Your Total Joint
Replacement Surgery
Michael Bollinger, M.D.
Bruce Bragonier , M.D.
Mark Friedman, M.D.
555 Petaluma Ave., Suite B, Sebastopol, CA 95472
(707) 823-7602
Michael Bollinger, M.D.
Bruce Bragonier , M.D.
Mark Friedman, M.D.
555 Petaluma Ave., Suite B, Sebastopol, CA 95472
(707) 823-7602
Table of Contents
Introduction .................................................................................................................................................. 2
Preparing for Surgery .................................................................................................................................... 3
Packing List for the Hospital.......................................................................................................................... 6
Preparing Your Home Before Joint Replacement Surgery ............................................................................ 7
Equipment Needs Following Total Hip Replacement Surgery ...................................................................... 8
Herbal Supplements and Orthopaedic Surgery ............................................................................................ 9
Managing Pain Prior to Orthopaedic Surgery ............................................................................................. 10
Iron Supplements ........................................................................................................................................ 11
What to Expect After Leaving the Recovery Room ..................................................................................... 12
Schedule for Your Hospital Stay .................................................................................................................. 13
Total Joint Replacement and Dental Procedures........................................................................................ 15
Total Joint Replacement Packet, 1 | P a g e
Michael Bollinger, M.D.
Bruce Bragonier , M.D.
Mark Friedman, M.D.
555 Petaluma Ave., Suite B, Sebastopol, CA 95472
(707) 823-7602
Introduction
Dear Patient and Supporters of our Orthopedic Patient,
Welcome to Palm Drive Hospital and our orthopedic program. We are excited to have this opportunity
to be such an important part of your life! Surgery can be a stressful time and we are here to take some
of the mystery out of your surgical course.
Enclosed you will find handouts and contact numbers that will be helpful in preparing you for your big
event. Studies have shown that the more prepared you are before surgery, the easier it will be for you
to participate in your care, which will help you reach your optimal level of your activities or daily living.
We have a dedicated team of professional staff who are waiting to care for you. The most significant
members are you and your family/friends, your Orthopedic Surgeon, Anesthesiologist, Primary Care
Physician, Nursing Staff, Physical Therapist, Occupational Therapist, Discharge Planner and Home Care.
GOALS FOR YOUR TOTAL JOINT REPLACEMENT







Successful pain management
Increase your strength, motion and mobility
Maximize your independence in self-care, transfers and walking
Improve standing
Continue to stay free of infection
Prevent post-op complications
Promote education and skills for returning to your activities for daily living as quickly as possible
IMPORTANT PHONE NUMBERS
Sebastopol Orthopaedics
PDH Pre-admission nurse
PDH PT (outpatient)
Dr. Murphy
823-7602
829-4346
824-8018
566-7026
Palm Drive Hospital
Surgery Waiting Room
Discharge Planning
823-8511
829-4334
829-4330
Total Joint Replacement Packet, 2 | P a g e
Michael Bollinger, M.D.
Bruce Bragonier , M.D.
Mark Friedman, M.D.
555 Petaluma Ave., Suite B, Sebastopol, CA 95472
(707) 823-7602
Preparing for Surgery
You have, or will receive, a two page handout from Sebastopol Orthopaedics entitled: “TOTAL JOINT
PATIENTS – HIPS, KNEES, SHOULDERS - Pre and Post Operative Instructions”. Please follow the
timeline detailed in this handout to prepare for your surgery.


Schedule your pre-op physical therapy as soon as possible. They will set you up with an exercise
program to prepare you for surgery. The better your physical condition going into surgery, the
easier your recovery will be.
Call (707) 824-8018 to schedule.
Within 30 days of surgery



Your surgeon may require clearances from:
o Primary Care Physician
o Dentist
o Cardiologist
o Other
Please schedule these appointments as soon as possible
Schedule your pre-op appointment with Sebastopol Orthopaedics – you will see the Palm Drive
Hospital pre-op nurse (Janese Nank (707) 829-4346) immediately following.
Two weeks before surgery


Attend your pre-op appointments
o with Sebastopol Orthopaedics
o and with the Palm Drive Hospital pre-op nurse (Janese Nank (707) 829-4346)
Please bring all of your prescribed medications, vitamins, and supplements to both of these
appointments.
Medications
Follow the instructions from your surgeon regarding medications that may need to be held. Typically
these include:




Aspirin
Blood thinners such as Coumadin or Plavix
NSAIDS
Metformin
Total Joint Replacement Packet, 3 | P a g e
Michael Bollinger, M.D.
Bruce Bragonier , M.D.
Mark Friedman, M.D.
555 Petaluma Ave., Suite B, Sebastopol, CA 95472
(707) 823-7602

You may take Tylenol, Celebrex, Vicodin, or Norco as directed for pain control as needed.
Month before surgery





Prepare your home (see handout).
Arrange for a ride home from the hospital.
Arrange for someone to stay with you for 1-2 weeks after surgery to help care for you.
Fill post op prescriptions one week prior to surgery.
Pack for the hospital (see handout).
Two days before surgery



Take the first of three antiseptic showers (follow the instruction sheet given by the pre-op
nurse).
Do not shave the surgical extremity 48 hours prior to surgery.
If there is any change in your physical condition (even a scratchy throat or skin abrasion), please
call Sebastopol Orthopaedics – (707) 823-7602.
Day before surgery


Do not drink or eat anything after midnight the night before your surgery – including gum, candy
and water
Follow pre-admission nurse’s instructions regarding which medications to take with a sip of
water (before midnight – any medications you have not previously stopped may be taken)
Day of surgery








Follow pre-admission nurse’s instructions regarding which medications to take with a sip of
water.
Leave your medications at home except inhalers and eye drops.
Dress in light, loose clothing.
Do not wear jewelry, hairspray or perfume.
Leave your valuables at home.
Check in at the hospital registration desk (Front Lobby).
After checking in you will be directed to our OPSU to get ready for surgery.
Your nurse will:
 Review your heath history.
 Take your vital signs.
 Start an IV.
 Teach you how to use the incentive spirometer.
Total Joint Replacement Packet, 4 | P a g e
Michael Bollinger, M.D.
Bruce Bragonier , M.D.
Mark Friedman, M.D.
555 Petaluma Ave., Suite B, Sebastopol, CA 95472
(707) 823-7602



 Review our pain scale.
 Prep your skin for surgery.
You will meet and discuss your heath history with your anesthesiologist.
You will meet your Circulating Nurse who will be responsible for your care while in the OR.
You will be in the OR from 2-4 hours, depending on the procedure.
Recovery Room





Nurses will be checking vital signs, temperature and pain.
You will be sleepy. Rest!
If your surgeon orders a CPM (continuous passive motion) machine, it will be set up here.
You will typically be in the recovery room 1-2 hours.
Visitors are not allowed in recovery, they may visit you once you are in your room.
Total Joint Replacement Packet, 5 | P a g e
Michael Bollinger, M.D.
Bruce Bragonier , M.D.
Mark Friedman, M.D.
555 Petaluma Ave., Suite B, Sebastopol, CA 95472
(707) 823-7602
Packing List for the Hospital



Personal toiletries
Leave your medications at home except for inhalers or eye drops (let the nurse know that you
have them).
Please leave valuables and all jewelry at home.
Television is available for each patient in every room.
At the hospital, you will be working with the physical therapist outside your room. They would like you
to feel comfortable; however use of an IV line will limit your use of street clothes. Previous patients
have told us that the most comfortable clothes for working with your physical therapy are:



Short bathrobe
Good support shoes or slippers
Loose-fitting leisure clothes that can accommodate IVs and drain tubes
We recommend bringing clothes that you would not mind if they get soiled with fluids.
You may also want to bring:





Underwear
A comfortable pillow
Reading materials
Battery-operated radio/CD player with headset
Other handiwork
Total Joint Replacement Packet, 6 | P a g e
Michael Bollinger, M.D.
Bruce Bragonier , M.D.
Mark Friedman, M.D.
555 Petaluma Ave., Suite B, Sebastopol, CA 95472
(707) 823-7602
Preparing Your Home Before Joint Replacement Surgery
There are certain things you’ll want to do to prepare your home before your joint replacement surgery.
This will make it easier for you once you return home post-operatively. Prepare the house so as to
minimize the need for stooping, reaching, and stair climbing. Plan on getting around, but relatively
slowly initially.
Bathroom
Depending on your baseline strength, you may need an elevated toilet seat. If you use a tub shower
with a door, you may need to have the door removed. Grab bars are an optional item. You may need a
raised or adjustable tub bench for use in the tub. Practice with your equipment prior to surgery.
Bedroom
Place your bedroom on the first level of your home if possible to avoid having to navigate stairs initially.
Raise your bed to increase height if the bed is too low to the flow (place blocks or books under the legs).
Place your bed so that transfers can be made in and out with ease. Place your pillow at the end of the
bed so that when you sit at the side of the bed, the pillow is on the opposite side of your injured hip.
Practice transfers in and out of bed utilizing a “log rolling” technique to ease stress on your hip. You
should not use a waterbed post surgery. Rearrange items in your drawers and closets to higher levels.
You will not be comfortable being down low right after hip replacement surgery.
Kitchen
You may want to freeze some meals ahead of time or purchase microwave food that can be easily
prepared when you get home. Place your most frequently used pots and pans to a higher level to
prevent you from excess stooping.
Around the House
Remove throw rugs to prevent tripping. Be especially careful if you have cats and dogs, since they tend
to be “underfoot.” You will benefit from a chair with arms (similar to a captain’s chair) or an elevated
recliner. Try to avoid use of a low sofa or low chair. You may want to gather frequently used items and
place them in a convenient accessible location.
Arrange for Help
You should arrange for someone to drive you home after surgery and have someone stay with you for
one to two weeks following surgery to help care for you.
Total Joint Replacement Packet, 7 | P a g e
Michael Bollinger, M.D.
Bruce Bragonier , M.D.
Mark Friedman, M.D.
555 Petaluma Ave., Suite B, Sebastopol, CA 95472
(707) 823-7602
Equipment Needs Following Total Hip Replacement
Surgery
Before returning home, your physical therapist will recommend the following equipment to help with
your safety and independence at home.



Crutches or walker
Tub bench
Handheld shower (optional)
Sebastopol Orthopaedics and Palm Drive Hospital generally do not provide equipment for you. The
exception is Medicare patients who have not had a walker in the past five years. You will be responsible
for obtaining and/or arranging for delivery of these items. Your insurance company may have a
preferred vendor for “durable medical equipment (DME)”. Be sure to check with your insurance
company before ordering. Listed below are a few vendors in the Sebastopol area who may be able to
assist you in supplying the needed equipment.
Used walkers can be found at:



Sutter VNA Hospice Thrift Store
Littons Springs Thrift Store (Healdsburg)
Sebastopol Senior Center – Equipment loaned out
New walkers and crutches can be purchased at:







CVS
Sonoma Surgical Supply (Santa Rosa)
Daniels Supply (formerly Redwood Empire Medical Supply in Rohnert Park)
Western Orthopedic (Santa Rosa)
Medical Dynamics (Santa Rosa)
Mobility Masters (on Dutton in Santa Rosa)
Pacific Medical Supply (Petaluma)
Total Joint Replacement Packet, 8 | P a g e
Michael Bollinger, M.D.
Bruce Bragonier , M.D.
Mark Friedman, M.D.
555 Petaluma Ave., Suite B, Sebastopol, CA 95472
(707) 823-7602
Herbal Supplements and Orthopaedic Surgery
Many people take vitamins and herbal supplements either once in a while, or all of the time. These
“herbs” are very popular, and many media outlets such as television or Internet or magazines describe
them as being totally “natural and safe.” However, research has showed that some of these herbs can
cause abnormal blood pressure, heart rates, bleeding, or over-sleepiness. “Herbs” can also interfere
with medications that your healthcare provider gives you. The effects of herbal treatments could cause
problems if you are having surgery and anesthesia.
It is very important that you tell all of your doctors if you are taking any “over-the-counter” medications,
including aspirin, herbs, vitamins, and dietary supplements.
Many orthopaedic surgeons and anesthesiologists feel that all herbs should be stopped one week prior
to surgery to keep you from having any problems. Your doctor requests that you stop the following
herbal treatments one week prior to surgery, as they have been proven to cause excessive bleeding*:







Dong Quai
Gingko Biloba
Ginger
Ginseng
White Willow Bark (salix alba)
Devil’s Claw (harpagophytum
procumbens)
Turmeric (curcuma longa)








Boswellia (bosellia serrata)
Stinging Nettle (urtica dioica)
Cat’s Claw (uncaria tomentosa)
Quercetin
Reservatrol
Cayenne
Omega-3 FA
St. John’s Wort
*AAOS, August 2001
Total Joint Replacement Packet, 9 | P a g e
Michael Bollinger, M.D.
Bruce Bragonier , M.D.
Mark Friedman, M.D.
555 Petaluma Ave., Suite B, Sebastopol, CA 95472
(707) 823-7602
Managing Pain Prior to Orthopaedic Surgery
Medications




One month prior to surgery – STOP Aspirin
Consult your Primary Care Physician if you take blood thinners (e.g., warfarin, Coumadin or
Plavix). Unless otherwise directed, generally stop taking warfarin or Coumadin 5 days prior to
surgery. Plavix should be stopped 7 days prior to surgery.
STOP herbal supplements and NSAIDS (Ibuprofen, Advil®, Motrin®, Aleve®, Naprosyn®) 7 days
prior to surgery.
You MAY take Tylenol, Celebrex, Vicodin or Norco for pain control as needed.
Non-steroidal anti-inflammatory medications are also called NSAIDS.
Examples of these medicines include Ibuprofen, Advil®, Motrin®,
Naprosyn®, Vioxx®, Relafen®, Clinoril®, Lodine®, Tolectin®, Orudis®,
Daypro®, Voltaren®, and Anaprox®.
You need to stop taking these medications because they prolong the time it takes your blood to clot.
This can cause serious problems after surgery. Failure to stop these medications in time may prevent
you from having surgery on your scheduled date.
Total Joint Replacement Packet, 10 | P a g e
Michael Bollinger, M.D.
Bruce Bragonier , M.D.
Mark Friedman, M.D.
555 Petaluma Ave., Suite B, Sebastopol, CA 95472
(707) 823-7602
Iron Supplements
These supplements are used to treat low blood iron or anemia by helping the body make red blood cells.
You should not use this medicine if you have an allergic reaction to iron supplements.
Brand Name(s): Feosol®, Fer-In-Sol®, Slow-Fe®, Femiron®, Feostat®, Fergon®, Ferralet®, Ferra-TD®, MolIron®, Niferex®, Hytinic®, Nu-Iron®.
How to use and store this medicine:
Your doctor will tell you how much medicine to take and how often. Take with plenty of fluids to avoid
the problem of constipation. Store at room temperature and out of reach of children; too much iron can
be very dangerous for them.
Tablets: Is best taken on an empty stomach, although it can be taken with food if upset stomach occurs.
Liquid: Is best taken on an empty stomach, although it can be taken with food if upset stomach occurs.
Iron may stain your teeth. This problem can be avoided by mixing with water or other liquids (fruit or
tomato juice) and drinking the medicine through a straw. Stains can be removed by brushing with
baking soda or peroxide. Store this medicine at room temperature only, and avoid heat, direct light, or
moisture.
If you miss a dose: Take the missed dose as soon as possible. Skip the missed dose if it is almost time
for the next regular dose. You should never take two doses at a time.
Drugs and foods to avoid: Tell your doctor if you are taking any antibiotics or Vitamin E. If you are
taking ciprofloxacin or tetracycline, then take these medicines three hours before or two hours after the
iron supplement. You should not use the iron at the same time as antacids (such as Maalox® or
Mylanta®). You should not use iron at the same time as certain foods such as eggs, milk, cheese, yogurt,
coffee, tea, cereals, or whole-grain bread.
Warnings: If you are pregnant or breastfeeding, talk to your doctor before taking iron. Make sure your
doctor knows if you have a hiatal hernia, stomach ulcers, intestinal ulcers, or bleeding problems. Iron
can cause dark stools. This is normal.
Side Effects: Call your doctor right away if you have bloody diarrhea, severe vomiting, unexplained
weakness, nausea, darkened urine, heartburn, constipation, or staining of the teeth.
Total Joint Replacement Packet, 11 | P a g e
Michael Bollinger, M.D.
Bruce Bragonier , M.D.
Mark Friedman, M.D.
555 Petaluma Ave., Suite B, Sebastopol, CA 95472
(707) 823-7602
What to Expect After Leaving the Recovery Room
You will be transferred to an inpatient room and greeted there by the nursing staff. A frame will be
placed on your bed to make it easier to move around. You will receive oxygen through a small tube
placed in your nose. Some patients will have a urinary catheter, which is a small tube used to drain
urine from your bladder. You will still have an IV in your arm to administer fluids and antibiotics.
You may have elastic stockings (TEDs) on your legs, as well as inflatable stockings called SCDs on one or
both of your legs. These help with circulation and prevention of blood clots. You will have a dressing on
your hip and possibly a drain coming from your leg. The drain collects any excess blood from your
operative site. Many patients also have an ice bag placed at the operative site.
You will be given a device called an Incentive Spirometer to assist you with breathing. The nursing staff
or respiratory therapist will teach you how to use it for deep breathing exercises. You should try to use
it 10 times per hour when awake.
You will be offered ice chips to start with, then water. If you are not nauseated, the nurses will advance
your diet. Please let them know if you follow any special diet.
Each surgeon manages pain differently. Discuss options with your nurse or surgeon.
Some patients require a blood transfusion after surgery due to blood loss. Every effort is made to
minimize this. However, blood loss is common during hip surgery.
The usual hospital stay for a total joint replacement is 2-3 days. Depending on your progress, you will
either go home or move to the next level of care.
Total Joint Replacement Packet, 12 | P a g e
Michael Bollinger, M.D.
Bruce Bragonier , M.D.
Mark Friedman, M.D.
555 Petaluma Ave., Suite B, Sebastopol, CA 95472
(707) 823-7602
Schedule for Your Hospital Stay
DAY OF SURGERY:

If you are out of recovery early enough, your physical therapist will come help you sit at the
edge of the bed and stand with a walker if you are able, and teach you the leg exercises to do in
bed.
POST OP DAY 1:






The physical therapist will help you get out of bed. Your goals will be to get out of bed with
help, walk with a walker, and sit up in a chair. The physical therapist or nurse will assist you
back to bed. You will review the leg exercises in bed.
Most patients will receive a blood thinner to help prevent blood clots. This may be a pill or a
small injection in your abdomen. Most patients will receive a multivitamin and a stool softener.
Laxatives are also available.
Your catheter should come out today, once you can get out of bed with a little help.
Continue to discuss your pain management plan with your surgeon and your nurse.
Discharge planning begins with the social worker, nurses, physical therapist and your surgeon.
Sleeping in the hospital: Lying on your stomach is ok. For side sleeping, you will be able to sleep
on your non-operated leg; however, it will be painful to sleep on your operated side. It will most
likely take 6+ months to have pain free sleeping on your operated side.
POST OP DAY 2:






You will continue with the exercise program designed by you and your physical therapist.
You should be able to walk out into the hall. Continue to do your leg exercises when in bed.
You will continue taking a blood thinner and prescribed medication.
Use your incentive spirometer every hour while awake to help prevent lung complications.
Social work will be in to discuss discharge plans. If you re discharged to home, we strive to have
you discharged by 11am so you’ll have time to get settled at home and have your prescriptions
filled.
You may go home today if you are moving about well enough and are medically stable.
Total Joint Replacement Packet, 13 | P a g e
Michael Bollinger, M.D.
Bruce Bragonier , M.D.
Mark Friedman, M.D.
555 Petaluma Ave., Suite B, Sebastopol, CA 95472
(707) 823-7602
POST OP DAY 3:










Most patients are now on oral pain pills rather than injections.
Continue to use your incentive spirometer every hour while you are awake.
Drink plenty of fluids and your IV may be disconnected.
You may be transferred to the next level of care today. If going home, begin making plans for
transportation for the next morning and social work will continue to help with the arrangements
for services or equipment needed.
Therapy progresses. You will stay out of bed longer and walk further.
You will be seen by an Occupational Therapist before you leave.
You may have limitations with bending to pick up objects due to hip pain, stiffness, and/or lack
of power to perform the activity. Occupational therapy can present options for assistive to
accomplish these tasks.
Most likely, you will go home today. However, you have to be independent and safe getting out
of bed and walking to be discharged home.
Equipment will have to be ordered per your surgeon’s order and arrangements completed
before going home.
If you’re not ready to go home, you may be moved to a rehabilitation facility for a short stay
until you are strong enough to go home safely.
Total Joint Replacement Packet, 14 | P a g e
Michael Bollinger, M.D.
Bruce Bragonier , M.D.
Mark Friedman, M.D.
555 Petaluma Ave., Suite B, Sebastopol, CA 95472
(707) 823-7602
Total Joint Replacement and Dental Procedures
It is very important for total joint replacement patients to remember that bacteria in your blood stream
can get into your artificial joint and cause infection. If you get an infection in your teeth, sinuses, throat,
bladder, feet or any place else, it must be treated. You will always need antibiotic coverage when you
have dental work, endoscopy procedures, flexible sigmoidoscopies, or other surgical procedures that
may put you at risk for an inflection. You should always tell (and remind) your primary care doctor that
you have had a joint replacement.
The American Dental Association and the American Academy of Orthopaedic Surgeons recommend that
prophylactic antibiotics be administered to patients who have had total joint replacements prior to any
dental work including routine cleaning*. Antibiotics should also be used prior to any urologic
manipulation or any procedure which may potentially cause a transient bacteremic state.
Suggested Antibiotic Prophylaxis Regimen (no second doses recommended):
Patients not allergic to Penicillin: use Cephalexin, Cephradine, or Amoxicillin
2 grams given orally 1 hour prior to dental procedure
Patients not allergic to Penicillin and unable to take oral medications: Cefazolin or Ampicillin
Cefazolin 1 gram or Ampicillin 2 grams given intramuscular or intravenously 1 hour prior to dental
procedure
Patients allergic to Penicillin: Clindamycin
600 milligrams given orally 1 hour prior to dental procedure
Patients allergic to Penicillin and unable to take oral medications: Clindamycin
600 milligrams given intravenously 1 hour prior to dental procedure
*JADA, Vol. 128, July 1997
Total Joint Replacement Packet, 15 | P a g e