Perfect execution of joint replacement surgery requires patient engagement throughout the entire process. In the SwiftPath program, you and your caregiver will be given the tools to help make the best decisions for your care, decrease surgical pain and the need for narcotics, reduce complications, and help to guarantee the outcome of your surgery.
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Do not take Flu-Mist (intra-nasal vaccine). This is a live, attenuated vaccine that can result in mild illness, which can be spread to other immuno-compromised hospital patients. If you do receive the Flu-Mist vaccine, it should be at least 2 weeks before or after surgery. Do not receive the standard, injected flu vaccine within one week of surgery.
Typically, we do not require this before surgery. New techniques in preserving blood or even getting your own blood back have prevented the need for you donating prior to surgery.
We recommend that all of our patients do their best to quit smoking. Nicotine use has been linked to delayed healing and increases the risk of infection.
How much time do I need to take off work following hip replacement surgery?
We try to return you to work as soon as possible. This may be as early as 2 weeks, depending on your job description. If you are able to sit at a desk or do minimal walking in a day, 2-3 weeks is reasonable. However, if you are required to be on your feet all day or walk extensively, this could take 6-8 weeks. Our goal is to get you back to work when you are safe and your pain is controlled.
It may be necessary to take 3-6 weeks off work depending on the physical demands of your job. If you are able to sit at a desk or do minimal walking in a day, 2-3 weeks is reasonable. However, if you are required to be on your feet all day or walk extensively, this could take 6-8 weeks. Our goal is to get you back to work when you are safe and your pain is controlled.
Dr. Kuechle is the only one who will be performing your surgery. For some surgeries, we do use assistants to hold or retract tissue, pass surgical instruments, and assist in closing the wound.
It is important not to eat after midnight the night before surgery. Any food in your stomach can lead to anesthetic complications. Please be sure not to have any food unless directed by your physician or anesthesia prior to surgery. But it is important to remain hydrated on the day of surgery. Water and other clear beverages (Gatorade, black coffee or tea) may be consumed until 3 hours before your scheduled surgery. No milk, cream or sugar is permitted.
"General" anesthesia is given through a tub in your throat or mouth. "Spinal" anesthesia uses a single shot in the lower back to numb the legs. Local anesthetic is injected into the surgical site. Prior to your surgery you will meet your anesthesiologist. It is important to discuss the type of anesthetic you will receive at that time. During hip and knee replacement, spinal anesthesia is most commonly used at our institution and allows for a faster postoperative recovery when compared to "general" anesthesia.
Bring comfortable clothing, a list of your medications and your SwiftPath guide.
It is very important that you have an accurate list of your medications prior to surgery. We will be able to tell you what medications to stop. This typically includes medications that will cause your blood to be thinner. Please bring the list with you prior to surgery.
Preoperative clearance is very important. There is no one that knows you better than the doctor who has been taking care of you. We want to make sure your lungs, heart and kidneys are all working as best as they can be before surgery.
Your nurse will take you to the operating room and you will be placed on the operating table. In the operating room you will notice there will be several people; a surgical tech that will be responsible for passing instruments and several nurses. The room is often cold. It is important to maintain a temperature that reduces the risk of infection. If you have any questions, please do not hesitate to ask them so we can make your brief time in the operating room more comfortable.
Please do not wear any make-up on the day of your surgery. This may interfere with our ability to perform anesthesia.
We ask that when you come to surgery that you do not have nail polish on your fingernails. During surgery we monitor your oxygen level through the fingertip. This can interfere with our ability to get a good reading.
Please do your best to remove all body piercings prior to surgery.
Loose and comfortable clothing. When you arrive at the surgery center or hospital, we will ask you to wear a surgical gown. Following the procedure, loose comfortable clothing will make it easier for you to get dressed and home safely.
Yes, you are still under the influence of an anesthetic and pain medication. You will need a ride home from the surgery center or hospital.
It is very unusual in the first 24 to 48 hours after surgery to see a wound infection at the site of surgery. High fever would be the first sign that we have a problem. A mild elevation in temperature (up to 100oF) does not mean that you have an infection. However, we ask that you check the wound for foul smelling drainage ,increased swelling or redness. If you are concerned about infection, please don't hesitate to contact us.
In hip and knee replacement breaking times and reaction speed can be diminished during the first 4 weeks after surgery. The important thing is to practice before getting out on the open road and be sure that you are safe getting from the brake to the gas and vice versa. Remember that it is illegal to operate a motorized vehicle under the influence of pain medication.
What are the signs of blood clots?
Although rare, blood clots do occasionally occur after hip and knee surgery. The signs of a blood clot are swelling in your legs that is worsening and will not go down with ice or elevation. A blood clot can also cause marked tenderness and pain in the calf (remote in the surgical site). However, some lower leg pain and swelling is expected following joint replacement. If you are concerned about a blood clot based on these signs, please call us and we will order the appropriate tests.
If your dressing is too tight, it is often because there has been additional swelling since surgery. The first thing to do is elevate your leg. Usually with elevation or icing, you will see that the swelling resolves on its own. However, if the dressing continues to feel too tight, it is okay to loosen any compressive wraps (such as an ACE bandage). If you experience numb or blue toes, please call us for further instruction.
Following knee replacement surgery, patients are often concerned about clicking or popping in their knee. Please remember that part of your knee is metal and part is plastic. During normal activity these surfaces can tap each other, resulting in the audible click. This sensation typically diminishes over the first few months.
Following surgery, you may have bleeding through the dressing. Often this is the size of a quarter or slightly larger. Please do not remove the dressing. Instead, reinforce it by putting another dressing on top of the current dressing. If it continues to bleed and you are concerned, please do not hesitate to contact us.
Constipation occurs when a person has 3 or fewer bowel movements in a week. It may be difficult or painful to "pass" stool. The stool may be hard or dry and you may feel "full" or uncomfortable. Not everyone has a bowel movement every day. Elimination patterns vary from person to person. The number of bowel movements you have may depend on what types of foods you eat, the medication you are taking, how much exercise you get, and other factors.
As long as you follow the post-operative precautions specific to your surgery, it is typically safe to have sex 4 weeks after joint replacement.
Please do not immerse the surgical area in water (bath, swimming pool, hot tub Jacuzzi, ocean) until the incision is totally dry and at least 6 weeks have passed.
After hip and knee replacement surgery, TED hose stocking may have been placed on your legs. This is to control the collection of blood in your legs while you are standing or walking. You are asked to continue wearing the hose on the operative leg, but may remove them at night and for showers. Two weeks after surgery, you may remove the hose but you may find that continuing to wear them on the operative leg reduces swelling.
Traveling in a car for long distances is typically safe as early as 2-3 weeks following hip or knee replacement. We do ask that when traveling you continue to perform ankle pumps and get out of the car every 60-90 minutes to walk. This will prevent the pooling of blood in your legs and the possibility of a blood clot. If you plan to fly after surgery, we ask that you wait 1-2 weeks if possible to reduce the risk of developing blood clots. If you do fly, we ask that you wear your stockings and perform ankle pumps during the flight. Please get up and walk the aisle of the plane at least once very 60 minutes. Occasionally blood thinners for high risk patients will be prescribed before lengthy air or car travel.
Following surgery, there may be circumstances that make it necessary for you to go to the emergency room. Certainly for chest pain or shortness of breath, please call 911. However, if you have a question about drainage from your wound or possible infection, please contact our office before making a trip to the ER.
When you discharge home, our goal is to get you walking and moving as quickly as possible. You will be caring for yourself, getting in and out of bed by yourself and certainly using the bathroom on your own. By 2-3 weeks after surgery we expect you to be walking well with minimal pain. In some, this may still require assistance of a cane or walker, but simply for balance. 6 weeks after hip replacement, we will allow you to return to most occupations and activities that you enjoy such as golf, simple walking or even bicycling. 3 months after hip replacement surgery you are starting to participate in a full round of golf or tennis.
When you discharge home, our goal is to get you walking and moving as quickly as possible. You will be caring for yourself, getting in and out of bed by yourself and certainly using the bathroom on your own. By 2-3 weeks after surgery we expect you to be walking well with minimal pain. In some, this may still require assistance of a cane or walker, but simply for balance. 6 weeks after knee replacement, we will allow you to return to most occupations and activities that you enjoy such as golf, simple walking or even bicycling. 3 months after knee replacement surgery you are starting to participate in a full round of golf or tennis. We recommend against high impact activities such as running, singles tennis, or aggressive alpine skiing. Our goal is for your knee replacement to last as long as possible.
At night you move very little, which may cause muscles to tighten and joints to stiffen. You may have noticed this sensation even before surgery. The best treatment usually involves movement and stretching. If you are awakened by a stiff joint, move it, whether walking or just stretching in bed.
Hip and knee replacements are made primarily of metal alloys. You can expect to trigger most airport alarms. If possible, inform the TSA agent of your joint replacement prior to passing through security. TSA no longer accepts "joint replacement cards." You should expect to undergo additional screening at airports and should budget your time accordingly.