Frequently Asked Questions
Minimally Invasive Total Joint Replacements
Frequently Asked Questions Minimally Invasive Total Knee Replacements
Will I have swelling? How can I get rid of it?
Every patient with a total knee will have some amount of swelling and discoloration. This is a normal occurrence. The best way to get rid of swelling and bruising in the leg, calf and ankle is by elevating your knee at least above your heart and preferably above your eyes for two weeks. Much of the swelling you experience should subside in 3-4 weeks; however, a fluctuating small amount of swelling may persist up to a year. This in itself is not an indicator for a serious problem with the knee.
What is the clicking I hear and feel in my knee?
The sensation of noise you experience is normal. The knee is made of two metal pieces (femur and tibia) and two polymer pieces (spacer and patella). When two surfaces move over each other, the mechanical sound you hear and feel is the result of the rigid surfaces of metal and polymer meeting instead of the cartilage of a normal knee. It will improve over time, but will never go away completely.
When do I start PT?
Physical therapy should begin 3 days post op. For most patients this is the Thursday or Friday following surgery. This is the same therapist you worked with before surgery in your pre-conditioning. Please be sure to talk to your therapist about scheduling this before your surgery so that you don’t miss out on your first visit. This is an important visit because they can give you exercises to work on over the weekend. Total Hip Replacements do not require physical therapy.
How long will I stay in the hospital?
Most patients stay in the hospital one night and are discharged the following day after surgery. Assuming there are no medical complications following the surgery, if you are able to walk 100 feet with the therapists, you can be discharged home. We recommend that you try to complete this task because the shorter your hospital stay, the smaller your risk for infection. This also allows you to tailor your own medication regimen and sleep in your own bed with the leg elevated as much as possible.
Note: we are now allowing some patients to go home the same day as surgery. If this is the case, we will discuss it with you in advance and will plan for this pre operatively. The overall instructions are the same.
What kind of blood thinner will I go home with?
Surgery predisposes every patient to a risk of Deep Venous Thrombosis (DVT). However, most of our patients are very low risk for getting a blood clot. Common findings that would make a patient higher risk are personal history of a blood clot, family history of blood clots, cancer, recent surgery, and current estrogen product use. If any of these items pertain to you, please let Dr. Lionberger and your Internist know. In this instance you may be sent home with Xarelto or Eliquis which we use for higher risk patients. If none of these risk factors pertain to you, you may go home on Aspirin (81mg) once daily for 6 weeks. Aspirin should never be taken with any anti-inflammatory medication except Celebrex. Additionally, using the prescribed DVT Prevention Unit (calf compression device) may eliminate the need for anticoagulants if you are prone to bleeding. We HIGHLY recommend this devise as it gives us this option if needed. We personalize everyone’s DVT protocol and it will be discussed with you after your surgery.
What do I do about constipation?
All narcotics cause constipation and nausea. While medications we give you can help alleviate these problems it is up to you to monitor these conditions. Constipation can be a major problem if left uncontrolled. After discharge you will have to watch this on your own using the prescribed medication Movantik or over counter mediations. For over the counter medication, we recommend starting with Miralax the day you get home to get you started on the right track. An inexpensive, but highly effective medication is Mag Citrate, costing “pennies” compared to an ER visit for constipation. This is recommended if still no BM within 2 days. We also recommend calling your PCP, as they have extensive knowledge and recommendations as well.
When can I start walking after the surgery and how much?
You will begin formal physical therapy training with the Physical Therapists at the hospital the day after your surgery. When you get home you should focus on your outpatient physical therapy program and elevating your knee higher than your eyeballs. Remember, if you must walk, for every 15 minutes that you are up walking around you should be elevating the knee for an hour. This applies for the first 2-3 weeks depending on the amount of swelling that you may have. The first two weeks are crucial for elevation and are not to be spend sitting upright for long periods of time (so save the sitting for later!). Remember, sitting up and walking are your ENEMY!
How much calf pain is acceptable? When should I start to worry about blood clots?
Calf pain can be an indicator for a serious condition called Deep Venous Thrombosis (DVT). However, not all calf pain is a blood clot. Some calf tenderness is normal, especially while there is swelling and discoloration in the knee and calf. Severe calf pain is something that you should call Dr. Lionberger or your Internist about. Other signs and symptoms of DVT/PE can include but are not limited to fever, redness in the calf and shortness of breath. All these symptoms are something you should note and call about. When in doubt the best course of action is to go to the Emergency Room to get a Doppler study of your leg.
Why am I numb on the outer portion of my knee?
The Infrapatellar branch of the saphenous nerve is disrupted in all total and partial knee incisions due to the exposure. Although it is natural to experience some numbness on the outside of the incision, this sensation gradually adapts so that in several months it is not noticeable unless one touches the exact area.
Bathing? Cleaning? When can I shower? Wound care
You may shower as soon as you get home from the hospital. Wrap the knee in cling wrap to the best of your ability for the first week to keep a good seal and keep it dry. If the occlusive bandage is still in place, clean around it. This dressing is intended to remain in place for 7 days postoperatively (refer to your guide for dressing change information). This is important to help prevent infection by not exposing the wound to the open environment. After the first week you may let water run over the area, but avoid direct streams and soaking of the incision.
What if I live upstairs? Can I do stairs after the surgery?
Following knee replacement, you will be able to walk up and down stairs. Please let your Physical Therapist know this while you are in the hospital so they can show you the proper way to approach stairs during your rehab. If your bedroom is up a significant amount of stairs, you may want to arrange to sleep downstairs on a couch for the first few nights at home.
When will I be able to drive?
Most patients are able to drive after two to three weeks. Dr. Lionberger will advise you of this at your first Post op appointment which will be at the three-week mark. You cannot take narcotic pain medications and operate a vehicle. Also it is best not to drive yourself to physical therapy appointments so that you can take the pain medications so you will be able to accomplish more in your PT sessions.
Family Support
All of our total knee patients need family and/or friends to help them for the first few weeks following surgery. Knee replacement is a family affair. Patients will need a family member or friend to take them to and from the hospital as well as physical therapy appointments. If you are concerned about this and need some assistance, please call Dr. Lionberger’s office and they can advise you on a course of action for assistance following surgery.
Should I bring clothes to the hospital?
You can bring robes; sweats etc. to wear while you are in the hospital, just be sure they easy to get in and out of. Otherwise, you will be issued a hospital gown for your stay. You will need to have at least one change of clothes for discharge.
When should I get to the hospital?
Our office will call you the Friday before your surgery to tell you what time to arrive. Most patients will be assigned a time 2-3 hours before their posted surgery time. The reason for this is to ensure you receive all pre-op medications and for you to have adequate time to meet the Anesthesiologist before the surgery. Bring a good book as there may seemingly be a lot of wasted time the day of surgery; but fear not, important preparation work is being done behind the scenes.
Should I take my home medications with me to the hospital? What should I take the day of surgery? Which medications should I stop before surgery?
Do not bring your medications to the hospital, but it is always a good idea to bring a list of your medications with you. If you have questions about which medications to take the day of surgery, please call your Internist. Most medications that you take daily, with the exception of blood thinners, can be taken the day of your surgery with a small sip of water. If you are on any blood thinners, please be sure to speak with prescribing physician for instructions on when to stop and restart this medication.
Will I need the walker? When can I stop using it?
Before your surgery you will be given a prescription for a walker. The prescription will be give to you at your pre op visit, though many of our patients borrow one from a friend or a family member. You should pick this up before your surgery date. Take it to the hospital, but leave it in your car. They will have one for you to use in the hospital, but you will need to get home safely, hence why you have it in the car. Most patients use a walker for 1-2 weeks following the surgery. After surgery you may progress yourself from a walker, to a cane, then no assistive devices as you become more confident in your strength with walking. PT will help guide you in this process. Please ask them if you have questions or concerns about progressing from the walker. If you are concerned about decreasing the use of the walker, please wait until your three week visit with Dr. Lionberger so he can discuss it with you personally.
When do I start the prescriptions that were given to at pre op?
All patients are given prescriptions such as Hydrocodone, Celebrex, Ambien, Tizanidine and Zofran at the pre op visit. The Celebrex and Ambien are to be taken one day before surgery as directed. The Hydrocodone and Tizanidine is only to be taken after surgery. Please fill these medications when you receive them. None of the medications we give will need to be taken on the day of your surgery as you will get them at the hospital. If you have any questions about these medications please refer to your med hand out given at pre op or speak with your pharmacist.
When do I need to see my primary care provider for clearance?
You should make an appointment to see your 4-6 weeks before your scheduled surgery date. This allows them time to get the necessary tests done.
Do I need Specialist Appointments for clearance?
If you regularly see a cardiologist, hematologist, pulmonologist, or any other specialized physician, please call them to let them know about your surgery and make an appointment to get a clearance from them as well.
When do I need antibiotics?
For 2 years following your surgery you will need prophylactic antibiotics if you have any dental cleanings or any other surgical procedures. Antibiotics can be prescribed by your Dentist or treating Doctor. If your Dentist refuses to prescribe this medication, please call Dr. Lionberger at least a week before your procedure for a medication to be called in. Medications requested the day of your procedure will not be filled. The necessary medication is Amoxicillin 2grams-1 hour prior to the procedure or if you have a true Penicillin allergy, Clindamycin 600mg-1 hour prior to the procedure.
Frequently Asked Questions Minimally Invasive Total Hip Replacements
Will I have swelling? How can I get rid of it?
Every patient with a total hip will have some amount of swelling and discoloration. This is a normal occurrence. The best way to get rid of swelling and bruising in the leg is to ice and elevate it. Much of the swelling you experience should subside in 3-4 weeks; however, a fluctuating small amount of swelling may persist up to a year. This in itself is not an indicator for a serious problem with the hip.
When do I start PT?
Total Hip Replacements do not require physical therapy after surgery.
How long will I stay in the hospital?
Most patients stay in the hospital one night and are discharged the following day after surgery. Assuming there are no medical complications following the surgery, if you are able to walk 100 feet with the therapists, you can be discharged home. We recommend that you try to complete this task because the shorter your hospital stay, the smaller your risk for infection. This also allows you to tailor your own medication regimen and sleep in your own bed with the leg elevated as much as possible.
Note: we are now allowing some patients to go home the same day as surgery. If this is the case, we will discuss it with you in advance and will plan for this pre operatively. The overall instructions are the same.
What kind of blood thinner will I go home with?
Surgery predisposes every patient to a risk of Deep Venous Thrombosis (DVT). However, most of our patients are very low risk for getting a blood clot. Common findings that would make a patient higher risk are personal history of a blood clot, family history of blood clots, cancer, recent surgery, and current estrogen product use. If any of these items pertain to you, please let Dr. Lionberger and your Internist know. In this instance you may be sent home with Xarelto or Eliquis which we use for higher risk patients. If none of these risk factors pertain to you, you may go home on Aspirin (81mg) once daily for 6 weeks. Aspirin should never be taken with any anti-inflammatory medication except Celebrex. Additionally, using the prescribed DVT Prevention Unit (calf compression device) may eliminate the need for anticoagulants if you are prone to bleeding. We HIGHLY recommend this devise as it gives us this option if needed. We personalize everyone’s DVT protocol and it will be discussed with you after your surgery.
What do I do about constipation?
All narcotics cause constipation and nausea. While medications we give you can help alleviate these problems it is up to you to monitor these conditions. Constipation can be a major problem if left uncontrolled. After discharge you will have to watch this on your own using the prescribed medication Movantik or over counter mediations. For over the counter medication, we recommend starting with Miralax the day you get home to get you started on the right track. An inexpensive, but highly effective medication is Mag Citrate, costing “pennies” compared to an ER visit for constipation. This is recommended if still no BM within 2 days. We also recommend calling your PCP, as they have extensive knowledge and recommendations as well.
When can I start walking after the surgery and how much?
You are mechanically able to walk following surgery. However, spending time sitting up and walking will increase your chances of swelling. It would be best for you to lay down as much as possible in the first two weeks to allow your hip to heal properly.
How much calf pain is acceptable? When should I start to worry about blood clots?
Calf pain can be an indicator for a serious condition called Deep Venous Thrombosis (DVT). However, not all calf pain is a blood clot. Some calf tenderness is normal, especially while there is swelling and discoloration in the leg. Severe calf pain is something that you should call Dr. Lionberger or your Internist about. Other signs and symptoms of DVT/PE can include but are not limited to fever, redness in the calf and shortness of breath. All these symptoms are something you should note and call about. When in doubt the best course of action is to go to the Emergency Room to get a Doppler study of your leg.
Bathing? Cleaning? When can I shower? Wound care
You may shower as soon as you get home from the hospital. Wrap the incision in cling wrap to the best of your ability for the first week to keep a good seal and keep it dry. If the occlusive bandage is still in place, clean around it. This dressing is intended to remain in place for 7 days postoperatively (refer to your guide for dressing change information). This is important to help prevent infection by not exposing the wound to the open environment.
What if I live upstairs? Can I do stairs after the surgery?
Following hip replacement, you will be able to walk up and down stairs. Please let your Physical Therapist know this while you are in the hospital so they can show you the proper way to approach stairs during your rehab. If your bedroom is up a significant amount of stairs, you may want to arrange to sleep downstairs on a couch for the first few nights at home.
When will I be able to drive?
Most patients are able to drive after two to three weeks. Dr. Lionberger will advise you of this at your first Post op appointment which will be at the three-week mark. You cannot take narcotic pain medications and operate a vehicle.
Family Support
All of our total hip patients need family and/or friends to help them for the first few weeks following surgery. Hip replacement is a family affair. Patients will need a family member or friend to take them to and from the hospital. If you are concerned about this and need some assistance, please call Dr. Lionberger’s office and they can advise you on a course of action for assistance following surgery.
Should I bring clothes to the hospital?
You can bring robes; sweats etc. to wear while you are in the hospital, just be sure they easy to get in and out of. Otherwise, you will be issued a hospital gown for your stay. You will need to have at least one change of clothes for discharge.
When should I get to the hospital?
Our office will call you the Friday before your surgery to tell you what time to arrive. Most patients will be assigned a time 2-3 hours before their posted surgery time. The reason for this is to ensure you receive all pre-op medications and for you to have adequate time to meet the Anesthesiologist before the surgery. Bring a good book as there may seemingly be a lot of wasted time the day of surgery; but fear not, important preparation work is being done behind the scenes.
Should I take my home medications with me to the hospital? What should I take the day of surgery? Which medications should I stop before surgery?
Do not bring your medications to the hospital, but it is always a good idea to bring a list of your medications with you. If you have questions about which medications to take the day of surgery, please call your Internist. Most medications that you take daily, with the exception of blood thinners, can be taken the day of your surgery with a small sip of water. If you are on any blood thinners, please be sure to speak with prescribing physician for instructions on when to stop and restart this medication.
Will I need the walker? When can I stop using it?
Before your surgery you will be given a prescription for a walker. The prescription will be give to you at your pre op visit, though many of our patients borrow one from a friend or a family member. You should pick this up before your surgery date. Take it to the hospital, but leave it in your car. They will have one for you to use in the hospital, but you will need to get home safely, hence why you have it in the car. Most patients use a walker for 1-2 weeks following the surgery. After surgery you may progress yourself from a walker, to a cane, then no assistive devices as you become more confident in your strength with walking. PT will help guide you in this process. Please ask them if you have questions or concerns about progressing from the walker. If you are concerned about decreasing the use of the walker, please wait until your three week visit with Dr. Lionberger so he can discuss it with you personally.
When do I start the prescriptions that were given to at pre op?
All patients are given prescriptions such as Hydrocodone, Celebrex, Ambien, Tizanidine and Zofran at the pre op visit. The Celebrex and Ambien are to be taken one day before surgery as directed. The Hydrocodone and Tizanidine is only to be taken after surgery. Please fill these medications when you receive them. None of the medications we give will need to be taken on the day of your surgery as you will get them at the hospital. If you have any questions about these medications please refer to your med hand out given at pre op or speak with your pharmacist.
When do I need to see my primary care provider for clearance?
You should make an appointment to see your 4-6 weeks before your scheduled surgery date. This allows them time to get the necessary tests done.
Do I need Specialist Appointments for clearance?
If you regularly see a cardiologist, hematologist, pulmonologist, or any other specialized physician, please call them to let them know about your surgery and make an appointment to get a clearance from them as well.
When do I need antibiotics?
For 2 years following your surgery you will need prophylactic antibiotics if you have any dental cleanings or any other surgical procedures. Antibiotics can be prescribed by your Dentist or treating Doctor. If your Dentist refuses to prescribe this medication, please call Dr. Lionberger at least a week before your procedure for a medication to be called in. Medications requested the day of your procedure will not be filled. The necessary medication is Amoxicillin 2grams-1 hour prior to the procedure or if you have a true Penicillin allergy, Clindamycin 600mg-1 hour prior to the procedure.
David R. Lionberger, MD