patient handbook and journal

PATIENT HANDBOOK AND JOURNAL
YOU. IMPROVED.
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ABOUT ORTHOCAROLINA
With expert physicians and care providers in locations throughout our region, OrthoCarolina is one of
the nation’s leading orthopedic practices. We bring expertise in the areas of foot and ankle, hand, hip and
knee, shoulder and elbow, spine, sports medicine and pediatrics to offer a continuum of care unmatched
in our region — and throughout the country.
Formed in 2005, by the merger of Charlotte Orthopedic Specialists and Miller Orthopaedic Clinic,
OrthoCarolina is one of the nation’s most comprehensive orthopedic practices. With a staff of more
than 120 physicians and 1,200 employees, OrthoCarolina provides advanced specialty care and general
orthopedics, supported by physical medicine and rehabilitation, physical therapy, advanced imaging and
orthopedic urgent care centers. OrthoCarolina has 33 locations throughout the region, and serves patients
from throughout the Southeast and across the country. In 2013 the group had more than 1,000,000
combined patient encounters.
For more than 80 years, the predecessor groups of OrthoCarolina provided the highest quality orthopedic
care to patients in the Charlotte, North Carolina region. In the 1920s, Dr. John Stuart Gaul, grandfather
to our current Dr. Gaul III, pioneered an orthopedic practice in Charlotte rehabilitating wounded soldiers
from WWI while earning a General Washington Offices Award of Merit for his dedication. At the same
time Dr. Oscar Lee Miller, a future president of the American Academy of Orthopedic Surgeons, was also
starting a practice to serve the North Carolina Orthopedic Hospital for the treatment of crippled children
that would grow to become the Miller Orthopedic Clinic.
During the 1940s, prior to the development of the polio vaccine, Drs. Miller and Gaul worked to
manage and treat the effects of polio throughout North Carolina — and share the knowledge and
techniques with others, locally and internationally.
Both practices continued to grow through the 1950s, and in 1955, a third orthopedic group, the Charlotte
Orthopedic Clinic was established. The 1970s brought the start of a residency training program at
Charlotte Memorial (now Carolinas Medical Center), as well as the first surgeries at the Orthopedic
Hospital of Charlotte, now Novant Charlotte Orthopedic Hospital. The 1980s and 1990s brought new
offices to support growing networks of community hospitals, the creation of numerous fellowship training
programs to supplement the residency program, and the merger of Gaul Orthopedic, Nalle Orthopedic,
Lake Norman Orthopedic and Charlotte Orthopedic Clinics into Charlotte Orthopedic Specialists. At the
same time, affiliated research institutes were growing and Miller Orthopedic Clinic was adding practices
in Shelby and Monroe as well as affiliating with multiple other regional providers.
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ABOUT ORTHOCAROLINA
2005 brought the merger of Miller Orthopedic Clinic with Charlotte Orthopedic Specialists into
OrthoCarolina, a move that aligned both strategically around a mission of excellence and created one of the
most comprehensive musculoskeletal care practices in the country. The merger has facilitated the:
»»Expansion of our advanced specialty care into more communities,
»»Growth of the orthopedic residency program as well as fellowships in Sports Medicine, Spine, Foot and
Ankle, Hip and Knee Replacement, Hand and Physiatry,
»»Substantial growth of orthopedic research through the OrthoCarolina Research Institute,
»»Adoption of sophisticated technology for medical records, quality reporting and business intelligence,
»»Opening of multiple Orthopedic Urgent Care Centers to provide weekend and evening access,
»»Growth of imaging, therapy, fluoroscopic injections, post-surgical and DME service lines, and
»»Expansion into communities throughout western North Carolina from Boone to Laurinburg, and, coming
in 2014, northeast to Winston-Salem.
In 2013 OrthoCarolina partnered with the Cleveland Clinic, the Rothman Institute in Philadelphia, and
the CORE Institute in Phoenix to found the National Orthopedic and Spine Alliance – a partnership whose
mission is to create a national consensus on the highest quality care of musculoskeletal conditions at an
affordable price.
Since our founding, we have been devoted to our patients, our community and our profession. We continue
to generate unprecedented growth through new locations, additional service lines and new providers
joining the group, giving patients greater access to care and OrthoCarolina greater resources to continue
improving our patients’ outcomes and experience of care. We are extremely proud of our heritage and our
vision for the future, and we look forward to you being part of the legacy of OrthoCarolina.
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PHYSICIAN ASSISTANTS
Dear Patient:
Physician Assistants (PAs) are licensed healthcare professionals who practice medicine as part of a team
with a physician. As part of their comprehensive responsibilities, PAs conduct physical exams, diagnose
and treat illness, order and interpret tests, assist in surgery and write prescriptions. Within the physicianPA relationship, physician assistants exercise autonomy in medical decision making and provide a
broad range of diagnostic and therapeutic services. A PA’s practice may also include education, research
and administrative services. OrthoCarolina employs many Physician Assistants and would like you to
understand their role and the value they bring to our practice.
The relationship between our physicians and physician assistants is one of mutual trust and respect.
The physician assistant is a representative of the physician, treating the patients in the style and manner
developed in partnership with the supervising physician. Our physician assistants are board certified,
licensed by the state of North Carolina, are medical staff members at all local hospitals and receive
specialty orthopedic training by our physicians. Many have worked and trained extensively in the field of
orthopedics.
If you would like more information regarding the physician assistant profession and/or physician assistant
utilization, please let a member of our staff know.
Sincerely,
Timothy A. Pysell, DrHA, MMSc., PA-C
Director of Physician Assistants
OrthoCarolina
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APPOINTMENTS
APPOINTMENTS FOR SURGERY PATIENTS
1. Medical Clearance Appointment (if needed): on _______________________ time ______________
with ________________________ location ___________________________________________
2. Pre-Operative Anesthesia Appointment (In-Person or Phone): date __________ time ______________
If in-person, please enter the main entrance of the hospital or surgery center and check in at the desk.
This is a mandatory appointment; your surgery may be postponed if you miss this appointment
3. Pre-operative Appointment at OrthoCarolina (if needed): with_______________________________
on_____________________time_________ location___________________________________
4. Surgery: Your surgery has been scheduled on ________________ at ________________________
_______________________________________________________________________________
_______________________________________________________________________________
Please make arrangements to bring your caregiver coach with you. They will need to assist you
following surgery as noted in this handbook.
Surgery will be cancelled if you do NOT have a caregiver coach!
The hospital or surgery center will let you know your surgery arrival time at your Pre-Operative
Anesthesia appointment
Do not eat or drink anything after midnight the night before surgery. Take only the medications
the Anesthesiologist told you to take the night before surgery or the morning of surgery.
5. Post-operative Physical Therapy Appointments at OrthoCarolina:
Dates _____________________________________________ time ________________________
location _______________________________________________________________________
6. Post-operative Appointment at OrthoCarolina:
with _________________________________________________________________________
Date ______________ Time ___________ location _______________________________________
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KEY POINTS TO REMEMBER:
»»Arrive 15 minutes early for each appointment so you have ample time to check in and to relax a few
minutes.
»»Bring this book with you.
»»Write down questions that you want to ask your surgeon or other caregivers so you don’t forget.
»»Bring your OC Coordinated Care Insurance card with you.
»»Do not give your private insurance card, such as BCBS, United, Aetna, to anyone as your OC Insurance Card
is all you need.
»»Bring your Care Coach to as many appointments as possible so they are informed. Have them jot down
notes and questions below in this book if needed.
Journal Entries and Questions to Ask for Appointments and Scheduling:
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PERSONAL ITEMS
PERSONAL ITEMS TO BRING FOR YOUR HOSPITAL STAY,
AND WHAT NOT TO BRING:
Remember that your preparation for surgery begins in the Pre-op area of the hospital, not in your hospital
room. Below are some suggestions of things that you will want to consider bringing and other items that will
be better left at home so that they do not get lost during your stay.
Personal items that you bring will need to be left with your Care Coach or in the car until you are taken to
your hospital room following surgery.
WHAT TO BRING TO USE DURING YOUR PREPARATION FOR SURGERY: Glasses, dentures, hearing aids that you will need during your preparation while you review your medical
history and sign consent forms.
If you use a CPAP machine for sleep apnea bring that with you.
WHAT TO BRING, HOWEVER LEAVE WITH YOUR CARE COACH OR IN THE CAR
UNTIL AFTER SURGERY:
»»Change of clothes/underwear, in a small bag or suitcase
»»Personal toiletries
»»Cell phone
»»Special pillow
»»Walker (you won’t need this until you are discharged from the hospital)
WHAT NOT TO BRING, BEST LEFT AT HOME:
»»Jewelry
»»Valuables »»Wallet
»»Extra glasses/hearing aids/dentures
»»Large suitcases
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SURGERY PATIENT EDUCATION CLASS
You and your care coach will attend an education session regarding your upcoming total joint replacement
surgery. Your OrthoCarolina Patient Navigator will work with you and your care coach to ensure this class is
scheduled for you.
The class will be taught by a Registered Nurse (RN), Physical Therapist, and may include a Pain Specialist. The
RN will talk to you about what to expect after your surgery, pain management, possible surgical complications
and how to prevent them. Other topics presented may include your care givers team and what to expect after
surgery. For example, such things as getting your home ready so that when you come home after surgery you
will be in a safe environment.
The Physical Therapist will demonstrate exercises to be practiced before surgery and some exercise you will
be doing during your hospitalization. The Physical Therapist will also discuss the daily progress that you can
expect, when you will be able to get out of bed and when you will begin walking. Before you are discharged
from the hospital your care givers will talk with you about exercise and activity and any restrictions that will
apply to you as an individual.
In addition your OrthoCarolina Patient Navigator will identify educational videos that you will want to watch
with your care coach. The videos are located on the OrthoCarolina website/portal. You can access the videos
any time that is convenient for you by following these easy steps:
»»Go to the OrthoCarolina Web Site: www.orthocarolina.com
»»Click on Patient Education
»»Select the area of the body
»»View the online videos in our orthopedics library
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PAIN MANAGEMENT
»»To help your nurses assess your pain level they will ask you to rate your pain on the scale below. The nurses
will also assess your sedation level (how sleepy are you), and watch your vital signs.
»»At the first sign of pain ask for pain medication.
»»If you are worried about taking your pain medication, talk with your nurses about it.
»»Be sure to talk with your doctor at your post op visit about different ways to manage your pain. Your care
coach can play a role with some of the following distractions that may be helpful:
»»Watch TV, play computer games, read, listen to a book tape, rest, ice therapy, compression and elevation.
PAIN ASSESSMENT SCALE
The Wong-Baker Faces Pain Rating scale is the standard pain scale used at hospitals and surgery centers and
is a 0-10 scale. A score of 0 means “no pain” and a score of 10 means “worst pain”. We need your help and
involvement to manage your pain in the right way.
Very happy,
No hurt
Hurts just a
little bit
Hurts alittle
more
Hurts even
more
Hurts a whole Hurts as much
lot
as you can
imagine
(dont have to be
crying to feel
this much pain)
Nada de Dolor
Poquito Dolor
Poquito Mas
de Dolor
Mas Dolor
Dolor
Mucho Dolor
Peor
Dolor
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Journal Entries and Questions to Ask about Pain Management:
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SMOKING & NICOTINE USE CESSATION
SMOKING, by John K. Ellington, M.D.
If you smoke, or use any nicotine products, we strongly encourage you to stop three weeks before your Total
Joint surgery. Examples of products that contain nicotine are: cigarettes, chewing tobacco, snuff, cigars,
nicorette gum, pipes, pot. Stopping these will decrease the chances of lung problems and speed up your
recovery and healing. The entire hospital campus and all health facilities are Tobacco Free, which means
tobacco use of any kind is prohibited indoors or outdoors.
FACTS:
»»Tobacco is the single most avoidable cause of premature death worldwide.
»»There are more than 50 million smokers in this country, and approximately 800 billion cigarettes are
smoked each year. Over 500,000 deaths per year in the United States alone can be attributed to smoking.
1 in 5 deaths are due to smoking! Smoking cigarettes kills more Americans than alcohol, car accidents,
suicide, AIDS, homicide, and illegal drugs combined. Smokers lost an average of 14 years of life because of
smoking. Smoking causes over 20 different medical problems/illness/disease/cancers.
»»Smoking is responsible for almost 9 out of 10 lung cancer deaths. Lung cancer is the leading cause of cancer
death in both men and women and it is one of the hardest cancers to treat. Smoking is a major cause of
heart disease, aneurysms, bronchitis, emphysema, and stroke.
»»More than 4,000 different chemicals have been found in tobacco and tobacco smoke, Among these are
more than 60 chemicals that are known to cause cancer.
ORTHOPAEDICS:
»»Studies show that smokers have a significantly longer time to heal fractures or fusions than non-smokers.
Smokers have a higher chance of fracture or fusion never to heal. Smokers have a higher chance of wound/
skin healing problems and higher chance of infection after surgery.
»»Smoking increases the risk of osteoporosis.
»»Smoking can cause or worsen poor blood flow in the arms and legs (peripheral vascular disease or PVD).
Surgery to improve the blood flow often doesn’t work in people who keep smoking. Because of this, many
surgeons who work on blood vessels (vascular surgeons) will not perform certain surgeries on patients
with PVD unless they stop smoking. Also, many orthopaedic surgeons will not perform certain surgeries
on patients with PVD.
»»120,000 amputations are performed each year due to PVD. (see pg. 74 references)
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Journal Entries and Questions to Ask about nicotine:
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PATIENTS WITH DIABETES
INSTRUCTIONS FOR PATIENTS WITH DIABETES
To maintain a normal blood glucose level:
»»Follow your prescribed diet
»»Test your blood sugars at least twice daily or as directed by your Diabetes Care Provider
Contact your Diabetes Care Provider if:
»»Blood sugars are consistently elevated (greater than 180)
»»You have not had a A1C blood test in the last 3 months
ADJUSTING YOUR DIABETIC MEDICATIONS FOR SURGERY
(Unless your Diabetes Care Provider directed you differently)
Medications
Oral Diabetes Medications (pills)
Night-Time Dose
(Night Before Surgery)
Yes
Morning Dose
(Day of Surgery)
No
*Lantus Insulin
Yes
½ Dose*
Regular Insulin
Humalog or Novalog
70/30 Insulin *NPH Insulin
Yes
No
Yes
No
Byetta
Yes
½ Dose*
Symlin
Yes
No
Insulin Pump
»»Continue your usual basal rates or adjust them
according to your Diabetes Care Provider’s instructions
»»Inform the hospital staff that you are wearing an
insulin pump when you arrive
* Type 2 Diabetic Patients:
If your blood sugar is less than 80 on the morning of surgery, do not take your insulin.
Journal entries and questions regarding your diabetes:
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ANESTHESIA
ANESTHESIA
Orthopedic or spine surgery requires that either spinal nerve block or general anesthesia be administered
before surgery. A very small number of patients have problems with anesthesia. These problems can
be reactions to the drugs used, problems related to other medical complications, and/or problems due
to the anesthesia. You will meet your anesthesiologist prior to surgery in the pre-op holding area. The
anesthesiologist will review your history and discuss options for anesthesia.
WHAT IS GENERAL ANESTHESIA?
General anesthesia is a type of anesthesia where you are put in a deep sleep by means of various medications.
Certain anesthetics prohibit you from breathing adequately, so the anesthesiologist must assist your breathing
during the course of surgery. This is done by placing a small breathing tube (endotracheal tube) into your
windpipe (trachea) after you are put to sleep. Minor side effects from general anesthesia and surgery are
common. These include nausea, sore throat, headache or a generalized “hang-over” type feeling.
WHAT IS SPINAL ANESTHESIA?
Spinal anesthesia is a type of “local” anesthesia that is administered through a catheter placed in the lower
back (lumbar region). A local anesthetic is injected in the skin to numb the area before the spinal catheter will
be placed. Once the catheter is placed, medications, including a local anesthetic and sometimes a narcotic, are
given through the catheter. It is then removed. The entire process usually takes five to twenty minutes. You
will be sedated by intravenous medications during the surgery and before your spinal procedure. Minor side
effects can occur from the narcotics including: itching, nausea, vomiting and/or decreased respiratory rate.
WHAT IS NERVE BLOCK ANESTHESIA?
A nerve block is the injection of numbing medication (local anesthetic) near specific nerves to decrease pain
in a certain part of your body during and after surgery. Your anesthesiologist may place a nerve catheter,
which may be used to continuously bathe the nerves in numbing medication for 2-3 days after surgery. A
nerve block is not for everyone and your anesthesiologist will evaluate whether it is the right option for you.
Journal entries and questions about anesthesia:
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HAND HYGIENE
HAND-WASHING PROTOCOL:
»»Beginning and End of the work day.
»»Before & After using gloves.
»»Before & After eating, drinking, smoking, handling medications or cosmetics.
»»Before & After using the toilet.
»»After wiping the nose or touching the face.
»»After touching contaminated surfaces & after exposure to blood/body fluids.
»»Between patients.
Wet
Soap
Wash
Rinse
Dry
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NUTRITION
Good nutrition will help get your body ready for surgery. In addition a nutritious diet will enhance healing
after surgery, help avoid constipation, and prevent infections.
Prior to surgery cook your meals ahead of time and place them in single serving containers. You can label the
contents so that they are easy to find, and perhaps freeze them. This will make it easy for you and your care
coach to prepare nutritious meals quickly. Stock fluids and keep them in easy reach. Bottled water, vitamin
drinks, clear broth, fresh juices are all good options. Remember ginger ale is also a good option as it helps
with nausea. It is important to drink the recommended six, 8oz glasses of water each day.
Try to avoid processed foods. Instead try choosing:
»»Oranges instead of orange juice
»»Baked potato instead of french fries
Foods that are rich in fiber will help prevent constipation, for example
»»Whole grain bread, toasted or not
»»Fresh fruit
»»Fresh or frozen vegetables
»»Cereal, good choices would be cream of wheat or oatmeal
Foods, such as lean protein also enhance the body’s ability to heal faster. Prepare foods by grilling, roasting, or
baking. Some examples of lean protein are:
»»Turkey or Chicken
»»Pork
»»Nuts, tofu, beans
Low-fat dairy is ok in moderation (can cause constipation)
Soymilk decreases the risk of infection
Eggs
Foods high in saturated fat can also contribute to constipation, avoid red meat.
It is important not to skip meals, even if you do not have an appetite or feel hungry.
Add protein powders in smoothies, or supplement such as Ensure or Boost between meals.
Foods that have a higher calorie content per bite compared to others are good choices, such as:
»»Yogurt instead of green beans
»»Peanut butter or almond butter, instead of margarine on toast
»»Cook with oil instead of cooking spray
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HOSPITAL NUTRITION
You will be able to have ice chips and small sips of water immediately following surgery. Once you can
tolerate clear liquids without vomiting or becoming nauseated you will be able to eat solid food.
Your nutritional plan will be determined by your physician with your input, based on your medical history. A
dietitian may visit you to find out what you like to eat. Menus will be available for you to select the foods you
like within your nutritional plan. Outside food can be brought in for the most part, however, make sure it is
approved by your surgeon. You may need a special diet, for example low fat or low salt, or just clear liquids
for awhile. A cheeseburger may sound good but it may not be what is best for you at the moment.
A large container with ice and water will be available on your bedside table. Your care coach will help make
sure this is within your reach.
PREVENTING CONSTIPATION
Prior to surgery, during your hospitalization and post-operatively, you will be prone to constipation. The
first way to prevent constipation is to eat a high fiber diet and drink at least six, 8 oz. glasses of water each
day. Walking is an important part of your recovery and will also help you avoid constipation. During
hospitalization, you will be given stool softeners daily. Again, it is important to continue your fluid intake to
help the stool softeners work effectively. We also advise that you continue to take stool softeners following
your discharge (you can buy these over the counter) until you are weaned off the narcotics.
NUTRITION AFTER HOSPITALIZATION
After you leave the hospital, your diet will continue to be one of the most important factors in the healing
process. Three balanced meals with healthy snacks will enhance tissue regeneration.
Journal entries and questions about nutrition:
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MEDICAL HISTORY
MEDICAL INFORMATION SHEET
Name Date of Birth
Allergies (Food or drug and the reactions they cause): For example, shellfish, corn, aspirin, latex, betadine,
soaps, etc.
Medical Conditions:
Past Surgeries: (everything counts, such as tonsillectomies, etc.)
Physicians seen on a regular basis:
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MEDICATIONS
You are to continue to take your medications as they have been prescribed.
It is important that you are honest and identify all drugs that you are taking. List all medications that you are
taking, including but not limited to, diet pills, over the counter medications such as baby aspirin, multi-dose
vitamins, Pepcid, herbal supplements, and minerals. This is important so that any interaction with other drugs
during your surgery can be avoided.
Name of Medications
Dose
Taken how often?
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What else do you want your care givers to know about you:
Phobias, such as needles, hospitals, white coat syndrome, sight of blood, etc.
Does your Care Coach know that you have selected have any phobias?
Journal entries and questions about Medications:
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BEFORE SURGERY
To prepare for surgery we have created this check list for you, so that you do not forget anything.
Please review each item and check it off as it is completed.
_____ Bring this book with you to all appointments and to surgery, so that you can record
instructions and take notes
_____ If you need a handicap parking placard please check with your state’s Department of Motor
Vehicles to secure the application. Complete your part of the application and bring it with you so
that doctor can complete and sign it. You will then return it to your state’s DMV along with the
appropriate payment to secure your parking placard.
_____ The night before surgery your meal should be light; you don’t want to over-due it. Your
body works hard to digest a high fat, high calorie meal and this can contribute to nausea after
surgery.
_____ Your lab work must be current, that is within 30 days of your surgery. You may be
contacted by your doctor with your CBC results and given instructions on how to take your
medications.
Bring the following with you on the day of surgery:
_____ Copy of your OrthoCarolina Coordinated Care Program Card
_____ List of all medications you are taking and the dose
_____ Your medical history
_____ Copy of Living Will and/or Power of Attorney (if you have one)
_____ Medications to STOP before surgery: Review the list of medications on page 31. Highlight
the medications that you are currently taking and note when you need to stop taking them.
Medications stopped prior to surgery may be taken 48 hours after your last dose of Coumadin.
_____ You are NOT to eat or drink anything after midnight the night before your surgery.
Remember this includes food, candy, gum, mints, or water.
Special Instructions: __________________________________________________________
_____ You have been given a special cleansing solution called Hibiclens. Starting the night before
surgery you need to shower using this solution. See more information on page 40.
_____ You may only take the medications on the morning before surgery that the Anesthesiologist
tells you to take. You should take them with just enough water to swallow them.
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List those medications here:
_____ It is suggested that you bring your walker, or one that has been provided for you, to the
hospital the morning of surgery. Please leave it in your car until after surgery. Your care coach can
bring it to you after you are settled in your room following surgery.
_____ The post-op instructions are important.
_____ For any questions or concerns remember to contact your Patient Navigator between the
hours of 8:00 AM – 5:00 PM. After hours and on weekends call 704-323-2000. A physician or the
physician’s assistant will be directed to return your call promptly. Remember if you call after hours
to tell the operator that you are a Coordinated Care Program patient.
Journal entries and questions regarding before surgery:
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MRSA
Methicillin-Resistant Staphylococcus Aureus (MRSA) are organisms (bacteria) that are resistant to some
antibiotics. It is possible for an individual to carry MRSA on their skin or in their nose and be free from
symptoms and never get the infection.
A simple nasal swab can determine if you are a carrier of the bacteria. If you have a history of MRSA or have
a positive culture extra precautions will be taken to prevent the bacteria from becoming an infection. The
following precautions may be taken:
»» Bactroban Ointment: You will be given a prescription for Bactroban Ointment that is to be placed in your
nostrils twice a day for five days. You will begin using it three (3) days before surgery and continue to use
it for an additional two (2) days while you are in the hospital.
»» Hibiclens Soap: Starting three (3) days before surgery you will wash from neck to toe with Hibiclens soap
(an antiseptic skin cleanser). This cleanser helps to kill germs and bonds with your skin so that it continues
killing germs after you use it. You will use the Hibiclens soap for an additional two (2) days while you are
hospitalized. Please see the Pre-Op Hibiclens Bathing Instructions sheet.
»» Hand Hygiene: Everyone entering your hospital room (hospital staff, physicians, and visitors) need to wash
their hands or use a hand gel sanitizer. We encourage you to make sure they do this by asking them if they
have washed or used gel on their hands.
Journal entries and questions regarding MRSA and hygiene:
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MEDICATIONS & ANESTHESIA
MEDICATIONS THAT CAN INCREASE BLEEDING OR MAY INTERFERE
WITH ANESTHSIA
Some medications impair the body’s ability to form a clot and stop bleeding. Obviously, failure to normally
form a clot is undesirable around the time of surgery.
ASPIRIN:
Ideally, aspirin should be discontinued a minimum of 7 (preferably 10) days prior to elective surgery. This
advice includes products containing aspirin, like Percodan™.
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS):
Non-selective COX inhibitors (NSAIDs, e.g. ibuprofen, ketoprofen, Advil, Motrin, many others) should
be discontinued a minimum of 5 (preferably 7) days before elective surgery. The selective COX inhibitor,
Celebrex, CAN be continued. If you have a question about your painkiller, ask your surgeon.
VITAMINS, SUPPLEMENTS, HERBALS:
Many herbal medications and supplements may increase bleeding and/or interact with medications used for
anaesthetic. In many cases, the exact composition of herbal supplements and the potential interactions are
unknown. Specific recommendations cannot be given. Therefore, DO NOT TAKE these medications for a
minimum of 7 days prior to elective surgery.
ALCOHOL & RECREATIONAL DRUGS:
Drink less alcohol as alcohol may alter the effect of the anaesthetic drugs. Do not drink alcohol 24 hours
before surgery.
Stop taking recreational drugs before surgery as these may affect the anaesthetic drugs. If you have a drug
addiction please tell your anaesthetist.
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MEDICATIONS PRIOR TO SURGERY
TAKE
DO NOT TAKE (Discontinue 7 Days Prior to Surgery)
»» Cardiac medications (for the heart)
»» Anti-reflux medications (Prilosec, Nexium,
Protonix)
»» Seizure medications (anti-convulsants)
»» Bronchodilators (inhalers and medication for the
lungs)
»» Steroids (prednisone)
»» Immunosuppressants
»» Thyroid replacement (Synthroid)
»» Anti-Parkinson medications
»» COX-2 antagonists (Celebrex)
»» Opiates (without aspirin; Tylenol #3, Norco,
fentanyl, etc.)
»» Chewable antacids (TUMS, Rolaids, etc.)
»» Diuretics (water pills, furosemide, hydrochlorotiazide)
»» Oral hypoglycemics (Glucophage, Avandia, Actos, DiaBeta,
Mecronase, Glucotrol, Amaryl)
»» Birth Control Pills & and male or female hormones
(including creams or patches)**, such as Emcyt, Estraderm,
Estratest, Estrace, Estradiol, Estrogens, Ogen, Premarin,
Prempro, Testosterone
»» Aspirin (and aspirin-containing compounds) such as:
Alka-Seltzer, BC Powder, Bufferin, Disalsid (Salsalate),
Dolobid (Diflunisal), Ecotrin or Uncoated Aspirin* (81mg325mg), Excedrin, Fasprin (81mg), Goody Powder,
Norgesic, Pepto Bismol, Percodan
»» Antniplatelets such as: Aggrenox (aspirin + dipyridamole),
Plavix* (dopidogrel), Pletal (cilostazol), Trental (pentoxil)
»» Antithrombotics such as: Ticlid
»» Anticoagulants, such as: Coumadin (discuss the use of
Lovenox with your surgeon—you will receive special
instructions and a prescription if you are placed on this
medication)
»» Non-steroidal Anti-inflammatory Drugs (Ibuprofen, Motrin,
Advil, Mobic, Orudis, etc.)
»» Weight reduction agents
»» Vitamins such as: A, C, E, K, Multivitamins, Fish Oil, /
Omega 3,6,9, Juice Plus, CoQ10
»» Herbs such as: Echinacea, Ephedra, Garlic, Ginkgo, Ginseng,
Kava, St. John’s Wort, Valerian, Saw Palmetto
»» Supplements such as: Glucosamine Chondroitin, MSM
»» Stop all non-steroidal anti-inflammatory (NSAID)
medications, such as: Advil (ibuprophen), Aleve (naproxen),
Anaprox (naproxen), Ansaid (flurbiprofen), Arthrotec
(voltaren + cytotec), Cataflam (diclofenac potassium),
Clinoril (sulindac), Daypro (oxaprozin), Diclofenac
(voltaren), Feldene (piroxicam), Ibuprofen (motrin),
Indocin (indomethacin), Lodine (etolodac), Meclomen
(meclofenamate), Mediprin (ibuprofen), Mobic (meloxicam),
Naprelan (naproxen), Naproxyn (naproxen), Nuprin
(ibuprofen), Orudus (ketoprofen), Oruvail (ketoprofen),
Relaten (nabumetone), Tolectin (tolmetin)
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*If you have Heart Stents and take Plavix and Aspirin: DO NOT STOP ASPIRIN; DO NOT STOP PLAVIX UNTIL
SEEN BY A CARDIOLOGIST PRIOR TO SURGERY
** You may wish to use another form of birth control at this time.
CONTACT YOUR MEDICAL DOCTOR FOR INSTRUCTIONS if you take any of the following medications:
Adderall, Cytoxan, Enbrel, Imuran, Librax, Librium, Methotrexate, Remicade
Remember: Stop only the types of medications mentioned above—DO NOT STOP taking other prescription
medications.
STOP
7 days before Surgery
Ok to take 7 days
Before Surgery
Date:
STOP
3 days before surgery
Ok to take 3 days
Before Surgery
Date:
Journal entries and questions regarding medications:
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Dr. __________________________would like you to take Acetaminophen (Tylenol) before surgery because
it allows your body to tolerate pain better. Taking it for 24 hours before surgery will help you to feel less pain
after the surgery and decrease the need for IV pain medication after surgery.
You will take two regular strength Acetaminophen (Tylenol) to equal 650 mg, by mouth every 6 hours,
starting the day before your surgery.
ATTENTION: DO NOT TAKE TYLENOL IF:
»»You are taking any medicine that already contains Acetaminophen (Tylenol). Please check with your doctor
or pharmacy if you are not sure.
»»Please let your surgeon know if you have ever been advised not to take Acetaminophen in the past
»»You have liver disease.
Date of Surgery:
Date to Start Acetaminophen (Tylenol):
Check off Time Taken
Time of day
11:00 am
5:00 pm
11:00 pm
5am day of surgery
*If your surgery is at 7am, take your 5am dose with a small sip of water
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MEDICATION RECORD SHEETS
Please keep this record until after your 1st Post-Op Visit, unless directed otherwise:
MEDICATIONS:
First, list the medications that you are taking, and when you take them:
Name of medication:
Example: Aspirin
Dose:
2 – 80 mg tablets
Frequency:
Every 6 hours
Week 1: Record the following information when you have taken your medication:
Medication Sunday
Date/Time
Ex: Aspirin
Monday
Tuesday
Wednesday Thursday
Friday
Saturday
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
2/9 8am
2 tabs
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Week 2: Record the following information when you have taken your medication:
Medication Sunday
Date/Time
Ex: Aspirin
Monday
Tuesday
Wednesday Thursday
Friday
Saturday
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
2/9 8am
2 tabs
TRACK THE FOLLOWING ITEMS WELL:
Week 1: Record the following information:
Sunday
Monday
Tuesday
Wednesday Thursday
Friday
Saturday
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
Fluid Intake
2/9 10am
8 oz water
2/9 2pm
1 can ginger
ale, etc
Urine/Bowel 2/9 6 am
Movements Urine light
yellow
2/9 12 pm
b.m.
Temperature 2/9 12 pm
1x/day
99.9
Walking
with
walker/
distance
2/9 12 pm
50 ft
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Week 2: Record the following information:
Sunday
Monday
Tuesday
Wednesday Thursday
Friday
Saturday
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
Fluid Intake
Urine/Bowel
Movements
Temperature
1x/day
Walking
with
walker/
distance
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EXTRA RECORD SHEETS:
Sunday
Monday
Tuesday
Wednesday Thursday
Friday
Saturday
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
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EXTRA RECORD SHEETS:
Sunday
Monday
Tuesday
Wednesday Thursday
Friday
Saturday
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
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EXTRA RECORD SHEETS:
Sunday
Monday
Tuesday
Wednesday Thursday
Friday
Saturday
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
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PREPARING YOUR SKIN BEFORE SURGERY
PRE-OP HIBICLENS® BATHING INSTRUCTIONS:
General Information:
»»Because the skin is not sterile, it is important to make sure that your skin is as free of germs as possible
before surgery. You can reduce the number of germs on your skin by carefully washing before surgery.
»»Chlorhexidine gluconate (CHG) is a special soap that is often used to cleanse the skin before surgery. One
common brand is Hibiclens®. If you are allergic to Chlorhexidine use __________________________
for your shower or bath.
Bathing Instructions:
»»Shower or bathe with Hibiclens® the night before your surgery and the morning of your surgery. (A total
of 2 showers or 2 baths with Hibiclens®)
»»Do not shave the area of your body where your surgery will be performed.
»»With each shower or bath, wash your hair as usual with your normal shampoo.
»»Rinse your hair and body thoroughly after you shampoo to remove all shampoo residues.
»»Apply the Hibiclens® soap to your entire body ONLY FROM THE NECK DOWN.
»»Do not use Hibiclens® near your eyes or ears to avoid permanent injury to those areas.
»»Wash thoroughly, paying special attention to the area (as specified by the nurse) where your surgery will
be performed.
»»Turn the water off to prevent rinsing the soap off too soon.
»»Wash your body gently for 5 minutes. Do not scrub your skin too hard.
»»Do not wash with your regular soap after Hibiclens® is used.
»»Turn the water back on and rinse your body thoroughly.
»»Pat yourself dry with a clean, soft towel.
»»Do not use lotion, cream, or powder.
»»Wear clean clothes.
Where to get Hibiclens®:
»»Your Preferred Pharmacy
»»Hospital may provide at your Pre-Op Appointment
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PRE-OP
You have completed the Hibiclens® at home prior to arriving for surgery.
After arriving at your facility for surgery you will be taken to the pre-op area and the nurse will help you
prepare for surgery.
Sage Wipes may be given to you by your nurse.
Do not allow this product to come in contact with your eyes, ears, mouth and mucous membranes.
»»Remove two cloths at a time with the foam holder and place onto a clean table.
»»Use one clean cloth to prep each area of the body in order as shown in steps 1 through 6 below. Wipe each
area in a back-and-forth motion. Be sure to wipe each area thoroughly. Assistance may be required. Use all
cloths in the packages. Pay special attention to the area you will be having surgery on.
1. Wipe your neck and chest.
2. Wipe both arms, starting with the shoulder and ending at the fingertips. Be sure
to thoroughly wipe the armpit areas.
3. Wipe your right and left hip followed by your groin. Be sure to wipe folds in the
abdominal and groin areas.
4. Wipe both legs, starting at the thigh and ending at the toes. Be sure to thoroughly
wipe behind your knees.
5. Wipe your back starting at the base of your neck and ending at your waistline.
Cover as much area as possible. Assistance may be required.
6. Wipe the buttocks.
»»Do not rinse or apply any lotions, moisturizers or makeup after prepping.
»»Discard cloths in trashcan.
»»Allow your skin to air dry.
»»Put your hospital gown on and tie it in the back.
»»You will remove dentures, contact lenses/glasses and jewelry.
Journal entries and questions regarding your skin preparation before surgery:
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PRE-OP AT THE FACILITY WHERE YOU ARE HAVING SURGERY
»»Your vital signs (temperature, pulse, blood pressure) will be taken.
»»An IV will be started to hydrate your body.
»»The nurse will review your medical/surgical history and medications as well as the results of your presurgery testing. Additional testing might be required at this time if ordered by your physician.
»»You will be greeted by the OR staff and transported to the Pre-Op Holding Area. At this time your family/
friends will be escorted to the Surgical Waiting Area. They will be asked to sign in at the reception desk. If
your family and/or friends decide to leave the surgical waiting area, they should tell the receptionist how
they can be reached.
PRE-OP HOLDING AREA
»»The Pre-Op holding area is where you will meet and talk with your surgical team.
»»The nurse in this area will go over your medical history with you and give you any additional instructions.
»»You will meet your Operating Room (OR) nurses.
»»Your surgeon will be there to answer any last minute questions. Then with your assistance, the surgeon
will mark the body part on which they will be operating.
»»An anesthesiologist will speak to you about your anesthesia options.
»»Then to help you relax you will be given medication and then you will be transported into the operating
room.
OPERATING ROOM (OR)
»»You will be prepared for surgery by the anesthesiologist and OR nurses.
»»It is not unusual for surgery to be delayed or changed due to emergencies or cancellations. You and your
family will be updated by the hospital staff when these changes occur.
Journal entries and questions regarding the Pre-Op preparations:
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POST ANESTHESIA CARE UNIT (PACU)
After surgery you will be moved from the Operating Room directly to a special recovery room, called the Post
Anesthesia Care Unit (PACU).
»»The PACU staff will continue to monitor you as you gradually wake up. You will remain in this area until
your vital signs are stable. Usually about 2 hours.
»»When you wake up you will have a blood pressure cuff on your arm, oxygen tube in your nose, and a pulse
oximeter (used to detect your oxygen level) on your finger.
»»If needed you will receive pain medication and/or medicine for nausea.
»»If you have had a hip replacement an x-ray will be taken of your new joint.
»»Your surgeon will speak with your family/friends in the surgical waiting area after the surgery is complete.
»»Your family and friends will be notified, usually by the receptionist in the waiting area, when you have
been transferred to your hospital room. Remind your friends/family that you will need to rest on the day
of surgery.
Journal entries and questions about the PACU stay:
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AFTER SURGERY
MANAGING YOUR DISCOMFORT
Managing your pain is important to your recovery. Our goal is to manage your pain so that you are able to
rest comfortably, move easier when it is time to get in and out of bed, and to participate in physical therapy.
To keep you as comfortable as possible our healthcare team will work closely with you. In order for your pain
to be treated effectively, it is important for you to:
»»Be sure to tell the nurse completing your medical history about what medications have or have not worked
for you in the past.
»»Remember it is ok to have some pain. We want to work with you to determine what level of pain is
acceptable for you.
»»Asking your nurse for pain medication on a timely basis is important for your comfort. Ask for medication
when you begin to feel discomfort. You will be asked on a scale from 1-10 to rate your pain. If you wait
until you are at an 8 rating, it is difficult to relieve your pain quickly. Asking for medication at a 4-5 rating
will bring you comfort sooner. Our goal is to keep you comfortable!
»»As you work with your doctor and nurses let them know if the pain relief measures are adequate.
»»If you are nauseated, tell your nurse. This is a common side-effect that can be treated with medication.
For additional pain relief, cold therapy is often applied. An ice pack, cold therapy units are examples of what
may be used. These will help to reduce swelling and relieve pain. Once the bulky dressing is removed from
the operative site, ice may be applied for 20-30 minutes at a time to relieve pain.
You can make your own Ice Pack by following these directions:
1 part rubbing alcohol (70% isoprophyl alcohol)
3 parts tap water
Mix together in a zipper lock baggie, then double bag it.
To make it more slushy, add alcohol. To make it more firm add water.
Be sure to put a towel next to your skin. Never apply the ice pack directly to the skin
With pain controlled and you are fairly comfortable you will be better able to participate in your own
recovery.
Journal entries and questions regarding Managing your discomfort after surgery:
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PREVENTING COMPLICATIONS
Complications can occur following any surgery. Below are some of the most common complications that can
occur. Every precaution is taken to prevent these from happening, however they can occur.
BLOOD CLOTS (THROMBOPHLEBITIS)
Your decreased movement following surgery and normal swelling put you at risk for developing a blood clot
formation in your legs.
Your surgeon may prescribe medication to prevent blood clots. Some of the most common used medications
for this are: Coumadin, Lovenox, and Xarelto. You need to follow your surgeon’s instructions carefully. In
addition lab work will be done if necessary to monitor your blood clotting levels.
Deep Vein Thrombosis (DVT) is a blood clot that forms in a vein deep in the body. Blood clots occur when
blood thickens and clumps together. Most deep vein clots occur in the lower leg or thigh. A blood clot in a
deep vein can break off and travel through the bloodstream to the lungs, heart, or the brain.
Signs and Symptoms to be aware of:
»»Increased pain in your calf, ankle and/or foot
»»Swelling or tightness of the calf, ankle, and/or foot
»»Tenderness or redness above or below your knee
»»Erythema or discoloration of the skin
»»Tissue warm and firm to touch
»»When you pull your toe toward your shin this causes discomfort in the upper calf
***If you experience any of these symptoms you need to let your surgeon know immediately. If you are from
out of state notify your Primary Care Provider immediately.
PULMONARY EMBOLUS
A pulmonary embolus is when a blood clot breaks away from the vein and travels to the lungs. This is an
emergency and you need to call 911.
Signs of a Pulmonary Embolus
»»Sudden chest pain or coughing
»»Sudden difficult and/or rapid breathing
»»Shortness of breath
»»Sweating
»»Confusion
Prevention of Pulmonary Embolus
»»Prevent blood clots in the legs
»»Recognize a blood clot in the leg and call your physician immediately
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We will work with you to prevent this from happening:
»»Anticoagulant therapy: You will be receiving Aspirin by mouth to thin your blood starting the day of
surgery.
»»You will have special wraps placed on your feet or legs. The wraps are attached to a compression device
and help circulate blood in your legs. They should be worn at all times while you are in bed. If they are
removed for care or therapy and not reapplied, your care coach should push the call button for assistance
to get it reapplied.
»»Leg Exercises: You will be asked to do simple exercises soon after surgery. To help prevent circulation
problems, these exercises, such as ankle pumps, quad sets and gluteal sets, will be very helpful. The staff
will initially help you with these exercises. Then we encourage you to do each exercise 10 times each
waking hour.
»»Getting you moving: We will get you up and moving as soon as possible after your surgery. You will be
encouraged to dangle your legs and/or stand up on the evening of surgery.
»»Meal times: It is best to sit up in the chair while eating your meals. This will assist in digestion and early
movement.
INFECTION
Infection following a joint replacement surgery can be very serious. Infection can spread into the artificial
joint from another infected area of your body, for example: the bacteria enters the blood stream during dental
procedures, urinary tract or skin infections. Even though this occurs less than one percent of the time, the
bacteria can move into the new joint replacement area and cause an infection.
Warning Signs of a possible infection are:
»»Persistent fever (higher than 100.5) degrees orally
»»Shaking chills
»»Increasing redness, tenderness or swelling of the surgical joint
»»Drainage from the surgical incision (note if there is an odor), may be cloudy
»»Increasing pain with both activity and at rest
If you develop any of these symptoms you should notify your surgeon immediately. If you are from out of
state you should notify your Primary Care Provider (PCP).
Journal entry and questions about DVT’s, infection or pulmonary embolus:
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PREVENTING INFECTION
Preventing is our priority and you need to do your part.
Tell your surgeon about any medical problems/conditions you have. Allergies, diabetes or obesity may affect
your surgery and treatment.
»»Hand Hygiene: Every patient’s room has a wall mounted hand gel sanitizer. Please ask everyone who enters
your room, family, friends, and hospital staff to use it.
»»Antibiotics: Prophylactic antibiotics are administered before you have surgery and are continued for 24
hours.
»»You should eat a healthy diet and drink lots of fluids
»»Take your temperature every day at least once until you have your post-op appointment.
»»Quit smoking.
»»Do not shave the surgery site. This may irritate the skin, thus making it easier to to develop an infection.
»»Be sure to keep your bed linens clean and changed every few days or more often if needed
»»Keep your pets away from your incision
What is your Surgical Team doing to Prevent Infection:
»»Before and after caring for each patient providers clean their hands
»»Your surgical team members will wear hair covers, masks, gowns, foot covers and gloves during surgery
»»They will administer antibiotics about 60 minutes before the surgery starts.
»»They will clean the skin at the site of surgery with special germ killing soap
DENTAL PROPHYLAXIS FOR TOTAL JOINT REPLACEMENT PATIENTS
We recommend that any dental work that needs to be performed, be performed prior to your surgery.
Depending on your dental health, we may schedule you to see your dentist prior to surgery to reduce the
chance of infection with your new total joint replacement.
Following joint replacement surgery, we recommend that you wait at least 3 months before you have any
dental work – this includes cleaning. However, should you have an immediate problem, such as an infection,
or broken, painful tooth, then you should see your dentist or oral surgeon immediately.
Following total joint replacement, we recommend that you always take an antibiotic 1 hour prior to any
dental procedure (includes cleaning). We recommend that you follow this for a lifetime. It is our goal to
prevent an infection in your total joint replacement.
Check with your doctor for your antibiotic prescription before your dental appointment.
Journal entries and questions regarding complications or Infection/Preventing Infection:
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PNEUMONIA
Before you go to surgery the nursing staff will provide you with an incentive spirometer and will teach
you how to use it. An incentive spirometer is a plastic device that will assist you in taking deep breaths. It
is important that you expand the air sacs in your lungs and clear air passages following surgery. This helps
prevent post operative fever and pneumonia.
Hold the incentive spirometer in an upright position, exhale normally. Then place your lips tightly around the
mouthpiece, take a deep breath (as if you are drinking a thick milkshake), remove the mouthpiece from your
lips and exhale normally. We encourage you to use your incentive spirometer every hour when you are awake,
repeating it 10 times consecutively . Be sure and breathe normally a couple of times between the deep breaths.
BOWEL FUNCTION
Your normal bowel activity may be slow to return to after surgery. Anesthesia and/or pain medication
contribute to this. Your first meal after surgery will be clear liquids (juice, broth, jello). This will help prevent
abdominal bloating. Drinking plenty of fluids is also important in helping to prevent constipation. You may
be given a daily stool softener to help prevent constipation. A laxative can be ordered prior to discharge if
you require it. If you have not had a bowel movement, be sure to let your nurse know and she will help you
determine if a laxative is appropriate. We encourage you to have fiber and bulk in your diet when you are
ready to eat solid food. Such things as cereal, fresh fruits, and vegetables are good selections.
REHABILITATION
As part of your post-op care you will start participating in Physical and Occupational therapy before leaving
the hospital and will continue physical therapy at home or in an outpatient facility. The speed and success
of your recovery depends a great deal on your motivation and participation in your therapy program. You
are the driving force toward a successful recovery. As your therapy progresses, you will experience less pain
and stiffness. We encourage your participation in exercise as it is an important part of your recovery. Our
rehabilitation team will work with you to improve your functional abilities.
»»Physical Therapist: will help you with appropriate exercises. They will help you use equipment properly,
work with you on transferring, walking, and stair climbing,
»»Occupational Therapist: will teach you to do tub/car transfers, self care activities and how to use adaptive
equipment like sock aids and reachers, for example.
Do not bring your walker with you to the hospital until it is time to be discharged. Every patient will have a
loaner walker and wheelchair to use while you are in the hospital.
Have your Care Coach bring your walker before you are discharged so that the therapist can assist you in
making sure it is adjusted correctly for you.
Remember the speed and success of your recovery depends a great deal on your motivation and participation
in your therapy program. You are the driving force toward a successful recovery. As your therapy progresses,
you will experience less pain and stiffness. We encourage your participation in exercise as it is an important
part of your recorery.
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The goals for your therapy are:
»»Straighten your knee completely (knee replacement only);
»»Bend your knee to 90 degrees or greater (knee replacement only);
»»Safely get in and out of bed
»»Your therapist and/or physician will help determine your need for a walker, crutches, or a cane. They will
help you use the proper equipment safely
»»Occupational Therapists will teach you how to dress yourself with minimal assistance.
Things to remember at discharge:
»»Everyone will need a walker after discharge and most people benefit from a 3 in 1 commode. OrthoCarolina’s
post surgical team will help you with these arrangements.
»»There are occasions when you are not able to go directly home. OrthoCarolina will work with you and the
insurance company to determine which facility will suit your needs. You will stay at the facility until it is
determined that you are safe to return home.
»»Your progress and readiness for discharge will be assessed daily. The case manager and/or social worker
will discuss the discharge plan with you and your family.
»»On the day of discharge, the nurse will review the discharge instructions. You should already have your
follow up appointment with the surgeon’s office. If you have any questions after discharge, please contact
your Patient Navigator.
»»You will receive a follow-up phone call from your Patient Navigator to check up on you after discharge.
(Holidays and weekends may cause this to vary slightly.)
»»It will be important that you continue the following things after you are discharged and return home:
Your Physical Therapy
Pain Management
Cough/deep breathing Walking INCISION CARE
»»Check your incision daily for increasing redness, pain, warmth, and/or drainage. These are signs of possible
infection.
»»Approximately 2 weeks after surgery, if you have staples, they will be removed.
»»It is normal to feel some numbness in the skin around your incision.
»»Your incision should be kept dry until your surgeon tells you otherwise.
»»Until your wound is thoroughly healed and no longer draining, avoid soaking it in water.
INSTRUCTIONS FOR CHANGING YOUR BANDAGE:
»»Your outpatient Physical Therapist will change your bandage. You and your Care Coach will be instructed
on how to change the bandage as well. Remember to bring your supplies with you to outpatient Physical
Therapy.
»»It is important that you wash your hands thoroughly with soap and water or use an alcohol based hand
sanitizer before and after your bandage change.
»»Do not remove steri-strips or surgical glue that may be helping to hold your incision together. Over time
they will come off by themselves as expected.
»»Your first bandage change will be the day after surgery. Then, unless instructed otherwise, it should be
changed every other day for the next 11 days.
»»To change your bandage you will need:
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»»For the first 3 bandage changes you will use Telfa AMD Antimicrobial Island bandage (white paper package
with purple writing). You will notice the bandage is made with a cloth like tape.
»»The last 3 bandage changes will be done with a clear Tegaderm bandage (this package has green writing
on it).
»»Aquacell dressing – do not remove for 7 days. You will be able to shower. If Aquacell has to be removed,
physician direction is needed. Starter package to be given.
DRIVING AFTER SURGERY
The ability for someone to resume driving after surgery is seldom a medical question, but more often a
legal question. It is the responsibility of all licensed drivers to drive safely at all times no matter what their
permanent or temporary impairment may be.
Keep in mind, following surgery, one’s reaction time may be severely compromised, secondary to medication
and/or pain. The ability to use all four extremities fully may also be impaired secondary to the surgery.
Again, it is the responsibility of each individual to drive safely no matter what his or her impairment may be.
With knee or shoulder surgery, the mechanics of driving seldom will cause harm to the operative site.
Realistically, most people are able to resume driving an automatic at approximately one week and a straight
drive at approximately two weeks. Keep in mind this varies based on each individual’s driving capabilities.
The responsibility of safe driving is that of the individual regardless of their medical condition.
WHAT YOU CAN EXPECT AFTER SURGERY
If you have met all of the PT and OT goals and all tubes have been removed you will most likely be discharged
from the hospital on the second or third day, if you are medically stable. Occasionally some patients are
discharged the same day! For planning purposes you can expect to be discharged about 11:00 am.
Journal entries and questions regarding Rehabilitation after surgery:
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LUMBAR SPINAL FUSION SURGERY CLINICAL PATHWAY
DAY OF SURGERY
The following “clinical pathway” has been developed to help outline the usual course of events as you recover
from your lumbar spinal fusion surgery. Depending on your individual needs and progress following your
particular type of surgery, you may meet your goals sooner or later than noted along the pathway. We will
review your progress daily to help you reach your goals as soon as possible. As always, let us know if you have
any questions or concerns about your hospitalization, medications, treatment or recovery time.
ACTIVITY AND DIET:
»»As you begin your recovery your surgeon may have you sit on the edge of your bed. He may even have you
get up, with the assistance of your nurse, to walk the night of surgery. Your nurse or Care Coach can help
you get into the most comfortable positions with pillows while positioning yourself in bed. You may lay on
your back, side, or abdomen. You should reposition yourself every hour while you are awake.
»»It is important that you let your nurse know if you become nauseated as you are started on a clear liquid
diet. You will progress to a regular diet as you are ready.
PAIN MANAGEMENT:
We want you to be as comfortable as possible. Your nurse will ask about your pain level to assist with this
process. Medications and muscle relaxants can have side effects that may have you breathe less deeply and
become too sleepy. The nurse will monitor this and will take your temperature, check your respiratory rate,
blood pressure, and oxygen levels regularly.
Measures you can take to help control your pain include:
»»IV pain medications will be started first and as soon as you are tolerating solid food, you can start taking
oral pain medications and muscle relaxants.
»»Be sure to let your nurse know what pain medications and muscle relaxants have worked best for you in
the past.
»»It is important for you to concentrate on deep breathing throughout your position changes. Do not hold
your breath.
»»It is ok to request ice to decrease swelling. Use ice for 20 minutes on, 20 minutes off.
»»Work with your Care Coach to distract you from your pain.
OPTIONAL ITEMS IF REQUIRED FOR YOUR CARE MAY INCLUDE:
»»An IV for fluids and other ordered medications.
»»Controlled Analgesia (PCA) pump for IV pain medication that you control.
»»A Hemovac (a drain) that helps prevent blood clots near your wound.
»»A Foley Catheter to drain your bladder.
»»Oxygen in your nose to assist your recovery from anesthesia and related medications.
»»Leg “wraps” while in bed (SCDs) and support stocking (TEDs) to help prevent blood clots.
»»You may be asked to use an Incentive Spirometer hourly to help exercise your lungs. This helps prevent
complications such as pneumonia.
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Journal entries and questions regarding Lumbar Spinal Fusion “clinical pathway”:
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BASIC BODY MECHANICS & HOME SAFETY
CONSIDERATIONS FOR BASIC BODY MECHANICS & HOME SAFETY
Standing:
»»To avoid bending or reaching adjust work heights.
»»Keep abdominal and buttock muscles toned.
»»Wear comfortable shoes with a good grip on them. No open backs.
»»It is good to change positions. Shift your weight, walk, or put your foot on a low step stool.
Where you walk:
»»Be sure that paths are wide enough for your walker and clear of obstacles, including pets.
»»Do not use throw rugs.
»»Keep extension cords away from areas where you walk.
Sitting:
»»Avoid sitting in chairs that rock, swivel or roll. A straight back chair with arms and a firm seat is best. You
may want to adjust the height of the seat by using a blanket, pillow, or cushion.
Pushing/Pulling:
»»Push rather than pull
»»Keep you head up and back straight
»»Slight bend to the knees and elbows
»»Keep your center of gravity below mid-mass load
Bedroom:
Sleeping:
»»Use a firm mattress.
»»Use pillows for positioning, i.e. under your knees if lying on your back; between your legs or behind
your back as a wedge when you are on your side.
»»You may sleep on your side or back.
»»Bedspreads should be removed from the bed during recovery.
»»Bedding should be clean when you come home from the hospital, and changed every few days, more
often if soiled.
»»Have bedding un-tucked so that access to the bed is easy.
»»Place the commode or urinal near the bed for convenience and safety.
»»No throw rugs.
»»Animals should not be allowed on the bed.
Sexual Activity:
»»No intercourse until one month after surgery.
»»Back pain may limit sexuality.
»»Focus on increasing sensuality, the romance and excitement of the relationship.
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»»Pain and frustration can inhibit pleasure and orgasm. Increase foreplay and have patience to increase
your pleasure.
»»Good, open communication from both partners is a must.
»»Try massage, touching and erotic play.
Bathroom:
Toileting:
»»Consider a raised toilet seat, making sure that you do not let yourself fall to the seat. Utilize grab bars,
walker or cane for assistance.
»»To avoid twisting, be sure that toilet paper is within easy reach.
»»If after toileting you have trouble with hygiene, a toilet aid may be needed to extend your reach.
Bathing:
»»Until you feel safe and confident to shower alone, have someone close by to assist you if necessary.
»»Use a step-in shower if available. If not, to get into the bath tub, stand next to the tub and step in
sideways one leg at a time.
»»Do not sit in the tub, rather use a shower or bath chair with no slip pads to sit on.
»»Grab bars should be used in the shower/tub. Do not use fixtures, towel racks, or soap dish bars for
support (grab bars can be purchased at a home building supplier).
»»Be sure that you have a non-skid mat on the floor outside the shower/tub. No rugs to trip over.
»»Be sure to keep the floor dry so that you do not slip.
»»Have towels and other needed items within easy reach.
»»Consider using a long handle bath brush.
»»Soap on a rope or liquid soap in a hanging bottle is helpful.
»»A hand-held shower arm is helpful as well.
Sink:
»»When you are at the sink, do not bend to look in a mirror or get to the sink.
Kitchen:
»»When cooking use the back burners on the stove.
»»Avoid using heavy pots & pans or items with faulty handles.
»»Do not use a step stool to reach high cabinets, rather have items within easy reach.
»»Slide objects across the counter or table instead of carrying them.
»»To conserve energy/stamina, use a chair or stool to sit on when you can.
Stairs:
»»Be sure that hand rails are securely attached.
»»Non-skid treads on steps, so that you do not slip and fall.
»»Be sure that you can see where the steps begin/end.
Other considerations:
»»Set up a living area on one floor if that is possible.
»»When using your walker, utilize a bag or basket attached to the walker to carry items.
»»If possible keep a cordless phone with you at all times.
»»Lighting is important throughout your home so that you do not trip and fall.
»»Have a good balance throughout your day…walking, sitting, laying down to help control swelling
and fatigue.
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Journal entries and questions regarding Body Mechanics and Home Safety:
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MOBILITY IN THE HOSPITAL & AT HOME
No Bending, Lifting, Twisting (B,L,T)
»»Do Not bend at the waist; do bend at the hips and knees.
»»Do Not lift objects heavier than a gallon of milk (10 pounds).
»»Do Not twist your trunk.
The only aerobic exercise prescribed by your surgeon immediately after surgery is walking. At one week
post surgery you will be expected to TRY and walk up to one mile OVER THE COURSE OF THE DAY. At two
weeks post surgery two miles over the course of the day, if you are able. Approximately 2,100 steps = 1 mile
and 4,200 steps = 2 miles. Use can utilize a step pedometer to monitor how far you are walking!
BED MOBILITY
When rolling to your side, move as a unit, with hips and shoulder moving simultaneously to avoid twisting.
You will hear your patient care team refer to this as a “Log Roll.” You will also be asked to tuck your chin
down and brace your abdominal muscles for added stability.
Getting In and Out of Beds and Chairs
To get into bed, sit on the edge then lower your upper body sideways, using your arms for support. At the
same time you are lowering your upper body, bring your legs and feet up onto the bed.
To get out of bed, the process is reversed. Avoid twisting by using the arm closest to the bed for support,
eliminating the need to reach across your body. Before standing, scoot as close as possible to the edge of the
bed and place your feet on the floor. If you are sitting on a chair without arms, push with your hands against
your thighs, keeping your head up and your back straight. Move slowly to avoid injuring your back.
USING A WALKER
»»Standing with a Walker
»»Slide your hips forward to the edge of the bed, chair or toilet seat.
»»Use your arms to push down on the edge of the object you are sitting on and lift yourself up.
»»Move your hands to the handgrips of the walker and stand straight up.
USING A CANE
»»Standing with a Cane
»»Slide your hips forward to the edge of the bed, chair or toilet seat.
»»Place cane in one hand by grasping the handle with your palm turned downward.
»»Raise yourself up by pushing down on the cane in one hand and down on the object you are sitting on
with the other hand.
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WALKING UP STAIRS
You will always lead with your stronger leg. Bring your cane and sore/weak leg up to that step. Take a minute
to get your balance and continue up steps, leading with your stronger leg.
WALKING DOWN STAIRS WITH A CANE
»»This time you will lead with your weaker leg.
»»On the upstairs landing, rest your weaker leg forward on the edge of the step.
»»Put cane on the step below. Place the cane near the front edge of the step to help you keep your balance.
»»Bring your weaker leg down to the next step.
»»Push down on your cane and slowly lower your stronger leg.
Journal entries and questions regarding special precautions/mobility to follow:
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BODY CHANGES
»»You may not have a good appetite following surgery. It is important to keep hydrated so that you do not
become dehydrated. Drinking plenty of fluids will also help increase your appetite.
»»If you have difficulty sleeping after surgery, this is normal. Be sure that you do not sleep or nap too much
during the day so that you can have a good night’s sleep.
»»It is normal for your energy level to be less during the first month following surgery.
»»Remember that medications that contain narcotics can promote constipation. Follow your surgeon’s advice
for using stool softeners or laxatives such as milk of magnesia if necessary.
BLOOD THINNERS
Blood thinners may be given to help avoid blood clots in your legs. ALWAYS FOLLOW the surgeon’s advice
regarding blood thinners.
STOCKINGS
»»To keep swelling down and to reduce the chance of blood clots your surgeon may ask you to wear special
stockings that compress the veins in your legs. It is important to follow your surgeon’s orders.
»»If swelling in the operative leg is bothersome, have your Care Coach help you elevate the leg for short
periods of time throughout the day. It is best to lay down and raise the leg above heart level.
»»Notify your physician if you notice increased pain or swelling in either leg.
INCISION CARE
»»Keep the incision dry.
»»It is important to keep your incision covered with a light dry dressing until the staples are removed, usually
10-14 days.
»»You should follow your surgeon’s instructions for showering/bathing.
»»If there is increased drainage, redness, pain, odor, or heat around the incision, notify the surgeon
immediately.
»»Take your temperature at least once a day and more often if you feel warm or sick. Call your surgeon if your
temperature exceeds 101.5 degrees F.
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CHANGING THE DRESSING (ONLY IF DIRECTED BY SURGEON)
1. Wash hands before and after changing the dressing.
2. Open all dressing change materials that have been provided for you.
3. Remove stocking and old dressing.
4. Inspect incision for the following:
»»increased redness
»»increase in clear drainage
»»yellow/green drainage
»»odor
»»surrounding skin is hot to touch
5. If Betadine® or hibiclens is ordered, take one Betadine® swab or hibiclens and paint the incision from top
to bottom. Then turn the swab over and paint the incision from bottom to top. Use remaining swab to paint
the drain site.
6. Pick up your dressing or bandage by one corner and lay over incision. Be careful not to touch the inside of
the dressing that will lie over the incision.
7. Place one dressing or bandage lengthwise and place the other dressing or bandage crosswise to form a “T”
to cover the drain site.
8. Tape dressing in place.
Journal entries and questions regarding body changes, blood thinners, stockings, incision care or dressing
changes:
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CONTROLLING DISCOMFORT
»»Take your pain medicine at least 30 minutes before physical therapy so that you can exercise comfortably.
»»You will gradually wean yourself off from prescription medication. Over the counter medications will be
recommended by your surgeon.
»»Have your Care Coach help you change positions about every 45 minutes throughout the day.
»»Utilizing ice on the affected joint will help decrease discomfort. Remember not to use it for more than 20
minutes at a time each hour. Follow your prescribed program to utilize ice before and after you exercise.
A bag of frozen peas works well when wrapped in a kitchen towel!
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PREVENTING OTHER POTENTIAL COMPLICATIONS
DISLOCATION - HIP ONLY
Signs of Dislocation
»»Severe pain
»»Rotation/shortening of leg
»»Unable to walk/move leg
Prevention of Dislocation
If your surgeon prescribes these precautions for you, follow these guidelines AT ALL TIMES:
»»DO NOT cross legs
»»DO NOT twist side-to-side
»»DO NOT bend at the hip past 90°
Note: if you are a THA Anterior approach this is not applicable
FALL PREVENTION
OrthoCarolina takes patient safety very seriously. Your OrthoCarolina team will do everything we can to prevent you from falling. You will be evaluated for potential fall risks and placed on “Fall Precautions” if necessary.
Loss of memory/confusion, drowsiness caused by pain medication, nausea, pain, low blood pressure, having
an IV site and/or decreased feeling in your legs (possibly due to spinal anesthesia postoperatively) are risk
factors that have been identified and will be considered for your safety.
PRECAUTIONS WE TAKE TO HELP PREVENT A FALL:
Remember you are NOT bothering anyone when you ask for help!
»»Do not attempt to get out of bed by yourself.
»»Your Care Coach can help make sure that the nurse call light, phone and your food and drinks are within
easy reach. You will be instructed on how to use the nurse call light. A button will be attached on your bed
so that you can call for assistance whenever needed.
»»It is important that you wear shoes or socks that fit well and grip the floor. No open back shoes.
»»Your bed will be in a low position with the wheels locked.
»»Hospital staff will check on you frequently.
»»Ask for assistance to go to the bathroom.
»»You and your Care Coach will be educated on how to prevent falls.
»»It is helpful to sit on the side of the bed for a few minutes to be sure you are not dizzy before getting up.
Remember the best outcome occurs when you and your support group and visitors follow the safety rules
above.
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HIP PRECAUTIONS
To help prevent a hip dislocation the nursing staff will help position you on your non-operative side.
Depending on the approach the surgeon takes will determine what precautions are followed. The nurse will
help place a pillow between your legs to help prevent dislocation and it is important to follow any other
instructions provided by your surgeon.
Additional precautions that will be helpful:
»»Do not cross your legs or ankles.
»»Do not bend from your hip more than 90 degrees (right angle). This happens two ways by bringing your
knee up too close to your chest, or by bringing your chest too close to your knee.
»»Do not roll your leg inward (standard total hip).
»»Do not roll your leg outward (minimally invasive hip replacement).
»»Do not sit with your hips higher than your knees.
»»Do not reach forward to the floor from a seated position.
»»No pivoting or twisting on the operative leg.
»»Avoid sitting on low chairs or toilets.
Journal entries and questions regarding potential complications or fall prevention:
TED HOSE / STOCKINGS
You may be asked to wear TED Hose or stockings, if so:
»»To help prevent blood clots from forming you maybe asked to wear TED Hose. These are tight fitting
stockings that place mild pressure on your legs to help circulate your blood.
»»To let you skin air out and inspect your skin, you should remove the TED Hose periodically every day
»»Any skin that is discolored or appears bruised should be reported to your surgeon.
»»To understand how long you should wear the TED Hose see your discharge paperwork for your physician’s
instructions on how long you should wear them after you leave the hospital.
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GOING HOME AFTER SURGERY
INSTRUCTIONS FOR GETTING DRESSED:
Your Occupational Therapist will go over dressing techniques with you. The approaches that you will be
taught are designed to follow the spinal fusion precautions, which help to protect your back during the
healing process. You can follow these same instructions when you are at home. If you have a soft foam
flexiform brace you may put your T-shirt on while sitting on the edge of the bed. Fasten bras in the front and
then turn them around to the back.
While sitting in a chair with good back support put on your pants, socks and shoes. Then you can stand up to
pull up your pants. You will receive special instructions if you are unable to sit. Your Occupational Therapist
will help to determine what equipment you will need. You will use the equipment at home until your doctor
discontinues your spine precautions (generally not covered by insurance carriers).
TOOLS AVAILABLE TO HELP YOU WITH DRESSING (OPTIONAL):
»»A reacher can be used to assist you with completing your activities of daily living while following your
post operative precautions. For example, it can be used to pull your pants over your feet and pull them to
your knees. You can then stand up to pull them over your hips. It is helpful if you wear pants that are not
tight fitting with perhaps an elastic waist band, that is lose around your waist. Remember they have to fit
over your brace.
»»Use your sock-aide to put on your socks. It is important to pull equally on both straps at the same time.
Socks that are loose fitting or stretchy will go on much easier than tight tube socks.
»»Use your long-handled shoehorn to put on shoes. Slip-on shoes, canvas tennis shoes, or loafers are easier to
get on and take off. If you will be wearing tennis shoes, you may need to have someone tie your laces for
you or you could purchase elastic shoelaces.
Journal entries and questions about TED Hose or getting dressed:
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GETTING INTO A VEHICLE
»»You may sit in the front passenger seat when riding in the car; recline the seat for comfort.
»»Use pillows behind your back for comfort.
»»To sit down, have your back to the seat.
»»Use the back of the seat and the door for support as you slowly lower yourself to the seat.
»»Bring legs into the vehicle one at a time as you rotate your head and shoulder toward the front.
»»Move your shoulders and hips as a unit.
»»If you have a high vehicle, use a small step stool or have the vehicle pulled up to the curb to increase
stability of getting in and out.
»»Riding in the car should be limited to essential travel over short distances and may be more comfortable
with the seat slightly reclined.
»»On long trips, you should get out of the vehicle and stretch at least every hour to relieve the stress of
prolonged sitting.
»»Check with your physician regarding when you may drive.
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ORGANIZING YOUR HOME ENVIRONMENT
HOUSEKEEPING
»»For the first two months following surgery avoid housekeeping tasks.
»»Do not carry anything heavier than a gallon of milk.
»»Prepare foods that you like and freeze them before surgery or purchase prepared foods at your grocery
store so that cooking tasks are easier.
CHILDCARE
»»Do not lift and carry children weighing more than ten pounds.
»»Children can climb up and sit on your lap.
»»Use highchairs, elevated changing tables and strollers.
»»Do not carry heavy diaper bags.
ENERGY CONSERVATION AND WORK SIMPLIFICATION
»»Pacing
»»Change in position
»»Planning
»»Prioritizing
»»Alternating light and heavy activities
Journal entries and questions regarding getting into your vehicle and organizing your home environment:
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EQUIPMENT NEEDED
Welcome to the Post-Surgical Department at OrthoCarolina. Your physician may order the following
equipment for your recovery needs following your surgery:
CERVICAL PROCEDURES
»»Soft Collar/Aspen Collar/Miami J: Immobilizes the neck and adds stability and support while you recover.
SPINE/BACK SURGERY
»»Kit – includes a “reacher”, back scrubber, sock aid and long shoe horn—these assist with independence and
reduce movements that can often be painful in the recovery.
»»Rolling Walker: assists you to safely walk as you regain strength and stability.
»»3 in 1 Bedside Commode: provides convenience and safety as you regain movement and speed.
»»Corset/LSO: gives you added support and comfort while you recover and get back to an active lifestyle.
HOW DO I OBTAIN THE RECOMMENDED EQUIPMENT?
»»Our post-surgical representative will contact you prior to your surgery to assess and order equipment you
may need or want.
»»Equipment will be delivered to the hospital and any necessary adjustments and patient education will
take place at that time. If you would like to obtain the equipment prior to your surgery, please call our
department at 704.323.2462.
THE BRACE
Your physician may have prescribed a brace for you because you have had a spinal fusion. The brace is
designed to protect your spine while healing takes place. The brace can be fitted before admission, or the first
day after your spine surgery; it is usually worn for a minimum of four weeks at all times when out of bed
(except while in the shower). You will need to wear a fitted T-shirt, camisole or sleeveless shirt under the
brace. When you return for your post-operative appointment, your surgeon will determine if you need to
continue to wear the brace.
Your physician will decide which of the following braces you need based on your specific case:
The Lumbosacral Corset Brace is an elastic corset type brace with a Velcro attachment in the front. Most
patients learn to put on and remove this brace independently, while some may require assistance from a
caregiver. This brace may be applied while sitting on the edge of the bed.
The Flexiform Brace is designed as one or two plastic molded pieces with straps on each side. It has a soft foam
lining with plastic overlay. This can be applied while sitting on the edge of the bed.
The Thoracic-Lumbo-Sacral-Orthosis (TLSO) Brace is designed as two molded plastic pieces (front and back)
with straps on each side. Most patients will require assistance to place and remove the TLSO brace. Your
Physical Therapist and Occupational Therapist will work closely with you and your caregivers on proper
procedures for placing the brace or taking it off. If you are experiencing problems with your customized
TLSO, notify the company that made your brace. In the meantime, pad any pressure areas with gauze or
cotton.
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Journal entries and questions regarding Equipment:
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NOTES & PHONE NUMBERS
Your Notes:
Dr. Name:
Nurses Name:
Navigator #:
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FREQUENTLY ASKED QUESTIONS
What is the recovery time for a total hip replacement?
»»This generally takes about three months. Everyone heals at a different pace so this time frame will vary
from patient to patient. Most often you will use a walker or crutches for about one month after your
surgery. Then you move to a cane outdoors and no support around the house for several weeks. You
return to normal activities gradually after that.
What is a dislocation of the hip?
»»Although this happens, less than 2% of the time, it does occur. A dislocation occurs when the ball
(femoral head) comes out of the socket (acetabulum).
What precautions should I take to avoid a hip dislocation?
»»You should avoid bending at the hip more than 90°. When sitting, a solid chair with arms is best. The
chair should not be too low. Sit with your legs positioned so that you can see your inner thigh, calf, and
foot, not the outside of your leg. If you need to reach to the floor when seated, reach between your legs,
not out to the side. Use an elevated toilet seat to avoid excessive flexing at the hip.
How long do I need to follow my dislocation precautions after total hip replacement surgery?
»»Follow your precautions very carefully for the first 6 weeks. You should avoid extreme positions of hip
flexion (bending) forever.
When can I discontinue using a raised toilet seat after total hip replacement surgery?
»»6 to 10 weeks is the recommended time frame. It varies per individual.
Can I sleep on my side after total hip replacement?
»»You may sleep on your operative side whenever you feel comfortable. You may sleep on your nonoperative side at 4 weeks with a pillow between your knees.
When do my stitches come out after total hip replacement surgery?
»»Your stitches are absorbable and do not need to be removed. The steri-strips that have been applied can
be kept in place until they fall off on their own. They will help keep the skin edges together. If they have
not fallen off by 3 weeks, you may peel them off.
How long do I need a bandage after total hip replacement surgery?
»»You need a bandage for approximately 1 week after total hip replacement surgery. A dry sterile gauze
should be reapplied daily. You may continue to wear a bandage to protect from irritation if you like.
When can I shower (get incision wet) after total hip replacement surgery?
»»If there is not drainage at the incision you may shower after three days. Initially, try to keep the incision
dry with a plastic wrap. If the incision gets wet, pat it dry.
When can I immerse my hip in water (e.g., bath, swimming pool, ocean, hot tub) after total hip
replacement surgery?
»»Again, if there is no drainage from the incision you may immerse your hip in water after two weeks.
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How long will I be on pain medication after total hip replacement surgery?
»»You will likely require some form of pain medication for about 3 months after total hip replacement
surgery. At first you will be on a strong oral pain medication (such as a narcotic). After the first month
most people are able to wean off from the narcotic. At this point they are able to switch to an overthe-counter pain medication (such as Tylenol or ibuprofen). If you are on Coumadin (warfarin), avoid
taking any NSAIDs (e.g., aspirin, ibuprofen, Advil, Motrin, Aleve, Naprosyn) without first consulting your
physician.
Will I go to rehabilitation or home after total hip replacement surgery?
»»Many factors are considered in this decision. Considerations include availability of friends and family
to assist with daily activities, home environment, safety considerations, post-operative functional status
as evaluated by the physical therapist in the hospital and overall evaluation of the hospital team. So it
depends. Many people do go home after their total hip replacement surgery. However, some do go to a
rehabilitation facility to regain skills needed to return home safely.
Do I need physical therapy after total hip replacement surgery?
»»Yes! Your therapist will help you walk, regain motion, build strength, and reach your post-operative
goals. Your therapist will keep your surgeon informed of your progress. The physical therapist plays a
very important role in your recovery after total hip replacement surgery. You will see a physical therapist
soon after your operation and throughout your stay at the hospital. If you go home, you will likely have
a therapist come to visit you (usually 2-3 times a week). Sometimes, you will be referred to an outpatient
physical therapist. If you go to a rehabilitation facility, you will receive therapy there.
What exercises should I do after total hip replacement surgery?
»»You will be given a list of appropriate exercises to do by the physical therapist. Generally swimming and
a stationary bicycle are good options. These exercises should be continued indefinitely, even after you
recover from your surgery. Do not use the stationary bicycle until you are at 4 weeks past surgery.
I think my leg lengths are different after total hip replacement surgery. What should I do?
»»It is not uncommon to feel as though your leg lengths are different after total hip replacement surgery. At
surgery, leg lengths are assessed very carefully and an attempt is made to make them as equal as possible.
Sometimes, the new hip has to be lengthened in order to obtain proper muscle tension (to help avoid hip
dislocation). Wait 3 months before making any final judgments about your leg lengths. Your muscles and
body take time to adjust to a new hip. In rare cases, a shoe lift may be prescribed for a true difference in
leg lengths. In most cases, however, no treatment is necessary.
Can I use weights after total hip replacement surgery?
»»You should not use weights for the first 2 months after surgery. Since everyone’s strength varies, consult
with your physical therapist before using weights. You will naturally begin with 1 lb and build to a 5 lb
maximum.
How long will I be on a “blood thinner” after total hip replacement surgery?
»»You may be on Coumadin (warfarin) as a “blood thinner.” This medication is used to help prevent
blood clots. You will start on Coumadin with a dose the night before surgery and continue while you
are hospitalized. You will stay on Coumadin for 4 to 6 weeks. It is important to have your blood thinner
level checked regularly and your Coumadin dose adjusted accordingly.
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How long should I take iron supplements after total hip replacement surgery?
»»Iron stores may be depleted post-operatively. Taking iron supplements for about 4 weeks after surgery is
usually sufficient.
If I am constipated after total hip replacement surgery what should I do?
»»A simple over the counter stool softener, like Colace, is helpful in preventing this problem. In rare
instances a suppository or enema may be required. Rest assured it is common to have this problem
following surgery. A variety of things can cause it, narcotic pain medication is a common cause.
When can I drive after total hip replacement surgery?
»»You should wait at least 1 month if you had surgery on your right hip. After 1 month, you may begin
driving as you feel comfortable. If you had surgery on your left hip, you may return to driving as you
feel comfortable as long as you have an automatic transmission. Be careful getting in and out of a car, and
avoid crossing your operated leg over the other. DO NOT DRIVE IF TAKING NARCOTICS.
When can I return to work after total hip replacement surgery?
»»This will depend on your profession. Typically, if your work is primarily sedentary, you may return after
approximately 1 month. If your work is more rigorous, you may require up to 3 months before you can
return to full duty. In some cases, more time may be necessary.
When can I travel after total hip replacement surgery?
»»When you feel comfortable after your surgery you may travel. It is important that you get up to stretch
or walk at least once an hour when taking long trips to prevent blood clots.
Will I set off the machines at airport security after total hip replacement surgery? Do I need a doctor’s
note about my surgery?
»»This does occur, depending on the type of airport security equipment and what type of implant you
have, we no longer provide a note/card about your implant. Airport security will screen you if necessary.
What activities are permitted following total hip replacement surgery?
»»You may return to most activities as tolerated after total hip replacement surgery, including walking,
gardening, and golf. Some of the best activities to help with motion and strengthening are swimming
and a stationary bicycle.
What activities should I avoid after total hip replacement surgery?
»»You should avoid impact activities, such as running and downhill skiing on expert slopes, and vigorous
racquet sports, such as singles tennis or squash. In addition, you should avoid any activity that may put
your new hip at risk for dislocation.
Can I have sex after total hip replacement surgery?
»»You should wait several weeks post-operatively before resuming sexual intercourse. Follow your hip
dislocation precautions. Having your legs apart is a safe position.
Can I drink alcohol after total hip replacement surgery?
»»You should not drink alcohol if you are on Coumadin or a narcotic medication. Otherwise you may have
alcohol at your own discretion.
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How long should I use compression stockings (TEDS) after total hip replacement surgery?
»»Compression stockings are used to help reduce swelling and improve circulation. They are recommended
for the first few weeks. You may wear them longer if your ankles swell without them.
Should I use ice or heat after total hip replacement surgery?
»»Ice should be used for the first several days after total hip replacement surgery, particularly if you have a
lot of swelling or discomfort. Once the initial swelling has decreased, you may use ice and/or heat.
Can I go up and down stairs after total hip replacement surgery?
»»Yes. Initially, you will lead with your non-operated leg when going up stairs and lead with your operated
leg when going down stairs. You can use the phrase, “Up with the good, down with bad” to help you
remember. As your leg gets stronger, you will be able to perform on stairs in a more regular pattern
(about 1 month).
Can I kneel after total hip replacement surgery?
»»Yes, you can kneel 6 weeks after total hip replacement surgery. When kneeling, touch-down with your
operative knee first. To get up from kneeling, use your non-operative leg first.
What should I expect for my range of motion (ROM) at 6 weeks? At 1 year?
»»Everyone’s range of motion (ROM) varies and depends on individual factors. Your potential will be
determined at the time of your surgery. In most cases, you will have enough motion to put on socks and
tie your shoes. Clipping toenails may be difficult.
Do I need antibiotics before dental work or an invasive procedure after total hip replacement surgery?
»»Yes. You will be given a letter explaining this in detail at your first follow-up visit. Avoid any dental
cleaning or non-urgent procedures for 3 months post-operatively.
I feel depressed after total hip replacement surgery. Is this normal?
»»It is not uncommon to feel depressed after hip replacement surgery. These feelings of depression
generally go away as you begin to return to your normal activities. Limited mobility, discomfort,
increased dependency on other people, and side effects of medication can all contribute to these feelings
of depression. If these feeling persist speak with your internist.
I have insomnia after total hip replacement surgery. Is this normal? What can I do about it?
»»Insomnia is a common complaint following hip replacement surgery. Non-prescription remedies such
as Benadryl or melatonin may be effective. If insomnia continues to be a problem, medication may be
prescribed for you.
How long will my total hip replacement last?
»»This varies from patient to patient. For each year following your hip replacement, you have a 1% chance
of requiring additional surgery. For example, at 10 years post-operatively, there is a 90% success rate.
When do I need to follow-up with my surgeon after total hip replacement surgery?
»»Follow-up appointments should be made post-operatively at 4-6 weeks, 1 year, 2 years, 5 years, 7 years,
and 10 years.
Who should I call with questions after total hip replacement surgery?
»»In the case of an emergency, call 911. For all other inquiries during the day, call the surgeon’s office and
ask for the nurse triage line. After business hours, listen to the recording and follow the instructions.
Most calls will be returned within 1 business day.
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Normal things about your New Hip
Abnormal Things about your New Hip
Call the office immediately if you experience:
Clicking noise with hip motion
Increasing redness, particularly spreading from the
incision
Skin numbness near or around the incision
Increasing pain and swelling
Swelling around hip, knee, and/or lower leg
Fever > 101.5 F
Warmth around the hip
Persistent drainage from your wound
“Pins and needles” feeling at or near the incision
Calf swelling or pain, particularly associated with
ankle motion
Dark or red incision line. This will gradually fade to
a lighter color
A sudden “giving away” of your hip with inability to
bear weight
Increased bruising if on Coumadin
Ankles swelling that does not decrease or resolve
overnight
Bleeding gums or blood in urine/stool
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REFERENCES
Dr. Ellington’s article on SMOKING (p.17)
*Centers for disease Control and Prevention. Annual Smoking-Attributable Mortality. Years of Potential Life
Lost and Productivity Loses-United States, 2000-2004. Morbidity Weekly Report 2008; 57 (n5):1226-1228
(accessed, 2009 May 5).
*Centers for Disease Control and Prevention. Health, United states, 2008, Hyattsville (MD); Centers for Disease
Control and Prevention, National Center for Health Statistics, 2009 (assessed 2009 May 5).
*Mokdad, AH, Marks JS, Stroup OF, Gerberding, JL. Actual Causes of Death in the United States. JAMA
(Journal of the American Medical Association), 2004, 291 (10): 1238-1245 (cited 2009 June 16).
*US Department of Health and Human Services. The Health Consequences of Smoking: A Report of the
Surgeon General, Atlanta:U.S. Department of Health and Human Services, Centers for Disease control and
Prevention, National Center for for Chronic Disease prevention and Health promotion, Office on Smoking and
Health, 2004 (accessed 2009, May 5).
*Porter SE, Hanley EN Jr, Am Acad Ortho Surg, 2001 Jan-Feb, 9 (1) 9-17. The musculoskeletal effects of
smoking.
*Rozental TD, Shah J,, Chaeko, AT, Zurakowski D, Prevalence and Predictors of Osteoporsis risk in
Orthopaedic Patients. Jim Orthrop Relat Res 2009 Nov 13.
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