Preparing for Surgery

Obtain Preoperative Clearance / Pre-Anesthesia Testing (PAT):

You are required to have preoperative “clearance” by our anesthesia team within one month of your surgery. This testing must be completed before surgery to ensure that it is medically safe for you to have surgery. Please call 216-444-6612 to schedule this appointment. Testing will include a review of your medical history and full physical exam, and may also include blood work, EKG, X-ray, medical, cardiac or other subspecialty clearance if needed.

Schedule Postoperative Physical Therapy:

Your first physical therapy appointment will be scheduled for you at a Cleveland Clinic location. If you are planning to attend physical therapy outside of the Cleveland Clinic, please provide our office with the name of the facility and fax number. We will make sure physical therapy script and protocol are available for the physical therapist.

Obtain Crutches (for lower extremity surgery only):

If you are having lower extremity surgery, you NEED to bring a pair of crutches with you to the surgery center. You may be able to get crutches at your pre-anesthesia clearance appointment. Alternatively, you can call to schedule an appointment at one of our physical therapy locations to pick up crutches and be taught how to use them properly. If these options do not work for you, you can obtain them at a local pharmacy (CVS, Walgreens, Walmart, etc.) or online (Amazon) and may be able to get insurance reimbursement (check with your insurance company!). If you do not have crutches with you on the day of surgery, your surgery may be canceled due to safety concerns following surgery.

Purchase an Ice Machine/Cryotherapy Device:

One of the most valuable adjuncts to postoperative care is cryotherapy, or cold therapy. Cryotherapy helps decrease swelling, inflammation, and pain by reducing blood flow to the surgical area and limiting the body’s inflammatory response. When used consistently, cold therapy can improve comfort, reduce reliance on pain medications, and make participation in physical therapy easier during the early phases of recovery.

We strongly recommend the use of a continuous ice delivery device following surgery. These devices provide consistent, controlled cold therapy to the knee over extended periods of time, which is often more effective and convenient than traditional ice packs. Continuous cryotherapy allows patients to maintain therapeutic cooling while resting or sleeping and helps avoid the temperature fluctuations associated with manual icing.

Using cryotherapy as an adjunct to a multimodal pain control regimen can significantly enhance postoperative comfort and swelling control. The following QR code will direct you to a popular continuous ice delivery device that is available for purchase online. If you choose to purchase this device or one similar, please bring this with you on the day of surgery so that it can be used as soon as the procedure is finished.

Develop a Perioperative Nutrition Plan (Nutrition around the time of surgery):

Nutrition plays a critical but often overlooked role in recovery after orthopaedic surgery. The body’s ability to heal depends heavily on having the right nutritional building blocks available during the perioperative period—the weeks before and after surgery. Optimizing nutrition during this time can support tissue healing, preserve muscle mass, reduce inflammation, and improve overall recovery.

Following surgery, the body enters a temporary catabolic state, meaning it breaks down muscle and tissue faster than it builds them. This effect can be amplified by postoperative pain, swelling, reduced activity, and decreased appetite. Without adequate protein and key micronutrients, patients may experience delayed healing, greater muscle loss, increased fatigue, and slower progress in physical therapy.

Adequate protein intake is especially important. Protein provides the amino acids necessary for collagen formation, muscle repair, and tendon and ligament healing. Nutrients such as vitamin C, vitamin D, calcium, zinc, and omega-3 fatty acids also play key roles in supporting immune function, bone health, and inflammation control. Proper fueling before surgery can help prepare the body for the stress of surgery, while targeted nutrition after surgery supports recovery during the most demanding phases of rehabilitation.

For these reasons, we recommend a structured perioperative nutrition strategy rather than relying on diet alone. Patients are encouraged to use Enroute, a clinically designed perioperative nutrition program, for a total of four weeks surrounding surgery. This typically includes nutritional supplementation for two weeks leading up to surgery and continued use for the first two weeks after surgery. Enroute products are formulated to deliver high-quality protein and key nutrients in appropriate ratios to support healing and recovery during this critical window.

Using a dedicated perioperative nutrition supplement helps ensure consistency at a time when appetite and routine may be disrupted. When combined with surgery and physical therapy, optimized nutrition is an important component of a comprehensive recovery plan designed to help patients regain strength, protect muscle mass, and return safely to activity.

The following QR code will direct you to our preferred nutritional supplement.

Notify the Office:

Please call the office or send us a MyChart message if you are prescribed an antibiotic, notice cuts, scrapes, blemishes, bug bites on operative extremity, become ill or develop any change in your health prior to your surgery, including minor conditions such as a cold, cough, or scrape on the operative extremity.

Stop Taking Certain Medications:

Certain types of medications need to be stopped one week before surgery. This includes but is not limited to NSAIDs (such as Voltaren, diclofenac, Mobic, meloxicam, ibuprofen, Motrin, Advil, Aleve, Anaprox, Naprosyn, Celebrex), herbal supplements, glucosamine, diet pills, cilostazol (Pletal), blood thinners (such as Eliquis, apixaban, Xarelto, rivaroxaban, clopidogrel, Plavix, warfarin, Coumadin) and vitamin E. You may take Tylenol (acetaminophen) up until midnight the night before your surgery. You may resume your medications after surgery.

Other medications that are allowed to be taken before surgery will be discussed at your pre-operative testing appointment.  Examples of medications to take the morning of surgery are Beta Blockers for blood pressure, inhalers and medication for gastric reflux

Make Transportation Arrangements:

You will need to have someone drive you home from your surgery and stay with you for 24 hours. You will not be permitted to take a taxi, public transportation or drive yourself home.

Await Info on Surgery Time:

You will be contacted after 3:00 PM the business day before your surgery with your arrival time. If your surgery is on a Monday, you will receive a call with your arrival time on Friday afternoon.

The Night Before Surgery

Please do not eat or drink anything after midnight. This includes water, chewing gum, hard candy & breath mints. If you do, it is likely your surgery will be cancelled.  You may brush your teeth, but do not swallow any water.

The Morning of Surgery

Do not apply lotions or deodorant (upper extremity surgery only), and minimize the use of make-up.

Before leaving home:  Remove contacts, all jewelry and body piercings.  Leave all valuables at home.

Wear loose-fitting clothing to accommodate bulky dressing or braces that you may have to wear after surgery.  Sweatpants, shorts and loose-fitting tops that zip or button in the front are best.

Do not take oral glucose-lowering agents or ACE inhibitors (such as captopril [Capoten], enalapril [Vasotec], lisinopril [Prinivil, Zestril], quinapril [Accupril]). Insulin will need to be adjusted or withheld.

Please remember to bring your crutches (lower extremity surgery only)

Your First Postop Follow Up:

Your first post op appointment will be scheduled for you approximately 1-2 weeks following your procedure (depending on what you are having done). You will be provided with immediate home-going instructions before leaving the surgery center after your surgery. Please reach out to our office if you do not have your first postoperative follow up visit scheduled.

Pain Control After Surgery:

Effective pain control after surgery is an important part of recovery, as it allows patients to participate fully in physical therapy, regain motion, and return to daily activities more comfortably. Modern postoperative pain management focuses on controlling pain while minimizing side effects and reducing reliance on opioid medications.

The Cleveland Clinic has been a national leader in pioneering opioid-free and opioid-sparing orthopaedic surgery through the use of a comprehensive, multimodal pain control strategy. Rather than relying on a single medication, multimodal pain control uses several complementary approaches that work together to target pain through different pathways. This approach has been shown to provide effective pain relief while reducing nausea, constipation, grogginess, and the risk of medication dependence or addiction.

A multimodal pain regimen typically includes a combination of medications such as acetaminophen and anti-inflammatory medications, along with other non-opioid agents that help reduce pain and inflammation. These medications are carefully scheduled to maintain consistent pain control, rather than waiting for pain to become severe. In many cases, patients receive a regional nerve block at the time of surgery, which can provide significant pain relief during the first one to two days after the procedure.

Non-medication strategies are also an important component of pain management. Ice therapy, elevation, compression, and early guided motion all help reduce swelling and discomfort. Physical therapy plays a dual role by restoring function while also helping control pain through movement and muscle activation. Education about what pain levels are normal during recovery helps patients feel more confident and less anxious during the healing process.

While some patients may still require a short course of opioid medication, many are able to recover comfortably with little or no opioid use. When opioids are prescribed, they are used judiciously and for the shortest duration necessary. This approach prioritizes patient safety while still ensuring adequate pain relief.

Driving After Surgery:

Before you are allowed to start driving, you must be off narcotic medications, out of sling or brace, off crutches (for right lower extremity) and have good leg control.