After Surgery

It is very unusual in the first 24 to 48 hours after surgery to see a wound infection or an 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 101.5 does not mean that you have an infection. However, we ask that you look at the wound and look for foul smelling drainage, increased swelling or redness. If you are concerned about infection, please do not hesitate to contact us for appropriate treatment.

After joint replacement surgery of the hip, knee or shoulder, you will typically take antibiotics prior to dental work. This will be for two years. A prescription will be provided by our office or most often is provided by the dentist. Please ask your dentist or inform them that you have had a joint replacement.

After shoulder surgery, you may be asked to wear a sling. If no repair of any tissue is performed in your shoulder, then the sling will be used just for your comfort and often is removed intermittently two days after surgery. However, if we perform a repair of tissue, whether it is the rotator cuff or the labrum in your shoulder, you will be asked to wear the sling for four to six weeks. It is very important that the sling be worn during the day and at night to prevent moving your arm in the wrong direction.

One of the most common questions after hip, knee or shoulder surgery is regarding driving. The answer is when you are safe and safe for other drivers on the road. This may be as early as two days and may be as late as six or eight weeks, depending on the surgery that you have had. 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. Also keep in mind that you cannot drive under the influence of pain medication, so it is important that you not take your pain medication when you are driving.

The duration of physical therapy ranges for all patients and frankly all procedures. While we begin therapy two days after surgery, some surgeries require anywhere from one week all the way to three months. We will make the appropriate referral and it is very important that you contact the physical therapy center prior to surgery and prepare yourself to do what is necessary to get your joint better.

After hip or knee replacement surgery, certainly a concern is blood clots. Although you must realize that these are rare; the signs of a blood clot are swelling in your legs that just will not go down with ice or with elevation, and this can also be in the foot or the ankle. A blood clot can cause pain in the calf or the thigh, although it is tough sometimes to tell if this is from the surgery or from a blood clot. So the signs are: swelling of your foot and ankle that will not go down with elevation, pain in the calf or thigh that is usually associated with redness and exquisitely tender. If you are concerned about a blood clot based on these signs, please call us and we will order the appropriate tests to find one.

If your dressing is too tight, it is often because there has been additional swelling since surgery. The first thing to do is to elevate your leg. Usually with elevation or additional icing of the leg, you will see that the swelling will go down and the dressing will not appear as tight. However, if it continues to feel too tight, it is okay to unwrap the dressing but do not remove it as it is helping us control the bleeding. With any questions or numbness or blueness of your toes, please do not hesitate to call us.

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. As you kneecap moves back and forth as you walk, get up from a chair or walk up and down stairs, this plastic is going to make a noise in that metal groove that it rides in. This is very normal and is likely expected after surgery.

Following surgery, you may have bleeding through the dressing that I put on at the time of surgery. Often this is about the size of a quarter or maybe even just slightly larger. Please do not remove the dressing but reinforce it. This would involve putting another dressing on top of the current dressing. However, if it continues to bleed and you are concerned about the amount of bleeding, please do not hesitate to contact us.

Home health care will involve a registered nurse coming out to your home the following day after you are discharged from the hospital. The registered nurse will work to evaluate your wound, assess your vitals, teach you how to dispense medication, remove the staples when needed and you will see the nurse for approximately three to four visits before being discharged. The home health physical therapy will start the following day you are discharged from the hospital. The physical therapist will work to instruct proper technique, reduce your swelling, regaining your range of motion and restoring your normal gait with the use of assistive equipment like a front wheeled walker or a cane. They will also answer any and all questions in regard to home physical therapy.

In most surgeries of the hip, knee or shoulder, restrictions will be based on how much pain or discomfort you may have as well as what has been repaired or reconstructed. Please refer to the specific procedure on our website that discusses your return to activities and restrictions.

A lot of patients ask me after surgery when it is safe to have sex. I think if you follow the appropriate precautions, for instance, a hip or knee replacement, it is safe to have sex when you are comfortable.

Following hip, knee or shoulder surgery, you may shower following your first dressing change. This typically occurs at two days after surgery. Please keep in mind that it is important to cover the incision or incisions if there is any drainage. Remember, what can come out can go in. When you decide to shower, it is important that you pat dry afterward and keep the area as clean and dry as possible.

Following hip, knee or shoulder surgery, you may swim when the incisions are closed and healed. Typically this occurs anywhere from eight to ten days after surgery. Please be sure that your sutures or your staples have been removed. If there is any drainage from the wound, please do not submerse the wound, no baths, no pools and please be careful in a shower.

After hip and knee replacement surgery, TED hose stockings 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 wear the TED hose stockings daily and may remove them at night. Three weeks after surgery, you may remove the TED hose stockings as the risk of blood clots has decreased significantly.

After hip and knee replacement surgery, there is always concern about traveling. Traveling in a car can typically occur as early as two to three weeks. I do ask when you are traveling that you continue to perform ankle pumps as well as get out of the car every forty-five minutes to an hour and walk. This will prevent the pooling of blood in your legs and the possibility of a blood clot. Other patients choose to fly after surgery. I do ask that you wait three weeks as this is the time that it takes for the risk of blood clots to drop significantly. If you do fly, I ask that you wear your stockings and perform ankle pumps during the flight. However, if the seat belt sign goes off, please get up and walk the isle of the plane. This will help prevent pooling of the blood in your legs and blood clots. Occasionally blood thinners for high risk patients will be prescribed.

It is important to schedule your follow-up appointment before surgery. This way you will know when you are coming back to the office to see us. This could be as early as two days, ten days or even three weeks.

After surgery, it is important to start your pain medication as soon as you start to feel pain. Following the surgery, you should try to eat something or get something in your stomach to prevent the side effects of the medication.

After surgery, you may be asked to use a continuous passive motion or CPM machine. After shoulder surgery, you will typically begin using the machine the day of surgery or the first day after surgery. This will be after your first physical therapy appointment. After knee surgery, you will typically begin immediately after surgery and then continue the machine at home for a period of three to six weeks.

Please discuss this with the sales representative prior to your surgery or at the time of delivery of the CPM unit.

Proper use of the shoulder CPM should be demonstrated prior to surgery or at the time of the CPM unit delivery by the assigned sales representative.

After hip and knee replacement surgery, you may have been asked to take a blood thinner such as low molecular weight heparin, Lovenox, Coumadin and sometimes aspirin twice a day. The risk of blood clots drops significantly three weeks after surgery. Therefore, you may stop taking the blood thinner three weeks after hip or knee replacement surgery.

Following surgery, there may be circumstances that make it necessary for you to go to the emergency room. Certainly for any chest pain, shortness of breath or difficulty at home, please do not hesitate to contact an ambulance and go to the emergency room. However, if you have a question about drainage from your wound or possible infection, please refer to our website or even contact our office so that we can answer those questions. As you would imagine, the emergency room often has a long wait. Often we can take away the need for you to go to the emergency room by answering these questions for you.

Everyone’s concern after surgery is getting back to the activities that they enjoy. Following surgery, your physical therapist and I will recommend when it is safe for you to return to activities such as tennis, soccer, golf or even mixed martial arts. Please refer to the specific procedure on our website to get an idea when it is safe to return to those activities.

Regardless of the surgery of the hip, knee or shoulder that you may have had, we will begin physical therapy almost immediately. This may be as early as the day after or two days after surgery. The important thing is to get your joint moving as quickly as possible. The exception to this is that injuries or surgeries that require postoperative splinting or bracing may require a delay in postoperative physical therapy.

After surgery, you will have a follow-up appointment with our office. This may be in one to three weeks. You will see me the majority of the time and occasionally one of my board certified orthopedic associates if there are urgent scheduling conflicts.

After hip, knee or shoulder surgery, many patients ask me “why is my joint so stiff at night?” The reason is simple. At night you are not typically moving it. You may notice that even after sitting for long periods of time or being stationary, which same stiff feeling will occur. If you are awakened by a stiff joint, the obvious answer is to get up and move it, whether this be walking or just simply moving it in bed. This will make you feel better. Do not be surprised if this could last up to two to three months after surgery.

Hip and knee replacements are performed with metal and plastic. Typically this is titanium or cobalt chrome. You can expect at the airport to set off the alarms. My advice is to let the attendant or security officer know that you have had a joint replacement prior to even getting embarrassed by the alarm.