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David R. Lionberger, MD

Patient Education: MIS Frequently Asked Questions

*Some of these questions pertain only to total knee replacements

Walking: When can I start walking after the surgery and how much?

You will begin formal physical therapy training with the physical therapists at the hospital the day after your surgery. When you get home you should focus on your outpatient physical therapy program and elevating your knee. Remember: for every 15 minutes that you are up walking around you should be elevating the knee for an hour. This applies for the first 2-3 weeks depending on the amount of swelling that you may have. The first two weeks are crucial for elevation and are not to be spent sitting upright for long periods of time (save the card game for later!).

Hospital Length of Stay: How long will I stay in the hospital?

Most patients stay in the hospital one night and are discharged the following day after surgery. Assuming there are no medial complications following the surgery, if you are able to walk 100 feet with the therapists, you can be discharged home. We recommend that you patients try to complete this task because the shorter your hospital stay, the smaller your risk for infection. This also allows you to tailor your own medication regimen and sleep in your own bed with the leg elevated as much as possible.

Blood Thinners: What kind of blood thinner will I go home with?

Surgery predisposes every patient to a risk of Deep Venous Thrombosis. However, most of our patients are very low risk for getting a blood clot. Common findings that would make a patient higher risk are personal history of a blood clot, family history of blood clots, cancer, recent surgery prior to this one and current estrogen product use. If any of these items pertain to you, please let Dr. Lionberger and your internist know. In this instance you may be sent home with Lovenox which are small injections you will give yourself for 10 days. If none of these risk factors pertain to you, you may go home on aspirin (325mg) twice daily for 6 weeks. Aspirin should never be taken with any anti-inflammatory medications except Celebrex. If you are not taking aspirin or Lovenox, or if you have questions or concerns, please call Dr. Lionberger or your internist right away.

Swelling: Will I have swelling? How can I get rid of it?

Every patient with a total knee will have some amount of swelling and discoloration. This is a normal occurrence. The best way to get rid of swelling and bruising in the leg, calf and ankle is by elevating your knee at least above your heart and preferably above your eyes. Much of the swelling you experience should subside in 3-4 weeks however a fluctuating small amount of swelling may persist up to a year. This in itself is not an indicator for a serious problem with the knee

Calf Pain: How much calf pain is acceptable? When should I start to worry about blood clots?

Calf pain can be an indicator for a serious condition called DVT. However, not all calf pain is a blood clot. Some calf tenderness is normal, especially while there is swelling and discoloration in the knee and calf. Severe calf pain is something that you should call Dr. Lionberger or your internist about. Other signs and symptoms of DVT/PE can include but are not limited to fever, redness in the calf and Shortness of breath. All these symptoms are something you should note and call about. When in doubt the best course of action is to go the emergency room to get a Doppler study of your leg.

Numbness: Why I am numb on the outer portion of my knee?

The Infrapatellar branch of the Saphenous nerve is disrupted in all total and partial knee incisions due to the exposure. Although it is natural to experience some numbness on the outside of the incision, this sensation gradually adapts so that in several months it is not noticeable unless one touches the exact area of reduced feeling. This is an unavoidable consequence of the incision.

Bathing, Cleaning: When can I shower? What do I clean the wound with and for how long?

You may bathe as soon as you get home from the hospital. Wrap the knee in saran wrap to the best of your ability and then clean the wound after the shower with peroxide before applying a new sterile dressing. Wounds should be cleaned with hydrogen peroxide daily for at least 1-2 weeks. Once the wound has scabs all over and is no longer draining, there is no need to cover it anymore with a dressing. Do not use any ointments on the incision until it is completely healed.

Stairs: What if I live up stairs? Can I do stairs after the surgery?

Following knee replacement you will be able to walk up and down stairs. Please let your physical therapist know this while you are in the hospital so they can show you the proper way to approach stairs during your rehab. If your bedroom is up a significant amount of stairs, you may want to arrange to sleep downstairs on a couch for the first few nights at home

Driving: When will I be able to drive?

Most patients are able to drive after three weeks. Dr. Lionberger will advise you of this at your first follow up appointment which will be at the three week mark. You cannot take narcotic pain medications and operate a vehicle. Also it is best not to drive yourself to physical therapy appointments so that you can take the pain meds so you will be able to accomplish more in your PT sessions.

Family Support

All of our total knee patients need family and/or friends to help them for the first few weeks following surgery. Knee replacement is a family affair. Patients will need a family member or friend to take them to and from the hospital as well as physical therapy appointments. If you are concerned about this and need some assistance please call Dr. Lionberger’s office and they can advise you on a course of action for assistance following surgery.

Clothing: Should I bring clothes to the hospital?

You can bring robes, sweats etc to wear while you are in the hospital, just be sure they have your name on them and are easy to get in/out of. Otherwise you will be issued a hospital gown for your stay. You will need to have at least one change of clothes for discharge.

Arrival time: When should I get to the hospital?

Maria will call you the day before your surgery to tell you what time to arrive. If you are a Monday surgery she will call you Friday. Most patients will be assigned a time 2-3 hours before their posted surgery time. The reason for this is for you to get all the pre-op medications you will need to for you to have adequate time to meet the anesthesiologist before the surgery. Bring a good book as there may seemingly be a lot of wasted time the day of surgery; but fear not, important preparation work is being done behind the scenes!

Home Medications: Should I take my home meds with me to the hospital? What should I take the day of surgery? Which medications should I stop before surgery?

When possible, it is a good idea to take all home medications with you to the hospital so that a pharmacist can take a look at them for any discrepancies. If you have questions about which medications to take the day of surgery please call your internist. Most medications that you take daily, except blood thinners, can be taken the day of your surgery with a small sip of water. If you are on any blood thinners please be sure to speak with your internist or cardiologist about these medications and stop them two weeks before your surgery unless otherwise directed by your physician team. These medications include Plavix, Aspirin, Coumadin, Aggrenox and others. If you currently take any of these meds please be sure to ask someone when to stop them. Likewise if you use a CPAP or BiPAP machine at home please bring it to the hospital with you.

Stockings: Do I have to continue to wear the white stockings that were sent home with me?

No you may take them off when you get home unless you prefer to wear them

Walkers/Canes/Wegdes/Cryo-Cuff: Will I need the walker? When can I get off it?

Before your surgery you will be given a prescription for a walker. You should pick this up before your surgery date. Most patients use a walker for 1-2 weeks following the surgery. After surgery you may progress yourself from the walker to the cane as you become more confidence in your strength and walking as well as your pain level. You can ask your physical therapist if you have questions or concerns about progressing from the walker. From the walker you may move to a cane and then gradually to using nothing at all. This will all be at your discretion. If you are concerned about getting off the walker please wait until your three week visit with Dr. Lionberger so he can discuss it with you personally.

Should I bring the walker, wedge and Cryo-Cuff to the hospital?

You can borrow a walker to use during your hospital stay if you prefer to leave yours at home. The Cryo-Cuff and wedge are essential to have with you in the hospital if you have purchased them so bring them with you.

Pre-op meds: When do I start the prescriptions that were given to me for pre-operative medication?

All patients are given pre-operative prescriptions such as hydrocodone, Celebrex, Lyrica, Ambien and promethazine. The Celebrex, Lyrica and Ambien are to be taken two days before surgery as directed. If you are confused about the directions with these or any of the pre-op medications please discuss the directions with your pharmacist. The hydrocodone is only to be taken after surgery. None of the medications we give you need to be taken on the day of your surgery as you will get them at the hospital.

Physical therapy: When do I start PT?

Physical therapy should begin 1-2 days following your discharge from the hospital and never later. For most patients this is the Thursday or Friday following your surgery. This is the same therapist you worked with you before surgery in your pre-conditioning. Please be sure to talk to your therapist about scheduling this before your surgery so that you don’t miss out on your first visit. This is an important visit because they can give you exercises to work on over the weekend.
Total Hip Replacements do not require physical therapy.

Internists, Medical Clearance and Specialists: Why do I have to see your internist?

When you are scheduled for your surgery you are assigned an internist at Methodist that will see you for your pre-op medical clearance as well as during your hospital stay. The reason we want you to see our internists here at Methodist for clearance is because if something were to go wrong with your surgery from a medical standpoint they will already be familiar with you and your personal health profile. It also allows us easy access to discuss and prevent complications/concerns that may arise before your surgery takes place.

When do I need to see the internist?

You should make an appointment to see the internist 2-3 weeks before your scheduled surgery date. This allows them time to get the necessary tests done.

Specialist Appointments?

If you see a specialist such as a cardiologist or vascular surgeon on a regular basis or you have specific health concerns addressed by a practitioner, please call them to let them know about your surgery and make an appointment to get a clearance from them as well.

Blood Donation: Do I have to donate blood?

Patients who are having more than one knee done should donate a unit of their own blood 2-3 weeks before surgery. You will be given information and orders to do this at you appointment. Total hip replacements should always consider donating blood as recommended during your visit with Dr. Lionberger.

Prior Authorizations

Our office policy is to not fight the insurance companies on medications because it is a losing battle. Several of the pre-op medications may require a prior authorization depending on your insurance company. If your insurance denies the medication we are prescribing to you for your benefit, you have the option of paying out of pocket or not taking it at all. However, please realize the is your recovery we are involved with and our recommendations are made with your best interest in mind not the insurance company’s financial welfare. We want your procedure to be as painless and successful as possible so please head our recommendations.

Surgery Deposits: Why do I have to pay a deposit for my surgery?

There are many people involved in the planning and preparation of each any every surgery that we do. If you cancel your surgery, there is a lot of work that goes into the cancellation and rescheduling of that case, not to mention the lost time slot that someone else have used. For this, we charge a refundable deposit at the time your surgery is scheduled. If you have to cancel your surgery, the surgery deposit is only refundable if you cancel 2 weeks or more before your surgery date. Please adhere to these guidelines as they are what help this practice run smoothly for everyone.

Staples/Sutures: Do I have to come and get anything taken out?

Most knees are closed with subcuticular sutures, or sutures under the skin surface. These sutures are dissolvable and do not need to be removed. If you have visible staples in your knee these do need to be removed 10 days after your surgery. You can have your Primary Care doctor do it in your hometown or even a Physical therapist. If you cannot find anyone that will remove them for you, we are happy to do it here at Nicole’s clinic on Fridays.

Pin Holes

The anchor point used for the computer sensory equipment is just below your incision. These pin holes will vary in size and position depending on body mass. For computer assisted surgery, these anchor point are necessary to maintain orientation. Although these may tend to drain after surgery, they usually will stop in several days and can be covered by a band-aid during the interim period.

Sutures

As you incision heals, the skin may try to push out the sutures underneath it. If you notice a stitch coming out of your incision, clean it with hydrogen peroxide twice daily and monitor it for stitch abscess (see below). If it remains uninfected, wait until your appointment with Dr. Lionberger and we can remove it at your visit.

Stitch Abscess

Occasionally sutures can have mild infections around them. If your incision has a spot that looks redder than the rest of the incision clean it vigorously with hydrogen peroxide and call Dr. Lionberger’s office to make an appointment. If needed, we may open it slightly to remove the offending stitch in the office.

Noises: What is the clicking I hear and feel in my knee?

The sensation of noise you experience is normal. The knee is made of two metal pieces (femur and tibia) and two polymer pieces (spacer and patella). When two surfaces move over each other, the mechanical sound you hear and feel is the result of the rigid surfaces of metal and polymer meeting instead of the cartilage of a normal knee. It will improve over time, but will never go away completely.

Antibiotics: When do I need antibiotics?

For two years following your surgery you will need prophylactic antibiotics if you have any dental cleanings or procedures, skin biopsies, colonoscopies or any other procedure where the skin surface will be penetrated. Antibiotics can be prescribed by your dentist. Please call Dr. Lionberger at least a week before your procedure for a medication to be called in if your dentist refuses to prescribe this medication. Medications requested the day of your procedure will not be filled. The necessary medication is Amoxicillin 2grams 1 hour prior to procedure OR if you have a true Penicillin allergy, Clindamycin 600mg 1 hour prior to procedure