Surgery Information

PREPARING FOR JOINT REPLACEMENT SURGERY

Dr. Poole takes special care to ensure patients are well prepared for their surgery.  In most cases, this will be an outpatient surgery with discharge to home the SAME DAY!  Of equal importance, he wants to make sure that the patient’s caregiver/coach is properly selected and prepared.  In addition to providing excellent educational materials to patients, Dr. Poole personally meets with the patient and caregiver at a pre-op appointment to ensure everyone is up to the task of recovering at home.  The patient’s caregiver is critical to the success in recovering, as they will need to help with many of the patient’s needs for the first 1-2 weeks. 

SURGERY LETTER/APPOINTMENTS:

• You will receive a letter in the mail approximately 4-6 weeks before surgery, outlining your upcoming surgery appointments, both pre-op and post-op. Please pay careful attention to these, as they are very important and cannot be missed.  You will have 4 appointments prior to surgery and 2 appointments after surgery:

1. You will have a pre-admission testing appointment approximately 3 weeks prior to surgery for bloodwork, EKG, consent, and history, at the hospital you are having surgery at. Please bring your ID, insurance card and medication list to this appointment.
2. You and your caregiver/coach will attend a joint class 2-3 weeks before surgery which will provide more information with regards to surgery and recovery and what is expected of your caregiver/coach after surgery. This is very important information.
3. You will have a pre-op appointment with Dr. Poole around 2 weeks prior to surgery. We REQUIRE that your caregiver/coach also attend this appointment. We will go over care after surgery, discuss/make a physical therapy referral and answer all your questions at that time.
4. You will have two post-operative appointments about 10-14 days after surgery and 1 month after surgery. We will remove your bandage at the first appointment and discuss questions, activity, medications and physical therapy. At the second appointment, you will have x-rays and discussion about your continued recovery. 

PREPARING FOR SURGERY:

In addition to the appointments which will prepare you for the surgery, here are some additional considerations: 

DO NOT HAVE ANY DENTAL CLEANINGS, DENTAL WORK OR VACCINES FOR 6 WEEKS PRIOR TO OR 6 WEEKS AFTER SURGERY, as this puts you at higher risk of infection with your surgery.

Make sure you look around your house and have your home prepared for your recovery!

• Remove obstacles, loose throw rugs, and identify where you will recover, and have it ready with everything you will need (TV/Remote, water bottle, books, blankets, pillows.)
• Get any equipment you might need – walker, crutches, toilet seat riser and shower stool (this will be discussed more at the joint class)
• Make sure you will be close to a bathroom – you will use it a lot the first few days after surgery as you get rid of all the fluids.
• Visit the tab here on our website to find more information about exercises that are good to do before surgery.

Click here for Exercises before surgery

NIGHT BEFORE SURGERY:

• Stay well hydrated 2-3 days prior to surgery, use Liquid IV 1-2 times/day and morning of surgery in additon to your usual water and other drinks.
• Take a shower and use your shower kit as instructed.
• Take 1000mg (2 extra strength) Tylenol before bed.
• Poole will call you to review the plan and will give you COVID test results at that time.

DAY OF SURGERY:

• Wake up, start hydrating with Liquid IV, etc. (only clear liquids). You may have black coffee or tea, no cream or sugar.
• Take your normal medications, as directed, by pre-admission testing/Dr. Poole!
• Take 2nd shower and use shower kit as instructed.
• Head to the hospital and arrive on time!

WHY OUTPATIENT SURGERY:

Dr. Poole has over 25 years of experience in joint replacement surgery and things have come a long way from when he started.  He has gained experience and knowledge that will make your surgery outcome successful and your recovery much easier.  There are several benefits to having your joint replacement as an outpatient, including the following:

• Recovering in comfort – Patients feel more comfortable in their own homes than they do in the hospital. They know the layout, and therefore are more comfortable moving around their own environment, as well as not having all the noise and distractions that come with a hospital environment.
• Lower risk of blood clots – Patients who go home are moving around sooner and more frequently, and this significantly reduces the risk of blood clots.
• Lower infection rate – though hospitals do everything they can to reduce infections, hospitals also have more people, some sick, so there is inevitably a higher risk for infection in the hospital setting. In your own home, you encounter fewer people and have control over who comes in and out, which reduces your risk.
• Potential cost savings- for some patients, outpatient surgery may be a more cost-effective option, particularly if it is cash pay or due to limitations of your insurance coverage.
• The procedure and discharge criteria are the same whether you stay in the hospital or not. However, patients receive a short-term anesthetic timed for the length of the procedure, they receive pre-emptive multimodal medications and long-acting local anesthetic medication injected into the tissues around the joint during the surgery, giving excellent pain management.  In addition, patients receive a medication to reduce blood loss and drains or transfusions are never necessary.  All these things contribute to the overall well-being of the patient and make it possible for the patient to go home sooner.
• A physical therapist will work with you soon after surgery to guide you on what exercises to do and how to move so that you will be successful with mobility at home. A nurse will also review all the discharge instructions and answer questions prior to you going home.

POST-OPERATIVE INFORMATION TO PREVENT COMPLICATIONS:

The complication rate after surgery is very low.  While uncommon, all surgical patients are at risk of complications.  Please follow these post-operative instructions and protocols carefully. 

CARE OF YOUR INCISION:

• You may experience mild bleeding or drainage at incision sites which should stop after 2-3 days. Leave the surgical dressing in place until you see us for your first post-operative appointment unless it becomes saturated (covering more than ½ the dressing or leaking out of the dressing)
• You will likely notice significant bruising that develops after 2-3 days. This is completely normal and expected.  It can also be very sore to the touch and sensitive. It will move down your leg with gravity and can even end up all the way down to your toes.  This will resolve over the next 1-3 weeks after surgery. 
• Do NOT touch or pick at your incision. Do NOT place any antibiotic ointments, creams, or lotions on the incision until cleared by our team to do so. 
• Monitor your incision for any growing redness, drainage, tenderness, or pus and immediately notify our office if this occurs.
• You will have absorbable stitches that do not have to be removed. Occasionally, you may have a “tail” or knot that pops through the skin.  If this happens, contact our office.
• TOTAL KNEE PATIENTS: You will have a “Prevena” incision care system – this is a waterproof negative pressure surface suction that removes fluid from the incision (sometimes there is not any, but it is still working to heal your incision), reduces swelling and provides protection from infection. You must plug it in daily to re-charge it.  After 7 days, the lights will begin to disappear one by one each day, at which time the machine stops working, usually after 14 days.  We will remove it at your first post-operative visit.  When showering, just leave the canister/pump portion outside the shower.  See patient instructions below:
• https://www.mykci.com/patients/prevena-therapy-for-patients

SIGNS OF INFECTION:

• It is common to experience mild fevers during the first few days after surgery along with mild nausea, dizziness or lightheadedness from anesthesia or narcotic pain medications. Drinking fluids, Liquid IV electrolyte replacement, deep breathing exercises and moving around within the activity guidelines should help this.  These symptoms should improve within 2-5 days.
• You are given intravenous antibiotics surrounding the surgery to prevent infection. You do not need to continue taking antibiotics once you are home.
• Good hygiene is very important to prevent any infections from occurring.
• Some signs and symptoms of infection include: High fever (over 101.5 degrees F), redness around the wound that may grow bigger, pus (yellow or green) draining from the wound, night sweats or chills and severe tenderness around the site. Notify our office immediately if any of these are experienced.

SHOWERING:

• You may shower when you feel you are able to. NO BATHING or SUBMERSION of the incision site for at least 3 weeks.  Your bandage is waterproof, but you may cover with saran or cling wrap if it makes you feel more comfortable.
• Keep your incision clean and dry.
• Do not use any powder, lotion, ointment’s, or creams until your incision is fully healed and you have been cleared to do so.
• Avoid touching your incision site or picking at any scabs or dry skin.
• Do not allow pets near your incision site and do not allow it to become dirty.
• You will not be able to soak in a tub, pool, or other body of water for a total of at least 3-4 weeks or until the incision site is COMPLETELY healed.

BLOOD CLOTS:

• Blood clots, or DVT (deep vein thrombosis) can result from multiple factors after surgery. We strive to prevent this with blood thinning medications (aspirin or Eliquis), your DVT pumps, ankle pumps and other exercises along with routine walking per the activity guidelines given.
• Wear your DVT pumps during the day on both legs for 2 weeks. Take them off and charge them at night.
• When sedentary, make sure to move your ankles up and down (ankle pumps) throughout the day to help blood flow and decrease the chances of getting a blood clot.
• Please let a team member know if you experience any of the following: Large amounts of swelling that does not go down with rest and elevation, cramping in your calf or lower leg, sharp, sudden chest pain or any difficulty breathing or shortness of breath.  This can all be symptoms of a DVT (deep vein thrombosis) or PE (pulmonary embolus).  If you have a history of previous blood clots, please make sure to inform your surgery team about this before and on the day of your surgery!   

PAIN MEDICATIONS:

• You will be given a prescription(s) for pain medication (refer to the medication regime handout). Take your medication with food and only as directed on the label.
• DO NOT mix pain medication with alcohol or drugs.
• DO NOT drive while taking narcotic pain medication. You may reduce your use of narcotic pain medication as soon as your pain allows.  Try taking non-narcotic pain medication (such as Tylenol or Ibuprofen) before taking narcotics.
• Ice, rest, and elevation can also help significantly with pain management.
• Our goal is to have you off narcotic pain medication within 2 weeks after surgery. It is not advised to just suddenly stop these medications; it is better to wean off them.  We can help you with this or you can also discuss with your pharmacist.
• Narcotic pain medication is reasonable for short-term use after surgery. The goal of pain medication after surgery is not to be pain-free, but to have a tolerable level of pain after surgery. Some discomfort is inevitable. Narcotics are addictive and have many side effects including respiratory depression, mood changes, nausea, constipation, and pain amplification.  To understand the concern regarding the opioid epidemic, please refer to the CENTER FOR DISEASE CONTROL (CDC) website.
  
  
  

Click here for Pain Medication Schedule - Total Knee Click here for Pain Medication Schedule - Total Hip

Prescription Requests and Refills:

• Allow 24 hours for a refill or prescription request.
• Please call us a few days before you run out of your medication.
• Please be aware that it is best to call Mon-Thurs, in the event you may run out of pain medication over the weekend. 

CONSTIPATION

You may have constipation after surgery, particularly with the use of narcotic pain medication.

To avoid constipation:

1. Drink a lot of water and fluids (64 ounces per day minimum)
2. Increase fiber intake by eating dried or fresh fruits, whole grains, vegetables, bran, apple juice and prune juice.
3. Use stool softeners or laxatives, as directed.
4. Decrease or stop narcotic pain medication as soon as able.

You should not go more than 3 days without a bowel movement.  Call your doctor if you have any issues with bowel movements after all these measures. 

ACTIVITY:

• For the first 7-10 days, you should be down for 2 hours, then up for 20 minutes (only). When down, you need to be reclined in a recliner, in bed or reclined on the couch.  Sitting up counts as being up.  For knees, you should have your entire leg elevated on 1-2 pillows at or above the level of your heart.  For hips, you should elevate the leg while still adhering to your precautions given. 
• You will be given exercises by your physical therapist in the hospital. You can do these exercises (some when lying down, some when up) 2-3 times per day, except for ankle pumps, which can be done several times throughout the day.  If you are up and doing too much, you will swell more, hurt more, and delay your recovery.
• You will begin formal physical therapy 10-14 days after surgery. We will make this referral at your pre-op appointment and advise you when it is ok to start.  Physical therapy usually occurs 2-3 times per week for 6-8 weeks after surgery.

ICE USE:

• Swelling and bruising in your leg is normal and should decrease with time. Ice the area to help with pain and swelling per the following guidelines. 

Knees:  Use the ice machine – on for 1 hour (while down) then off for 1 hour.  Do this throughout the day and then ice 1 hour before you go to bed, then leave off.  If you wake up in the night and feel it needs ice, do it for 30 minutes and then go back to bed.  DO NOT leave the ice machine on all night!!

Hips: Use an ice pack.  Ice for 30 minutes while laying down then remove.  Do this throughout the day and before bed.  Do not keep ice on it all night, but you may ice it for 30 minutes if you wake up and feel it needs it. 

• After about 2 weeks, you can begin to decrease the amount of icing based on your pain and swelling. You will still want to ice after activity and physical therapy for a period of several weeks. 

• Knee Patients – It is recommended that you have an ice machine. Depending on the facility you have surgery at, you may need to obtain an ice machine.  These are not covered by insurance; however, we sell these at our office at a discounted price.

SLEEP:

• Getting back to a normal sleep pattern can be difficult. If you are having trouble, avoid taking an afternoon nap.  If pain is preventing sleep, schedule your pain medication so you can take 1-2 pills one hour before bed.  Elevate your leg and apply ice 1 hour prior to bed. 
• You may also try taking an over-the-counter sleep supplement once off narcotics if absolutely needed (such as CALM, Kirkland brand sleep aid, Unisom, Tylenol PM). Using meditation apps or relaxation techniques prior to bedtime may also help.

DRIVING:

• Driving after surgery is done at your own risk and you assume all liability when doing so. You must be off all your narcotic medications.  You must feel like you can operate the vehicle safely to avoid harm to yourself and others.  It can be helpful to sit in the driver’s seat and go back and forth between the brake and gas pedal to assure your reaction time is normal.  Be a cautious driver.  If an accident were to occur, you could be blamed due to your recent surgery.  Practice driving in a large, empty parking lot before proceeding on the road.

WORK/RETURN TO WORK:

• Most people return to work in approximately 4-6 weeks after surgery. At the minimum, you will need at least 2 weeks off from work.  Return to work depends on the demands of your job and on the procedure performed.  Desk jobs or working from home may be resumed more quickly, while heavy labor jobs or jobs that require a lot of standing or walking may require upwards of 8-12 weeks off.  You may request to be released any time you feel ready to return to the job, however, you should not return to full duty without physician clearance.
• FMLA/Disability Paperwork: As soon as you receive your surgery packet, you may want to contact your Human Resources (HR) department and determine what paperwork is necessary for you and/or your caregiver/coach to obtain leave from work.  We charge a $25 fee to complete this paperwork along with your return-to-work form.  Any additional paperwork will also incur a $25 fee.

I HAVE A NEW JOINT, NOW WHAT?

Use it, do not abuse it:

• In the first few months after surgery, you may still experience swelling and soreness, especially after increased activity. Slowly increase your activity over time and ice and elevate, if needed, after activity.
• Low impact exercises are best after joint replacement. Things like walking, swimming, and biking are the most joint-friendly.  Running, jogging, and weightlifting are possible, but cause more stress on the joints and can “wear it out” sooner.  Many of our patients still enjoy skiing, golf, tennis, and other activities after recovery from surgery.
• It is important to continue the home exercise program given to you by your physical therapist, indefinitely, to keep your strength and flexibility after joint replacement.

Follow-up:

• After your initial post-operative appointments, we will plan to see you back at the 1 year and 10-year mark for x-rays. If you are doing well, you will just get an x-ray and Dr. Poole, or our P.A. will review these and send a note with their report.  If you have questions or any issues, you can also get an appointment and see the provider to review these in person.

FAQ – Expectations After Total Knee Replacement  - you may experience: 

1. Numbness on the outside of the knee:

All patients will have a numb patch on the outer part of the knee after surgery due to skin nerves being cut during surgery.  It will slowly regenerate after surgery, but some people will have some numbness indefinitely.

2. Swelling in the joint:

You may experience swelling in the joint, after activity, for 3-6 months after surgery.  Some may experience permanent swelling.  Skin and tissues thicken after surgery and it is very common to have the operative knee look bigger than the non-surgical knee.

3. Clicking of the Joint:

The total knee is made of metal and plastic that move over each other during activity.  With this movement of these pieces over one another, you may hear noise especially for the 1^st year; however, it may never totally disappear.

4. Pain with kneeling:

You may experience discomfort or an odd feeling when kneeling on the knee.  This can be improved by placing a towel or knee pad beneath the knee.

5. Stiffness in the knee:

It is a common occurrence to hear from patients’ that there is residual stiffness in the knee after surgery even after regaining full range of motion.

6. Sharp sensation at top of knee:

Some patients report a “sharp” knife-like sensation around the top of the knee, It is not fully understood why this is experienced but is reported by some patients after total knee arthroplasty.