Scheduling Your Surgery
Once you have decided to proceed with surgery, there are a number of things that need to be taken care of before the day of the operation:
Selecting a Date For Surgery
Dr. Martin’s medical assistant will schedule your surgery. Dr. Martin is usually scheduled out for about six weeks.
She will also assist you with preparing your preoperative studies including blood work, chest x-rays, ECG, and urinalysis. If you see a specialist (eg. cardiologist) some specialized tests may be required at an additional visit.
Appointment With The Primary Care Doctor (PCP)- ONLY IF DISCUSSED IN OFFICE.
Some patients may only require lab work, if this is the case please disregard this section.
Evaluation by an PCP is sometimes needed before we proceed with the operation. An appointment with the PCP is usually made 4-6 weeks before surgery, unless you have some serious medical problems that need more time to correct. If you have any infection (teeth, bladder, prostate, kidney, uterus, etc.), it should be treated and cleared up before undergoing joint replacement surgery.
Diseases such as diabetes and heart disease do not disqualify you from surgery, as long as they are under control. Some conditions may make the risk of joint replacement too great (chronic infection or a recent heart attack or stroke). The PCP will help you weigh the risks of surgery against your age and general health.
If Dr. Martin has talked to you about completing labs only prior to surgery, this is all you will need.
Surgery Location Information
If you are having surgery at our surgery center, SurgCenter of Greater Phoenix, the center will call you a few times prior to surgery. Once to confirm your date and insurance coverage and once a day before surgery to review your medical information. If you have questions for the center do not hesitate to call them.
If you are having surgery at Scottsdale Liberty Hospital, the patient advocate will call you prior to surgery. Once to confirm your date and insurance coverage and once a day before surgery to review your medical information. If you have questions for Liberty do not hesitate to call them.
Surgery and Your Current Medications
Non-steroidal anti-inflammatory medications should be stopped 7 days prior to your surgery. These medications are naproxen (Aleve), ibuprofen ( Motrin, Advil), aspirin (Bayer, low dose). . If you are taking aspirin or aspirin-containing drugs such as Percodan, Excedrin, Anacin or taking multivitamins, vitamin E oil, or fish oil these should also be stopped 7 days prior to surgery .
If you are on Coumadin it will have to be stopped, under the supervision of your prescribing physician, several days prior to your surgery.
The reason that these medications are discontinued is because they can increase bleeding at the time of surgery.
Extra strength Tylenol, Vicodin, Percocet, Norco, Ultram and Tylenol with Codeine may be taken by mouth up to the night before your operation. Your PCP may want you to take certain of your regular medicines (for high blood pressure, diabetes, hypothyroid etc.) with a sip of water on the morning of surgery, even though you are not supposed to eat or drink anything after midnight. You may do so.
Prepare your Home for Return
When you return home from the hospital, you will be using a walker for balance. These small preparations can make the transition home smoother:
1.Ensure hallways and rooms are free of clutter and tripping hazards
2.Organize your living areas to avoid excessive lifting, bending or reaching
3.Store heavy and frequently-used objects at or above waist level (counter height).
4.Consider moving items in the lower parts of the fridge/freezer to a higher shelf.
5. Consider preparing a bedroom area on the main living level for short-term use upon your return home
6. Set up a firm chair with armrests
7. Arrange for extra help with household tasks if needed
8. Keep an ice pack in your freezer for possible joint swelling after surgery. A bag of frozen peas will also work.
What to Bring
The Night Before Surgery
The night before surgery, you should take a long shower or bath utilizing antibacterial soap and be sure to scrub the surgical limb ( either provided in the class or purchased at a local pharmacy). Avoid heavy fragrances or skin irritating products.
On the night before surgery do not eat or drink after midnight. Food in the stomach can cause anesthetic complications. Do not smoke or drink alcohol for 48 hours before surgery. Smoking increases anesthetic risk. Alcohol delays emptying of the stomach.
Patients are admitted the same day as the surgery. You will check in 90 minutes prior to your surgery. Please be on time.
When you arrive on the morning of surgery, go directly to the surgical services office. A map will be provided in the preop packet. From there you will be taken to the pre-anesthesia area where you will change into a hospital gown, and an intravenous line will be started.
The anesthesiologist will see you there and discuss anesthetic options and risks. He will discuss the advantages of general anesthesia in conjunction with an adductor canal block ( a lower leg pain block). At this time the anesthesiologist will administer some sedative medication and you will be transferred to the OR.
In The Operating Room
Total knee replacements range from 45 to 60 min. You will be in the operating room for about another 45 minutes (for anesthetic induction before, and recovery after, the operation). Your incision will be closed with 3 layers of absorbable sutures and steri-strips (little white bandages), no stitches or staples to remove. A large ace bandage will be placed after the surgery has been completed.
When the operation is over, Dr. Martin will meet with relatives or friends in the surgical waiting area to give them a progress report.
What to Expect After Leaving The Operating Room
You will wake up in the recovery room. You will be comfortable and usually surprisingly free of pain. You will have “calf pumps” on your legs: pneumatic pumps which help to prevent blood clots. You will be in the recovery room for about 1-3 hours. During this time you will have physical therapy assess your ability to walk with either crutches and a walker. They will also teach you exercises to do at home for the next 3 days, or until you begin therapy.
Patient Instructions for Home Care
-Your dressing, the large ACE wrap, is to remain in place for three days after the surgery.
-You may remove the dressing yourself after three days. Unwrap the ACE. You will find a white cotton wrap underneath. You may carefully cut or tear this away. Beneath that are steri-strips ( little white or brown bandages) . If some of this come off with the removal of the bandage, this is fine. For the rest that remain attached, do not try to peel it off.
– If your incision shows no drainage, you may leave the leg open to the air and begin showering.
– NO SOAKING in a bathtub, hot tub, jacuzzi, or pool until after your follow up in the office.
– If your incision is draining, cover the leg with gauze ( from any pharmacy) and re-wrap in an ace bandage. Check daily to see when the draining stops. Also notify the office.
– You will be taking Aspirin 81mg, 1 pill in the morning and 1 pill at night starting the night of your surgery. You will do this for 2 weeks to prevent blood clots. Over the counter Aspirin is fine, and any brand will do.
– If you have a history of blood clots or are allergic to aspirin, we will prescribe Xarelto for you. This will be taken for the 2 weeks in place of the aspirin.
-If you are already on blood thinning medications your prescribing doctor should have discussed when to resume your medications.
– Your block anesthesia will continue to work for about 48 hours after your surgery, and in that time you will be premedicated so that when the block fades, your pain will remain managed.
– Our office will provide you with a prescription for pain medication via the pharmacy provided to us in your portal.. Take this medication as instructed on the bottle. Stay ahead of your pain, especially for the first 2-3 days and when therapy begins. If you are allowed to take NSAIDS, Ibuprofen ( Advil, Motrin) or naproxen (Aleve) can be taken with the pain medication that the hospital gave you. 800 mg of Ibuprofen every 8 hours or 500 mg of naproxen twice a day in addition to your pain meds may help alleviate any residual pain.
* be aware that these drugs can increase risk of bleeding when given with the aspirin, please watch for nosebleeds, bleeding on urination, or increased drainage from your incision.
-All patients are given antibiotics through their IV to prevent infection. starting just before the operation. No antibiotics are needed after.
– Stool softener: Narcotic pain medications are extremely constipating. While you are in the hospital you will be given a medication called Colace to soften your stools. We highly recommend continuing on with this medication at home while you are taking the pain medication to prevent impaction. Colace (docusate) is over the counter and can be purchased at any pharmacy.
– Many patients still develop constipation and need a mild laxative on the second or third day after surgery, Dr. Martin recomends milk of magnesia most commonly if the colace is not working.
– NSAIDS: It is ok to start taking anti inflammatories after your wound stops draining and after the OK from your PCP or our office.
– Tylenol: is ok to take IN PLACE of your narcotic prescription. Most narcotics have tylenol in them already, do not take at the same time.
-ICE: ice will always be helpful in reducing pain and swelling. Icing anytime after activities will be beneficial. Make sure to have a soft material between your skin and the ice. NEVER PUT ICE DIRECTLY ON THE SKIN.
– Normal Medication you take at home: will be determined by the doctor before you leave the hospital. If you have questions regarding this list you are given, please call your PCP.
– We often set up home therapy for our total joints after surgery, you should receive a phone call regarding this.
– If you would like to start out patient therapy right away, you will be provided a physical therapy prescription and an option of locations close to your home.
– Before formal therapy begins, please do the exercises the hospital provides every day around 3 times a day to help your knee begin recovering.
– You will be provided a prescription for physical therapy at your follow up appointment if you opt for home therapy
– We recommend using the walker or crutches for balance purposes for the first 2-5 days around the house and out in public for at least a week depending on your stability
– Your follow up appointment should be scheduled when you schedule your surgery, typically they are within a week from surgery. At this time we will reassess your status.
20401 N 73rd st Suite 155
Scottsdale, AZ 85255
Concerns at Home
– Note that practically every patient runs a temperature up to 99.5 or even a hundred degrees in the first few days after replacement surgery . It is so common as to be considered “normal”. If your temperature goes over 101 degrees it starts to be a source of concern. If it does exceed 101, please call the office.
– Drainage from the wound is not uncommon. Drainage is treated with regular dressing changes and no showering until it ceases. Some types of drainage can indicate infection. Note if you have new drainage after the incision has already healed, if the drainage is cloudy or green, and if it has a strange odor. These symptoms and increasing redness around the wound, could signify impending infection. Our office should be notified, and in most instances you will need to come in and let Dr. Martin or Allyssa take a look at it.
If you have questions or concerns that have not been answered or any issues arise please call our office, or if you have a medical problem that cannot be handled over the phone go to Scottsdale Thompson Peak’s ER for immediate care.
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****In case of a true medical emergency, please do not wait for a return call, head straight to the nearest ER****