FAQs
When do I know it’s time for a knee replacement or hip replacement?
This is a hard decision for many patients, and you are not alone! I think this is decision best made by the patient after consultation with his or her doctor. I recommend waiting until you have arthritis that is causing pain that bothers you on a daily basis and is affecting the activities that you want to do.
Should I delay my surgery because of covid-19?
This is also a hard decision for patients, and it depends on your risk factors. HSS is an orthopaedic specialty hospital that only treats orthopaedic conditions and does not treat COVID-19 now. All surgical patients are tested for COVID prior to surgery. We follow a strict mask policy and enforce limited visitor guidelines in order to lower the risk of transmission as much as possible. For most patients with an arthritic knee or hip, proceeding with surgery under these conditions is quite safe and there is no need to delay.
As of Fall 2021, all employees at HSS are required to be vaccinated. It is my strong recommendation that you vaccinate against COVID-19 prior to elective surgery.
Which surgical approach is the best for total hip arthroplasty (THA)?
There are 2 main approaches to the hip used most commonly today: the posterior approach and the anterior approach. Both are safe approaches to use, and I perform both approaches. I select the approach that is right depending on the patient. While the complication rate is equal overall, there are advantages and disadvantages to each approach. The posterior approach affords an extensile exposure to the femur and acetabulum and is the preferred approach in complex cases where extensive exposure is required. Most revisions will be performed posteriorly for this reason.
The anterior approach may have a slight advantage in terms of early recovery. A recent study from the Mayo clinic showed that patients are able to walk without a cane or walker 24 hours earlier after an anterior approach compared to a posterior approach. The risk of dislocation may be slightly lower after anterior approach compared to the posterior approach. One disadvantage of the anterior approach is a slightly higher risk of wound complications as the skin is thinner anteriorly and closer to the groin. The rate of wound complications is even higher for obese patients with the anterior approach so it is generally avoided.
Both approaches can be considered “minimally invasive.” The goal of surgery is the same regardless of the approach: to eliminate hip pain and improve mobility and hip range of motion.
Medical Clearance/Medications
On your pre-admission testing day, an internal medicine physician will evaluate your health and provide a risk assessment for surgery (medical clearance). This generally involves blood work and a physical exam.
Patients who take blood thinners such as Coumadin, Plavix, Lovenox, Eliquis, Xarelto, etc. must speak to their doctor and/or cardiologist for specific instructions for discontinuing prior to surgery. We generally hold these medications for a period of time leading up to surgery except in rare cases.
Full strength aspirin (325 mg), anti-inflammatories (NSAIDs) like Advil, Aleve, Celebrex, Mobic, Diclofenac should be discontinued 7 days prior to surgery. Baby aspirin (81mg) can be continued.
If you take opioid medication (Percocet/oxycodone, Norco, Vicodin, Dilaudid, etc) regularly then we will also refer you to a chronic pain specialist prior to surgery.
Use of any tobacco product or recreational drugs needs to be discontinued for at least 30 days before and after surgery. If you need help quitting smoking, please ask and we can refer you to our smoking cessation experts. The risk of wound complications and infections is increased significantly in patients who smoke.
Day Before Surgery Instructions
A nurse from the call center will contact you after 3:00 PM the business day prior to your surgery with instructions. They will inform you of the time to arrive at the hospital and where to go. You may call (212) 606-1630 at any time to hear a pre-recorded message giving pre-operative information.
You may follow a regular diet the day before surgery. No solid food after midnight, clear fluids only.
All jewelry and piercings must be removed.
What pain medication will I use after my surgery?
Most patients require pain medication for the first 5-7 days following surgery. We use a multimodal approach to pain management. This means we use medications that target different pathways to lower pain levels. There will be modifications at times based on responses to these medications during your time in the hospital, but in general the regimen is as follows:
Acetaminophen (Tylenol) oral: take 1000 mg (2 tablets of extra strength Tylenol) every 6 hours. Multiple studies demonstrate that taking oral acetaminophen regularly in the first few days after surgery will lower the amount of narcotic/opioid pain medication that is required. For the first 5 days I recommend taking acetaminophen routinely every 6 hours. After that the acetaminophen can be taken as needed. Patients with liver disease will need to avoid acetaminophen.
Meloxicam (Mobic) oral: take 15 mg once a day for the first 4 weeks after surgery. This is a strong anti-inflammatory (NSAID). If you are taking this medication you should not take additional NSAIDs such as ibuprofen (Advil) or naproxen (Aleve) while you are taking Mobic. Patients with kidney disease or ulcers will not be prescribed this medication. If an alternative NSAID such as Aleve or Advil is your preference, then you can take this in liu of Mobic, but you should not take both.
Pantoprazole (Protonix) oral: take up to 40 mg once a day. This is a proton-pump inhibitor that is typically given to patients while they are taking meloxicam (Mobic) to protect the GI tract from ulcers. You can discontinue this when you discontinue the meloxicam.
Oxycodone oral: 5 mg tablets (take 1-2 tablets) every 4 to 6 hours as needed for breakthrough pain. Most patients take this periodically for the first 5-7 days after surgery. This medication is an opioid (narcotic) so it may be avoided in elderly patients to prevent confusion/delirium. Some patients prefer to avoid narcotics entirely after surgery. Opioids are habit forming, and for this reason I recommend you begin weaning from them as soon as possible.
Tramadol: 50 mg to 100 mg every 6 hours as needed for breakthrough pain. This is also a narcotic, but generally milder than oxycodone. It can be used instead of oxycodone or in combination with oxycodone for treating acute postsurgical pain.
Colace/Senna: These are stool softeners that may be prescribed and can also be purchased over the counter. You should take this as long as you are taking a narcotic for pain control (oxycodone/tramadol/dilaudid, etc) as these will lead to constipation.
How long will I spend in the hospital after my surgery?
Most patients spend 1 night in the hospital after their surgery and leave later in the day the following day. If you have surgery on Monday, you will likely leave Tuesday afternoon. Younger patients without medical problems may leave the same day of surgery and elderly patients may spend more than 1 night in the hospital prior to discharge. No matter what, we will make sure that you are safe to be home prior to discharge. This means you will have to “clear” physical therapy by demonstrating that you can safely ambulate around your house. If you have stairs at home, you will also practice stairs with the therapist while in the hospital.
When can I drive after surgery?
All opioid medication must be discontinued prior to driving. Patients undergoing a left-sided THA or TKA will be able to drive within a few weeks after surgery. However, driving is delayed longer after a right-sided THA or TKA as it is the braking side. I recommend you wait until you are comfortably ambulating without a gait aid and are confident in your reflex time in moving that side. This is typically around 4-6 weeks after a right-sided THA or TKA.
My leg is swollen/Bruised after surgery. Is this normal?
Swelling is expected after surgery. The swelling tends to increase and peak around 2 weeks following the operation. Bruising is also expected and can track all the way to your foot over time. For swelling that becomes bothersome, I recommend compression socks. You can purchase these at the Recovery Shop website. https://shop-recovery.com/pps-password-form/?c_id=67 (CODE=HSS38) I also recommend that you keep the leg elevated as much as possible (when you are not ambulating) for the first week after surgery. Some degree of swelling will be present on the side of surgery up to 4-6 months after your procedure.
Swelling that is associated with a localized area of tenderness in the calf is concerning for a blood clot. If you develop calf tenderness in combination with swelling, call us to discuss and we may consider an ultrasound to diagnose a deep vein thrombosis.
Do I need to ice the leg after surgery?
Icing your knee or hip after surgery can help reduce swelling and inflammation and is recommended. After knee surgery, I recommend the Polar Wave or Polar Cube ice machine for icing. You can purchase this through the Recovery Shop website. https://shop-recovery.com/pps-password-form/?c_id=67 (CODE=HSS38) This is not required, and if you prefer to use your own icing regimen, that is absolutely fine. Do not ice to the point of numbness as this could lead to frost bite type of injuries.
Can I shower after surgery?
In the majority of patients following primary TKA or THA, I use dissolvable sutures and Dermabond glue to close the skin. This is then covered with a Mepilex adhesive dressing. The Mepilex dressing should stay in place for the first 7 days after surgery and then can be removed. It is ok to start showering on the second day after surgery. Let water run over the area, but do not scrub the bandage or the incision once the dressing is removed.
If you have incisional drainage after 48 hours after surgery, please call the office to talk with Dr. Gausden or one of the nurse practitioners (212) 606-1897.
What physical therapy should I do after surgery?
Total Knee Arthroplasty (TKA): for the first 2 weeks a physical therapist may go to your house (home PT) to help you mobilize, teach you exercises, and help you regain your range of motion (ROM). Within 2 weeks from surgery, our goal is to get the knee fully extended (straight) and bending to 90 degrees (a right angle) or more. The risk of not moving the leg after a TKA is that the knee could become quite stiff and ultimately require another operation (manipulation under anesthesia) in order to break up scar tissue and regain motion. Walking in combination with these PT exercises to regain ROM are the requirements for the first 2 weeks. Generally, after 2 weeks you can start gentle exercise (stationary bike with low resistance, Elliptical trainer, etc.). After 2 weeks you will also begin outpatient PT.
It is possible to “push too hard” during the first few weeks after surgery. Listen to your body and if you walk to the point of exhaustion and end up able to less the next day, you have “overdone it.” Aggressive massage around the knee cap after surgery should be avoided as well.
Total Hip Arthroplasty (THA): for the first 2 weeks after THA the majority of the exercise you will be doing will revolve around walking. Keep it simple and maintain your hip precautions if you had a posterior approach. After 2 weeks you may start using a stationary bike, Elliptical trainer, etc. A physical therapist may come to your home (home PT) for the first few weeks and after 2 weeks you can start outpatient PT.
What should I be concerned about or look out for after my surgery?
Excessive redness around the incision, dehiscence or opening of the incision, drainage for more than 3 days after surgery, or fever of greater than 101.5°F
Do i need to use antibiotics before going to the dentist after a THA/TKA?
Yes, I recommend taking amoxicillin 2000 mg (4 x 500 mg tabs) one time an hour before you have dental work done. This can be prescribed by our office or your dentist. It is my preference you wait on nonessential dental work for 3 months following the THA or TKA.
What should I buy for around the house?
This depends on your specific situation. You will be set up with a preoperative physical therapy session and they will discuss this with you ahead of your surgery. You can see my list of recommendations on the Recovery Shop website according to procedure. https://shop-recovery.com/pps-password-form/?c_id=67