POST-OP TOTAL JOINT REPLACEMENT INSTRUCTIONS
You will be discharged with prescriptions for pain medication, blood clot prevention and constipation. If you are under the care of a pain management program, that physician will be responsible for post-op pain management. We are not in the office every day, so we will need at least a 48-hour turnaround time for refills that can be electronically submitted to the pharmacy. Voicemails are not checked on Saturday or Sunday. Please do not call for refills over the weekend, if possible. If absolutely necessary, you can call Dr. Moore after regular business hours at 602-385-0438. For post-op questions during normal business hours please call my medical assistant Sam at 602-385-0432.
(3) Post-Operative Medications you will be required to take:
Baby Aspirin 81 mg (Blood Thinner
one pill twice a daily for 6 weeks
If you are already on a blood thinner, Lovenox, Coumadin, Plavix, Xarelto, Eliquis, etc-then you will NOT take the baby Aspirin.
Meloxicam 7.5 mg (Anti-inflammatory)
One pill in the morning with food and water for 4-6 weeks for the swelling
If you have an allergy to NSAIDs or stomach or kidney problems, have stents, or are on another blood thinner besides baby Aspirin, then you will NOT take meloxicam
Tylenol 650 mg "Tylenol Arthritis" (Pain medication)
Two pills every 8 hours until you no longer have pain. Do not exceed this amount.
Don’t miss this. Every 8 hours. THIS is your main pain medication.
(3) Post-Operative medications you will take as needed:
Oxycodone 5 mg -or- Norco 5mg/325mg (Narcotic pain pill)
One pill every 4-6 hours as needed for breakthrough pain. This means that if your Tylenol isn’t providing 8 hours of relief, then you can take a 5 mg oxycodone pill in between your Tylenol pills. Get off the Oxy as soon as you can make it 8 hours with just Tylenol.
Your initial Rx will only be a 7-day supply of pills, please use them wisely. Ice and elevation will be your friend. These pills cause constipation and other side effects. If more pain pills are needed, we can provide, but we do not provide pain medication after 6 weeks following surgery.
Many patients only take the Narcotic pain medication before or after therapy and at night to help them sleep for the first few days.
Cyclobenzaprine (Flexeril) 5 mg(muscle relaxer)
Only take as needed for muscle spasms. Some will take at night to help them sleep. The side effect is that it causes drowsiness. Do not plan on leaving the house if you take one.
Colace 100mg Twice Daily as needed for constipation. You may also add an over-the-counter laxative or stool softener as needed until your bowel functions return to normal. Most pain meds will cause constipation, so a diet high in fiber and a stool softener will be helpful.
You might be given a prescription for an antibiotic. Take it as directed until completed.
All other prescription home medications can be resumed. Be cautious when resuming multivitamins, fish oil, turmeric, and other naturopathic medications as they may be natural blood thinners. Upon discharge, we may or may not recommend or prescribe new medications. Please follow the dosage directions on your prescription. Do not take more than prescribed.
**We will no longer fill your Narcotic Pain Medication After 6 Weeks Post Surgery** If you still require pain medication, you will need to notify your family physician, or we can refer you to a pain management physician.
Your first follow-up appointment after a total knee will be7-14 days after your surgery.
Your first follow-up appointment after a total hip will be7-14 days after your surgery.
Your 1st post-op appointment should already be set up by our surgery scheduler. If uncertain, please call Sam, my medical assistant, at 602-385-0432 for confirmation or to set up the appointment.
PLEASE NOTE AT THAT VISIT YOU MIGHT BE SEEN BY AN ASSISTANT SURGEON OR PHYSICIAN ASSISTANT.
Please adhere to all guidelines until seen for your follow-up visit. This includes any activity or weight-bearing restrictions and any precautions that may have been given to you.
FIRST 2 WEEKS AFTER SURGERY
For the first 2 weeks after total knee replacement, ice, elevate and compress the knee. You can ice directly over your white ted hose stocking 20 minutes at a time with 10-minute breaks in between as tolerated. You may walk around the house, but as soon as you get things done, ice and elevate as much as you can. Keep the ankle above the knee on 2-3 pillows and knee above the hip, with your leg above heart/chest level.
Bruising up and down the leg is normal and NOT a concern. The skin may turn black and blue.
Try to minimize any excessive activity; take it easy and only get out of the house for physical therapy.
SURGICAL DRESSINGS & BATHING
Please call our office if you are concerned about the appearance of your incision, or if you develop substantial drainage. The bandages are made to absorb blood. If blood leaks out from under the bandage and gets on your clothes, then you will probably need a dressing change. Reinforce the dressing until you can get an appointment to come into the office. Call the office number if you can’t get a hold of the office. Do not just go into the ER.
In most cases, a water-resistant/waterproof adhesive dressing will be placed at the time of surgery. However, this dressing should still be covered when showering. For total knees, remove your white ted hose stocking and cover the bandage with clear plastic wrap. Do not get the dressing wet. For hips, you can do the same, or avoid the dressing coming into contact with the shower stream. After showering, remove the clear plastic wrap and put the white ted hose back on.
All dressings should be removed 1 week after surgery. If your appointment is later than one week following surgery, then the dressing can be removed by the patient. You will have steri-strips across the incision. Those will fall off by themselves. For the next week or so cover the incision with a simple dressing such as "Island Dressings" or large "Band-aids" from your pharmacy. If you are concerned about how your incision looks or there is drainage, please make an appointment to be seen sooner than the scheduled appointment. DO NOT USE alcohol, peroxide, or ointments of any kind on your incision until cleared to do so.
Swelling around the incision, as well as in your feet and legs, IS NORMAL. To help with this, elevate your feet on the arm of the couch while lying flat as much as possible. Your leg should be elevated above your heart to really be effective. Wear the compression socks as well as any mechanical compression devices if provided. Pump your ankles up and down and do circles whenever you are still. Muscle action helps to move collected fluid out of the tissues and veins and improve circulation. Ice packs may be used and will also help with the pain. Report any persistent swelling, calf tenderness, increase in pain, sudden shortness of breath, or pain in the calf with ankle flexion, warmth, or redness.
Home exercises will provide you with a home therapy program. As you feel stronger, increase the number of repetitions you do in each session.
YOU are responsible to continue the exercises at least 3 times a day. The outpatient therapist will be amazed at the progress you have made before showing up at their clinic. The majority of all joint replacements will have outpatient physical therapy. You will begin formal outpatient therapy 2-5 days after you get home. Recommendations, as well as the therapy prescription, will be provided prior to surgery. If there are any questions or concerns related to the PT referral, please contact the office.
Please check with us before you swim, use a whirlpool, drive, or ride a bicycle.
Driving may be resumed once you are no longer taking narcotic medications and feel you can safely operate the vehicle. You may wish to practice in an empty parking lot at first.
SLEEPING AND POSITIONAL RESTRICTIONS
- FOLLOWING A TOTAL KNEE REPLACEMENT
You may sleep on your operative or non-operative side with a pillow between your knees. Avoid twisting motions, stooping, or kneeling. After 3 months you may kneel. You won’t hurt the prosthesis, but many patients say they don’t like how they feel.
- FOLLOWING A TOTAL HIP REPLACEMENT
Please avoid extreme positions. Listen to your body and let pain be your guide. Avoid any painful movements or positions. If you plan to resume yoga or something similar, please consult with Dr. Moore first.
Sex may be resumed at your discretion. Please keep in mind the positioning guidelines for hip replacements. Be creative and conservative. For an actual study and diagrams of safe sexual positions after total joint replacement, you may refer to the following orthopedic paper.
SURGERY & DENTAL PROCEDURES AFTER JOINT REPLACEMENT
Infections left untreated can spread to your joint by way of the bloodstream. The consequences of this can be quite serious. Do NOT schedule any dental visit/procedure within 3 months following your surgery.
Please call us or your dentist/doctor before any invasive procedures like (dental work, colonoscopy, etc) so someone can provide you with antibiotic coverage. This applies forever, not just in the first 2 years. This includes routine fillings, cleanings, caps, extractions, scopes, biopsies, etc.
If you have any surgical procedures planned, please advise your surgeon you have a joint replacement and will need coverage with an antibiotic.
See your internist if you develop or suspect any type of active infection such as bladder infection, upper respiratory symptoms, etc., so that antibiotics can be ordered right away.
Report any complications to my office immediately. This includes excessive bleeding, wound breakdown, severe redness around the incision, uncontrolled pain, or fever over 101.5 degrees.
If you have any questions or concerns, please call the medical assistant during regular office hours at 602-385-0432. If you are having any problems or need to reach a physician for urgent needs after hours or on the weekend, please call Dr. Moore’s phone number 602-385-0438.