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1-2 Months Prior to Surgery

*Call to schedule an appointment with your primary care physician for medical clearance.  This appointment will need to take place 3-4 weeks prior to the surgery date.  You will need bloodwork done and an EKG.  If your primary care office does not do these procedures (bloodwork, EKGs) in the office, make sure you have them done prior to your appointment and take the results to your primary care appointment for review. We might be able to use some of your recent bloodwork if you just had a checkup with your primary care physician, but some of the tests are specifically for surgery and probably aren’t routinely done by your doctor.

 

* Decrease smoking as much as possible (or stop ideally) 6 weeks before and after surgery to lower risk of infection and wound healing problems

 

*If you have diabetes your Hgba1c must be below 8 to proceed with scheduling surgery to lower the risk of infection. Control your blood sugars as much as possible leading up to surgery and after surgery to lower your risk of wound healing and infection issues. If your Hgba1c is above 8 please work with your primary care doctor to better control your diabetes then we can reschedule surgery at a later date.

 

*Confirm the location of your surgery with Valerie (Dr. Weidner’s scheduler). Dr. Weidner operates at 2 hospitals (Inova Fair Oaks & UVA Haymarket), and 2 outpatient surgery centers (Stone Springs and Northern Virginia). If you discussed with Dr. Weidner that you would be going home on the day of surgery we would recommend surgery at one of the two surgery centers. The surgery centers are smaller, more efficient, and patients generally have a more positive experience compared to the hospitals. There is probably also a little bit lower risk of infection at the surgery centers compared to the hospitals. Surgery centers in general are less expensive also, some patients have insurance plans that charge a significant copay if you have surgery at the hospital rather than the surgery center. For patients that are planning to stay overnight then you need to schedule at either Fair Oaks or Haymarket hospitals.

 

*Call to set up preoperative AND postoperative outpatient physical therapy at a location of your choice. The therapist will teach you exercises and stretches to do leading up to your surgery as well as how to use the rolling walker you will use after surgery. Both our Fair Oaks and Manassas offices have physical therapists next door that work with us, but you are welcome to go to any PT location that is convenient for you.

*Postoperative PT sessions should begin 2-5 days after surgery and will need to take place 2-3 times a week. Hip replacement patients should plan for 2-4 weeks of therapy. Knee replacement patients should plan for about 6 weeks of therapy. If you were not given the prescription at your appointment with Dr. Weidner, please call us with the fax number for the PT facility you will be using and we can send the order.

*Our preference is for you to use the therapy office at one of our locations as they can let us know if you are having issues. Our Manassas location PT phone number is 703-361-0465. Our Fair Oaks location PT phone number is (703) 361-2164.

*If you do not have someone to drive you to PT postop and think you NEED home physical therapy for a couple weeks please let Valerie/Dr. Weidner know and this can be arranged. Home PT is usually less beneficial than office PT, the therapists do not have equipment at your home and sometimes do not show up when they are supposed to. Home PT in general is more expensive also.

 

*Get any equipment you might want/need after surgery. Including Ice Machines (particularly helpful for knee replacement patients), Walkers, Canes, hip replacement kit (search on amazon). These items will be FSA/HSA eligible. Walker will be given at hospital/surgery center on day of surgery and billed to insurance by the facility if you do not already have one.

 

*Our office has Ice Machines available for purchase – please ask Valerie if interested. Or borrow from friends/buy elsewhere. HIGHLY recommended for knee replacement patients in particular. Not covered by insurance, FSA/HSA eligible.

 

Total Joint Classes: If your surgery is going to be at Stone Springs Surgery Center you will be contacted by the surgery center to schedule for their Total Joint Education meeting. You are encouraged to attend this meeting, it is very informative.

 

*If you are currently working, your workplace may have disability and/or FMLA paperwork they will require you to have filled out regarding your time off work after surgery. It is your responsibility to check with your human resources department to get this paperwork to us as we do not carry these forms in our office.  We require 1 week to fill this paperwork out for you although turnaround time is typically 1-2 business days.  See details below for how paperwork will be completed unless we are told otherwise.

           

*Your first day of disability will be the day of your surgery. 

*At 6-8 weeks: We will send you back to work ‘light duty’ (limit standing/walking <30minutes at a time; no squatting, crawling, kneeling)

*At 12 weeks:  You will be sent back ‘regular duty without restrictions.’

 

3-4 weeks prior to surgery

*Complete your preoperative clearance physical with your primary care physician. Please have labs faxed to (703)393-2517. Take your preoperative testing order form we have given you to the appointment so your physician knows what we would like ordered.

 

1 week prior to surgery

*Stop taking non-steroidal anti-inflammatory medication (NSAIDs, eg Advil, Motrin, Ibuprofen, Aleve, Naproxen, Aspirin, Meloxicam, Diclofenac). You may only take Tylenol for pain until surgery unless otherwise directed by our office.

*If you are taking anticoagulant medication (i.e. Coumadin, Xarelto, Lovenox, Eliquis, Pradaxa), contact the physician who prescribes it to decide when they want you to stop the medication prior to surgery – usually 3-5 days before surgery.

* Stop GLP-1 medications (wegovy, ozempic, monjaro, etc) 1 week before surgery

* Stop biologic Rheumatoid arthritis medications (enbrel, humira, orencia, cimzia, etc) for one dose before and one dose after surgery to help prevent wound healing issues

* Telehealth Pre op appointment with Dr. Weidner. Please review all documents you have been given and ask Dr. Weidner any questions or concerns you have at this time.  Dr. Weidner will give all your postop prescriptions at this appointment so you can get them before surgery and have them ready at home.

* Use mupirocin antibacterial nasal ointment inside your nose 2x/day for 5 days before surgery. You place this on a Q-tip and swab inside the nose. It helps to decrease the risk of infection. Dr. Weidner usually sends this to your pharmacy at the time of the office visit when you decide to proceed with scheduling surgery, if you haven’t received it remind him to resend at the time of your preop telemedicine appointment.

*Please have your ‘Virginia Advance Directive for Health Care’ form completed and sent back to Valerie.

* If you are scheduled for surgery at INOVA Fair Oaks Hospital call Presurgical Scheduling at (703-391-3500, #3) for an appointment interview to go over your medical and medication history.  They will tell you which medications you may take leading up to surgery as well as which medications you may take the DAY OF surgery.

*UVA Haymarket, Stone Springs & Northern Virginia surgery center patients will receive a call from the hospital/surgery center for their preoperative interview.

*ALL the hospitals/surgery centers will call you within a couple days of the surgery to confirm the time you are expected to arrive on the day of surgery. Valerie/Dr. Weidner do not necessarily have this information.

 

Day before surgery

*Do not eat anything on day of surgery or any food within 8hrs of surgery

*You may drink clear liquids (water, black coffee) on the morning of surgery

*Shower with Hibiclens CHG soap the morning 1 day before surgery, the night before surgery, and the morning of surgery. Sleep in clean clothes and bedsheets the night before surgery. Do not use Hibiclens soap on head or genital area. Hibiclens is obtained without prescription at the pharmacy.

 

Day of surgery

*Arrive at least 2 hours prior to surgery and go to the location as instructed by Valerie.

*Bring your photo ID, insurance card, and list of all medications you are taking to the hospital.

*You will often get spinal anesthesia which is an injection in the back to make the legs numb temporarily during surgery with sedation similar to a colonoscopy. Some patients may have general anesthesia depending on patient and anesthesiologist preference. Knee replacement patients will also have nerve blocks by the anesthesiologist prior to surgery to help with pain control after surgery.  The anesthesiologist will be able to answer any questions you have about this and will thoroughly explain the procedure to you including risks and benefits.

*If you are going home on the day of surgery you should plan on ~6 hrs from the time you check in before surgery, have surgery (~75-90 min), and wake up from anesthesia in the recovery area before you are ready to go home. Someone can drop you off and pick you up later if they would like, they do not need to stay the whole time.

 

Your Hospital Stay

*After surgery, your focus in the hospital will be on physical therapy (range of motion, ambulation, and function) and pain control.

*If staying overnight the hospital case manager will meet with you during your hospital stay to set up home equipment delivery and file it through your insurance (i.e., rolling walker, 3-in-1 commode).

 

Nice to Know Tidbits

* Please wait until at least 3 months after surgery to have any non-emergent dental work.  After 3 months no antibiotics are needed prior to routine dental work.

* Numbness on the outside of the knee is normal after knee replacement and the outside of the thigh after hip replacement. The area of numbness will get smaller over time but takes many months to resolve. There will probably always be an area of numbness near the incision for all surgery patients and on the outside of the knee for knee replacements

* Knee replacement patients are allowed to kneel on the knee after the incision has healed. Though it may be sensitive it isn’t doing any damage to the knee replacement.

 

 

 

 

 

 

Dr. Weidner's Post-Op Instructions for Hip & Knee Replacement Surgery  

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GENERAL RECCOMENDATION

While we realize you have just undergone surgery, we don’t think of you as sick and neither should you! Your goal each day should be to make more progress than you did the previous day. However, it is recommended (especially for knee replacement patients) to rest, ice, and elevate the leg particularly for the first 10-14 days after surgery to control swelling which will help with pain and the overall recovery. Recommend 50 min/hr of ice and elevation, 10 min/hr of light walking around or exercises while awake.

 

MEDICATIONS

Take the following medication as directed:

1. For Pain:  Narcotic (Percocet or Norco) pain medicine as prescribed throughout day as needed. Can take 2 pills at a time even if rx says one. Can cause constipation – recommend to get over the counter stool softeners before surgery and use frequently (Colace, senna, MiraLAX, etc.).  

2. Blood clot prevention: Aspirin 81mg two times per day x 30 days unless otherwise directed starting day after surgery.

3. Anti-inflammatory:  Celebrex 100mg two times per day x 30 days starting night of surgery

   1. Do not take regular anti-inflammatories (Ibuprofen, Aleve, Motrin, Meloxicam, Diclofenac, etc.) while taking the above dose of Aspirin. Celebrex is safer for the stomach.      

   2. After 1st 30 days of Aspirin + Celebrex you can then switch back to other anti-inflammatory medicines (Ibuprofen, Aleve, Motrin, Meloxicam, Diclofenac, etc.)

4. Cefdinir 300mg 2x/day for 7 days postop starting night of surgery – antibiotic to help prevent infection

5. Dexamethasone 4mg 2x/day for 4 days postop for Knee replacement patients without diabetes starting night of surgery – steroid which is a strong anti-inflammatory

6. Tranexamic Acid 1300mg 2x/day for 1 week postop for Knee replacement patients starting night of surgery – helps limit bleeding/swelling

7. Other: **You should resume taking your normally prescribed preoperative medications unless otherwise directed

***If you find the cost for any of the postop medications to be significant at your pharmacy please let us know and we can send prescriptions to Cost Plus Drugs online pharmacy (Mark cuban pharmacy) which has the below prices:

Celebrex $7.40 for 60 tabs             Cefdinir $12.50 for 30 pills

Aspirin $6.20 for 60 tabs                Dexamethasone $12.80 for 30 pills           Tranexamic acid $37.70 for 30 tablets

             

             

Pain Medication Tips:

• Do not drive while taking pain medications.

• Do not drink alcoholic beverages while taking pain medications.

• Pain medication should be taken with food as this will help prevent any stomach upset.

• Pain medications can cause constipation. Eat high fiber foods and increase your fluid intake. To alleviate constipation, purchase a stool softener over the counter at any pharmacy and follow the recommended directions on the bottle.

 

 

Blood Clot Prevention

• You will be prescribed a medication to take to prevent blood clots, usually Aspirin.

• Make sure to take these medications as prescribed, for the duration that is on the medication. While taking these medications you may not take anti-inflammatory medications such as Diclofenac, Meloxicam, Ibuprofen, Advil, Aleve, or Naproxen because of the risk of bleeding.  You can take Celebrex instead of these medications.

• In addition to taking these medications, you can decrease the risk of developing a clot by making sure you are getting up and taking small walks or doing the exercises below every few hours during the day.                           

 

DRESSING/SHOWERING

Keep ACE bandage on leg to help with swelling for 2 days after surgery after knee replacement. After two days you can unwrap the ACE bandage and shower with the dressing on the skin. Hip replacement patients can shower the day after surgery with waterproof bandage on. KEEP WATERPROOF DRESSING ON until 1st postop appt 2 weeks after surgery. You can shower with this bandage on. Slight bleeding is common but if the dressing becomes saturated out to the edges call the office and let us know.  After removing dressing at 1st postop appt in office you may now get the wound wet with showering but avoid scrubbing the incision. When showering, let the soap and water run over the incision and then pat dry. Avoid soaking in hot tubs, pools, lake/beach until the wound is completely healed about 6 weeks after surgery as this increases the risk of post-operative infection. 

 

CANE/WALKER

Use a cane or walker for security and comfort. Full weight bearing is allowed as tolerated with pain and swelling being your guide to activities. You will be working with your physical therapist on discontinuing these devices so please continue to use them until directed.

 

PHYSICAL THERAPY

You should have received a prescription for physical therapy from our office preoperatively. If you did not, call us and we can send it to you.

**Please make sure you start physical therapy within 2-3 days of surgery either via home P.T. or at an outpatient office. If you are starting with home PT you should set an outpatient PT appointment for 2 weeks after surgery (hip patients may wait until returning to office for 1st postop appt to see if any further PT is needed, knee patients will need at least 4-6 weeks of PT). It is preferred that home PT be reserved for patient’s that live alone and have nobody to take them to outpatient PT, outpatient PT is usually more effective.

 

EXERCISE

       Begin exercise the day after surgery. Repeat 10 min/hr when awake during daytime, rest/ice/elevate the other 50 min/hr for the first 10-14 days (especially knee replacements)

Quad sets: Push the back of the knee into the bed and hold a count of 10.

Straight leg Raises (SLR): Keeping knee straight, lift the leg off the bed and hold for a count of 10.

     **These may be difficult at first but keep trying it even if you are unsuccessful**

Ankle pumps: Flex ankle up and down multiple times (as if pushing a gas pedal) to help blood flow in your legs.

Heel Slides: Sit on firm surface with your leg straight out in front of you. Slowly slide the heel of your operative leg toward your buttock by pulling your knee to your chest when you slide.

Knee Flexion: Knee replacement patients should sit in a chair and let their knee bend. Progressively move your body forward to get the knee to bend back more as tolerated.

 

 

 QUESTIONS/CONCERNS

A doctor is on call in the office all the time and can be reached by calling 703-393-1667 for any of the following symptoms:

Fever greater than 101.5 degrees F. 

Numbness, loss of good color or coolness in the foot. 

Severe pain unresponsive to narcotic medication.

Excessive bleeding or vomiting.

Difficulty breathing, shortness of breath, chest pain CALL 911

Dr. Weidner can also be reached on his cell phone for emergencies at (will be given to you on the real instruction sheets once surgery scheduled) or via email (will be given to you on the real instruction sheets once surgery scheduled)

 

FOLLOW-UP

You should have been scheduled to return to see Dr. Weidner in his office about two weeks after surgery.

       If you need to verify or change your post-op appointment, please call 703-393-1667