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Lower Extremity Post-Operative Instructions

1. Weight Bearing
   1. Dr. Higgins will instruct you before surgery as to how much weight you may put on your leg.
2. Ice and Elevation

• Ice will be your friend for the first several days after surgery. Icing the operative site will help to minimize swelling and help relieve pain or discomfort. A bag of ice, or frozen vegetables wrapped in a towel works well. Apply ice to and replace as needed. If your skin is too cold, take a break, but otherwise don’t both with the 20 minutes on 20 minutes off routine.

3. Pain Medication/Prescriptions

• Tylenol (acetaminophen) Take 1000mg every 8 hours. This is a mild pain reliever that works in two ways. First, it relieves pain on its own. Second, it makes other pain mediations work better, it’s synergistic.
• Oxycodone (Roxicodone): Take ½, 1, or 2 pills every 4 hours as needed. This is a strong narcotic pain pill that is meant for pain relief after a major surgery like a knee replacement. This is the pain medication you should cut back on first.
• Mobic (meloxicam): Take once daily for 30-60 days as prescribed. This is an anti-inflammatory medication that some patients are given after surgery. After hip replacement, it helps decrease pain and inflammation and helps to decrease the chance of bone developing in muscles around the hip after surgery (heterotypic ossification).

4. Blood Thinner:  You will be placed on a blood thinner after surgery to decrease the risk of blood clots and pulmonary embolism associated with surgery. You will be placed on Aspirin, Lovenox, or Xarelto depending on your risk factors, and should be taken as instructed. Blood thinners are usually prescribed for 30 days after surgery.

5. Nausea: Pain medications can cause nausea and a prescription for nausea medicine either Phenergan or Zophran will be provided to be taken as needed.

6. Constipation: The pain medications taken after surgery can cause constipation. To avoid constipation, adhere to the following protocol until your bowel habits normalize.

• A stool softener, Colace, or similar is helpful. You can get these over the counter.
• Milk of Magnesia (30 ml) taken once or twice a day is available over the counter.
• Prune juice or prunes can be helpful.
• Magnesium citrate is a powerful laxative that is available over the counter if the above has not provided relief within 48 hours.

7. Surgical Dressing: 

• If the dressing is too tight, you can remove the ace wrap and reapply.
• If you are in a cast or splint do not remove it unless instructed to do so by Dr. Higgins.
• Some bloody drainage may soak through the dressing. If this occurs, reinforce the dressing with gauze and an ace wrap.

8. Bruising:

• Bruising on the thigh, calf, or ankle may develop after surgery. Ice these areas as needed.

9. Showering: 

• Showering in a cast or splint for the first 2 weeks after surgery is generally a bad idea (even in a cast bag) and sponge baths are recommended. If your case is an exception, Dr. Higgins will inform you before surgery.

10. Fevers:

• Low-grade fevers (less than 101 Fahrenheit) are common after surgery and generally last only a short period of time. These fevers are most often caused by mucus in your lungs. Deep breaths, coughing, and moving around a bit are usually all that is needed. If you are having fevers shortly after surgery, the chances of that fever coming from an infection at the surgical site are very low.

11. Driving

• There is no time limit for driving after surgery. You should not drive with a cast or splint on your right foot. To drive, you need to be able to operate the vehicle safely. That means you should not take narcotic pain medicine and drive. You need to be comfortable and confident you can slam on the breaks in an emergency, etc. If you are uncertain about being ready to drive, go to an empty parking lot and practice first.