How do you address pain management and nausea after joint replacement/resurfacing surgery?

  • We prefer to use spinal anesthesia. This helps control bleeding better during surgery and is associated with less pain medication consumption after surgery.
  • We use an injection of pain medication directly into the hip at the time of surgery, to help keep the pain in the first 24-36 hours well controlled.
  • We use multimodal pain medications while trying to minimize the use of narcotics. We typically use:
    • Dexamethasone (10mg) for two days after surgery,
    • Tylenol three times a day (never exceeding 4000mg in 24 hours) for the first month after surgery
    • Naproxen (500mg) twice daily for the first two weeks after surgery
    • Omeprazole (20mg) once a day while on an NSAID (Naproxen, Advil, or Melocixam)
    • Tramadol (50mg-100mg) every 8 hours for the first week after surgery for moderate pain
    • Hydromorphone/Dilaudid (2-4mg) every 4 hours for the first week after surgery for severe pain
    • Colace (100mg) twice a day while on narcotics (tramadol, hydromorphone)
    • Senna (8.6mg) twice a day while on narcotics (tramadol, hydromorphone)
  • We use an anti-emetic to limit nausea, and it is critical you take this medication in the first week even if you don’t experience nausea
    • Ondansetron (4-8mg) for the first week of surgery
  • We use a blood thinner to limit blood clots, and it is critical you take this medication in the first four weeks even if you feel fine
    • Typically Aspirin 81mg twice a day for four weeks
    • In rare occasions, we may use Apixaban/Eliquis depending on your history

Between all the medications and physical therapy, what do the first few days look like after joint replacement/resurfacing surgery?

Below is a table that has been designed as a guideline. If you do not have some medications listed here, you may ignore them or take as directed on your discharge instructions.

GENERIC (BRAND): Hydromorphone (Dilaudid), Acetaminophen (Tylenol), Omeprazole (Prilosec), Tramadol (Ultram), Naproxen (Aleve), Docusate (Colace), Sennosides (Senna), Ondansetron (Zofran), Dexamethasone (Decadron)

Time Activity Detail
0100 Medication Dilaudid 2-4mg  (AS NEEDED for severe pain; can take up to 4 mg every 4 hours)
0500 Medication Dilaudid 2-4mg  (AS NEEDED for severe pain; can take up to 4 mg every 4 hours)
0600 Wake up
Medication		 Tylenol 1000 mg (Take two 500 mg tabs, or three 375 mg tabs (depending on what you have)
Tramadol 50 mg (As needed for moderate pain; can take up to 100 mg every 8 hours)
Omeprazole 20 mg (To help with digestion, take before breakfast)
0700 Breakfast Decadron 10 mg (Drink at least 8 oz. of water)
0800 Medication Aspirin 81 mg (Prevent blood clots- take with breakfast)
Colace 100 mg (Stool softener- take with breakfast)
Senna 8.6 mg (Take two tablets for 17.2 mg total dose- take with breakfast)
Naproxen 500 mg (Anti-inflammatory- take with breakfast)
0900 Medication Dilaudid 2-4 mg (AS NEEDED for severe pain; can take up to 4 mg every 4 hours)
1000 PT Walk
1030 PT Strength exercises
1100 PT Stretching
1130 PT Ice and Elevate (Ice-20min on, 20 min off)
1200 Lunch (Drink at least 8 oz. of water)
1300 Medication Dilaudid 2-4 mg (AS NEEDED for severe pain; can take up to 4 mg every 4 hours)
1400 Medication Tylenol 1000 mg (Take two 500 mg tabs, or three 375 mg tabs (depending on what you have)
Tramadol 50 mg (As needed for moderate pain; can take up to 100 mg every 8 hours)
1430 Nap
1700 Medication
PT		 Dilaudid 2-4 mg (AS NEEDED for severe pain; can take up to 4 mg every 4 hours)
Walk
1730 PT Strength exercises
1800 PT Stretching
1830 PT Ice and Elevate
1900 Dinner (Drink at least 8oz of water)
2000 Medication Aspirin 81 mg (Prevent blood clots- take with dinner)
Colace 100 mg (Stool softener- take with dinner)
Senna 8.6 mg (Take two tablets for 17.2 mg total dose- take with dinner)
Naproxen 500 mg (Anti-inflammatory- take with dinner)
2100 Medication Dilaudid 2-4 mg (AS NEEDED for severe pain; can take up to 4 mg every 4 hours)
2200 Medication Tylenol 1000 mg (Take two 500 mg tabs, or three 375 mg tabs (depending on what you have)
Tramadol 50 mg (As needed for moderate pain; can take up to 100 mg every 8 hours)
2230 Bedtime (Try to get 8 hours of sleep)

For redundancy:

  • Dexamethasone (decadron) should be taken the first two days after surgery. Take with breakfast.
  • Naproxen (if given) should only be used for two weeks. After it is finished, you may take over-the-counter Advil or Motrin instead.
  • Zofran (ondansetron) is used for nausea as needed only.

What activities can I do right after joint replacement/resurfacing surgery?

Click on the links below for postoperative activities for your surgery.

  • You are encouraged to get up and moving the same day!
  • During the first 6 weeks, you are allowed full range of motion with no precautions but 75% weight bearing to allow your soft tissues to heal and recover
  • It is very important you keep your wound dry
  • You will be fully weight bearing as tolerated after 6 weeks
  • You are encouraged to walk as much as possible, especially outdoors because it best engages multiple muscle groups. You should feel comfortable about going out shopping, going to a movie, going to a restaurant, and even taking short trips. You should pay attention to how your leg feels and should limit your activity if the discomfort worsens substantially or if the swelling becomes significant. We recommend wearing compression stockings when traveling. If you want to take a plane ride immediately after surgery, ask Dr. Ramkumar before going.
  • You may start using a stationary bike after your first postoperative visit or 2 weeks after surgery.
  • In the early post-operative period (2-3 weeks after surgery) please:
    • Remember to take your indomethacin and naproxen
    • Use your brace to allow your soft tissues to heal
    • Avoid taking narcotics before exercises or a physical therapy session. Each patient needs an intact uninterrupted biofeedback to protect the wound and the surgical site during the early healing phase.
  • For one year to ensure implant to femoral neck integration/healing:
    • Do not lift more than 40-50 pounds unless seated
    • Do not run, jump, or lift heavy objects
    • No leg presses, no stairmaster, no strenuous exercise
    • Take: Calcium 2000 mg daily, Vitamin D 2000 IU daily
  • Ice or a cooling unit is recommended, but ensure that no ice is directly applied to the skin as this can cause severe skin damage requiring further surgery.
  • For the full postoperative recovery protocol, you may view this here.

  • In the first two weeks, you are allowed full range of motion but 75% weight bearing to allow your soft tissues to heal and recover; after Dr. Ramkumar evaluates your wound, you may progress to full weight bearing. It is very important you keep your wound dry and free from sweat near the groin.
  • You are encouraged to walk as much as possible, especially outdoors because it best engages multiple muscle groups. You should feel comfortable about going out shopping, going to a movie, going to a restaurant, and even taking short trips. You should pay attention to how your leg feels and should limit your activity if the discomfort worsens substantially or if the swelling becomes significant. We recommend wearing compression stockings when traveling. If you want to take a plane ride immediately after surgery, ask Dr. Ramkumar before going.
  • You may start using a stationary bike after your first postoperative visit or 2 weeks after surgery.
  • In the early post-operative period (2-3 weeks after surgery) please avoid:
    • Extension and external rotation (i.e. kicking a soccer ball)
    • Bridging (i.e. hip thrusting from a laying position)
    • Any situations where you are exposing your incision to excessive sweat by drying the incision
    • Taking narcotics before exercises or a physical therapy session. Each patient needs an intact uninterrupted biofeedback to protect the wound and the surgical site during the early healing phase.
  • Ice or a cooling unit is recommended, but ensure that no ice is directly applied to the skin as this can cause severe skin damage requiring further surgery.
  • For the full postoperative recovery protocol, you may view this here.

  • In the first two weeks, you are allowed full range of motion but 75% weight bearing to allow your soft tissues to heal and recover; after Dr. Ramkumar evaluates your wound, you may progress to full weight bearing
  • You are encouraged to walk as much as possible, especially outdoors because it best engages multiple muscle groups. You should feel comfortable about going out shopping, going to a movie, going to a restaurant, and even taking short trips. You should pay attention to how your leg feels and should limit your activity if the discomfort worsens substantially or if the swelling becomes significant. We recommend wearing compression stockings when traveling. If you want to take a plane ride immediately after surgery, ask Dr. Ramkumar before going.
  • You may start using a stationary bike after your first postoperative visit or 3 weeks after surgery.
  • In the early post-operative period (2-3 weeks after surgery) please avoid:
    • Patella mobilization and deep tissue massage of the incision.
    • Step ups, squats, lunge type maneuvers, and resistance bands.
    • Active assist or passive ROM exercises to gain more flexion. You may work on your own to straighten and bend your knee actively. No forceful maneuvers!
    • Taking narcotics before exercises or a physical therapy session. Each patient needs an intact uninterrupted biofeedback to protect the wound and the surgical site during the early healing phase.
  • Ice or a cooling unit is recommended, but ensure that no ice is directly applied to the skin as this can cause severe skin damage requiring further surgery.
  • For the full postoperative recovery protocol, you may view this here.

  • In the first two weeks, you are allowed full range of motion but 75% weight bearing to allow your soft tissues to heal and recover; after Dr. Ramkumar evaluates your wound, you may progress to full weight bearing
  • You are encouraged to walk as much as possible, especially outdoors because it best engages multiple muscle groups. You should feel comfortable about going out shopping, going to a movie, going to a restaurant, and even taking short trips. You should pay attention to how your leg feels and should limit your activity if the discomfort worsens substantially or if the swelling becomes significant. We recommend wearing compression stockings when traveling. If you want to take a plane ride immediately after surgery, ask Dr. Ramkumar before going.
  • You may start using a stationary bike after your first postoperative visit or 3 weeks after surgery.
  • In the early post-operative period (2-3 weeks after surgery) please avoid:
    • Patella mobilization and deep tissue massage of the incision.
    • Step ups, squats, lunge type maneuvers, and resistance bands.
    • Active assist or passive ROM exercises to gain more flexion. You may work on your own to straighten and bend your knee actively. No forceful maneuvers!
    • Taking narcotics before exercises or a physical therapy session. Each patient needs an intact uninterrupted biofeedback to protect the wound and the surgical site during the early healing phase.
  • Ice or a cooling unit is recommended, but ensure that no ice is directly applied to the skin as this can cause severe skin damage requiring further surgery.
  • For the full postoperative recovery protocol, you may view this here.

Is it safe to have an x-ray, CT scan, or MRI after my joint replacement/resurfacing surgery?

Yes! You will still be safe to go through diagnostic testing in the future with your metal prosthesis. However, you should tell your provider, as special tests might need to be ordered due to the metal of the components. When you are traveling, you do not need worry about TSA machines flagging you for your total hip replacement.

Is swelling and bruising after joint replacement/resurfacing surgery normal?

You can expect to see some swelling and bruising of the leg after hip replacement surgery. This swelling and bruising can get a bit worse for a week or so after the operation. This bruising may be quite dark and may go from the thigh to the foot. In addition to bruising, there may be swelling of the area around the incision as well as the entire leg and foot. The swelling (especially in the foot and ankle) typically gets worse through the course of the day. Some of the swelling can be improved if the leg is elevated when you are laying down (putting the foot up on an ottoman or elevating your heel on multiple pillows while sitting on a couch). You may need to use 4-5 pillows to elevate your leg, and please elevate it above the level of your heart to reduce swelling. Please contact our office or report to local emergency room if there is extensive swelling, pain associated swelling, and/or trouble breathing.

Is it normal to have sleep issues after joint replacement and what can I do about it?

Up to 85% of patients will experience some disturbance in their sleep pattern in the weeks following joint replacement surgery. For example, difficulty falling asleep, staying asleep, or waking up too early are commonly reported. To deal with this sleep disturbance, we suggest you avoid caffeine after mid-day (this includes coffee, tea, and soda). Avoid taking “cat naps” and going to bed late in the evening (10:30-11:00pm or later). In certain cases, you may take a melatonin.

When can I take my the wrap on my knee down (after partial or total knee replacement)?

You can take it down about 2 or 3 days after surgery. It helps with swelling. You can use it as much or as little as you like after day 2. Do not take down the sticky adhesive dressings covering your wound whatsoever.

When can I bathe after joint replacement/resurfacing surgery?

You will likely have a sealed dressing on, so you can shower immediately after surgery. Dr. Ramkumar prefers you keep the thigh wrapped to avoid any incidental leaking if there is even a small break in the dressing seal. This dressing can be removed 7 days after surgery, and does not need to be replaced by any dressing. Showering over the incision with soap and water is fine, but do not directly scrub the surgical incision and pat the surgical area dry. Do not apply lotions, creams, or ointments directly on the incision. Do not use a tub/bath, hot tub, or swim until you see Dr. Ramkumar.

When can I drive after joint replacement/resurfacing surgery?

Patients usually feel comfortable to drive between 3-6 weeks after surgery. Dr. Ramkumar cannot formally know when you are safe to drive but he has the following criteria:

  • No longer taking prescription narcotic medications such as Ultram, Dilaudid, Oxycodone
  • Walking without a cane for a week.
  • You feel comfortable enough to slam on the brake.