You have taken the first step to improving your quality of life and lifestyle. In anticipation of your upcoming surgical procedure, there are several items I would like you to keep in mind. Our goal in providing health care is to make your surgical experience as pleasant as possible. If you follow these simple do’s-and-don’ts before surgery, I believe this will substantially improve your satisfaction.
What is a joint replacement?
Joint replacement, aka arthroplasty, entails removing the arthritic surfaces from the joint and replacing these surfaces with metal and plastic components. It is actually more of a resurfacing since only the damaged joint surface is replaced. The tendons, ligaments, arteries, veins, and nerves are all left untouched.
What is my new joint made of?
Dr. Mead uses implants made by the company Zimmer. In general, the components are made up of a metal alloy (including cobalt chrome and titanium) and polyethylene plastic. You MUST let us know if you have any metal sensitivity, as we have the ability to test for allergies to the metals that make up the components.
Minimally invasive vs traditional surgical technique?
Dr. Mead uses the minimally invasive approach for his joint replacements. This means that your incision will be smaller, there is less trauma to surrounding tissues, and a quicker recovery than with the traditional method. Special instruments are used to allow the same components to be implanted that are used with the traditional technique.
How long will my new joint last?
The longevity of your joint depends on several factors. Typically a new joint will last anywhere from 15-25 years. Factors that can affect this include age, body weight, activity levels after surgery, and surgeon skill.
Is there anything I can do to extend the longevity of my new joint?
Well for starters, you picked the right surgeon! Following Dr. Mead’s post operative protocol will give you the best chance for a successful outcome. Keeping your body weight at a healthy level and choosing low impact exercise activities also helps.
What needs to be done to prepare for surgery?
Several things must be done to be prepared for surgery. You will need medical clearance from your primary care doctor. If you have any cardiac history, clearance from your cardiologist may be required as well. You must inform us of any medical problems and provide us with a list of your current medications and supplements. You will also be required to have a pre-admission appointment at the hospital. Being as “healthy as possible” prior to surgery is another good idea. Eating a balanced diet of nutritional food and being at an optimal weight is important. Antioxidant scanning and supplement recommendation is offered in our office as well. Low antioxidant scores have been linked to poor incision healing after surgery. Stop all aspirin and anti-inflammatory medications as well as all supplements 14 days before surgery. These medications, vitamins, and supplements are associated with excess bleeding.
If you sustain scratches or scabbing on operative leg, your surgery will likely be cancelled. Avoid yard work, ant mounds (bites), and wear long pants after dark to prevent mosquito bites. Also keep small animals off your lap as their claws can scratch you. Any skin abnormality increases the risk of infection.
Instructions for skin preparation, pre-surgery medication protocol, and medication/supplement discontinuation will be given to you.
It has been recommended that you start Miralax the day prior to surgery and continue taking it after surgery until your bowel movements return to normal. Pain medications tend to cause constipation.
Finally, it has also been recommended that you change your bed linens, towels, and wear clean pajamas the day prior to surgery.
How long will I be in the hospital?
Patients typically stay 2-3 nights in the hospital following surgery. If you are planning to go to inpatient rehab, Medicare requires you to stay 3 nights in the hospital before being discharged to a rehab facility.
Home vs Rehab…which is better?
If you can recover at home, go home. Patients recover better at home with the Home Health physical therapists and nurses. Rehab facilities are a good option for patients that do not have help at home or who are recovering a little slower. Also, patients undergoing bilateral procedures may benefit from rehab.
How much therapy is needed?
This varies from patient to patient. Typically Home Health comes to your house for a few weeks, or as long as you are considered “home bound”. After this, you will go to outpatient physical therapy. Please let our office know when you are ready for this and we will help make arrangements. Outpatient physical therapy may last anywhere from 4-6 weeks depending on your progress. Knees require more therapy than hips do.
How much motion will I have in my joint after surgery?
For knees, this depends upon how stiff the knee was before surgery. If your knee was limited before surgery, it will be more difficult to obtain full range of motion although this is possible with hard work. The knee will bend but the soft tissues that aren’t replaced are used to the limited motion. There is potential for improvement but individual results vary based on self-discipline, pain control, and degree of swelling. For hips, we do not stress motion as much as you will have strict hip precautions for the first 6 weeks after surgery. These guidelines allow the soft tissues to heal properly and prevent dislocation. Dr. Mead’s dislocation rate is less that 0.1%.
How long will I have hip precautions?
There will be strict temporary hip precautions which will be taught and reviewed in the hospital. At 6 weeks after surgery, those precautions will be relaxed but you will have some permanent guidelines that will be reviewed in the office.
How long will I use ambulatory aids?
The physical therapists will advance you as you progress. You may fully weight bear on your new joint, unless otherwise told not to. Safety and endurance are key factors. One of the goals is to get you walking without a limp, which can take some time to achieve, especially in people who already limp secondary to their arthritis. Typically patients are no longer using aids between 3-6 weeks.
Will I need any adaptive equipment at home?
Your home health agency will make arrangements for adaptive equipment that you may need at home; crutches, walker, elevated commode, etc.
Will I have trouble sleeping?
Sleeping problems are common after surgery. If you are having problems with sleep, do not take naps, as this only makes it worse. This usually gets better with time. If you can’t sleep because of pain, be sure to take your pain medication in the evening. Over the counter or prescription sleep aids may be used in some cases. You may sleep with a pillow between your legs. Do NOT put a pillow under your knees to sleep. Hip replacement patients must follow the sleep positioning guidelines learned at the hospital.
How long will I be on blood thinners?
Knee replacement patients usually take Coumadin for 2 weeks following surgery and then go on Aspirin once instructed to do so. Hip replacement patients stay on Coumadin for 4 weeks. Patients that are on “chronic Coumadin” will initially be followed by our office and then referred back to their managing physician. The Home Health nurse will do your blood draws twice a week to check your levels and give you dosing instructions. Once you are no longer “home bound”, you will be instructed to go to a lab for blood draws and will be contacted by our office ONLY if there needs to be a change in your Coumadin dose. If you haven’t received a call from the office, that means you need to take your current dose and there is no change in dosing. Please do not call us if you haven’t heard from us as the answer will be the same. We ask that you take your Coumadin dose in the evenings (after 6pm).
How long will I be on pain medications?
Usually 6-8 weeks. You will be discharged with pain medication prescriptions. Please notify us in advance if you need a refill. Refills are not handled on the weekends. Many of the prescription medications cannot be called in and require a written prescription. Please let us know if certain pain medications make you nauseated so we can avoid these. Also, if something works really well for you, let us know this as well.
When do I restart my prescription medications?
When you are discharged from the hospital. Do not restart Aspirin without contacting us. You will be instructed when you can safely resume Aspirin. Unless specifically told not to restart a medication, you should continue your prescription medications when you are discharged. Pay close attention to the discharge instructions given to you as your internist or family physician may have added or deleted medication while you were hospitalized. You should not be taking any multivitamins or supplements while on Coumadin. You will be instructed when it is safe for you to resume these.
What about my incision?
You can shower immediately after discharge. The dressing is impervious to water as long as it is sealed completely. If you have questions whether the dressing is sealed properly, ask the home health nurse. You may not completely submerge in a tub however. The home health nurse will remove your staples approximately 2 weeks after your surgery. It may take another week or so until the incision is completely healed. Once completely healed, then you may submerge your knee under water, swim, etc. Topical ointments such a vitamin E oil may be used once to incision is completely healed to help reduce the appearance of your scar. Sunscreen is also a must because the incision loses its natural ability to protect itself from the sun.
How long will I have swelling?
Swelling after surgery is normal. If you were given stockings at the hospital to use, please wear them. Elevating your feet and icing can also help. Do NOT use a heating pad. Ankle pumps also help with circulation. Please let us know if you have any persistent swelling, calf tenderness, pain in your calf with ankle flexion, warmth or redness, or any drainage from your incision. Your replaced knee may continue to have some swelling up to a year after surgery.
How long will I have pain?
Again, everyone is different. As you get further out from your surgery, your pain symptoms should improve. The arthritic pain that you are used to will be gone, but the surgical pain and recovery can take some time to resolve. Continue taking pain medication for 4-6 weeks. It may take up to 6-12 months before your knee or hip feels “normal”.
When can I drive?
It typically takes 3-6 weeks for you to feel that you can handle a vehicle in an emergency situation. It is recommended that you practice in an empty parking lot before you return to the road. You should not drive while under the influence of pain medication.
When can I return to normal activities?
Please remember that everyone recovers differently. As you feel better, you can do more. You can restart golfing, tennis, and swimming after the 4 week point if you feel up to the activity. Your physical therapist will help guide you as to what activities are appropriate. Please remember to start slowly and work your way up to pre-operative activity levels or better. Do not rush.
- Skiing: 3-6 months after surgery
- Bicycling: 2-3 weeks after surgery, start on a stationary first (you may start on a stationary bike at any point when you feel up to it)
- Gym: 3 weeks after surgery
- Tennis: 6 weeks after surgery, as tolerated, Doubles only
- Work: depends upon the type of work you do. If you have a sedentary job and can return to work with a walking device (cane) you may return as quickly has 2-4 weeks. Physically demanding jobs take at least 6 weeks to return to. A trial of part-time work before returning to full-time is wise. Remember that every person is different in terms of recovery and rehabilitation rate.
When can I fly or drive a long distance?
You can travel by plane or go on a relatively long car trip 3 weeks after surgery. This may vary on individual circumstances. Always ask Dr. Mead prior to making plans within 6 weeks of surgery. It is advised to stretch every half-hour or so and do ankle pump exercises. The concern is that blood clots can form after surgery and also with prolonged sitting. The combination of the two increases the risk of blood clot formation.
Will my replacement set off metal detectors?
Yes. Please use common sense with regard to travel. Allow for extra time at the airport. Implant cards are not issued anymore as airport security does not pay attention to them. If you would like documentation, please ask our office staff as a form letter is available.
Will I need a handicapped parking sticker?
Usually not. Most patients do not qualify for them by Florida state law. We want you walking after surgery and getting the exercise.
Do I need antibiotic prophylaxis?
Yes! Infections that are left untreated can spread to your joint by way of the bloodstream. This can happen at anytime during the life of your new joint. Call us before you have any dental work or cleanings done. We can provide you with the needed antibiotics. Your dentist may also provide you with the antibiotics. See your internist if you suspect any kind of infectious process (bladder, sinus, wound, etc). If you have a surgical procedure scheduled, let your surgeon know that you have a total joint replacement and you will need prophylactic antibiotics.