What to Expect the Day of Your Joint Replacement Surgery

The Night Before

Your phone alarm is set for 4:30 AM. Your bag is packed. And your mind is running through every possible scenario.

This is completely normal. Joint replacement surgery is one of the most common and successful orthopedic procedures performed today — over 2 million are done in the U.S. annually — but when it's your joint being replaced, the statistics matter less than the uncertainty.

This guide walks you through exactly what happens on surgery day, hour by hour, so nothing catches you by surprise.

Key Takeaways

• You'll typically arrive 2 hours before your scheduled surgery time
• Most patients are awake within 30–60 minutes of surgery ending
• Physical therapy usually starts within hours of surgery — often the same day
• Many patients go home the same day or the following morning

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Pre-Surgery Prep (The Days Before)

Your surgical team will give you specific instructions, but here's what most pre-op protocols include:

7 days before: Stop blood-thinning supplements (fish oil, vitamin E, turmeric). Your surgeon will tell you which prescription blood thinners to stop and when.

3 days before: Begin using the antiseptic skin wash (usually chlorhexidine/Hibiclens) on the surgical area. This significantly reduces infection risk.

The night before:

• No food after midnight (or as directed — some centers allow clear liquids until 2 hours before)
• Shower with the antiseptic wash
• Lay out loose, comfortable clothing for the ride home — elastic waistband pants and a button-front shirt
• Confirm your ride and your caregiver for the first 24–48 hours

What NOT to do: Don't shave the surgical area. Razor nicks create entry points for bacteria. If hair removal is needed, the surgical team handles it with clippers in the OR.

Arrival: The 2 Hours Before Surgery

Most hospitals ask you to arrive 1.5–2 hours before your scheduled surgery time. Here's what that window looks like:

Check-In and Pre-Op Bay

You'll check in at the surgical registration desk, confirm your identity and procedure (yes, they will ask you multiple times which joint you're having replaced — this is a safety protocol, not forgetfulness), and change into a hospital gown.

A nurse will:

• Start an IV line in your arm or hand
• Take your vital signs (blood pressure, heart rate, temperature, oxygen level)
• Confirm your medication list and allergies
• Have you sign consent forms
• Mark the surgical site — your surgeon will draw on the correct knee or hip with a surgical marker, and you'll verify it's right

The Anesthesia Conversation

Your anesthesiologist will visit you in pre-op. This is one of the most important conversations of the day. They'll discuss two main options:

Spinal anesthesia (regional): A single injection in your lower back numbs you from the waist down. You're awake but sedated — most patients describe it as "being aware but not caring." This is increasingly the preferred option because:

• Less nausea afterward
• Better immediate post-op pain control
• Lower risk of blood clots
• Faster mental clarity after surgery

General anesthesia: You're completely asleep. Some patients prefer this, and certain medical conditions may require it.

Many centers now use a nerve block in addition to either option — an injection near specific nerves that provides 12–24 hours of targeted pain relief in the surgical area.

What patients often don't expect: The anesthesiologist's visit is brief — usually 5–10 minutes. But you can ask questions. "What will I feel?" and "How will you manage my pain after?" are both perfectly appropriate.

Saying Goodbye (Briefly)

Your family or support person will typically stay with you in pre-op until it's time to move to the operating room. In most hospitals, this is when they'll head to the waiting area. A surgical coordinator or nurse will update them during the procedure.

In the Operating Room

A member of the surgical team will wheel your bed down the hallway to the OR. Here's what you'll see:

The operating room is bright, cool (around 65°F — intentionally cold to reduce infection risk), and full of equipment. You'll see your surgical team — usually 4–6 people including the surgeon, anesthesiologist, surgical assistant, scrub nurse, and circulating nurse.

The "Time-Out"

Before anything begins, the entire team stops for a formal surgical time-out. They'll confirm out loud:

• Your name
• The procedure being performed
• Which side (left vs. right)
• That the correct imaging is displayed
• That antibiotics have been given

This happens for every surgery in every hospital. It's one of the most important safety innovations in modern surgery.

The Procedure Itself

Hip replacement typically takes 60–90 minutes. The surgeon removes the damaged ball-and-socket joint and replaces it with a metal and ceramic/plastic artificial joint. Modern anterior-approach hip replacements work between muscles rather than cutting through them, which is why many patients can walk within hours.

Knee replacement typically takes 60–90 minutes. The surgeon resurfaces the ends of the femur and tibia with metal components and places a medical-grade plastic spacer between them. If your surgeon uses robotic assistance, the robotic arm guides bone cuts with sub-millimeter precision.

Shoulder replacement typically takes 90–120 minutes, depending on whether it's a standard (anatomic) or reverse shoulder replacement.

What you experience during surgery with spinal anesthesia: Most patients remember being wheeled into the OR, a brief period of awareness, and then the sedation takes over. You may hear voices or feel pressure, but no pain. Many patients have no memory of the procedure at all.

The Recovery Room: The First 1–2 Hours After

You'll wake up (or the spinal will begin wearing off) in the Post-Anesthesia Care Unit (PACU). This is a monitored area where nurses track your vitals closely as the anesthesia clears.

What You'll Feel

Pain: Surprisingly manageable for most patients, thanks to the nerve block and multimodal pain protocol. Most patients rate their pain 3–5 out of 10 in the first few hours. The nerve block does the heavy lifting during this window.

Thirst and dry mouth: Very common. You'll start with ice chips and work up to clear liquids.

Grogginess: If you had general anesthesia, expect some mental fog for 1–2 hours. Spinal anesthesia patients are usually alert sooner.

Cold: The OR is cold and your body temperature drops slightly during surgery. Warmed blankets are standard — don't hesitate to ask for more.

Nausea: Possible but much less common than it used to be. Modern anti-nausea medications are given preventively.

The First Steps

Here's what surprises most patients: you may walk on your new joint within 2–6 hours of surgery.

A physical therapist will visit you — sometimes while you're still in recovery — and guide your first steps with a walker. For hip replacement patients, this often happens within 2–3 hours. Knee replacement patients may take a few more hours, especially while the nerve block is active.

This first walk feels strange. Your body is processing a lot. But getting up early is one of the strongest predictors of a smooth recovery. It reduces blood clot risk, prevents stiffness, and starts the healing process.

What patients often don't expect: The first time you stand, the physical therapist and nurse will be right there. It's okay to feel unsteady. It's okay to only go 10 feet. The point is starting.

The Decision: Home Today or Stay Overnight?

Depending on your surgeon, your procedure, and how you're doing, you'll either:

Go home the same day (outpatient). Increasingly common for hip and knee replacements in healthy patients. You'll be discharged 4–8 hours after surgery if you can walk safely with a walker, manage stairs if needed, tolerate oral pain medication, and urinate on your own.

Stay one night. The traditional approach and still appropriate for many patients. You'll continue IV pain medication overnight, do another PT session the next morning, and go home by noon.

Stay 2+ nights. Less common now but appropriate for patients with complex medical histories, bilateral (both sides) procedures, or those who live alone without a caregiver.

Going Home: What the First 48 Hours Look Like

Whether you leave same-day or the next morning, the first 48 hours at home set the tone for your entire recovery.

Pain management: Your nerve block will wear off 12–24 hours after surgery. This is often when patients feel the most pain of the entire recovery — have your oral medications ready and take them on schedule, not just when pain spikes. Ice and elevation are your best friends during this window.

Movement: Walk every 1–2 hours while awake, even if just to the bathroom and back. Sitting still for long stretches increases blood clot risk and stiffness. Your PT will have given you exercises — do them.

Sleep: Expect disrupted sleep for the first 1–2 weeks. Ice your joint before bed, take your pain medication 30 minutes before you want to sleep, and use pillows strategically (between your knees for hip replacement; under your knee for knee replacement — but never a pillow behind the knee that keeps it bent).

What's normal: Swelling, bruising (sometimes dramatic — your thigh may turn purple and it'll track down to your ankle), warmth around the joint, mild fever for the first day or two, and fatigue.

What's NOT normal (call your surgeon): Temperature above 101.5°F, increasing redness or drainage from the incision, calf pain or swelling in one leg significantly more than the other, sudden shortness of breath, or pain that gets worse instead of gradually improving after day 3.

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The Bigger Picture

Joint replacement surgery has come remarkably far. Thirty years ago, this was a 5-day hospital stay with months of heavy rehabilitation. Today, many patients are home the same day, walking within hours, and back to their normal lives in weeks.

The single best thing you can do for your outcome is prepare. Prehab your body, set up your home, choose an experienced surgeon, and know what to expect — which you now do.

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Find the Right Surgeon

Looking for a surgeon who performs this procedure routinely? Browse orthopedic surgeons ranked by Medicare procedure volume to compare experience across 8,100+ surgeons in all 50 states. Volume matters — and now you know the right questions to ask at your consultation.