What to do before your knee replacement surgery date

Preparing for knee replacement surgery means handling medical clearance, arranging your home and transportation, and following your surgeon's specific instructions about medications and fasting. Most of this preparation happens in the weeks before surgery, not the night before. Your surgeon's office will give you a written pre-surgery checklist — follow it exactly, because missing even one step can delay your operation.

Start by scheduling a pre-operative appointment with your primary care doctor, usually four to six weeks before surgery. This visit clears you medically and flags any conditions — like uncontrolled blood pressure or a recent infection — that could complicate recovery. Bring a list of every medication and supplement you take, because some will need to stop days or weeks before surgery.

Key Takeaways

  • Your surgeon will provide a written pre-surgery checklist that specifies which medications to stop, when to stop eating and drinking, and what time to arrive at the hospital.
  • Arrange for someone to drive you home and stay with you for at least the first 24 hours, because you will not be able to drive or care for yourself when ready after surgery.
  • Prepare your home before surgery by moving frequently used items to waist height, removing tripping hazards, and setting up a recovery space on the ground floor if possible.
  • Stop taking blood thinners, aspirin, and certain supplements on the dates your surgeon specifies, because they increase bleeding risk during and after surgery.
  • Fast completely (no food, water, or gum) from midnight the night before surgery unless your surgeon gives different instructions.

Stop or adjust medications on your surgeon's schedule

Blood thinners like warfarin, apixaban, and dabigatran must stop several days before surgery — the exact timing depends on which medication and your bleeding risk. Aspirin and ibuprofen also increase bleeding, so most surgeons ask you to stop these five to seven days before the operation. Do not stop any medication on your own; call your surgeon's office with a list of everything you take and ask which ones to pause and when.

Bring the written list of medication changes to the hospital on surgery day. Vitamins, supplements, and herbal products can also affect bleeding or anesthesia — fish oil, ginger, ginkgo, and St. John's Wort are common culprits. Your surgeon's pre-surgery paperwork usually lists which supplements to avoid; if it does not, ask during your pre-operative visit.

Arrange transportation and at-home support for the first week

You cannot drive yourself home after surgery because of the anesthesia and pain medication. Arrange for a family member or friend to pick you up and stay with you for at least 24 hours — ideally longer if you live alone. This person will help you move safely, take medications on time, and watch for signs of infection or complications.

If you live alone and have no one to stay with you, talk to your surgeon's office about other options: some hospitals arrange temporary home health aides, or you may need to stay in a rehabilitation facility for a few days. Do not plan to manage alone in the first week. You will need help with basic tasks like bathing, dressing, and preparing meals.

Prepare your home before surgery day

Move items you use daily — medications, phone charger, remote controls, snacks — to a table or shelf at waist height so you do not have to bend or reach down. Remove throw rugs, electrical cords, and pet toys from walkways, because you will use a walker or crutches and tripping is a serious risk. If your bedroom or bathroom is upstairs, set up a temporary recovery space on the ground floor with a bed or recliner, a nightstand, and straightforward access to a bathroom.

Stock your freezer and pantry with straightforward meals before surgery — soups, frozen vegetables, canned beans, and other foods that require minimal preparation. Prepare and freeze meals in single portions if you can. Have ice packs ready (or frozen vegetables in a bag) for swelling, and buy extra pillows to prop your leg while sitting or lying down.

Complete pre-operative testing and medical clearance

Your surgeon's office will order blood work, an EKG (heart tracing), and possibly a chest X-ray, depending on your age and medical history. Schedule these tests at least two weeks before surgery so results are back in time. If any result is abnormal, your surgeon may ask your primary care doctor to clear you or may reschedule the operation.

Attend your pre-operative appointment with your anesthesiologist if the hospital schedules one. This doctor reviews your medical history, past reactions to anesthesia, and any breathing problems. Tell them about sleep apnea, acid reflux, or difficulty with anesthesia in the past — this information changes how they manage your care during surgery.

Follow fasting and hygiene instructions the night before

Your surgeon will specify a fasting window — typically no food or drink after midnight, though some surgeries allow clear liquids until a few hours before. Follow this exactly. Eating or drinking before anesthesia can cause serious complications. Do not chew gum, suck on mints, or use mouthwash the morning of surgery unless your surgeon says it is safe.

Shower or bathe the night before surgery using regular soap. Some surgeons ask you to use a special antimicrobial soap or wash your leg with it — if so, your pre-surgery paperwork will say so. Do not shave your surgical leg yourself; if hair removal is needed, the hospital will do it with clippers right before surgery. Wear clean, loose-fitting clothes to the hospital and leave jewelry, watches, and piercings at home.

Understand what happens on surgery day and when ready after

Arrive at the hospital at the time your surgeon's office specifies — usually one to two hours before your scheduled surgery time. Bring your insurance card, photo ID, and the pre-surgery paperwork your surgeon gave you. A nurse will start an IV, check your vital signs, and ask you to confirm your name and the surgical site. A surgeon will mark your knee with a pen to prevent operating on the wrong leg.

After surgery, you will wake in a recovery room with your leg wrapped and possibly in a brace or immobilizer. You will feel groggy, and your leg will be numb from local anesthesia and swollen from the surgery. A nurse will monitor your pain and blood pressure, give you ice and elevation, and help you move your leg gently. Most people go home the same day or stay one night; your surgeon will tell you which applies to you.

Frequently Asked Questions

What if I take blood thinners for a heart condition or stroke prevention?

Tell your surgeon when ready — do not stop blood thinners on your own. Your surgeon will coordinate with your cardiologist about when to stop, whether to switch to a different blood thinner temporarily, or whether to use a bridge medication. This conversation must happen weeks before surgery, not days before.

Can I eat or drink anything the morning of surgery?

Follow the exact fasting instructions your surgeon gives you. Most surgeons say nothing by mouth after midnight, but some allow clear liquids (water, black coffee, apple juice) until a few hours before. Eating or drinking when you should not can force the hospital to cancel surgery that day.

What should I wear to the hospital?

Wear clean, loose-fitting clothes that are straightforward to remove — sweatpants and a button-up shirt work well. Leave jewelry, watches, and piercings at home. Wear slip-on shoes because you will not be able to bend down to tie laces. Bring your insurance card, photo ID, and any paperwork your surgeon's office gave you.

What if I get sick or develop a fever before surgery?

Call your surgeon's office when ready, even if it is just a cold or minor fever. Infections and illness can complicate anesthesia and surgery. Your surgeon may ask you to reschedule, or may clear you to proceed — but do not assume it is fine to come in without asking.

How long does the surgery itself take?

A typical knee replacement takes 60 to 90 minutes. Your surgeon's office will tell you the expected time when you schedule pre-operative testing. The time from when you arrive at the hospital to when you go home is much longer — usually four to six hours — because of check-in, anesthesia, recovery, and discharge paperwork.