POST OPERATIVE INSTRUCTIONS: Dr. Zabinski
The following instructions should be followed closely, except when overruled by specific procedural instructions.
Notify your doctor of any unusual changes in your condition and feel free to call the office with any questions.
JOINT REPLACEMENT HOME CARE
With less invasive joint replacement surgery the importance of immediate aggressive rehab and therapy is much less then in the past.
Although you will be having one or two Home physical therapy sessions within the first five days after surgery during this critical period for wound healing these exercises are NOT your focus.
Instead your priority for the first 5 to 7 days after surgery is controlling swelling and bleeding (which usually gets worse the first 5 days after surgery).
Controlling and limiting this swelling and bruising is important for good early wound healing which in turn helps to lessen the risk of infection.
How do you keep the swelling and bruising down?
The answer is to focus on FOUR things… elevation of your leg; rest; compression of the wound; and icing the wound.
Elevation is THE MOST IMPORTANT thing. You must keep your leg and knee ABOVE YOUR HEART. To do this you must be in bed with the leg raised on a pillow or a foam leg elevator that you can buy on Amazon. The other way is in a recliner chair reclined back as far as it can go with the leg again propped up on pillows or a foam wedge.
Sitting in a chair with your leg up on an ottoman is NOT ACCEPTABLE as it does not elevate your leg above your heart.
We recommend elevating your leg for 21 to 22 of the 24 hours in a day for the first 5 days after surgery (YES that much time!!!). That still leaves you with 2 to 3 hours per day for therapy, exercise, showers, walking, eating and other activities.
The second most important way to control swelling is to rest your body… sleep, read a book, watch a movie or meditate. This helps your body to recover from the stress of surgery and also decreases swelling and bleeding at the site of surgery.
The third technique to control swelling is COMPRESSION.
For hip replacement patients this means wearing tight shorts that extend to the mid-thigh. Examples are biking shorts, girdles, spanx, or exercise compression shorts. Wear them at ALL times except for showering for the first two weeks after surgery
For knee replacement patients this means using one or two 6 inch wide ace bandages to wrap the knee. The knee should be wrapped snugly but not too tight. The ace wrap should stay on for at least 20 hours per day for the first two weeks after surgery… you can remove it for showers and knee exercises
Both hip and knee replacement patients should also wear calf high compression socks/stockings at all times except for showers (yes even for sleeping!) for the first two weeks after surgery.
The last technique to control swelling is to apply ice to the wound, this is surprisingly the least important of the steps, you should apply ice round the clock for the first 5 to 7 days after surgery… 20 minutes on then 40 minutes off, you can skip the hours you are sleeping.
Ice should never be applied directly to the skin, it can be outside your compression shorts if you had a hip replacement or outside one or two wraps of the ace bandage if you had a knee replacement. A great technique for knees is to wrap the first ace bandage around the knee, then put the ice bag on the knee and then wrap the ice bag snuggly in place around the knee with the second ace bandage
Remember all this time spent elevating, resting, compressing and icing your surgery site still leaves you with 2 – 3 hours per day for exercises, walking, showering, eating etc. We suggest breaking this time into 4 separate 45 minute sessions per day.
Lastly there is one exercise you MUST DO EVERY HOUR when you are awake. This is the CALF PUMP EXERCISE …flexing and extending your ankle up and down strongly at least 30 times. This exercise helps to pump blood through your leg and is part of preventing blood clots which can develop after joint replacement surgery. This exercise will NOT increase wound swelling.
If you have additional questions about these instructions please ask your nurse or therapist before being discharged.
Lastly once you are home if you have more questions or problems please call the office at 609-927-1991.
COMMUNICATION AFTER SURGERY
We are here to help if there are problems after surgery… please call the office at 609-927-1991 with questions or problems. Often you will have to leave a message for your doctors physician assistant, they may be in the OR or seeing patients and not answer your call immediately BUT they absolutely will call you back the same day of your call.
Also, if something is going on that is URGENT please call the office at 609-927-1991 and select the option to hit # 8 for a patient with a postoperative URGENT problem. You will be directed to a physician assistant who will help you address your problem. Again we kindly ask that you limit use of this prompt to TRULY URGENT matters.
Please understand that urgent care centers and emergency rooms should be used only when ABSOLUTELY necessary. Obviously if a medical emergency such as significant shortness of breath, chest pain or change in mental status happens call 911 and/or get to the ER as soon as possible. If you do visit the emergency room please insist that the ER doctor speak DIRECTLY to your Shore Orthopaedic physician about your problem after it has been evaluated. The local emergency rooms all have a list with complete contact information for him.
Outside of these true medical emergencies however PLEASE let us evaluate your problem and decide if additional testing or medical evaluation is needed. Urgent care centers and emergency rooms may not be familiar with your surgical procedure and they may not be certain about what is normal and what is NOT normal after surgery. This can lead to unnecessary testing/ treatment or even an unnecessary hospital admission.
Your surgery is OUR surgery… and your outcome is very very important to us. Help us to take care of you after surgery by communicating what is going on and then giving us the opportunity to evaluate your concerns.
If, for whatever reason you don’t hear from us after several calls or if your condition is worsening, your health is the most important thing and you should get medical care wherever possible. It is our expectation and goal that this will never occur.
PAIN MEDICATION AND CONSTIPATION
As you are probably aware narcotic pain medications are both addictive and have multiple side effects including nausea, vomiting, confusion, constipation and mood changes.
Although they are necessary for a short time after surgery it is our goal for you to get off these medications and transition to non-narcotic pain medications like tramadol (which you have also been given a prescription for if not allergic) or over the counter medications like Tylenol, Aleve or ibuprofen as soon as possible.
Also because of changes in state law we can only prescribe a maximum of 60 narcotic pills at the time of surgery and a second additional prescription 1 to 2 weeks later for sixty pills. This second prescription is ONLY if needed. No additional prescriptions can be given.
Some guidelines to help…
- Do NOT take narcotic medications around the clock… take them only when absolutely necessary and don’t just keep taking more if the prescribed dose isn’t helping. One or two pills every 4 to 6 hours is the MAXIMUM dose but this is absolutely NOT the recommended dose. We want you to take much less then this dose and to wean off the medications as soon as possible. Start weaning off by taking the pain medications just 3 times per day, then just morning and night then just at night time until finally stopping them altogether and transitioning to Tramadol or Tylenol/Aleve/ibuprofen.
- Use non medication techniques such as meditation, massage, acupressure on the palm of the hand or sole of the foot to help control pain. Distract yourself by reading a book or watching a movie. Perform 5 minutes of eyes closed slow deep breathing. Have a good conversation with a friend or relative. All of these help greatly to control pain and distract the brain.
Being constipated will worsen your pain and makes you feel bad so DON’T LET IT HAPPEN. The combination of taking pain medications and being inactive can really cause difficulties moving your bowels. Here is how to avoid it:
- We ask every patient to use at a minimum Miralax one capful twice a day beginning the morning after surgery
- In addition to the Miralax don’t get dehydrated… drink lots of water as well as fruit juices such as prune, pear or apple juice that promote bowel movement
- Another great product is “smooth move” which is a hot tea you can find at most supermarkets, it really works!
- If the above is not working and you have not had a bowel movement in 48 hours after surgery move right away to the big guns like oral Dulcolax pills, Dulcolax suppositories, milk of magnesia or as a last resort a bottle of magnesium citrate.
All of the products listed above are over the counter and do not require a prescription. Once you are certain your bowel movements are back on normal schedule you can stop the medications and juices. Also obviously stop these if you experience diarrhea.