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Patient Guide to TJR :: FAQs
Pre-operative Exercise :: Pre-op Hip Patient Documents
Pre-op Knee Patient Documents :: Pre Surgery Forms
Patient Guide To Total Joint Replacements
Please take the time to review all information and complete all forms required before scheduled appointments.
You will be receiving a packet of information from the office which will contain a great deal of information. Brenda Edenfield is the Surgery Scheduler for Dr. Vaughn. She will initiate the first contact with you to discuss your surgery schedule options and other appointments related to your surgery. If you have any questions after that discussion, please contact her at (919) 863-6932.
While in the hospital a case manager is assigned to you. He or she will work closely with you and your insurance company on discharge plans, equipment, and physical therapy.
As with any type of surgical procedure, there are certain risks or complications associated with Total Joint Replacement surgery. Risks include, but are not limited to: blood loss and potential need for transfusion, blood clots, pulmonary embolism, dislocation, injury to nerves or blood vessels, fracture, infection that could possibly require debridement or implant removal with or without chronic antibiotic therapy, poor wound healing, uneven leg lengths, failure of implant, persistent pain, persistent swelling, persistent stiffness, reaction to anesthesia, and on rare occasion, death. Further discussion of potential complications and risks will be held at the preoperative history and physical appointment should you have any questions.
Dr. Vaughn is the surgeon for your surgical procedure. He generally has the physician assistant as his first assist. There are other healthcare team members that are involved with the procedure as well. After your surgery is completed you will be transferred to the recovery room. Once you are stable in the recovery room you will be transferred to the Orthopaedic floor for your continued post-operative care.
You will be using a device called a Plexi-Pulse while in bed. This is a device that assists with circulation and decreasing the risk of a blood clot.
Total Knee Replacement surgery patients generally have a wrap groin to toes on their operative leg. It is used for compression and stabilization. It is not uncommon to feel as though the leg is “heavy” and difficult to move initially. This is removed the morning after surgery.
Early mobilization, out of the bed, is the goal. Most patients are up and out of bed with the help of Physical Therapy, standing, taking several steps, and getting to a chair the same day of the surgery. The majority of the time you will weight bear as tolerated, unless Dr. Vaughn has indicated otherwise. The patient will be advised post-operatively should the weight-bearing status be anything other than weight-bearing as tolerated.
Decisions about Physical Therapy will be discussed at the pre-operative appointment with the Physician’s Assistant.
The case manager will work with your insurance company to make appropriate arrangements for your discharge; this can include Home Health Physical Therapy for two weeks, and any equipment that is needed.
The average hospital stay is one to two days. All necessary discharge plans will be in place before leaving the hospital.
Staples are used to hold the incision together. The standard time for the staples to remain is 10-14 days. You will have an appointment scheduled for your first visit after the surgery for staple removal at the time of your pre-operative History and Physical appointment. This appointment is not an option. It is a required visit.
To care for your incision, simply wash it gently with soap and water, rinse it, and pat it dry with a clean towel. A special soap is not required. Avoid side-to-side motion in order to prevent spreading of the incision edges. Gently wash the incision in an up and down motion. You may shower, but you must have someone there to assist you at first. That person may be a staff member from the home health agency or it may be a family member if they have been instructed on how to help you. When you shower, the incision can get wet. Let the soapy water run over it, rinse it well and be sure to pat it dry with a clean towel. DO NOT SCRUB THE INCISION. DO NOT take a tub bath until the staples are removed and the wound is healed.
DO NOT USE PEROXIDE ON YOUR INICISION. DO NOT USE ANY TYPE OF OINTMENTS, CREAMS, OILS, OR LOTIONS ON YOUR INCISION WHILE THE STAPLES ARE IN. DO NOT COVER WITH ANY TYPE OF DRESSING OR TAPE.
If the incision has no open areas after staple removal, you may begin using a lotion that contains Vitamin E or Vitamin E oil approximately one week after the staples have been removed. If you have had a Total Hip Replacement, please avoid sleeping on your operative side while the staples are in place. Once they are removed you may sleep on that side. Most patients like to have a soft pillow between their knees when sleeping on their side. If you have a Total Hip Replacement, you are required to use a pillow between your knees for six weeks after the surgery.
Swelling (edema) is common following Total Joint Replacement surgery. Some patients experience swelling while still in the hospital, while others notice it when they get home and become more active. Still others may not have any swelling. Areas most likely to have swelling are the foot, ankle, hip and, at times, the thigh. Swelling and warmth in the hip can be expected for six months up to a year after Total hip Replacement surgery.
Elevate your feet higher than the level of your heart when lying down to counter the swelling,. Your “toes should be higher than your nose.” Do this during your rest periods for forty-five minutes to an hour, at least two times a day. If the swelling does not decrease after sleeping all night and after elevating your legs during the day, please contact Raleigh Orthopaedic Clinic at (919) 781-5600, ext. 5070. Ice packs on the operative side are encouraged and recommended. You may use ice packs for 15-20 minutes, then off for an hour. If the swelling does not improve with rest, elevation and ice, please call the office. Please try the measures recommended above before calling the office.
Signs of infection may include redness, swelling and/or drainage at the incision site. These signs may be coupled with an elevated temperature of 101ºF or greater. If you experience any of these signs, please call Dr. Vaughn’s office at (919) 781-5600. Should you need to call after office hours, there will always be an on-call person available to you and your questions will be answered. If you need further evaluation, you will be directed to the appropriate place.
You are initially asked to sit for no longer than 30 minutes at a time. You are encouraged to get up, walk around, and change your position frequently. Long car trips are discouraged initially, but should you have to take a car trip you are asked to stop at 45 minute to 1 hour intervals, get out of the car, and move around for 10 minutes. If you do not take breaks, you will become uncomfortably stiff, experience swelling, which could lead to blood clot formation, especially during the first six weeks.
You are also asked to not walk without your walker, or cane until you are instructed to do so by your Physical Therapist. Although you may feel that you can walk without these devices, remember that healing is occurring and needs to be protected by the use of a supportive device. Walk frequently on level ground as tolerated. Go outdoors if weather permits. At the start, even surfaces are better, as opposed to hilly areas. Choose a large area, such as a shopping mall.
Stair climbing is allowed in moderation. Physical Therapy will begin working with you on stairs before you leave the hospital. Please follow directions given to you by your Physical Therapist. During the initial weeks at home after your surgery, please limit the use of stairs to one round trip per day, if possible.
As for driving, you are asked to wait 2-6 weeks after your release from the hospital. You may only drive if you have complete control of your operative leg. This will be discussed at your first follow-up visit in the office after surgery. You must NOT drive while using narcotics for pain management.
Total Knee Replacement patients should put a pillow under their heel with their leg in extension (leg is straight). Press the knee flat to the bed, table, or floor. Relax and then repeat for 10 repetitions. Total knee replacement patients should stay in extension on a pillow for 20 minutes. Repeat this four times a day.
With your first follow-up visit in the office, you will be seen by the Physician Assistant or Nurse Practitioner for staple removal, discussion of any questions you may have following your discharge from the hospital, renewal of any narcotic pain medications, and outpatient physical therapy, depending on your needs and progress. After that initial visit 10-14 days after your surgery, you will be scheduled for your first post-operative visit with Dr. Vaughn. At that time, you will have x-rays done and see Dr. Vaughn.
Be advised, Raleigh Orthopaedic Clinic has after-hours call coverage. If you have any problems after hours, your call will be received by the provider that is on-call and you will be directed accordingly. Please note: NO MEDICATIONS WILL BE CALLED IN AFTER HOURS OR ON WEEKENDS. Please plan ahead. It is to your advantage to call the office during regular hours for refills. Your records are available at that time and changes can be made if necessary.
All incisions are closed with staples. A dressing called “Aquacel” may be used. This is removed three days after surgery. The Aquacel dressing may be removed sooner if it is soiled or if the edges start rolling up. You may shower (NO TUB BATHS) with the Aquacel on and after it is taken off.
You can find additional information on Total Joint Replacement at the following websites:
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