General Instructions 

 

• Use ice to help control the swelling and pain.  DO NOT USE HEAT – this will increase the swelling. 

 

What to do if you are concerned about your symptoms after discharge:

• Call the office (858-939-5434) if you develop develop drainage from the site of the wound or redness surrounding the wound, increased pain, increased leg swelling, new/severe headache, or fevers (over 100.5).

 

• Go to the emergency room if you develop chest pain or shortness of breath.

 

When to follow up with your surgeon:

• You should have an office appointment about 4 weeks following your discharge from the hospital.  If you do not, please call 858-939-5434. 

 

• Generally, you should return to see your surgeon at the following intervals, but this may be individualized depending on special circumstances:

  • Approximately 4 weeks after surgery 

  • Approximately 4 to 6 months after surgery 

  • One year after surgery 

  • Then once every 2 to 4 years. 

 

Medications

 

Pain medication

• Take pain medication as needed.

 

• You may experience side effects from narcotic pain medications.  Common side effects are constipation, nausea, drowsiness or sleepiness, dizziness, headache, dry mouth, and itching. 

• Opioids can be dangerous if you take them with alcohol, sleeping pills, or with certain other drugs. Make sure you tell your doctor about any medications you are taking, including over-the-counter, vitamins and homeopathic medications.

  • **DO NOT mix pain medications with alcohol.

  • **DO NOT drive while taking narcotics.

 

• Take your Colace, Senna, and any other medications on a daily basis (Miralax, Dulcolax, Milk of Magnesia, Metamucil, etc.) to prevent constipation. Take these medications DAILY for as long as you are taking narcotic pain medications.

 

• To help wean off of the pain medications or to supplement pain control you can use Tylenol and Celebrex.

 

Prevention of blood clots

• You will be taking aspirin 81 mg twice daily for 4 weeks to prevent blood clots unless otherwise told by your surgeon.

  • If you are already taking aspirin, do not add this to your prescribed aspirin regimen. Take only the prescribed amount of aspirin and do not resume your normal aspirin until speaking with your surgeon.

 

• Try to avoid taking additional anti-inflammatories such as Advil, Motrin,  ibuprofen, meloxicam (Mobic), etc for 4 weeks.

 

• Wear your white stockings during the day – these help control the typical swelling in your legs after surgery and minimize the chance of blood clots.

 

Antibiotics

• You will not be discharged from the hospital with any antibiotics unless you are being treated for an infection or are a high risk case. 

 

Wound Care

 

• You may shower when you arrive home if the dressing seal is air tight.  Avoid direct spray onto the dressing. 

 

• Maintain your bandage in place for 14 days after surgery. Then you may leave the incision open to air. 

 

• Keep water exposure to the incision site brief and blot it dry when you get out.

 

• You may notice bruising around the incision and into the thigh or leg.  This is common and should begin to go away within 2 weeks after surgery.

 

• Do not bathe, swim, or jacuzzi (i.e. do not submerge the incision) for 6 weeks or until cleared by your surgeon.

 

• Do not use ointments or creams on the incision for 6 weeks.  

 

Activity

 

• You can put all of your weight on your operated leg.

 

• Maintain your hip precautions until advised by your surgeon. 

 

• You may walk as much as you can tolerate with your walker, cane or other assistive device.

 

• Driving: Doctors do not have a license with the DMV to “clear you” or “release you” to return to driving. To return to driving, there are 3 primary criteria that must be met:

1. You need to be off of narcotic pain medicines (otherwise you are driving under the influence).

2. You need to be able to get in and out of the driver’s seat comfortably.

3. You must have regained your normal reflexes / strength.  

 

• Average time to return to driving is around 2-4 weeks but depends on the individual, and also partly depends on what side had surgery (i.e. right leg operates the pedals; people with left side surgery can generally get back to driving much sooner unless you have a clutch).

 

• Estimated return to work varies depending on the demands of your job.  Some ambitious patients return to desk jobs / administrative type work as early as 1 week after surgery (but usually more like 1 month).  For active labor or heavy labor, it may take 3 to 6 months to return to work. 

 

• You should do the exercises given to you at discharge until you return for your four-week visit. At that time, you may be given a new set of exercises. You should continue to exercise until your muscles are pain-free and you can walk without a limp. It is a good idea to continue your exercises as a lifetime commitment to keep your muscles strong.

 

 

Bowel Management after Joint Replacement Surgery 

 

In patients taking opiate pain medications after surgery, constipation is very common.  The following medication regimen will help to prevent this problem:

 

1. Senna S daily ((docusate sodium 50 mg and Senna 8.6mg) 1-2 tablets by mouth each day)

 

1. MiraLax ((polyethylene glycol 3350) 17g diluted in water or juice) twice a day while patient is taking opiates.

 

If no BM x 3 days, give mag citrate ½ of a bottle (approximately 150 mL or approximately 5 oz). If no results after the first ½ of mag citrate, then give the other ½ bottle the next day.  Please note, if the patient has renal disease, mag citrate should be avoided.  If the patient still has no results, please contact physician.