Helpful Information About Your Surgery

Looking after a plaster cast

Casts are usually made from either plaster (plaster of paris) or fibreglass. Plaster is often used in the early stages of treatment because it can be moulded/shaped more accurately (eg. for wrists/forearm).

Plaster back-slabs (plaster that does not fully enclose the limb) are often used in the first few weeks after surgery to allow for swelling and to check wounds.
Fiberglass casts are lighter and more durable. They are often put on after stitches have been removed and swelling controlled.
Keep the arm/leg elevated as much as possible.

Remember-Elevate, Elevate, Elevate!

Arm

  • rest the arm on pillows when sitting or lying down
  • resting on a sofa with your arm across the back is ideal
  • use the sling provided as instructed/advised

Leg

  • when sitting or lying prop the leg up on pillows.
  • just going to the toilet a few times a day means the leg is down for an hour and it can take a whole day of keeping the leg up to correct this.
  • the first two weeks are not the time to go out socialising.

Swelling

  • Swelling of the fingers or toes around a cast is common
  • Minimise swelling by elevating the leg/arm
  • Move the fingers/toes to help keep the blood circulating

How do I look after the cast?

  • Keep the plaster dry
  • Wet casts can itch, smell and be uncomfortable
  • In the shower- cover the plaster with a garbage bag & seal with tape
  • Don’t be tempted to itch the skin under a cast with anything (chopsticks, pencil, knitting needles, rulers, or coins).  This can cause skin irritations, and result in infections under the cast
  • Don’t put creams or powders on the skin under the cast

What if there is a problem with my cast?
Most cast problems are minor, but there are a few signs to be aware of when you have a cast-

  • Severe pain
  • Damage to the cast- areas of moisture, odour, discharge
  • Pins & needles or numbness
  • Unable to move fingers or toes
  • Change in color to the skin
  • Change in temperature to fingers or toes

Mild symptoms should be relieved by elevating the arm/leg and taking simple painkillers.  Otherwise, it may become an emergency that the blood flow is restricted and you may need to attend the emergency department even at midnight.

If you think there is a problem with your cast, you should contact your doctor.

Steroid injections into the knee

There are a variety of treatments to relieve the symptoms of osteoarthritis in the knee. In arthritis, the surface of the bone becomes damaged. This damage can cause swelling, stiffness, pain and disability. One treatment option is to inject corticosteroids into the knee. Corticosteroid injections can be useful for treating flare-ups of osteoarthritis and help relieve symptoms by reducing inflammation in the joint. Injections may be beneficial for people who are unable to take non-steroidal anti-inflammatories (NSAIDS), and for people who have not had relief from NSAIDs (voltaren, ibuprofen, celebrex, mobic).

The procedure

  • You will be seated with your legs hanging over the side of the examination table.
  • The skin will be prepped with an alcoholic chlorhexidine.
  • The surgeon may use a needle to draw out any extra fluid that is in your knee.
  • The steroid is mixed with local anesthetic and injected, usually just below your kneecap.
  • Generally the injection is not painful
  • A small bandaid is applied to the injection site.

What to expect after the injection

  • you are able to drive
  • the local anaesthetic generally wears off in 2-3 hours. You may experience some pain and discomfort. Paracetamol (panadol/panamax) is advised to relieve discomfort initially.
  • the steroid effect usually works within 24 to 48 hours
  • applying ice to the area (not directly on the skin) can be beneficial
  • rest the affected area for 24 hours
  • avoid strenuous activity for several days
  • the pain relief lasts from 6 to12 weeks
  • steroid injections are not considered a long term solution

PRP (Platelet Rich Plasma Injections) & Synvisc Injections
There are some patients that may benefit from a more complex injection than a simple steroid injection.  PRP involves taking some blood, extracting the platelets, and then injecting 3-5ml of platelets into the joint or tendon.  The broad principles above apply.

Synvisc is occasionally used for arthritic joints.  It costs approximately $500.  80% of patients feel that they have a worthwhile result for six months or more.  Patients with an egg allergy cannot use it.  Again, the broad principles above apply.

Getting ready for surgery

Simple, basic, preparation can make a world of difference to your postoperative recovery. It allows you to concentrate on recovering from surgery without the extra stresses associated with daily life.

Things to consider

  • Roll up mats and other tripping hazards
  • Rearrange furniture- allow for easy access to door way, bathrooms etc
  • Remove pot plants that clutter verandahs, doorways & paths
  • Roll up the garden hoses/ have ease of access to garden paths & gates.
  • Stock up the pantry, fridge and freezer
  • Have meals planned and prepared
  • For those that are isolated from shops, consider some long life milk in the pantry and bread in the freezer.
  • Organise pets. Plan ahead with canned pet food to make shopping after surgery less troublesome (and lighter).
  • Plan the care of your pets whilst in hospital (neighbours/kennels)
  • Attend to those odd jobs around the house prior to surgery (light globes etc.)
  • Change bed sheets/towels prior to day of surgery- takes the stress away from dealing with washing/drying of heavy items
  • Organise/coordinate family, neighbours and friends. If you live alone: having someone that can drop in daily is ideal. If you don’t have people that can drop in, arrange family/friends to contact you on a daily basis. In this situation it is preferable if they can contact you morning and night to check all is okay.

Preparation can make a huge difference.

What to expect after foot surgery

Generally, you will be in a plaster back-slab, or have a bulky dressing, for 10-16 days after foot surgery. You will be non-weight bearing (unable to walk on the operated foot).
At the review appointment with the surgeon the sutures will be removed.

Depending on the procedure you have had, will determine the type of footwear for the next stage of recovery- these include
• Vacocast Boot (Moon Boot)
• Fibreglass Plaster
• Rigid sole shoe
• Fore foot reliever shoe
• No special footwear required.

After some foot surgery it’s not possible to walk on that leg for six weeks or more – consider hiring a knee scooter.   A knee scooter can help enormously with independence after surgery.

Discuss with your surgeon the anticipated period of non-weight bearing /type of footwear required post surgery.

Airport Alarms

The most commonly used materials in joint replacement surgery include titanium, stainless steel and cobalt-chrome.  Metal detectors used at airports SHOULD pick these up, along with everyday items (belts, buckles, & steel strengthened RMW boots).

When planning a trip to the airport there are a few things that will make the experience easier without causing unnecessary delays:
• Be prepared that your new joint may be detected
• Inform security staff that you have a hip/knee/shoulder replacement
• Wear clothing that allows for easy access to show the surgical scar. Be prepared that you may be required to show the scar to security staff
• Some orthopaedic companies provide a card that states you have a metal implant.
​   However, the security staff will usually ask you to step aside for further screening
• You will likely be screened with a metal detecting wand
• Airport security staff are familiar with travellers with joint replacement and generally deal with them without causing undue delay

​The best thing to do is remain calm. Your goal is to move through the process as quickly as possible by letting security staff do their jobs.
​And importantly, enjoy your holidays.

Admission to hospital

Patients are generally admitted on the day of surgery to the hospital through the Surgical Admission Unit. Same day admission has successfully reduced the risk of post-operative infections.

What can I eat or drink before surgery?
Prior to surgery, no solid food is permitted for six hours. This typically means midnight for morning operations, and 7am for planned afternoon operations.  The hospital will be in contact in the 24 hours prior to surgery to confirm the times.
You are permitted Powerade & CLEAR FLUID up until 2 hours prior to surgery.

For St John of God: We generally ask that you have half or more of a bottle of Powerade an hour before you were due at the hospital.
For Ballarat Day Procedure Centre, you should have your last drink 1.5 hours before you are due there.
Clear fluid means black tear or coffee, water based drinks & water.  MILK & milk containing drinks are NOT included in this list.

What do I bring to hospital?

You will only be staying a few days, so don’t bring too much.
Wear to hospital the clothes you will wear home.
Nightshirts and boxer shorts allow for easier access for dressings/ bandages / having the wound attended to & topped up with local anaesthetic agents.
A second set of night attire allows for any drama like needing to wash the first set.
Bring some magazines, but don’t bother with laptops.
Some people like to bring their mobile phone /ipad /kindle.
Don’t bring/wear jewellery.

Reducing the risk of Deep Vein Thrombosis (DVT) after surgery

A Deep Vein Thrombosis (DVT) is a clot that can occur within the veins of the leg and pelvis before, during or after surgery.  They can move up to the lung, and at its worst – can be fatal.  If every patient having a joint replacement operation has an ultrasound of the calf – 10-20% will have a small clot, which often does not require any change of treatment.

How do I minimize the risks of developing a DVT?
• Walking, moving your foot up & down, contracting the calf muscle
• Compression Stockings. They help with promoting venous (blood) returning into the circulation reducing swelling in the lower leg
• Aspirin, or other blood thinning medications, are routinely used for 6 weeks after surgery
• Avoid inactivity for extended periods of time – if allowed to walk – walk every hour in daylight hours.  If watching the TV, foot up & down exercises at every add break.  If reading, foot exercises at the end of every article or page
• Put your leg up – lying down is much better than bolt upright with a footstool.  Lounge suite is good (except if recent hip replacement)

What symptoms would suggest a DVT?
• Pain and tenderness of the calf
• Swelling of the calf not resolved with elevation
• Severe, unexplained pain in your foot, ankle or calf
• Chest pain or shortness of breath could mean a clot in the lung (this is very serious)

What if I do get a DVT?
Depending on the size and location of the blood clot determines the treatment. Small clots below the knee are treated with compression stockings and tablets – blood thinning agent (Aspirin) and keeping moving. In some instances stronger blood thinning agents are required (e.g. clexane, warfarin)

If you, or a family member, have had a blood clot before, you MUST tell your surgeon to ensure additional preventative steps are taken.

Common Medications prescribed after Joint Replacement Surgery

What are they all for?

Cartia (aspirin)
Cartia reduces the stickiness of platelets (component of our blood) and stops the platelets clumping together to form blood clots.  Cartia decreases the risk of heart attacks, strokes and Deep Vein Thrombosis (DVT) after surgery.  Routinely used for 6 weeks after surgery.
Other anticoagulants might be used instead – including warfarin, plavix, clexane and xarelto. The type of anti-coagulant varies between patients and considers other factors (heart disease, previous stent surgery, AF, previous DVT)

Panadol (paracetamol)
Panadol is a painkiller.  It can be used for mild pain, but we most commonly use it after surgery as background to enhance the effect of other medications – it is certainly useful in the first three weeks from surgery.

Mobic or Celebrex (anti-inflammatories)
These medicines work by reducing hormones that cause inflammation and pain in the body. It is used to relieve the symptoms of joint pain, tenderness, swelling and stiffness.  They prevent a condition called heterotopic ossification, or unexpected bone formation, which once was commonly seen after hip replacement surgery.  Typically we use these medications for three weeks after surgery.

Somac (pantoprazole)
Somac belongs to a group of medications known as proton pump inhibitors. It decreases the amount of acid produced by the stomach. In joint replacement surgery it is prescribed to prevent ulcers associated with the use of non-steroidal anti-inflammatories and aspirin. Somac can assist with nausea and reflux.

Movicol
Constipation and its sequel is our most common complication of surgery. Movicol is a type of laxative.  It assists in keeps the bowels moving. It relieves constipation by increasing the water content and volume of the stools in the bowel, making them softer and easier to pass. Immobility, change in routine, anaesthetics and pain relieving medications can all increase the risk of constipation after surgery.  Movicol, fluid, and walking is the solution.

Norspan Patch (buprenorphine)
Buprenorphine belongs to a group of medicines called opioid analgesics (like morphine). Norspan patches are used as a constant background for moderate to severe pain.  The drug passes through the skin into the blood.  We often have the patients change the patch six days after surgery, and then further instructions after we see you in the post operative clinic. Shorter cooler showers are better to avoid the patch releasing too much drug and making you dizzy.  If you have no pain, it may cause nausea and need to be removed.  Phone the ward or your surgeon for advice before removing.

Tramal (tramadol)
Tramal is a pain killer, either by itself, or in combination with other drugs – like the above list. Tramal works in a number of ways within the brain to reduce pain.  In theory, it can interact with antidepressants, but most people on normal doses won’t have a problem.  It works for 93% of our patients – but the others can experience hallucinations or nausea from it.

Endone
Endone belongs to a group of medicines called narcotic analgesics (like morphine, heroin and codeine). Narcotic analgesics act to “distance oneself” from pain.  It is used to relieve moderate or severe pain after surgery. Some surgeons prefer endone instead of tramal.

Powerade
OK – this isn’t really a medication, but by having some clear fluid with a little salt and glucose in your stomach, it seems people wake up after surgery in better shape and with more energy.  We ask that you drink at least half a bottle of Powerade one hour prior to your admission time at hospital.  The anaesthetist will allow you to have clear fluids up until two hours prior to surgery.

Please inform your surgeon of any allergies and ensure your surgeon is aware of any medications you are taking.

Constipation after Joint Surgery

Constipation after joint replacement surgery can be a common occurrence. It is something we strive to avoid.

What actually is constipation?

There are many definitions of constipation. Constipation is the inability to pass faeces or having difficulty passing faeces, because it is dry or hardened. We all have our own “normal” pattern for bowel movements- for some that may be 2-3 times a day, for others 2-3 times a week.  Alterations to this normal pattern can be classed as constipation to the individual. So if you use your bowels three times a week prior to surgery, then there is no reason for concern. However for those that use their bowels daily, a change to 2-3 times a week is classed as constipation.
As the time frame of constipation increases so to does its severity. As the length of time between bowel movements increases, more water is absorbed back into the bloodstream, causing the stool to harden in the colon. The discomfort increases, along with the damage that can be done by straining to have a bowel movement. As a result there can be symptoms of reduced frequency of bowel motions, difficulty and straining when passing bowel motions, passing small, hard, lumpy stools; and a feeling of incomplete/inability to empty the rectum. Additionally some people experience abdominal bloating, generalised feeling of being unwell and loss of appetite. Occasionally, some people complaining of diarrhoea may in fact have ‘overflow’ diarrhoea as a result of constipation.

What causes constipation after surgery

Post-operative patients are prone to constipation for a variety of reasons:

  • Pain Medications prescribed
  • Change in eating and drinking habits
  • Change in activity levels
  • The anaesthetic
  • Change in daily routine-
    • different bathroom/toilet
    • sharing bathroom/room with others
    • different surroundings

Preventing and Treating Constipation

If you are prone to constipation please mention this to your surgeon.  A stool softener (Movicol) is often prescribed in hospital and you may also be discharged home with Movicol.

  • Drink plenty of fluids- water and fruit juices.
  • Eat plenty of fruit/vegetables
  • Ensure that you get adequate walking/exercise.

Why is Constipation a Big Deal After Surgery?

Constipation can progress to impaction. Impaction is when the stool is so hard and dry that you cannot have a bowel movement. The hardened stool must be removed by enemas, manual disimpaction or (in advanced cases) surgery.

If your bowels have not worked within three days of surgery please seek advice from your local Pharmacy.  If they still haven’t worked the next day – contact you surgeon.  It is more advisable to act promptly rather than to wait until the situations escalates and hospitalisation is required.

Sleeping & Eating after Joint Replacement

After surgery, normal sleeping and eating patterns can be altered.

​Why?

There are many theories as to what causes changes in sleep and appetite after surgery-

  • the anaesthetic
  • the surgery
  • blood loss
  • change in bowel habits
  • fatique
  • pain
  • post operative medications
  • change to normal routine after surgery.

In truth, it can be a combination of all or none of these theories.
Generally speaking, there is nothing to be alarmed about.
It is more important to eat small, regular, light meals.  Ensure that you have adequate fluid intake. Avoid coffee or tea in the evenings.  Take the prescribed painkillers if it is difficult to get comfortable. It is often better to take these medications prior to going to bed, rather than spending the night being uncomfortable and unsettled.

If people aren’t sleeping reasonably when we see them at 12 days after surgery, we often prescribe a tablet for nerve pain that also works as a mild sedative, getting the sleep/wake cycle back on track.

In time things should return to normal, but in the interim try not to dwell too much on these changes and focus on getting back to life.

Bruising after Joint Replacement Surgery

Bruising after a Total Hip or Total Knee Replacement is normal. For some, the bruising can be mild, whilst for others the bruising can be extensive in nature.

After a Total Knee Replacement, some people may have bruising in the thigh, around the knee, down the shin, extending to the ankles and even toes.

In Total Hip Replacement, some people may have bruising around the suture line, into the buttock or groin. For some the bruising may extend down toward the knee, and for some even to the ankles/toes. Deep bruising may appear less intense and take longer to appear. A corked thigh sensation is something that is not uncommon after hip replacement.  This is due to deep bruising in the thigh muscle.

What is normal?

Below are photos of patients after Total Knee Replacement. Both are female, and not on any blooding thinning medications prior to surgery. The photos are taken at day 11 after surgery at the post-op appointment in the rooms.  (The bruising may have been more severe a few days earlier)

Whilst extensive bruising may seem ‘alarming’, it is also short term and normal. Differences as to why some people bruise more than others are varied, but can include- blood thinning agents (aspirin, warfarin, xarelto), the nature of surgery itself, skin tones & colourings, and areas of loose skin.  Additionally, some people have a propensity to bruise more easily.

Bruising usually begins to fade and disappear during week 2 after surgery.

​Similarly you will notice the change in colour of the bruising- from deep red/purple, to greenish, to a yellowish type hue before fading completely.

What can be done to expedite healing of bruising?

In the initial post operative phase applying ice can be beneficial. Ice should not be applied directly to the skin. A bag of frozen peas, or ice packs, in a pillowslip is ideal. Elevation of limbs is also helpful. These both help with the degree of swelling, which can help with discomfort after surgery.

Remember bruising is short term and normal. However, please contact the rooms if you have any concerns.

Have Other Questions?

If we have not answered your question well enough on this page or if you have a question which is not covered please get in contact with your doctor.

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