10 Critical Steps To Take Tonight: Your Ultimate Checklist When Knee Surgery Is Tomorrow

The hours leading up to major orthopedic surgery, such as a Total Knee Arthroplasty (TKA) or even a less invasive arthroscopic procedure, can be filled with a mix of anticipation and significant anxiety. As of late 2025, the best medical advice emphasizes that the final 24 hours are crucial, not just for physical preparation but also for mental optimization. Taking proactive steps tonight will directly influence the success of your procedure tomorrow, your anesthesia experience, and the speed of your initial recovery phase.

This comprehensive, step-by-step checklist is designed to guide you through the essential tasks you must complete tonight, ensuring you arrive at the hospital or surgical center fully prepared, calm, and ready for a smooth transition into your recovery. It’s time to move from feeling overwhelmed to feeling empowered and organized for your big day.

The Essential Pre-Operative Checklist: Tonight’s Non-Negotiables

Your orthopedic surgeon and the surgical team have provided specific instructions, and following those directives is paramount. However, this checklist covers the universal, critical steps that apply to nearly all knee procedures, from ACL reconstruction to a full knee replacement.

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1. Strictly Adhere to the NPO (Nil Per Os) Rule

• The Golden Rule: Do not eat or drink anything after the specific time your surgical team instructed, which is typically midnight. This is known as the NPO rule.
• Why it Matters: Having food or liquid in your stomach dramatically increases the risk of aspiration (inhaling stomach contents) during the administration of general anesthesia or sedation. This is a severe, life-threatening complication.
• Check Your Exceptions: Only take medications explicitly approved by your anesthesiologist or surgeon, and only with a tiny sip of water. Confirm which medications (like blood thinners, certain diabetes medications, or herbal supplements) you were told to stop days or weeks ago.

2. Complete the Pre-Surgery Cleansing Ritual

Modern surgical protocols place a high emphasis on skin preparation to minimize the risk of Surgical Site Infection (SSI).

• The Special Wash: If your surgeon provided a special antiseptic soap, such as Chlorhexidine Gluconate (CHG), use it exactly as directed tonight. Focus on the surgical site and follow the instructions for rinsing and drying.
• Personal Hygiene: Take a shower or bath tonight. However, do not shave the surgical leg tonight, as this can create microscopic cuts that increase infection risk. If hair removal is necessary, the hospital staff will handle it tomorrow.
• Remove All Adornments: Take off all jewelry, including wedding rings, earrings, and body piercings. Remove all nail polish, acrylic nails, and makeup. These items can interfere with monitoring equipment (like pulse oximetry) and harbor bacteria.

3. Finalize Your Home Recovery Nest

The first 48 to 72 hours post-surgery are the most critical for comfort and pain management. Preparing your recovery area now is a massive stress-reducer for tomorrow.

• The Command Center: Set up your main recovery area (often a bed or a comfortable recliner) on the ground floor to avoid stairs. Ensure you have easy access to a phone, remote controls, books, water, and charging cables.
• Mobility Aids: Place your walker, crutches, or cane within easy reach. Practice using them one last time to ensure they are the correct height and you feel confident.
• Trip Hazards: Perform a final sweep of the path from your recovery area to the bathroom. Remove all throw rugs, loose cords, and clutter that could cause a fall.
• Bathroom Prep: Ensure your elevated toilet seat, shower chair, and non-slip mats are installed and ready to use.

Managing Pre-Surgery Anxiety and Mental Preparation

It is entirely normal to feel nervous or experience significant anxiety the night before a major procedure like Total Knee Replacement (TKR). Acknowledge these feelings, but do not let them dominate your final hours of preparation. This is where your mental preparation comes into play.

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4. Practice Guided Imagery and Visualization

The power of the mind is a recognized tool in modern recovery protocols. Instead of focusing on the operating room, shift your mental energy.

• Positive Visualization: Spend 10-15 minutes visualizing a successful surgery. Imagine the surgical team performing the procedure flawlessly, waking up comfortably in the Post-Anesthesia Care Unit (PACU), and then successfully completing your first physical therapy session.
• Mindfulness and Breathing: Use controlled breathing techniques. Inhale deeply through your nose for a count of four, hold for four, and exhale slowly through your mouth for a count of six. This simple exercise can lower your heart rate and activate your parasympathetic nervous system, promoting relaxation.
• Listen to a Calming Podcast or Music: Avoid news or stressful media. Choose calming music, an audiobook, or a meditation track to distract your mind from the surgical stressor.

5. Confirm Logistics and Essential Documents

A final check of your administrative and logistical details will prevent a rushed, stressful morning.

• The Hospital Bag: Pack your bag completely. Include loose-fitting, comfortable clothing, non-slip socks, personal toiletries, your CPAP machine (if applicable), and your insurance card/ID.
• Transportation and Escort: Confirm the arrival time and contact information for the person who will drive you to the hospital and, more importantly, the person who will drive you home after your discharge (if it’s an outpatient procedure).
• Review Instructions: Read the printed surgical instructions one last time. Note the exact time you must arrive and the location of the admissions or registration desk.

The Medical and Logistical Deep Dive

For a successful outcome, the medical details must be perfect. These steps ensure you are medically optimized for the procedure.

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6. The Anesthesia Discussion

If you haven't already, review your anesthesia plan. Knowing what to expect reduces fear.

• Types of Anesthesia: Understand whether you will have general anesthesia (fully asleep), a spinal block (regional anesthesia), or a combination. Modern knee surgeries often utilize a spinal block with light sedation for better pain control immediately after the procedure.
• Pain Management Plan: Confirm the post-operative pain management strategy, which often involves a multimodal approach combining nerve blocks, NSAIDs, and opioid medication.

7. Final Pre-Hab/Pre-Conditioning

If you have been following a pre-habilitation ("pre-hab") program, a final, gentle session can be beneficial, but do not overexert yourself.

• Gentle Movement: Perform a few sets of your approved exercises, such as gentle quadriceps sets or ankle pumps. This helps maintain muscle activation and blood flow, which is key for preventing Deep Vein Thrombosis (DVT) and promoting early recovery.
• Rest is Key: After a light stretch, prioritize rest. A good night's sleep is the best preparation for your body's healing process.

8. The Support System Check-In

A strong support network is a significant factor in a successful recovery.

• Contact Your Caregiver: Touch base with your primary caregiver or "coach" who will be helping you in the first few days. Confirm their schedule and ensure they know where all the necessary supplies are located.
• Set Boundaries: Let friends and family know that you will be in recovery and may not be able to communicate much for the first 24–48 hours. This reduces the pressure to "perform" and allows you to focus on healing.

9. Confirm Medical Optimization

This is a final, internal check to ensure you are in the best possible medical state.

• Blood Pressure/Diabetes: If you monitor your blood pressure or blood sugar, ensure your readings are within your goal ranges. Uncontrolled chronic conditions can delay surgery or complicate recovery.
• Infection Check: Scan your body for any new cuts, rashes, or signs of a cold or flu. If you notice anything concerning, call your surgeon's office immediately, as an active infection can be a reason to postpone surgery.

10. Embrace the Transition

Tonight marks the end of chronic knee pain and the beginning of your journey toward a new, active life. Embrace the discomfort of the transition.

• Acceptance: Accept that the next few days will be challenging, but they are temporary. The pain you feel tonight is the pain that is about to be fixed.
• Focus on the Future: Remind yourself of your "why"—the activities you look forward to doing again, whether it's walking the dog, playing golf, or simply climbing stairs without pain. This positive mental framework is one of the most powerful tools for a speedy recovery and successful physical therapy.