Dr. Swanson will evaluate you in his office to determine if you are a candidate for total hip replacement using the minimally invasive technique. Nearly every patient undergoing total hip replacement with Dr. Swanson is a candidate for the minimally invasive technique as the incision length used is based on patient size and weight and may vary from 3 inches in the very thin, petite patient to 5 inches in the large, heavy patient. Most patients require a 3 ½ to 4 inch incision. At this time Dr. Swanson will explain the technique, including its potential risks and complications. Surgeries are generally scheduled 2-3 months in advance, due to Dr. Swanson’s schedule.
Insurance and x-rays
If Dr Swanson does not have your latest x-rays, forward a copy of the most recent x-rays to his office. Dr Swanson will review your x-rays and submit his report to the insurance company. Dr Swanson’s staff will handle the insurance authorization.
Preoperative Medical Clearance
All patients over 50, and younger patients with any health problems, will be required to get clearance from a medical doctor prior to surgery. Dr. Swanson’s staff will help you arrange your pre-operative medical appointments either with your regular medical doctor or with one of our pre-op medical doctors; they will also give you the paperwork to take to your medical doctor when you schedule your surgery. Call and schedule an appointment to be seen 4-5 weeks prior to surgery. Take the instruction form entitled “Preoperative Medical Consultation” to your doctor at time of your appointment. A young person without health complication may only be required to have the standard hospital admission blood tests that should be done within 30 days of surgery.
Autologous Blood Donation
Only rarely is a blood transfusion necessary for standard, minimally invasive total hip replacement. Additionally, the blood supply is now considered quite safe with regard to HIV, hepatitis, and other infectious agents. However, if you are having both hips replaced within 6 weeks of each other, Dr Swanson may recommend that you donate blood for your surgery. You can begin donation 6 weeks prior to surgery. Most private insurance companies do not cover the cost, which can be a few hundred dollars per unit of blood. Additionally, if your blood is not needed for your surgery, it will be discarded; it cannot be used for other patients. Dr. Swanson’s staff will give you an order sheet to bring with you to the blood bank. United Blood Service will transfer the donated blood to the hospital. By donating early in the 6-week period, your body will have time to rebuild your blood count prior to surgery. Drink plenty of water 1-2 hours before giving blood, as it will help hasten the procedure and prevent light-headedness after donation. Schedule 1½ hour to complete your blood donation. If you are donating out of state, special arrangements for blood transportation must be arranged. There will be an extra cost for the transportation.
Patients who have chronic anemias with hemoglobins (blood counts) between 10 and 13 are often candidates for erythropoietin injections (a protein which induces red blood cell production by the bone marrow). If you have a chronic anemia, let Dr. Swanson know so that he can determine if you are a candidate for erythropoietin.
Jehovah’s Witnesses and some other religions do not allow any type of blood transfusion. Luckily, minimally invasive surgeries can usually be performed without any type of blood transfusion. However, if one’s religion allows for the use of a “cell saver” which collects any blood as it is lost, filters it, and returns it to the patient, it may be used to minimize intra-operative blood loss.
Iron and Vitamin C
You should use an iron supplement prior to blood donation or if otherwise directed by Dr. Swanson or your medical doctor) to replenish your body’s iron stores as it produces new red blood cells. Take an over-the-counter iron supplement such as Ferrous Sulfate or Ferrous Gluconate, 325 milligrams 3 times daily beginning the first day of donation and continue until surgery. Vitamin C, 1000-1500 milligrams each day is recommended to facilitate iron absorption by your gastro-intestinal tract. Many people find iron to be constipating. The use of a gentle laxative such as Colace, Senokot, or Manna Cleanse may be helpful. Ferrous Gluconate is used by many people who cannot tolerate Ferrous Sulfate. Product literature states that it is more easily absorbed by the body and does not cause constipation. In any event, don’t overlook this aspect as you will be stronger and have more energy post-operatively if you avoid anemia.
Anti-inflammatory Medication, Aspirin, and other Blood Thinning Agents
Do not take any aspirin or anti-inflammatory medications for 10 days prior to surgery (and that means NOT EVEN ONE PILL). These include Aleve, Advil, Motrin, Ibuprofen, Naprosyn, Mobic, Voltaren, Relafen, Daypro, etc. All of these medications thin the blood and may cause excessive bleeding during surgery. Other blood thinners, such as Coumadin (warfarin), Plavix, or Persantine will also need to be stopped prior to surgery. Ask Dr. Swanson how long before surgery to stop these medications. In general, Coumadin must be stopped 3-4 days prior to surgery, and Plavix 10 days prior to surgery. Vitamin E and other herbal supplements, such as St. John’s Wort, Kava-Kava and Ginko Biloba may also cause thinning of the blood and should be discontinued prior to surgery. Any herbal supplementation should be discussed with Dr Swanson or his staff.
Pre-Op Instructions and Hospital Orders
Three to five days prior to surgery, you will meet with one of Dr. Swanson’s assistants for an orthopedic History and Physical examination. Bring a list of your medications and the milligram dosages you take with you. Also, bring a copy of your medical history, including all medical problems, prior surgeries, and previous surgical problems, to this appointment. Call the office where pre-surgery tests were done to make sure they were forwarded to Dr Swanson’s office prior to this appointment, or pick up the results and bring them in yourself. If your pre-operative tests are unavailable or your medical clearance has not been completed, your surgery may be postponed.
Centennial Hills Hospital Pre-Admission
Dr Swanson does surgery at Centennial Hills Hospital in Las Vegas. He has established a team that he works with consistently. At the time of your History and Physical appointment you will be given instructions regarding your preadmissions appointment at Centennial Hills Hospital. Bring all of the information listed below.
Only a few insurance payers are not contracted with Centennial Hills Hospital. In this case, Dr. Swanson will try to work with the hospital administration to allow your surgery while not having you pay any more out of pocket than if you had stayed in your insurance network. If this is not possible, your surgery may be scheduled at an alternative hospital. Dr. Swanson’s team will take care of obtaining insurance authorizations.
The Pre-admit process may take about 90 minutes. Please bring the following items:
- Physician Admission/Pre-operative Order Form
- Insurance card(s)
- Picture ID (Driver’s license or Military ID, etc)
- List of current medications
- Pre-Anesthesia form completed
- Autologous Donation Card (if self donation done)