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Pre-operative Checklist of RequirementsNon-smokerOff narcotics or has pain management MD with plan for peri-op pain med managementWeight loss optimized (BMI >30 associated with increased risk of complications)Your BMI today: _________Failure of Tylenol, NSAIDs, activity modification, PT to provide pain reliefNo history of intra-articular steroid injection within 3 months of anticipated surgery PCP medical clearance to undergo total joint replacement (and/or cardiology clearance if cardiac disease)Dental clearance documenting no active infections or outstanding dental issuesIf RA/SLE and/or on disease-modifying agents, refer to AAHKS-ARC 2017 guidelines for when to holdBlood tests:CBC, BMP, INR HgA1C if diabetic (must be <8.0, <7.5 preferred)LFTs and complete coags if history of coagulopathy or liver diseaseESR/CRP if history of infectionT&S if hgb <10 or patient is unable to receive tranexamic acidUrine analysis if elderly or history of UTIs (and Urine tox screen if history of drug use)EKG (if >60 years old or history of cardiac disease)MSSA/MRSA nares and throat swab screening >1 week prior to surgeryMSSA + must use bactroban nasal ointment 2x/day for 5 days prior to surgery MRSA + surgery postponed until swab negativeChlorhexidine wipes 3 days pre-op (including morning of surgery)Appropriate XRs completed: total hip candidates must have AP pelvis with marker balltotal knee candidates must have long leg standing XR and AP, Rosenberg, lateral and sunrise viewsConsent signed*Surgery Scheduler* (*phone*) will schedule surgery date and provide instructions for APO Clinic appointment once PCP/dental clearance obtained and will help make sure the above is done, but please keep this list with you and notify the office if you believe that you are missing part of the pre-op requirements.Post-operative Expectations*these are general expectations; you will be notified if your recovery protocol will differSpinal anesthesia wears off in recovery roomGet out of bed and walk with physical therapy day of surgery using assistive deviceKnee replacements = No restrictions on knee range of motion. Drain out post-op day 1.Hip replacements = posterior hip precautions (no flexing hip >90 degrees with internal rotation and crossing leg)Pain control with Tylenol and toradol and ice, plus tramadol or roxicodone as neededHome on post-op day 1 or 2 once cleared by Physical TherapyOk to shower over incision on post-op day 2 or 3 if no wound drainage and then leave incision open to air. No soaking in a tub or swimming in pool or ocean until healed. Allow steri strips to fall off on their own.Take aspirin 81mg daily for 1 month post-op and walk as much as possible for blood clot prevention.Wean off narcotic pain medications as soon as possible and use ice, Tylenol, and NSAIDs (if tolerated and ok by PCP) as necessary for pain controlNo elective dental work for 3 months after surgery. Must take amoxicillin 2000mg 30-60minutes prior to dental cleanings or dental work for 2 years post-op.Outpatient PT will be arranged on an as needed basis. Whenever possible, you will be referred to home health PT in the immediate post-op period, but it is your responsibility to perform your exercises on your own as instructed by PT.Follow-up appointments:Total knees: 4 weeks for XRs, wound check, and range of motion check (should bend to at least 90 degrees), then 3 months, 6 months, 1 year and yearly if doing wellTotal hips: 6 weeks for XRs and gait check, then 3 months, 6 months, 1 year and yearly if doing wellPlease never hesitate to call the clinic (*phone*) if you have any questions or concerns.If you experience any post-op chest pain or shortness of breath, you should go to your nearest emergency room for evaluation. If you are ever admitted to another hospital for a complication related to your surgery, please have *surgeon* notified. ................
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