Discharge Instructions

for

Patients Post Orthopedic Surgery

Dental Visit

Based on the latest recommendations, antibiotics need to be taken prior to dental cleanings for the rest of your life after joint replacement surgery. They should be taken on the day of your appointment one hour before cleaning. Two grams of Ampicillin is the drug of choice. However, if you are Penicillin allergic then the alternative would be Clindamicin, 600-900 mgs.

Ted Hose

Our recommendation is to wear them for 2-3 weeks post surgery. You should wear them during the daytime on both legs.  Also use the Ted Hose when taking plane trips that are longer than 3 hours duration. To keep them clean wash them in Woolite.

Signs and Symptoms of a Pulmonary Embolism

Within the first 6 weeks of surgery it is especially important that you pay attention to any  sudden shortness of breath that occurs while at rest (sitting or lying down); any pleuritic type chest pain (hurts to breathe on one side with each breath); and severe pain like you were suddenly stabbed with a knife in your chest. All of these warrant a trip to the Emergency Room. In addition, other things to pay attention to are syncope or near syncope (loss of consciousness). These may be fleeting events and pass quickly but it is recommended that you seek medical attention immediately (do not wait until next day). Finally if you should have any sudden unusual leg swelling or severe Charlie Horse-like pain that does not go away with a simple stretch seek medical attention, as well.

Medications

The medications prescribed will vary depending on the Surgeon who performed your surgery.

Blood Thinners

Some surgeons will have you taking Ecotrin ( Enteric Coated Aspirin), Warfarin (Coumadin), or Lovenox for a period of time post surgery. All of these are used for DVT (Deep Venous Thrombosis or “blood clot”) prophylaxis and are suppose to thin the blood. If your doctor has you taking Aspirin he will most likely prescribe a Proton Pump Inhibiter such as Nexium, Protonix, Acidphix , or Prevacid to take during the duration of the therapy to mimimize gastrointestinal bleeding.  Prilosec OTC is a reasonable alternative if none of the PPI’s are covered by your insurance.

With any medication that thins the blood it is important to watch out for internal bleeding. Any signs of Melena (black tarry-like stools) should be medically evaluated.

Anti-Inflammatory Agents

If your surgeon prescribes Celebrex some insurance carriers will not cover this. It is important that you follow the instructions outlined by your Surgeon.  Never take any other anti-inflammatory agents while on Celebrex such as (Motrin, Aleve, or Indocin).

Pain Medication

Most patients will be given a 2 week supply of narcotic pain meds. Patients should gradually wean themselves off these meds by decreasing the dosage (instead of 2 pills every 6 hrs, take 1 pill every 4 -6 hrs, and then ½ pill every 4 hrs). The idea is to wean yourself down to the point where you can just take Extra Strength Tylenol.

Constipation

A frequent side effect of pain medication is constipation. Please do not wait days before trying to get relief. While you are in the hospital you are most likely receiving Colace (a stool softener) and Senekot (a vegetable laxative). It is reasonable to continue on these, however, some patients get gassy with Colace.  Alternatives to these agents would be prunes or prune juice on a daily basis. For greater stimulation we recommend Milk of Magnesia or Dulcolax tablets. Glycerine suppositories can also be used. Extreme cases of constipation may warrant the use of Magnesium Citrate 1/3-1/2 the bottle or Miralax as directed.  Enemas should not administered.