Getting ready for surgery
The weeks before a hip replacement are a chance to lower your risk and recover better. This page covers the things that make the biggest difference, and the targets we work toward together.
The pre-surgical discussion
Surgery starts with a conversation, not a date. Before a hip replacement is booked, Dr. Khoshbin goes through what the operation involves, what recovery looks like, the risks that apply to you, and whether non-surgical care still has more to offer. The decision is made together, and there is no pressure to rush it.
That discussion also sets out the getting-ready plan below. Most of these steps take some lead time, and the timing of surgery flexes to let you get to your best starting point.
These targets are about safety, not gatekeeping
The goals below come from research on what lowers the risk of problems after hip replacement. They are things we work toward with you and your family doctor, so that your operation goes smoothly and you recover well.
What we work on together
Weight
Carrying extra weight raises the risk of wound problems and infection after a hip replacement, and it makes the operation harder. National surgical guidance uses a body mass index under 40 as the threshold for elective hip replacement. The risk does not switch on suddenly at 40; it rises gradually, so every step down helps. We aim to get as close to and below that mark as we reasonably can, and we can help with support to do it.
Blood sugar
High blood sugar slows healing and raises infection risk. HbA1c is a blood test that reflects your average sugar over about three months. For people with diabetes, we aim for an HbA1c under 7.5% before surgery, worked out with your diabetes team or family doctor. Good control is usually achievable with some lead time, and we plan around it rather than rush.
Smoking
Smoking narrows blood vessels and slows healing, which raises the risk of wound and infection problems. Stopping before surgery helps, and even a few weeks makes a difference. We can point you to support to quit.
Blood count and blood conservation
Starting surgery with a low blood count (anaemia) raises the chance of needing a transfusion, so we check it in advance and treat it if it is low, for example with iron. Modern anterior hip replacement usually involves little blood loss, and a medicine called tranexamic acid is used during surgery to reduce bleeding further, so transfusion is uncommon. When blood is needed, it is carefully matched and screened.
Teeth, skin, and medicines
Active dental infection is best treated before surgery, and the skin over the hip should be in good condition. We also review your medicines, since some blood thinners and supplements need pausing beforehand. Your team will give you clear instructions.
- BMI: the American Academy of Orthopaedic Surgeons references a BMI under 40 for elective hip replacement; large 2025 data show infection risk rising continuously from about a BMI of 37. (Connors et al., J Arthroplasty 2023; Orringer et al., Bone Joint J 2025.)
- HbA1c: a target under 7.5% is supported for reducing infection risk; arthroplasty studies place the discriminating threshold near 7.7 to 7.8% for the hip. (AAFP 2021; AAHKS multicentre, J Arthroplasty 2017; continuous-variable analysis, J Arthroplasty 2025.)
- Tranexamic acid is strongly recommended to reduce blood loss and transfusion in hip replacement. (AAOS 2023 hip OA clinical practice guideline.)
Looking after your other joints
Hip arthritis rarely travels alone. Many people with a worn hip also have arthritis in a knee, an ankle, the hands, or a shoulder. Before hip surgery, it helps to have those joints managed well too, so your recovery is not held back by another painful joint.
We work with rheumatology and with Dr. Mahendira's dedicated osteoarthritis program to keep your other joints as comfortable as possible with non-surgical care, so you come to surgery in the best shape and leave it able to move.
If you have an inflammatory arthritis
Some people come to hip surgery with an inflammatory arthritis, such as rheumatoid arthritis or an inflammatory muscle disease (myositis). These conditions, and the medicines that control them, need careful handling around surgery. Some medicines are paused before an operation to lower infection risk, and it is best to settle any flare first. We coordinate this with your rheumatologist so nothing is missed.
For inflammatory muscle disease, we work with the Toronto Myositis Centre and Dr. Vinik. For rheumatology care and complex osteoarthritis, we work with Dr. Mahendira.
Recent hip injection
If you have had a steroid injection into the hip, the timing of surgery matters. As a cautious measure for a planned operation, Dr. Khoshbin does not schedule a hip replacement within six months of a steroid injection into that hip. Tell the team if you have had one, and when.
This page is general information, not personal medical advice. Your own targets and plan depend on your health, and are set with your surgeon and family doctor.