We take preventing infection seriously. All total joint surgery is performed in laminar flow operating rooms, which help reduce the risk of bacterial contamination. The entire surgical team wears body exhaust suits which help eliminate the chance of breath or skin contamination. You are given IV antibiotics in the pre-op holding area and again immediately prior to your surgery. Further, IV antibiotics are continued after surgery.
At the Leone Center for Orthopedic Care, we use multimodal strategy to anticipate and manage each person’s post operative-pain. This begins pre-operatively with medicine taken the morning of your surgery. This helps both to lessen and control postoperative pain. Your anesthesiologist will make sure that you are comfortable throughout the procedure and in the recovery room.
At the conclusion of your surgery, a combination of long acting local anesthetic and narcotic is injected in the surgical area to reduce early post-operative pain.
For patients who have undergone a total or partial knee replacement, the anesthesiologist will insert a tiny catheter into the groin near the femoral nerve which is connected to a small battery operated pump. This device will continuously dispense a precise concentration of local anesthetic over several days and in our experience, has resulted in greatly diminished pain after these procedures.
Once in the recovery room, I prescribe a combination of Intravenous (IV) NSAIDS and Tylenol. A steroid was given just prior to the procedure and a second dose is administered the next day. Excellent hydration is emphasized. Although narcotics are prescribed as a backup, they are used much less frequently because patients don’t need them. If possible, I prefer that patients avoid using narcotics because they tend to cause nausea and occasionally confusion. I have been very pleased with this multimodal approach, which no longer features narcotics, because patients feel so much more comfortable immediately after surgery and avoid so many of the complications related to narcotics that we routinely used to see. Read more on my blog.
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.
Our entire team is very sensitive to postoperative pain. You will be encouraged to take your pain medicine prior to your therapy and to “stay ahead” of any pain.
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.
Postoperative Anesthesia Care Unit (PACU)
In the postoperative anesthesia care unit, the nurse will monitor your temperature, blood pressure, pulse and the electrical activity in your heart (EKG) to make sure your condition is stable. Your comfort level will be carefully monitored.
After you awaken from anesthesia and are comfortable and stable, you will be taken to your inpatient room or suite. The nursing staff will assess your comfort level to ensure that you receive the appropriate amount of pain medication.
On the day after your surgery, you will be visited by Dr. Leone and his team as well as by an internist who works closely with Dr. Leone’s patients; or by your own Holy Cross physician.
Your physical therapy will start the morning after your surgery. Expect to get out of bed, practice standing and sitting, and be given assistance in getting to the bathroom. Our patients tell us that the “first time is tough” but they’re really proud of themselves afterward. Beginning to move not long after surgery is extremely therapeutic because it helps your blood circulate and prevent your skin from breaking down.
Your second day after surgery you will dress in your own cloths and be out of bed for all meals. Dr. Leone and his team will visit you again, as will the internist. You will have two physical therapy sessions. We’ve created a special “gym” on our orthopedic floor where you will go for your therapy.
Your nurse will continue to assess your pain and provide medication as needed. Your case managers will meet with you and coordinate your discharge—either to your home or to another facility. They will help ensure that you have the supplies that you will need. All your instructions will be reviewed and written down. Any prescriptions will be given to you and an appointment for your suture removal will be made.
The Day Three description below includes steps that may be taken on Day One or Two should you be one of the many patients who are ready and eager to go home on their first or second post operative day. Some are not ready or prefer an extra day of therapy before leaving.
On day three, if an additional day is needed, you will be visited by Dr. Leone and his team. Plans will be finalized for your discharge, and the discharge instructions and prescriptions will be reviewed by your Patient Liaison. You will have a morning physical therapy session.
If you are going to be transferred to our IRU (Intensity Rehabilitation Unit) on the 6th floor of HCH, expect to be transported to your new room in the early afternoon.
If you’ve made the decision to rehabilitate in another facility prior to going home, then we will make all arrangements for your transfer.
Most patients participate in out-patient therapy after being discharged from the hospital. I encourage this, especially for patients who have had knee replacements. I strongly advise patients to have arrangements made with a facility prior to discharge. In fact, I hesitate to discharge a knee-replacement patient until I know a rehab appointment has been set up. If patients prefer to have physical therapy at home, we can assist with that, however we counsel patients to transition to out-patient therapy as soon as possible, because typically the quality of rehab at a specialized center is better.
For your safety, we will arrange for a member of the hospital staff to help you get downstairs with all of your belongings. They will also help you collect any valuables left with Security. You will be taken to the discharge area at the entrance to the hospital and assisted into your vehicle prior to the 12:00 PM discharge time.