Before your surgery

Your pre-operative assessment

A few weeks before your operation you will be asked to attend a pre-operative assessment clinic, usually run by specialist nurses with anaesthetic support. The appointment can take two or three hours, so allow plenty of time and bring someone with you if that helps.

The purpose is to make sure you are as safe and as ready as possible. The team will:

• Take a full history of your health, previous operations and previous anaesthetics.
• Check your heart and chest, blood pressure, weight and height, and your usual walking distance.
• Take blood tests, including a full blood count to check for anaemia, kidney function, and a diabetes check (HbA1c) where relevant.
• Swab your nose and skin to look for MRSA and other bacteria that could cause a wound infection. If found, this is treated with a simple cream and body wash before surgery — it is common and nothing to be embarrassed about.
• Arrange an ECG heart tracing, and occasionally a heart scan or chest X-ray.
• Take X-rays of the hip so the implant sizes can be planned in advance.

Bring your medicines

Bring every medicine you take in its original box or a printed list from your GP — including inhalers, eye drops, patches, herbal remedies and anything you buy over the counter. Some medicines need to be stopped or adjusted:

• Blood thinners such as warfarin, apixaban, rivaroxaban and clopidogrel usually need to be paused, and the timing must be exact. Never stop them on your own — always follow the written instruction you are given.
• Diabetes medicines, especially insulin and drugs whose names end in "-gliflozin", need a specific plan for the day before and the morning of surgery.
• Blood pressure tablets are mostly continued, but some are held on the morning of surgery.
• Anti-inflammatory painkillers such as ibuprofen and naproxen are often stopped shortly beforehand.

You will be given clear written instructions telling you exactly what to take and what to hold, and when. Keep that sheet somewhere you will not lose it.

Getting yourself ready

The pre-operative period is sometimes called "prehabilitation". Going into surgery in the best condition you can manage is genuinely one of the most effective things you can do — teams who optimise patients properly beforehand see substantially fewer complications.

Move a little, often

You are not being asked to train for anything. Short, frequent activity within your pain limits is what counts: a daily walk even if it is only to the end of the road, sitting to standing from a chair a few times a day, gentle cycling on an exercise bike, or exercises in a warm swimming pool where the water takes your weight. Strengthening your arms matters too, because you will be using a walking frame or crutches afterwards.

Stopping smoking and alcohol

Smoking narrows the small blood vessels that heal your wound and roughly doubles the risk of wound problems. Stopping even four to six weeks beforehand makes a measurable difference, and your team can refer you for free support. Keeping alcohol within 14 units a week helps your liver handle the anaesthetic and reduces the risk of confusion afterwards.

Weight, food and blood sugar

A body mass index above 35 roughly doubles the risk of both wound infection and dislocation, so you may be offered a supervised weight-management programme. This is not a judgement — it is risk reduction. Just as important is eating enough protein: meat, fish, eggs, beans, dairy. Older adults often eat too little protein, and your body needs it to heal the wound and rebuild muscle. If you have diabetes, steadier blood sugar before surgery means better wound healing afterwards.

Teeth, skin and infections

Bacteria anywhere in the body can travel to a brand-new joint. Have any dental problems treated before your operation, and tell your team straight away if you develop a chest infection, urine infection, or any break or sore in the skin of your leg. It is far better to postpone by a fortnight than to risk an infected joint.

How you are feeling

Feeling anxious before a major operation is normal, and it is not a small matter: anxiety and low mood are linked to more pain and slower recovery. Your team may use a short questionnaire (the Hospital Anxiety and Depression Scale) to check how you are coping. Being well informed genuinely reduces distress — which is precisely what this guide is for. Ask for a joint-school session or a pre-operative class if your hospital runs one.

If you have any memory problems or have been confused in hospital before, tell the team. Older patients can develop temporary confusion (delirium) after surgery, and there is a great deal that can be done to prevent it: keeping your glasses and hearing aids with you, good pain control, avoiding certain sedative drugs, keeping you hydrated, and having familiar faces and objects nearby.

Preparing your home

You are likely to be home within one to three days, so the work is best done before you go in. An occupational therapist may visit or telephone to help.

• Clear the floor. Loose rugs, trailing cables, pet bowls and clutter are the main causes of falls in the first weeks. Take rugs up altogether.
• Raise your seating. Low, soft chairs, sofas and beds are difficult and can strain the new joint. You may be given a raised toilet seat, a chair raiser and a bed lever — practise using them beforehand.
• Move things to waist height. Put kettle, cups, plates and food where you can reach them without bending or stretching.
• Stock up. Fill the freezer with easy meals, and arrange shopping deliveries for the first two or three weeks.
• Bathroom. Consider a non-slip mat, grab rails and a long-handled sponge. A shower is easier than a bath at first.
• Stairs. If your bathroom is upstairs, plan whether you will sleep upstairs or set up a temporary bed downstairs. Both work — decide in advance.
• Help. Arrange for someone to be with you for the first few days, and to help with shopping, laundry and pets for a couple of weeks. Ask a neighbour to check in if you live alone.

Useful equipment

A long-handled shoe horn, a sock aid, a helping hand (grabber) and a long-handled sponge together cost very little and remove most of the frustration of the first fortnight, since you will be told not to bend your hip too far. Your therapist will confirm which of these you need.

What to pack

• Your medicines in their boxes, plus your written medicine instructions.
• Loose, comfortable day clothes and a dressing gown.
• Well-fitting flat, closed-in shoes or slippers with a firm back — not backless slippers, which cause falls.
• Glasses, hearing aids with spare batteries, dentures and their case.
• Toiletries, and any walking aid you already use, labelled with your name.
• Phone and charger with a long cable, and a book, puzzle or radio.
• A written list of your questions, and next-of-kin phone numbers.

Eating and drinking before surgery

You will be told to stop eating around six hours before your operation. Clear fluids — water, black tea or coffee, squash without bits — are usually allowed until two hours before, and many hospitals actively encourage a carbohydrate drink, because arriving dehydrated makes you feel far worse afterwards. Follow the exact times you are given, and ask if you are unsure.