected into the area
of the back that contains spinal fluid using a very small needle.
The injection is generally well tolerated and will make you go numb
from the waist down. This means you will feel no pain, though you
will remain conscious. A screen will shield the operation so you
will not see the operation unless you want to. Your anaesthetist is
always near you and you can speak to them whenever you want to.
If you prefer, you can also have drugs that make you feel sleepy
and relaxed (sedation). This will mean you will not be aware of
what is happening during surgery though you may hear the noises of
what is going on around you.
This generally provides better pain relief, and as such you do
not need so much strong pain relieving medicine in the first 24
hours after the operation.
There is some evidence that less bleeding may occur during
surgery which would reduce your risk of needing a blood transfusion
or developing blood clots.
You remain in full control of your breathing. Your breathing
should be better in the first few hours after the operation, so you
have a lower chance of developing a chest infection. You should
have less sickness and drowsiness after the operation and may be
able to eat, drink and walk sooner.
Common side-effects (less than 1 in 100) include headache,
dizziness, bladder problems, aches and pains and bruising/
Uncommon side-effects (less than 1 in 1000) include itching and
existing medical conditions getting worse.
Rare side effects (less than 1 in 10,000+) include serious drug
allergy, nerve damage, equipment failure, heart attack, stroke or
Local anaesthetic is injected in and around the joint by the
surgeon at the time your new joint is going is being replaced. It
is typically combined with spinal or general anaesthesia.
Provides good pain relief immediately following surgery. Reduces
the need for strong painkiller injections like morphine and
therefore reduces side effects like nausea and vomiting. It also
allows early mobilisation and physiotherapy.
May not provide adequate pain relief and hence may need to be
combined with morphine injection.
This is an injection of local anaesthetic near the nerves which
go to your leg. This will numb part of the leg and make it
pain-free for several hours after surgery. You may also not be able
to move it properly during this time.
You won't need such strong pain relieving medication during and
after your anaesthetic, and therefore won't feel so sick.
You should be more comfortable for several hours after your
The numbness and weakness may last up to 16-24 hours, delaying
your ability to walk and do your exercises.
Rarely there is risk of damage to the nerves.
There is a small risk that you may need to have a blood
transfusion. A transfusion of blood or blood products is only given
when the benefits outweigh the risks.
You have the right to decide whether you want to have the
treatment or not. You can ask as many questions as you need to
ensure you are making the right choice.
You will be asked to sign a consent form to show that the
benefits, risks and alternatives for your treatment, including
transfusion of blood products, have been explained to you. The
consent form will confirm that you have been able to ask any
questions and you agree to receive the treatment.
If you refuse to have a transfusion when needed, the risks to
your health are likely to increase.
Further information about blood transfusions can be found at: www.nzblood.co.nz
Before your operation you will need to attend a
pre-operative education class. This will usually be two or three
weeks before your surgery. This is a group session run by staff who
will be involved in your care. The class is designed to help better
inform and prepare you for your upcoming hip or knee replacement
surgery. You are encouraged to ask any questions you have, however
simple you may feel they are.
Please note you will be loaned home equipment during this class
that will need to be carried back to your car. We therefore
encourage you to bring a support person with you.
Preparing for your discharge
home from hospital
It is important to consider how you will manage
your care in your home once you are discharged from hospital. It is
essential to start planning now.
Before you come to hospital organise your daily living needs in
preparation for your return home.
Please note you should be ready to go home by 11am on the day you
Please make plans for your transport home accordingly.
This list will help you prepare for your return home:
- Arrange for someone to take me to hospital.
- Arrange for someone to take me home on the day I
- Arrange for someone to stay with me for a few days after
discharge (if I live alone).
- Tell family, friends and/or neighbours about my operation.
- Organise family/friends who are willing to help with chores/
- Cook extra meals and freeze them.
- Buy extra groceries and/or arrange for someone to do
my grocery shopping.
- If necessary, cancel my home help, Meals on Wheels, or other
services that come to my home, while I am in hospital.
- Organise appropriate seating at my home.
- Consider buying a long-handled shoehorn and sock-aid. Place
commonly used items at waist height to prevent the need to
- Get a clothes horse for my laundry.
- Organise a gardener for six weeks if needed. Organise someone
to look after my pets.
- Check my house security, cancel paper delivery and organise for
my letterbox to be cleared.
- Make a list of useful contact numbers.
- Remove rugs and mats, loose cords and anything that can be
a trip hazard.
- Pack ALL my medications/herbal
products/alternative medications and supplements.
Preparing for your hospital stay
Smoking and your lungs
We strongly advise that you try to avoid getting chest
infections (stay away from people with coughs and colds) and give
up smoking at least two weeks before the operation date. Continuing
to smoke doubles your risk of complications, compromises healing
and can add to the risk of developing confusion after your
operation. It can also intensify the effects of your
If you need help to quit smoking, please contact resources such
as your Doctor (GP) or Quitline (0800 778 778) www.quit.org.nz or www.health.govt.nz\tobacco
Bay of Plenty District Health Board has a "No Smoking" policy
on- site and throughout hospital grounds. To minimise withdrawals
from nicotine, nicotine patches are available for free for the
duration of your hospital stay.
Alcohol and drugs (such as Cannabis and P)
We encourage you to minimise your drug/alcohol consumption prior
to and after your surgery. Drug/alcohol consumption significantly
increases the risk of complications, compromises healing and can
add to your risk of developing confusion after your operation. It
can affect your anaesthetic and pain relief requirements.
Reduce sources of infection
Surgery may be cancelled if you have any source of infection
such as ulcers, tooth problems, sores or open wounds. We advise you
to see your dentist to have your teeth checked prior to having a
joint replacement operation. Please visit your GP to have ulcers
and other sores checked.
Managing your weight
If you are overweight, recovery can be more difficult as you
have more strain on your muscles and joints. It can be hard to lose
weight, especially with reduced mobility but exercise and
changes in diet even without weight loss can reduce your chance of
complications after surgery. Talk to your GP or other health
professional about managing your weight. It is also important to
tell them if you have had a recent weight loss.
It is advisable to remain as active as possible leading up to
your surgery, to strengthen your muscles and speed up recovery.
What to do if you become unwell
It is important we know if you have any of the following:
- A cold or cough.
- Skin infections - such as a sore, graze, pimple or eczema,
- especially around your operation site.
- Burning pain or passing urine more often than usual.
- You are generally unwell - such as diarrhoea, vomiting or
- high temperature.
Any of these conditions could cause your operation to be
postponed. For your safety it is important that we know about them
prior to your operation. You will receive a phone call from the
Surgical Admission Unit two days before your operation day to check
whether you are unwell.
If you do not receive a call and you are unwell please
phone the hospital where you are having your operation and ask to
speak to someone in the Surgical Admission Unit.
Tauranga 07 579 8000
Whakatane 07 306 0999
What do I bring to hospital?
- You should leave valuables at home (eg; jewellery, bank or
credit cards etc.) The Bay of Plenty District Health Board does NOT
take responsibility for stolen items.
- You may bring something to read.
- Night clothes, easy to wear day clothes, shoes or
- Walkers or other aids you may use.
- You may also bring your own pillow which will make your
hospital stay more comfortable. Please make sure your pillowcase is
not blue or white (these are hospital colours).
- Please bring all your current medications in their
Please name your personal belongings.
Mobile phones may be used on the ward, but please be considerate
of other patients.
The day before your operation
Your skin - using the body wash
prevent a wound infection after your operation, we ask that you use
the Chlorhexidine 4% skin wash. The tube is intended for two washes
before your operation. We ask that you shower or bath the night
before and the day of your surgery. If possible, we would prefer
that you shower rather than bath.
When you shower or bath, wet your body all over and then turn
the shower off or stand up in the bath. Using half of the tube of
Chlorhexidine soap, lather your body and hair with foam and
remember to wash skin folds and inside your tummy button.
Be careful to avoid contact with your eyes.
Leave the foam on the skin for at least two minutes and then
rinse off and dry your body thoroughly using a clean towel. Get
dressed in clean clothes.
Don't shave, pluck or wax your skin
It is very important that you do not shave or wax anywhere
within the vicinity of the operation site before your operation. If
it is necessary for hair to be removed, the staff will clip the
hair with a specially cleaned surgical clipper on the day of
surgery. This is to help reduce the risk of infection.
Eating and drinking
An empty stomach is important for a safe anaesthetic. We suggest
you have a generous supper (after dinner snack) the night before
you come to hospital. Unless you are a diabetic you will have been
given two packs of pre-op drink when you attended the Education
Class. Please follow these instructions carefully.
Please do not drink the preop if you are
a known diabetic or taking medications for diabetes.
Eating and drinking instructions
You may eat (unless you have been instructed otherwise) up to
six hours before your operation.
Up to two hours before the time of your operation you may
continue to drink clear fluids (up to 400mls only); this will
include your two cartons of pre-op drink which need to be drunk
just prior to the two hours before your operation.
Clear fluids are any liquids that you can see through; this
includes water and clear fruit juice without pulp and tea or coffee
without milk. You should avoid carbonated (fizzy) drinks.
Morning surgery admit Tauranga 7am, Whakatane 7.15am:
- Drink one pre-op drink at 5.30am
- Drink the second pre-op drink at 5.45am (finish both by
Afternoon surgery admit Tauranga 12.30pm, Whakatane 11am:
- Drink one pre-op drink at 10.30am
- Drink the second pre-op drink at 10.45am (finish both by
Pre-op* is a clear carbohydrate (sugar) drink designed to
prepare your body for your operation; it is best served chilled,
shake well before use.
In the six hours prior to surgery DO NOT
chew chewing gum, suck lozenges or lollies.