Joint Replacement Post Surgery Information

by Jsantos, October 8, 2013

Joint Replacement Post Surgery Information

Antibiotics after Joint Replacement

Protocol for antibiotics after joint replacement:

The development of infection following total joint replacement is a serious problem. Although rare, there are documented cases of such infection caused by bacteria introduced into the bloodstream during certain dental procedures and other invasive procedures. Infections that are left untreated can spread to your joint by way of the bloodstream. This can happen at anytime during the life of your new joint. Call us before you have any dental work or cleanings done. We can provide you with the needed antibiotics. Your dentist may also provide you with the antibiotics. See your internist if you suspect any kind of infectious process (bladder, sinus, wound, etc). If you have a surgical procedure scheduled, let your surgeon know that you have a total joint replacement and you will need prophylactic antibiotics.

Prophylaxis should consist of a single 2-gram dose of amoxicillin or cephalexin given orally one hour prior to the dental procedure or invasive procedure. In patients who are allergic to penicillin and keflex, 600mg of clindamycin may be given instead.

Dermatologic procedures don’t need antibiotic prophylaxis unless an infection is suspected.

In case of swelling:

Some swelling over your incision as well as in your legs and feet is normal.  Usually you will notice it towards the end of the day.  What you can do:

  • Wear your stockings!
  • Elevate your feet on a footstool whenever you are sitting up in a chair.
  • Use ice packs anywhere, anytime you like.  Also a good mild pain reliever.  Do not use a heating pad; it will aggravate swelling.
  • Get in the habit of doing ankle pumps and circles whenever you are sitting still.  Muscle action helps to move collected fluid out of these tissues.  It also improves your circulation.
  • Report any persistent swelling, calf tenderness, pain in the calf with ankle flexion, warmth, or redness, or any drainage from your incision.


In most cases a physical therapist will be coming to your home several times a week.


Use your walker or crutches at all times, indoors and out.  Do not increase your weight bearing on the operated leg (unless you have been specifically instructed to do so by Dr. Mead) as you begin to feel better.  Your new joint needs time to heal!


Continue your exercises as you have been doing them in the hospital three times a day.  Your therapist will provide you with a home program prior to your hospital discharge.  As you feel stronger, increase the number of repetitions you do in each session, rather than introducing new types of exercises.

[box type=”gray”]Check with Dr. Mead before you:

  • Swim
  • Whirlpool, Jacuzzi
  • Drive
  • Use a bicycle [/box]


Following a total knee replacement you can pretty much trust your knee to tell you when you have reached your maximum comfortable range of motion.  Avoid twisting motions, bending over or stooping.  You may sleep on your non-operative side at night with a pillow between your knees.

Following a total hip replacement, there are two basic positions you must avoid:

  • Flexion over 90 degrees: the angle between your torso and thighs should not exceed 90 degrees in any position.  In other words, do not get into a situation where your knee is higher than your hip.  Look for any chair with arms and a firm seat: you can always build up the height with towels, blankets, phone books, anything.  Do not stoop or bend over.  Avoid very soft or very low chairs and recliners.
  • Adduction/rotation: you should continue to keep your legs aligned so that you can see about 18 inches of space between your feet.  Do not cross one leg over the other.  You should continue to sleep with pillows between your legs at night: you may sleep on your non-operated side at night only if you have someone to log roll you on to that side with pillows in place to maintain that proper alignment.  You cannot turn yourself safely.


You may use a shower stall 24 hours after your staples are removed.  Do not use a bathtub.

Sexual Activity

May be resumed at your discretion.  Keep in mind, though, any positioning guidelines we have given you.  You may not be comfortable supporting your partner’s weight right away; be creative, conservatively.


Infections left untreated can spread to your joint by way of the bloodstream.  The consequences of this can be quite serious.  Please take the following precautions:

  • Call us before you have any dental work done so we can provide you with antibiotic coverage.  This includes fillings, caps, extractions, cleanings, everything.
  • See your internist if you suspect any kind of infection process: bladder infection, infected wound, upper respiratory infections, etc., so that antibiotics can be provided.
  • If you have any surgical procedure scheduled, let your surgeon know that you have a total joint replacement and you will need prophylactic antibiotics before, during and after surgery.
  • Call us if there is any doubt whether you need antibiotics.  This is important.  Consider it an investment.

Remember, we are only a phone call away if you have any questions or concerns.  We want to continue to be a resource for you.

Total Hip Replacemente Home Program


Principal rules:

  • Hip should be kept straighter than a right angle
  • DO NOT cross your legs
  • DO NOT turn your knee in

Sit in a chair made higher with two firm pillows

  • DO sit evenly on both buttocks
  • DO NOT sit in soft chairs or sofas
  • DO NOT sit with hips all the way to the back of the chair
  • DO NOT lean towards the operated side


Principal rules:

  • Hip should be kept straighter than a right angle
  • DO NOT cross your legs
  • DO NOT turn your knee in
  • Bed height should be at least 27 inches from the floor
  • Sleep with a pillow between your legs
  • Sleep on your back


Principal rules:

  • Hip should be straighter than a right angle
  • DO NOT cross your legs
  • DO NOT turn your knee in
  • Use a raised toilet seat
  • Lean towards the operated side when performing hygiene


  • DO wait for your doctor’s okay before wetting your operated side by showering
  • DO NOT sit in a bathtub


Please ask your orthopaedic surgeon, occupational or physical therapist or nurse for clarifications.

Home Health Protocol

  1. Monitor healing process, notify  MD of adverse healing.  Call Judy if wound has adverse conditions.  DO NOT fax a nursing note to office
  2. Cleanse incision line with H2O2.
  3. Leave post operative dressing on until post op day #7.  Apply dressing as needed with sterile 4×4’s with tape if drainage is present.  If wound is dry, leave it open to air.
  4. Remove staples/sutures at post op day #14.
  5. Apply steri-strips to incision line.
  6. Patient may shower 10 days post op, strength permitting.
  7. Patient will be on COUMADIN for 6 weeks FROM THE DAY OF THE PROCEDURE.  Instruct patient to take his/her Coumadin at 6pm.  This allows us plenty of time to notify the patient of any dosage changes as necessary
  8. Laboratory Work:  Draw PT/INR on admission visit and then Monday, Wednesday, and Friday  Have results faxed to Dr. Mead’s office at 262-2657 the day they are drawn if at all possible.
  9. If INR is less than 1.6 or greater than 3.8 call Dr. Mead’s office with results.  If after hours have Dr. Mead paged for orders.