What does the process look like leading up to robotic joint replacement surgery?

Dr. Ramkumar has a detailed process and checklist to ensure your safety prior to undergoing joint replacement. Although joint replacement is a common operation, it is a very important life event and we want to minimize as many preventable risks as possible. Although tedious, the process is as follows:

  • Enrollment in our remote patient monitoring program, where Dr. Ramkumar can track your symptoms throughout the process, activity levels, biometric data, wound healing, and rehabilitation regimen. You will also have digital access to Dr. Ramkumar’s practice, from his protocols and instructions to messaging.
  • Body mass index (BMI) check: must be 40 or lower, this is dependent on your weight
  • Smoking status check: must stop quitting for 6 weeks prior to surgery, and we will do a blood test the morning of your surgery to ensure cotinine is out of your symptom
  • If on Disease-Modifying AntiRheumatic Drugs (DMARDs) like methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine, Dr. Ramkumar follows nationally recommended guidelines to discuss when to stop and resume medications
  • Preoperative Labs
    • Hemoglobin > 10g/dl
    • INR < 1.4
    • HgbA1c < 7.5
    • Cotinin <10 ng/ml
    • Lipid panel
    • Albumin >3.5 g/dL
    • ESR <12mm/h (if >50 needs work up) and CRP <3.0 mg/dL (if > 30 needs work up)
      • If ESR >50 or CRP is >30, needs work up by the primary care physician and labs repeated a month later to ensure normalization prior to surgery
    • Vitamin D >30 ng/dl
      • If your current Vitamin D level is between 10-19 you need to take —-> 6,000 IU daily
      • If your current Vitamin D level is betweeen 20-24 you need to take—> 5,000 IU daily
      • If your current Vitamin D level is between 25-29 you need to take—> 4,000 IU daily
      • If your current Vitamin D level is between 30-34 you need to take—> 3,000 IU daily
      • If your current Vitamin D level is between 35-39 you need to take—> 1,000 IU daily
      • If Vitamin D is below 30, you need to have repeat labs in 3 months to make sure your Vitamin D level has increased to be above 30.
    • Platelets > 70,000K/ul
    • Magnesium < 1.7
    • MRSA/MSSA preoperative PCR
    • Mupirocin/Bactroban (2% ointment) for all: Apply topically with a q-tip twice a day to each nostril for 5 days before surgery.
  • Additional Imaging
    • Full length standing XRs
    • CT scan for the MAKO
  • Preoperative Clearances
    • Preoperative Medicine Clearance: for all patients
    • PCP: if lipids or A1c elevated
    • Cardiology: any cardiac history
    • Dental: if poor dental hygiene and needs dental cleaning
    • Endocrinology: If Vit D < 10, if A1c > 7.5, if hypercalcemic order PTH and refer
    • Allergy: if you have ever experienced hives or any other more severe reaction to a penicillin or cephalosporin, we will refer you for allergy testing