Frenquently Asked Questions

    Narcotic Free Total Joints

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    • What are narcotics?

      Narcotics are powerful pain medications that are derived from opium. Morphine, codeine, hydrocodone, dilaudid and Percocet (oxycodone) are all narcotics.

    • What is wrong with narcotics?

      Narcotics are highly addictive and have potent side effects. They can cause sleepiness, impaired decision making, constipation, intestinal ileus, slow breathing and death.

    • What is the narcotic epidemic?

      Thousands of people are currently taking narcotics. From 2000 to 2015 more than half a MILLION people died from drug overdoses. 91 people in the USA die DAILY from opioid overdose. Many CHILDREN get addicted to these meds when they take them from relatives. Many people sell these medications.

    • What is narcotic free total joint replacement?

      I provide patients the opportunity to have a new hip or knee replacement without the need for powerful narcotics medicines. I realize that many patients feel the same way I do about narcotics-- -they’re scary! Many of my patients are able to use NO NARCOTICS after surgery.

    • How is narcotic free total joint replacement accomplished?

      I use multiple methods to help patients avoid narcotics:

      • Special nerve blocks using local anesthetics
      • Simplified exercises that reduce swelling and pain
      • Muscle sparing surgery
      • Ice and elevation (don’t underestimate this one!)
      • Education and Engagement using the Swiftpath Model
      • Patient optimization starting 6 weeks BEFORE surgery happens
      • Non-narcotic medications that control swelling, inflammation, and pain
      • Using blood thinners that don’t cause as much bleeding and swelling
      • Using tourniquet free techniques
      I am committed to reducing narcotics in my practice and appreciate that my patients also want the same thing.

    Tourniquet Free Total Knee

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    • What is a tourniquet?

      A tourniquet is like a giant blood pressure cuff that is put around the upper thigh and is inflated to a very high pressure to stop all bleeding during surgery. The majority of total joint surgeons use a tourniquet to perform knee replacement. The main reason is convenience—a tourniquet provides a surgical field that has less bleeding. The question is do we really need it?

    • What are the problems with tourniquets?

      Tourniquets create bleeding and bruising to the upper thigh because they are inflated to a very high pressure for generally more than an hour. Wide awake military recruits cannot tolerate a tourniquet for more than 20 minutes-- -one third the time that surgeons leave the tourniquet inflated for much older patients. This increases the risks of :

      • Swelling
      • Infection
      • Metabolic disturbances
      • Blood clot
      • Nerve damage
      • Slower recovery
      • Longer complaints of pain

    • Why don't surgeons stop using tourniquets?

      Most surgeons are taught to do this surgery with a tourniquet which is generally associated with successful outcomes. It is hard for surgeons to stop using what has worked reasonably well in the past and switch to a new technique. Surgeons don’t like change. The data however supports getting rid of the tourniquet. Consider how uncomfortable a blood pressure cuff on the arm is when the nurse inflates it…and that’s for one minute. I know what I want for myself and I recommend you discuss this with your surgeon.

    • Is there a way to control bleeding without a tourniquet?

      YES, I believe there is. I use several simple techniques that control bleeding in the incision and within the knee where the implant is placed.

    Frequently Asked Questions

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    • What is outpatient joint replacement?

      Historically, all joint replacements were done as inpatients. This is largely because joint replacement surgery has involved large incisions, significant blood loss, significant pain management issues, and a wide variety of complications. For that reason, it's always been felt that joint replacement patients needed to be in the hospital. Now, with minimally invasive surgical techniques, sophisticated periarticular injections, multimodal pain management, and computer navigation, patients are simply able to go home on the day of surgery and do not require hospitalization. This carries significant advantages in terms of decreased pain, decreased complication risks, improved patient satisfaction, and decreased exposure to the potential for hospital-acquired complications and infections.

    • How long will I need assistance after surgery?

      It is always better to be over-prepared than under-prepared. We suggest you plan on having someone with you consistently for 3-5 days after surgery. However, plan to have someone available to help you for the following week or two after that.

    • Is SwiftPath a nationwide program or just a local program?

      SwiftPath is a national program that is continually expanding. For specific locations, refer to the surgeon locator map on the SwiftPath website.

    • Can I get a handicapped parking pass?

      Yes, we will provide you with one at your “Decision for Surgery” visit (pre-op appointment).

    • What is the knee replacement made of?

      The knee replacement that we use is made up of cobalt chrome and highly cross-linked polyethylene.  

    • How long is the surgery?

      The actual time that it takes to perform knee replacement is typically 50-60 minutes. Hip Replacement generally is a touch less than that. However, with the time required for blocks, anesthesia, room set-up, and transfer to the recovery room, the wait time for your family will be roughly two to three hours. I am very fortunate to have an amazing team of professionals who will be helping you.

    • What type of anesthesia will I have?

      You will meet with an anesthesiologist the morning of your surgery to discuss what form of anesthesia will work best for you. Some patients will do better with spinal anesthesia while others require general anesthesia.  My anesthesia team is excellent and will help guide you to the best choice.

    • Do I need to bring the ice machine to hospital?


    • Do I need to bring my walker to hospital or surgery center?

      Yes. Patients will need their walker at the surgery center. Please address this issue with my staff. Some insurance companies give you and us a hard time about prescribing a walker before surgery. At the hospital, patients will receive a walker but if you have one at home, no need to automatically buy another. Have your coach bring it in AFTER surgery and the therapist or nurse can make sure the height is adjusted appropriately for you.

    • Should I get the Flu Vaccine before or after surgery?

      I believe that patients should get a flu shot at least 2 weeks PRIOR to surgery during the flu season.  Your regular doctor typically can do this for you and many pharmacies offer this option.

    • Do I have to donate blood before surgery?

      No. New techniques in preserving blood have prevented the need for you donating prior to surgery.  However, we obtain blood work generally 6 weeks prior to surgery.  If your blood count is low we need to address it.  Patients who have surgery with a low blood count are at increased risk for infection.  I postpone surgery until it is corrected.

    • Do I need to quit smoking?

      YES.  We require that all of our patients quit smoking. Smoking and nicotine use has been linked to delayed healing and doubles the risk of infection.  If you test positive for tobacco, your surgery will be cancelled and will NOT be rescheduled.  I am serious about preventing infection.

    • Why is Diabetes control important?

      When your blood sugar spikes above 140, the white blood cells go on vacation.  White blood cells help you fight infection.  Poor control of diabetes increases your risk of infection.  I will NOT operate on patients with a hemoglobin A1c above 7.7 because this tells me that the blood sugar is frequently ABOVE 140.  Work with your doctor to get better control.

    • How much time do I need to take off work following hip replacement surgery?

      We try to return you to work as soon as possible. This may be as early as 2 weeks, depending on your job description. If you are able to sit at a desk or do minimal walking in a day, 2-3 weeks is reasonable. However, if you are required to be on your feet all day or walk extensively, this could take 6-8 weeks. Our goal is to get you back to work when you are safe and your pain is controlled.

    • How much time do I need to take off work following knee replacement surgery?

      It may be necessary to take 3-6 weeks off work depending on the physical demands of your job. If you are able to sit at a desk or do minimal walking in a day, 2-3 weeks is reasonable. However, if you are required to be on your feet all day or walk extensively, this could take 6-8 weeks. Our goal is to get you back to work when you are safe and your pain is controlled.

    • What medications do I need to stop taking and when do they need to be stopped?

      It is very important that you have an accurate list of your medications prior to surgery. We will be able to tell you what medications to stop. This typically includes medications that will cause your blood to be thinner. Please bring the list with you prior to surgery.  I want to personally review your meds at the decision for surgery visit.

    • Why is it important to obtain a preoperative clearance from my family doctor?

      Preoperative clearance is very important. There is no one that knows you better than the doctor who has been taking care of you. We want to make sure your lungs, heart and kidneys are all working as best as they can be before surgery. In particular, we want tight diabetes control and need your blood pressure to be well regulated.

    • When can I return to activity after my hip or knee replacement?

      The answer to this question depends a lot on surgical techniques and the specific protocols being used.  When joint replacements are done the traditional way with full-sized surgical approaches and prolonged hospital stays, it typically takes patients 6 months to 2 years to resume daily activities.

    • When can I return to activity after my hip or knee replacement?

      The answer to this question depends a lot on surgical techniques and the specific protocols being used.  When joint replacements are done the traditional way with full-sized surgical approaches and prolonged hospital stays, it typically takes patients 6 months to 2 years to resume daily activities.  

      The SwiftPath Program emphasizes minimally invasive surgical methods, a reduction in narcotics, modern pain management, and early mobilization.  The SwiftPath patients participate in an online patient reported outcomes platform that informs us when they are able to return to activities.  Over half of these patients are reporting return to full routine daily activities (community ambulation, return to work, etc.) by 3-4 weeks.

      Many SwiftPath patients are anxious to return to all activities, including sports, as early as 6 weeks. "When can I start hiking? When I can I start traveling? When can I start cycling, golfing, squatting, playing tennis, racquetball?”   When it comes to returning to recreation, it is important to understand that while the surgery might be healed and the implant is in a good position, the soft tissues around the joint (tendons, ligaments, muscles, and the capsule around the joint) have been engaged in this arthritis process for ten years, and they have to be rehabilitated over a period of 2 years.

      As they heal, the scarring, the contracture, the deteriorated muscles all loosen up, become more elastic, and develop better resilience.  These tissues that haven’t really moved over the excursion of the joint is now going to start moving over a normal excursion of the joint. If the tissues are forced to work too hard, too soon, injury will result.

      Those injuries can take six months to recover. It's like any other pulled muscle, like any other torn muscle.

      Our philosophy is to allow gradual, incremental return at a slow pace with careful attention to symptoms of pain, stiffness, and swelling.
      Return to one activity at a time. Don’t start running, jogging, cycling and traveling and doing a lot of things all at once.
      Start with simple, low-impact activities first (walking programs, elliptical, stationary bike, water aerobics).  Avoid high-intensity, decelerating activities that can lead to injury.

      Allow your return to recreation to occur incrementally, being careful to note any problems that arise with each increment. Pay attention to and record any symptoms of pain and swelling and allow yourself to recover before resuming.  
      Avoid high risk activities that could lead to fracture or implant failure.

    • What will happen in the operating room?

      Your nurse will take you to the operating room and you will be placed on the operating table. In the operating room you will notice there will be several people; a surgical tech that will be responsible for passing instruments and several nurses. The room is often cold. It is important to maintain a temperature that reduces the risk of infection. If you have any questions, please do not hesitate to ask them so we can make your brief time in the operating room more comfortable.

    • Do you cut through the quadriceps?

      We use an approach that is based on minimally invasive surgical techniques. This includes utilizing a mobile soft tissue window.   We do not use a tourniquet which has been shown to lead to less pain and bruising and less quadriceps pain compared to the those surgeons who use a tourniquet.

    • How long is recovery?

      • Typically, it takes about two days to start decreasing narcotic use. Although 30% of patients are able to use no narcotics at all
      • It takes 7 to 10 days before patients are independent enough to start thinking about driving or considering community ambulation, getting to the clinic and starting outpatient physical therapy.
      • It takes 4 to 6 weeks before patients are reaching activity levels they were at prior to surgery. It takes up to two months before the joint replacement is truly beginning to improve to its maximum.
      • It can take up to two years for the hip or knee replacement to finish improving.

    • Is there anything I can take to reduce the pain?

      Pain management is a complex combination of cold therapy (icing), use of multimodal pain management including anti-inflammatories and acetaminophen, and the occasional use of narcotics. This is best managed specifically with your physician.

    • When do I stop eating and drinking?

      Do not eat, drink, or chew gum after midnight the day before your surgery.  The anesthesia team will tell you which medicines they want you to take the morning of surgery.

    • What do I wear the morning of surgery?

      Loose fitting clothing - easy on and easy off is best.  When you arrive at the surgery center or hospital, we will ask you to wear a surgical gown. Following the procedure, loose comfortable clothing will make it easier for you to get dressed and home safely.

    • What can I bring to the hospital?

      • Plan like you are going on a short vacation.
      • Bathroom supplies, a gown or robe, and loose fitting clothing to wear upon discharge.
      • Bring a list of your current medications as a reference, if needed.

    • Can I wear make-up the morning of surgery?

      Please do not wear any make-up on the day of your surgery. This may interfere with our ability to perform anesthesia.

    • Can I wear nail polish or acrylic nails?

      We ask that when you come to surgery that you do not have nail polish on your fingernails. During surgery we monitor your oxygen level through the fingertip. This can interfere with our ability to get a good reading.  The minimum we need is one nail per hand to be without polish. It makes things easier if you remove all polish however.

    • Do I need to take out my body piercings?

      Please do your best to remove all body piercings prior to surgery.  We use electrocautery to help minimize blood loss. Electric current could be a problem with piercings.