We take preventing infection seriously. I begin preoperatively. We encourage a diet of rich in fruits, vegetables, lean protein, such as chicken or fish, and whole grains. This helps build up your nutritional strength and blood levels to help the healing process. You are also instructed to take Vitamin C and Iron. You will be asked to wash using a special soap called Hibiclens both the night before your surgery and again the morning of your surgery. Refer to my Hip Booklet for more specific instructions.
Smoking increasing the risk of infection and interfere with healing. If you smoke, we ask that you to stop 3 weeks prior to your surgery. Special nicotine patches will be supplied when in the hospital.
Our emphasis and goal at the Leone Center is to preempt and diminish postoperative pain. Our protocols are designed to “stay ahead of pain curve” rather than play “catch up”. Pain is managed with a multi-modal approach that includes everything from the type of anesthesia used, to pain medicines given before, during and after your surgery, and prior to physical therapy. At the completion of your surgery, I inject the tissues around you new hip with a “cocktail” of different meds including a long-acting local anesthetic, a NSAID, and morphine. These combination has greatly reduced postoperative pain and the need for narcotics. This has resulted in our patients routinely getting out of bed the day of surgery and walking and avoiding many complications associated with surgery.
Our multi-modal approach designed to prevent and lessen pain has been remarkable effective and helps explain why our patients rehabilitate much faster and go home so much sooner. While narcotics are still part of our “recipe”, unlike traditional models and teaching, they are no longer the center pillar, but rather a much smaller part of the mix. While narcotics do effectively relieve pain, they are associated with a lot of potential complications including nausea, vomiting, constipation and occasionally confusion and respiratory suppression. With our new protocol that more effectively mitigate pain and minimize narcotics, our patients experience this complications much less frequently and hence go home and rehabilitate so much faster.
We make arrangements for your medications, including pain medication, to be filled and given to you at the time of discharge. Many patients express their thanks because they do not have to worry about getting prescriptions filled after leaving the hospital and they feel more confident having the pain medication on hand, even if they don’t have to use it.
Postoperative Blood Clots and Pulmonary Emboli
Many steps are taken to prevent blood clots and pulmonary emboli after surgery on the hip or knee. Pre-operatively, Dr. Leone will assess your vulnerability to clots and emboli based on your medical history and examination. The protocol administered both before and after surgery will be based on this assessment.
After surgery, all patients get leg or foot pumps that passively circulate blood and help prevent clots. Getting out of bed and starting physical therapy the morning after your surgery is very important. It gets your blood circulating and prevents skin breakdown. Most of our patients are started on a blood thinner the day after surgery.
SURGERY (Third Floor) In the operating theater:
My team and I work in a special laminar flow operating room which filters the air in the room to make it cleaner.
We also wear body exhaust suits (they look like a space suit) which completely isolate our breathing from you, to reduce further the risk of infection.
our incision will be meticulously closed with a running suture (as opposed to conventional staples). In my experience, this suturing technique provides a superior seal and extra protection against infection. It is performed like plastic surgery, using a single stitch.
A special sterile surgical dressing is applied in the operating room that allows the incision to breathe. You will awaken in the recovery room with a foam splint between your legs to protect your hip. This will be replaced with a pillow when you fully awaken.
Postoperative Anesthesia Care Unit (PACU)
You will be transported from the operating room to the PACU after your operation is complete. This is where you will return to consciousness as your anesthesia wears off.
Post-operative area Phase II
If you are going home the same day as your surgery, then you will be transferred to our Phase II area. If you have family or friends waiting, they are welcome to join you here. You will be visited by a physical therapist and can go home when you can walk, eat and go to the bathroom.
4 West Orthopedic Unit
If you are going to stay in the hospital after your surgery, then you will be transferred to 4 West which is our specialty orthopedic floor. An orthopedic nurse specialist and nurses aide will be assigned to care for you. This team will make sure you are stable, comfortable and have everything you need. You will receive daily visits from me and from my team. A general medical doctor or other specialist may also be part of our team depending on your needs.
The Day of your surgery:
Most patients get out of bed and start walking with supervision the day of your surgery. This is wonderfully therapeutic. Getting out of bed so quickly after surgery helps your circulation, protects your skin against pressure sores and results in an “I can do it” attitude and confidence that results in a faster recovery.
The Day following your surgery:
The morning after your surgery you are encouraged and assisted getting out of bed for breakfast, changing out of a hospital gown into your own clothes, and walking to the bathroom to wash up for your day. You will receive physical therapy and occupational therapy. You will practice standing, sitting, walking, getting in and out of bed, going up and down steps and even getting into and out of a car.
You will receive instructions on how to use a walker and then progress to a cane or other ambulatory device when appropriate, with the goal of walking device-free as soon as possible. The physical therapist also will provide instructions in the use of reachers or “grabbers” and sock aids, as needed.
Occasionally a patient is not ready to go home the first day after their surgery and will benefit from another day or two in the hospital. This decision is individualized for each patient with their unique and specific needs and desires.
Dr. Leone and his team will give you specific guidelines regarding body positions to avoid the morning after surgery depending on his assessment of the stability of your hip during surgery. These are not the same for everyone and tend to be much less restrictive than in years past. The goal is to encourage the new prosthetic ball to remain fully seated within the new socket until the surrounding tissues heal and mature which provides stability.
Managing Post-Operative Pain
As part of The Leone Center surgical protocol, we work to stay ahead of the pain curve. We emphasize pre-empting pain rather than playing “catch up.” Pain is more effectively managed with a multi-modal approach that includes everything from the type of anesthesia used to the pain medications given before, during and after your surgery, and prior to physical therapy.
Medications administered the morning prior to or during surgery include:
Tylenol to lower your sensitivity to pain as well as decrease the amount of pain.
Neurontin which also helps to decrease postoperative pain by affecting chemicals and nerves in your body that are involved in pain pathways.
Medicines which decrease anxiety and make you drowsy.
A long-acting narcotic to dull pain receptors before pain sets in, as well as medication to prevent nausea following surgery.
An IV steroid just prior to the start of your surgery and postoperatively.
After implanting the components, the tissues around the new joint are injected with a
“cocktail” including a long-acting local anesthetic, morphine and an NSAID. This combination has greatly reduced post-operative pain and the need for narcotics. This has resulted in our patients routinely getting out of bed the day of surgery and walking.
You will receive tranexamic acid just prior to surgery and postoperatively. This medication decreases intra- and post-operative blood loss.
IV antibiotics before and after surgery to lower the risk of infection.
In the recovery room, you will receive an IV NSAID called Toradol.
This is a super-version of aspirin that works to decrease pain via an alternate “pathway” in the body and has proven to be remarkably effective.
Narcotics are prescribed as a backup but are being used in smaller amounts and with less frequency. Narcotics are avoided whenever possible because they tend to cause nausea, constipation and occasionally confusion. Also Tylenol as well as a NSAID is continued on a regular schedule.
Our entire team is very sensitive to your post–operative pain. You will be encouraged to take pain medication initially on a schedule and prior to your therapy to help stay ahead of the pain curve.