Surgery FAQ

Frequently Asked Questions About Surgery

WHEN WILL I KNOW WHAT TIME MY SURGERY IS AT?

a. The HOSPITAL will call you the day before to let you know what time and where to arrive on the day of your surgery.
b. You usually have to be there about 2-3 hours before your scheduled time.

WHAT MEDICATION SHOULD I DISCONTINUE BEFORE SURGERY?

• Seven days prior to surgery for the following:
b. Any anti inflammatory medication (for example Motrin, Ibuprofen, Advil, Aleve, Naproxen, Celebrex, Diclofenac, Mobic, Aspirin)
c. Any supplements or vitamins
d. Any anticoagulants (blood thinners) such as Coumadin, Xarelto, Eliquis
e. ****Any medication you might take for Rheumatoid Arthritis (or similar conditions) ex. Methotrexate, Imuran *** ASK Dr. LaReau: some of these medications need to be discontinued ONE MONTH PRIOR TO SURGERY ****

WHERE AND WHEN SHOULD I GO FOR MY PRE OPERATIVE TESTING?

a. You should get this done at the hospital or at your Primary Physicians office at least 2 weeks prior to surgery. It is best to have this done prior to your pre operative visit with us.
b. * However, do not get them done earlier than a month prior to surgery due to hospital requirements *

WHY DO I HAVE TO SEE MY DENTIST PRIOR TO SURGERY?

We want to make sure that you are not developing any infection that can later spread through the blood stream and seed your new implant causing an infection around the prosthesis.

WHAT IS THE SOAP I’M SUPPOSED TO USE PRIOR TO SURGERY?

a. It is called Hibiclens (Chlorhexidine), it is an antiseptic agent with topical antibacterial activity.
b. It can be purchased at any drug store such as Walgreens or CVS etc.
c. PLEASE SEE ATTACHED INSTRUCTIONS for further information

CAN I OBTAIN A HANDICAP PLACARD FOR MY CAR?

a. Yes if you decide to obtain one, just ask us for an application at your pre operative visit or we can send you one in the mail at any time.
b. You fill out the top portion of the front page and take it to secretary of state/DMV or mail it to Springfield (address provided on the back of the application).

HOW LONG WILL SURGERY TAKE?

On average it is about an hour and a half long. Surgery length can vary considerably however, depending on the condition of the arthritic tissues

HOW LONG WILL I STAY IN THE HOSPITAL?

a. Hospital stay is determined on your day-to-day progress.
b. An average stay is anywhere from 1-3 days.
c. If on post operative day 1, you feel good, your pain is well controlled, the medicine doctor and physical therapist clears you then it is acceptable to leave on the day after your surgery.
d. Physical therapy requires you are able to use stairs prior to discharge if you have them in your home
e. If you are a Medicare Patient, the insurance company requires you to stay for three nights if you choose to be discharged to a rehabilitation facility.

WHO DETERMINES WHERE I GO AFTER SURGERY?

a. It is mainly up to you, the extent of help and support you have at home, and the physical therapy recommendations in the hospital. We recommend planning IN ADVANCE where you will go prior to surgery
b. If you pass everything that is required of you from the physical therapist in the hospital and you are comfortable with going home you are certainly welcome to do so. A social worker in the hospital will see you and work on setting up a nurse and a physical therapist to work with you at home for about 3 weeks from surgery. You are not responsible for setting this up yourself, it will all be arranged in the hospital.
c. If you choose to discharge to a rehabilitation facility this will also be set up by the social worker in the hospital. You can certainly research facilities prior to surgery to have a couple favorites, however, a list will be provided to you at the hospital by the social worker with facilities that accept your insurance and are close to your house. Transportation to the rehabilitation facility is either with a family member or the hospital will set up transportation for you.
d. The amount of time you stay in the rehabilitation facility is up to you and your progress. Patients on average stay anywhere from about week to 3 weeks.

WHAT IS THE HIP PROSTHESIS MADE OF?

a. The cup that is placed onto the pelvis is Titanium and it has a plastic (polyethylene) liner on it
b. The stem that goes into the long femur bone is usually Titanium
c. Lastly the ball that is placed on the femoral stem is either ceramic or metal (cobalt chrome)

WHAT IS THE KNEE PROSTHESIS MADE OF?

a. Femoral components are metal (cobalt chrome) vs oxinium. Tibial components are typically titanium
b. There is a plastic (polyethylene) liner that separates them. The kneecap (patella) is usually resurfaced with a small plastic part placed on it as well. The remained of the knee cap (the part you feel on the outside of the leg) will remain.

WILL CEMENT BE USED ON MY REPLACEMENT?

a. Only if needed for the HIP replacement, mainly on the femoral stem. Most replacements do not require cement but are implanted via what is called a press-fit. The decision to cement is made in surgery if the bone is found to be too soft to support the femoral stem.
b. The cup usually does not get cemented but can sometimes require screws if the bone is found to be soft or deficient
c. Most KNEE replacements require cement for both the femoral and tibial components

WHAT HAPPENS IF I HAVE A METAL ALLERGY?

a. Depending on the kind of metal allergy you report, we might refer you for metal sensitivity laboratory testing prior to surgery
b. Both HIP and KNEE implants do have options for metal sensitive patients, example ceramic, oxinium.
c. The titanium hip implants are safe in patients with Nickel allergy.

WHEN WILL I FEEL BETTER?

a. * Every patient is different* and will need different length of rehabilitation depending on their age, health, activity level and level of impairment prior to surgery.
b. From our experience, average rehabilitation time is usually around 6-8 weeks for Hips and 8-10 weeks for Knees

WHEN CAN I GO BACK TO WORK?

a. Return to work depends on your recovery and the kind of work you are in.
b. We do not recommend returning to work while you are still taking narcotic pain medication and you are unable to drive for at least a few weeks following a right side surgery or if you drive a manual transmission car.
c. Some patients choose to work from home earlier but on average return at about 4-6 weeks (at times earlier with hip replacements) but this certainly depends on the job requirements. Some do need to be off for about 3 months.

WHEN CAN I DRIVE?

a. We DO NOT recommend driving while you are still taking any pain medication.
b. For RIGHT side surgery: we do not recommend driving for at least 3 weeks and this is only if you are no longer taking pain medication and are able to ambulate without any assistance. The reason for the delay in driving is not due to the amount of pain you might have, however, due to the possible delay in reflex raising your leg up and moving your foot from gas to break and vice versa. The muscles that allow to lift your leg up for this kind of action are in the surgical area and will take some time to strengthen after the surgery.
c. If you drive a stick shift we also want you to wait for 3 weeks.
d. For LEFT side surgery: You are able to drive as soon as you feel comfortable and if you are no longer taking narcotic pain medication. Most patients wait 1-2 weeks prior to driving but this is up to your discretion.

WHEN CAN I SHOWER?

a. You should not shower for one week following your surgery.
b. At one week you should continue to use a dressing to cover your incision and keep the incision as dry as possible until you see us for your first visit in the office which is usually 3 weeks from surgery.

WHEN CAN I TAKE A BATH OR GO INTO A POOL?

Not for AT LEAST one month from surgery and this is only if your incision is completely healed.

WHEN DO MY STAPLES COME OUT?

a. Your staples will come out at your first post operative visit which is usually at 3 weeks from surgery.
b. ** NOT all patients will require closure with staples **. This decision is made in surgery.
c. If you do not have staples but white strips on your incision then you should let those strips just fall off on their own.

WHEN WILL MY FIRST POST OPERATIVE VISIT BE?

It is at around 3 weeks from surgery. Vicky usually makes this appointment for you at the time of surgery scheduling. If you are unsure of your appointment time, give her a call once you leave the hospital to confirm this date, 630-794-8652.

HOW LONG SHOULD I TAKE PAIN MEDICATION?

a. Pain medication is to be taken on as needed basis. If you have little or no pain you do not need to take any. Some patients stop a few days after surgery but some will need some for a few months.
b. On average people mainly take medication around physical therapy time and at night time but this is up to you.

HOW LONG SHOULD I USE THE KNEE BRACE FOLLOWING KNEE REPLACEMENT SURGERY?

You should use the immobilizer each night until we tell you it’s ok to stop. Following knee surgery it is important to work on both the bending and straightening. It is imperative to use this brace in order to keep your knee straight at night time which will provide extra extension therapy.

HOW LONG DO I KEEP THE TED HOSE (COMPRESSION STOCKINGS) ON?

These are important to keep swelling down and prevent blood clots. It is important to wear them for at least 2 weeks. You can take them off at night time if needed otherwise keep them as much as you can tolerate.

CAN I SLEEP ON MY OPERATIVE SIDE FOLLOWING SURGERY?

Yes you are allowed to sleep on your surgical side. Sometimes patients place pillows in between the legs for comfort or with hip surgery they will place a pillow next to the operative side for extra cushion.

DO I NEED TO HAVE AN ABDUCTOR PILLOW BETWEEN MY LEGS WHEN I SLEEP AFTER A HIP REPLACEMENT?

a. You do not need this pillow if your surgery was performed through the anterior approach.
b. Posterior approach surgery DOES require this pillow.

WHAT ARE MY RESTRICTIONS AFTER KNEE OR HIP SURGERY?

a. NO KNEELING ever following a knee replacement surgery due to a risk of fracture of the patella and/or wearing out the implants faster
b. NO HIGH IMPACT ACTIVITIES (running, jumping, sky diving)
c. IT IS OK to ride a bike, hike, walk as much as you want following both knee and hip replacement

WHY AM I TAKING CELEBREX AFTER SURGERY (OR OTHER ARTHRITIS MEDICATION)?

This medication can be helpful for reducing inflammation and preventing the body from forming extra bone–in hip replacement particularly.

WHY AM I BEING CONTACTED BY ATI PHYSICAL THERAPY REGARDING MY POSTOPERATIVE CARE?

Hinsdale Orthopaedics works with ATI to assist in managing your progress and care transitions following surgery to improve efficancy, efficiency, and patient safety.

YOU WILL EXPERIENCE SWELLING AFTER SURGERY.

a. HIP surgery can cause some swelling of the whole thigh and even the whole leg anywhere from a few weeks to a few months. It is even possible to see some swelling that shows up as a small “bulge” around the incision area. This is usually normal and expected, especially in very slender patients. Let us know if this area becomes significantly red or the incision begins to drain.
i. * Let us know if you are experiencing increasing hip pain, swelling, redness, drainage or pain/redness in the calf

b. KNEE surgery: It is expected to have significant swelling of the knee following a total knee replacement. This can be of the knee and even the rest of the leg.
i. Swelling and Warmth of the knee following surgery can last anywhere from a few months to even a year.
ii. * Let us know if you are experiencing increasing pain, swelling, redness drainage from the incision or pain in the calf.

YOU SHOULD WAIT TO GO TO THE DENTIST FOR THREE MONTHS AFTER YOUR SURGERY.

a. You should take antibiotics for an HOUR prior to your dentist appointment (even for a simple cleaning) for at least 2-3 years after surgery.
b. HOWEVER, if you tolerate antibiotics well, it IS recommended to take these pre procedure antibiotics FOR LIFE to any dental procedure, colonoscopy etc in order to lower your risk of an infection developing around your implant in the future.

OTHER POSSIBLE COMMON REACTIONS AFTER SURGERY:

a. Low grade fever (100.5 F) for even up to a week
b. Small amount of blood or fluid leaking from the surgical site
c. Bruising, swelling as noted above and discoloration in the involved leg
d. Mild numbness close to the incision site or even the whole thigh or knee area for up to a year if not longer. Small amount of people will always have a slightly dull sensation around the incision site.
e. Mild weakness of the operative leg

USE CRUTCHES, CANE OR WALKER FOR AS LONG AS YOU NEED TO.

Your therapist will advance you as tolerated. It is better to use an assistive device than to limp when walking.

DO NOT PLACE ANY OINTMENTS OR LOTIONS ON THE INCISION UNTIL CLEARED TO DO SO.

Preoperative Hibiclens Bathing Instructions
Before surgery it is important that you take an important role in your surgical care. To assist in the prevention of a surgical site infection, we ask that you follow these instructions to prepare your skin to be as germ free as possible.

You will need to shower with a special soap called chlorhexidine gluconate (CHG). A common name for this soap is Hibiclens.

If you are allergic to CHG or for any other reason that washing with CHG is not possible, please follow the below instruction and use antibacterial soap.

1. Read the “Drug Facts” information and directions on the bottle:

a. Hibiclens is NOT to be used on the head or face, keep out of eyes, ears and mouth.
b. Hibiclens is NOT to be used in the genital area.
c. Hibiclens should NOT be used if you are allergic to chlorhexidine gluconate or any other ingredients in this preparation. * You can test a small amount on the palm of your hand first if there is any question.

2. Night Before Surgery:
a. When you bathe or shower:
1. Wash your hair as usual with your regular shampoo. Then rinse hair and body thoroughly to remove and shampoo residue.
2. Wash your face with regular soap or water only.
3. Wash your genital area with regular soap or water only.
4. Thoroughly rinse your body with warm water from the neck down.
5. Turn off the water to prevent rinsing the CHG soap off too soon.
6. Apply the minimum amount of Hibiclens necessary to cover the skin. Use Hibiclens as you would any other liquid soap. You can apply Hibiclens gently to the skin and wash gently for 5 minutes with a wash cloth. Pay special attention to the area of surgery.
7. Turn the water back on and rinse thoroughly with warm water.
8. Do not use your regular soap after applying and rinsing Hibiclens.
9. Pat yourself with a clean towel.
10. Do not apply lotion, powders or perfumes to the areas cleaned with Hibiclens.
11. Put on clean clothes.

3. Morning of Surgery: If time permits, follow ‘Night Before Surgery’ instructions but if time is limited, just wash the area intended for surgery as the instructions above state.