FAQs
When do I know it is time for a knee replacement or hip replacement?
This is a hard decision for many patients, and you are not alone!
This is a decision best made by the patient after consultation with his or her doctor. Dr. Gausden recommends waiting until you have arthritis that causes pain on a daily basis and affects the activities that you want to do.
Which surgical approach is the best for total hip arthroplasty (THA)?
There are two main approaches to the hip used most commonly today: the posterior approach and the anterior approach. Both are safe approaches to use, and Dr. Gausden performs both approaches. She will select the approach that is right for each individual patient. While the complication rate is equal overall, there are advantages and disadvantages to each approach. The posterior approach affords an extensive exposure to the femur and acetabulum and is the preferred approach in complex cases where extensive exposure is required. Most revisions will be performed posteriorly for this reason. For both approaches she will use MAKO-Stryker robotic navigation.
The anterior approach may have a slight advantage in terms of early recovery. The risk of dislocation may be slightly lower after anterior approach compared to the posterior approach. One disadvantage of the anterior approach is a slightly higher risk of wound complications as the skin is thinner anteriorly and closer to the groin. The rate of wound complications is even higher for obese patients with the anterior approach, so it is avoided. Depending on patient body habitus, the incision for your anterior hip replacement may be oriented vertically or diagonally (“bikini”).
Another possible complication after an anterior hip replacement is a patch of numbness to the outside of your hip. This is normal and shrinks with time, but it may be permanent. This does not affect your function, only the sensation to the outside of your thigh.
Both approaches can be considered “minimally invasive.” The goal of surgery is the same regardless of the approach: to eliminate hip pain and improve mobility and hip range of motion.
Will I be having a robotic joint replacement?
Dr. Gausden uses robotic navigation (MAKO-Stryker) or computer navigation (OrthoAlign) for total knee replacements. She will decide which system to use based on your pre-operative deformity, range of motion, and bone quality. Both options allow for more precise positioning of components. Dr. Gausden generally uses robotic navigation (MAKO-Stryker) for total hip replacements (both anterior and posterior). If you have questions about robotic joint replacement, please ask Dr. Gausden during your consultation.
MAKO CT Scan for Robotic Surgical Planning:
Since Dr. Gausden does robotic surgery for both knee and hip replacements, we will need a special CT scan for surgical planning with the MAKO Robot. Some insurance companies (Medicare excluded) may not approve this CT scan as it is not deemed medically necessary. However, Dr. Gausden does consider this a medical necessity for the quality and precision of your joint replacement and requires this for all surgical planning.We will reach out to you directly if your CT scan is not approved and discuss your options. Option 1 would be to pay for the scan out of pocket at a discounted rate of $675-750. Option 2 would be to see if you qualify for financial assistance through HSS. If you qualify then the CT scan could be covered up to 50-100%.
What do I need for medical clearance prior to surgery?
On your pre-admission testing day, an HSS Internal Medicine physician will evaluate you and your medical history and provide a risk assessment for surgery (medical clearance). This will involve a physical exam, blood work, an EKG, and a chest X-ray at minimum. You will also have any additional images performed as required by Dr. Gausden for surgical planning on this day.
What medications should I stop prior to surgery?
*A detailed assessment of your medications and when to stop and start them will be provided for you on your pre-operative clearance day by your HSS Internal Medicine physician. The following guidelines are for general purposes only. *
Blood thinners such as Coumadin, Plavix, Lovenox, Eliquis, Xarelto, etc. should be discontinued prior to surgery -- instructions for discontinuing your specific blood thinner will be given at pre-op clearance. You may be asked to speak with your primary physician and/or cardiologist regarding your blood thinner prior to surgery.
Anti-inflammatories (NSAIDs) like Advil, Aleve, Mobic, Celebrex, Diclofenac, and full-strength aspirin (325 mg) should be discontinued 7 days prior to surgery. Baby aspirin (81 mg) can be continued.
GLP-1 agonists such as such as Ozempic, Mounjaro, Wegovy, Zepbound, Trulicity etc. should be discontinued 7 days prior to surgery.
Most vitamins, supplements, and hormones should be discontinued 14 days prior to surgery.
If you take opioid medication regularly (Oxycodone/Percocet, Tramadol, Norco, Dilaudid etc) then we will refer you to an HSS Chronic Pain specialist prior to surgery. Whenever possible, it is best to discontinue opioid use prior to surgery as chronic use of opioids is associated with difficulty controlling pain following a joint replacement.
Dr. Gausden requires patients to discontinue use of any tobacco products or recreational drugs for at least 30 days before and after surgery. The risk of post operative wound complications and infection is significantly increased with tobacco use and/or drug use. If you need help quitting smoking, please ask and we can refer you to our smoking cessation experts.
What should I expect on the day before surgery?
A nurse from the HSS call center will contact you after 3:00 PM on the business day prior to your surgery with detailed instructions. They will inform you of your surgical time, when to arrive at the hospital, and where to go when you arrive at HSS. You may call (212) 606-1630 at any time to hear a pre-recorded message giving pre-operative information.
You may follow a regular diet the day before surgery. No solid food after midnight, clear fluids only (water, plain tea, black coffee (no cream/sugar). You may take a small sip of water for medications on the morning of surgery.
If you take any GLP1-agonists such as Ozempic, Mounjaro, Wegovy, Zepbound, Trulicity etc.: no solid food/clear fluids only starting at 8:00 AM the day before your surgery.
All jewelry and piercings must be removed.
How long will I spend in the hospital after my surgery?
Total hip and total knee arthroplasty are now considered outpatient procedures, and it is safe for most patients to leave on the day of surgery. In fact, we find that most patients progress better at home than they do in the hospital, and we encourage discharge home for this reason.
Some patients may spend one night in the hospital after surgery and leave the following day if they have significant medical problems and need monitoring (history of unstable heart conditions, breathing problems, etc). No matter when you leave the hospital, we will make sure that you are safe to go home prior to discharge. This means you will have to “clear” physical therapy by demonstrating that you can safely ambulate around your house. If you have stairs at home, you will also practice navigating stairs with the therapist while in the hospital.
What pain medication will I use after my surgery?
Most patients require pain medication for at least the first 5-7 days following surgery. Dr. Gausden uses a multimodal approach to pain management—this means we use medications that target different pain pathways to lower your pain level. There will be modifications at times based on responses to these medications during your time in the hospital, but in general the regimen is as follows:
Acetaminophen (Tylenol): take 1000 mg every 6 hours for at least the first 5-7 days post operatively. After that you may take as needed. Multiple studies demonstrate that taking oral acetaminophen regularly in the first few days after surgery will lower the total amount of narcotic/opioid pain medication required. Patients with liver disease will need to avoid acetaminophen.
Meloxicam (Mobic): take 15 mg once a day for the first 6 weeks after surgery. This is a strong anti-inflammatory (NSAID). If you are taking Meloxicam, you should not take additional NSAIDs such as ibuprofen (Advil) or naproxen (Aleve). Patients with kidney disease or history of stomach ulcers will not be prescribed this medication.
Pantoprazole (Protonix): take 40 mg once a day. This is a proton-pump inhibitor (PPI) that is given to patients while they are taking meloxicam (Mobic) to protect the GI tract from ulcers. You can discontinue this when you discontinue the meloxicam at 6 weeks.
Oxycodone: 5 mg (take 1-2 tablets) every 4 to 6 hours as needed for breakthrough pain. Most patients take this regularly for the first 5-7 days after surgery, then as needed after that. This medication is an opioid (narcotic) so the dose may be lowered or may be avoided altogether in elderly patients to prevent confusion/delirium. Opioids can be habit forming, and for this reason we recommend you begin weaning off of them as soon as you no longer need them for pain control.
Please alternate oxycodone with acetaminophen (Tylenol) e.g. do not take at the same time, space out by a few hours after the last dose of oxycodone. This allows you to better control your pain until you are due for the next dose of oxycodone.
Tramadol: 50 mg (take 1-2 tablets) every 4 to 6 hours as needed for breakthrough pain. This is also a narcotic, but generally a more mild alternative to oxycodone.
Senna/Miralax: These are laxatives that may be prescribed and can also be purchased over the counter. You should take these as long as you are taking a narcotic for pain control as these often cause constipation.
Ondansetron (Zofran): This is an anti-nausea medication typically prescribed for you in case of nausea post operatively.
What medication will I use to prevent blood clots (deep vein thromboses or pulmonary emboli)?
Dr. Gausden will most likely have you take a baby aspirin (81 mg) twice daily for the first 6 weeks after your total knee or total hip replacement. For patients who have risk factors that predispose them to developing blood clots we may use a higher dose of aspirin (325 mg twice daily) or use an alternative blood thinner (apixaban [Eliquis], rivaroxaban [Xarelto], coumadin [Warfarin], enoxaparin [Lovenox]). For patients with restrictions on weight bearing (revision surgery or periprosthetic fractures), we will generally use a higher dose of aspirin or an alternative blood thinner.
The best method for preventing blood clots is early mobilization after surgery. The more you are able to ambulate after surgery, the lower your risk of developing a blood clot.
My leg is swollen after surgery. Is this normal?
Swelling of your operative leg is expected after surgery. The swelling tends to increase and peak around 2 weeks following the operation. Bruising is also expected and can track all the way to your foot over time. Early and frequent icing of your surgical site is one of the best ways to control this swelling. We also recommend that you keep the leg elevated as much as possible (when you are not ambulating) for the first week after surgery. Some degree of swelling will be present on the side of surgery for at least 4-6 months after your procedure.
Dr. Gausden recommends using compression socks when you feel you can tolerate compression of the surgical leg. You may need assistance with applying the compression stockings early on. Ace bandage wraps are excellent alternatives to compression stockings as well.
New, acute onset swelling that is associated with a localized area of tenderness in the calf is concerning for a blood clot. If you develop calf tenderness with swelling and redness, call our office to discuss and we may consider an ultrasound to assess for a deep vein thrombosis.
Do I need to ice my leg after surgery?
Icing your knee or hip after surgery is one of the best ways to reduce swelling, pain, and inflammation. After surgery, Dr. Gausden recommends either the Breg Polar Wave Ice Machine or the NICE1: Cold + Compression Therapy System, (please refer to last page of your surgical packet). We use the Recovery Shop for all of our post-operative supplies. The ice machine is not required, and if you prefer to use your own icing regimen (ice packs, frozen peas), that is absolutely fine as long as you are icing regularly. We typically recommend icing for 30 minutes on, at least 30 minutes off. Do not ice to the point of numbness as this could lead to surgical site injuries similar to frost bite.
Can I shower after surgery?
For most patients following primary knee or hip replacements, Dr. Gausden uses absorbable sutures and waterproof Sylke tape to close the skin. This is then covered with a waterproof Mepilex dressing. The Mepilex dressing will stay in place and should be removed after 7 days. You can shower on the day after surgery, but do not submerge your incision until we see you for your first post operative visit. Let the water run over the surgical site, but do not scrub the dressing or the incision itself.
You can remove the Sylke tape after 3 weeks post operatively. Gently peel back a corner and slowly remove from the incision. You may shower but do not submerge/scrub the incision, and do not apply lotion/scar cream to the incision until your post op visit.
For revision arthroplasty or periprosthetic fracture surgery, Dr. Gausden may use a non-absorbable closure such as staples or non-absorbable sutures. Your incision may be covered with an incisional vacuum dressing for added protection. Specific instructions will be given to you upon discharge from the hospital regarding incisional care and staple/suture removal.
If you have incisional drainage after surgery, please call the office to talk with our team as soon as possible (212) 606-1897.
When can I drive after surgery?
You will not be able to drive yourself home on the day of surgery—you should arrange transportation home ahead of time. Dr. Gausden prefers that you do not rely on public transportation in order to get you home safely after surgery.
Ultimately, you are responsible for determining your ability to safely operate a motor vehicle. You should not drive if you are still using narcotic pain medication. The average return to driving is 2 weeks for left sided surgery and 3–4 weeks for right sided surgery. You will need to be able to press down on the brakes quickly and with force in case of emergency. We recommend practicing first in a safe environment prior to getting on the road.
What physical therapy do I need to do after surgery?
Total Knee Replacement (TKR) or Unicompartmental Knee Replacement (UKR):
The first 2 weeks after a knee replacement are the toughest—you will be focused on icing, doing home exercises, and working with a home physical therapist that will be arranged for you. You can think of a knee replacement during this period as a part-time job—icing, pain control, home exercises, and walking will be time consuming. You will generally start off walking with a walker then progress to a cane as you feel comfortable.
For the first 2 weeks a physical therapist will come to your house (home PT) to help you mobilize, teach you exercises, and help you regain your knee range of motion (ROM) in a gentle manner.
Within 3 weeks from surgery, our goal is to get the knee fully extended (straight) and bending to at least 90 degrees of flexion (a right angle). The risk of not moving your leg after a knee replacement is that the knee could become quite stiff and ultimately require another operation (manipulation under anesthesia) in order to break up scar tissue and regain motion.
For the first 2 weeks you will be walking and doing these PT exercises to regain your range of motion at home. After 2 weeks you will begin outpatient physical therapy which most patients do for 6-12 weeks, at a pace of 2-3 appointments per week. You can start gentle exercise (stationary bike with low resistance, Elliptical trainer, etc.) once you start going to your outpatient PT facility.
It is possible to “push too hard” during the first few weeks after surgery. Listen to your body and if you walk to the point of exhaustion and end up able to less the next day, you have “overdone it.” Aggressive massage around the incision after surgery should be avoided as well.
We generally say it takes 12 weeks to feel 85% recovered, but a full year to realize the maximum benefit. The quadriceps and hamstrings take time to re-strengthen, as well as dedicated personal effort even outside of your scheduled outpatient physical therapy appointments.
Total Hip Replacement (THR):
For the first 2 weeks after a hip replacement the best thing you can do is walk on your new hip. You will generally start off walking with a walker then progress to a cane as you feel comfortable. You can choose to have a physical therapist come to your house (home PT) within the first 2 weeks post op to work on mobilization and general strengthening. Keep it simple and maintain your hip precautions if you’ve had a posterior approach.
After 2 weeks you will begin outpatient physical therapy which most patients do for 6-12 weeks, at a pace of 2-3 appointments per week. You may start using a stationary bike, Elliptical trainer, etc. along with your outpatient PT.
It is possible to “push too hard” during the first few weeks after surgery. Listen to your body and if you walk to the point of exhaustion and end up able to less the next day, you have “overdone it.” Aggressive massage around the incision after surgery should be avoided as well.
We generally say it takes 8-12 weeks to feel 85% recovered, but a full year to realize the maximum benefit. The muscles around your hip take time to re-strengthen, as well as dedicated personal effort even outside of your scheduled outpatient physical therapy appointments.
*Regardless of knee or hip surgery, you are responsible for setting up your outpatient physical therapy visits. Please find a location that is convenient for you within the first week post operatively, and we can send a PT prescription to the facility of your choosing. If you are not sure where to attend outpatient PT, please reach out to our office and we can assist you in finding a location using your zip code.*
What should I buy for around the house after surgery?
This depends on your specific situation. You will be set up with a preoperative physical therapy session and they will discuss this with you ahead of your surgery. You can see Dr. Gausden’s list of recommendations on the Recovery Shop website according to procedure.
https://shop-recovery.com/pps-password-form/?c_id=67
What is my implant made of?
Generally, Dr. Gausden uses a titanium total hip arthroplasty, with a ceramic head and a highly cross-linked polyethylene or plastic liner. The total knee system Dr. Gausden uses (which is compatible with the MAKO robotic technology) is the Stryker triathlon total knee system, which contains cobalt chromium and polyethylene or plastic insert.
We do not recommend allergy skin patch testing, as multiple orthopaedic studies have shown very little correlation between a positive skin reaction and metal allergy to an implanted orthopaedic device. The type of allergic reactions that someone would get on their skin to jewelry is mediated by a different response than an allergy to a deep implant. Metal hypersensitivity that is clinically significant after total knee replacement is incredibly rare, and in those incredibly rare cases the theoretical hypersensitivity is generally attributed to the nickel in a cobalt chromium implant. Total hip implants mostly do not have large amounts of nickel (exceptions would be cemented implants) and are usually made of titanium. A clinically significant allergy to titanium would be even more rare and is not something generally reported in orthopaedic literature.
If a patient wants allergy testing prior to an orthopaedic procedure (which is not our recommendation) blood testing (lymphocyte transformation testing or LTT) is the best that is available today. Unfortunately, this is not covered by insurance and will be an out-of-pocket cost to the patient over at least $300 or more. Even with LTT it is possible that you have a positive reaction, but the clinical significance of this test result is in question. If a patient wants a “hypoallergenic implant,” please ask Dr. Gausden and she will refer you to another surgeon for your total knee replacement.
What should I be concerned about or look out for after my surgery?
If you develop excessive redness around the incision, incisional drainage, dehiscence/opening up of the incision, fever of greater than 101.5°F that has not responded to Tylenol, or pinpoint swelling/calf tenderness, please call the office to talk with our team to discuss your symptoms— (212) 606-1897.
If you fall or injure yourself and cannot bear weight on the surgical site, are having difficulty breathing, chest pain, or have lost consciousness, please call 911 for urgent medical attention.
When am I safe to undergo dental cleaning or dental surgery?
We ask patients to wait until 3 months after surgery before undergoing any kind of dental work. After that time, we will have you take prophylactic antibiotics 1 hour prior to dental work. You should typically continue this for a lifetime post-operatively. Of course, in the case of infection or other dental emergencies, you should be evaluated by your dentist immediately.
What if I need forms or paperwork to be completed prior to surgery?
Please note our office gets many forms per patient to be completed ahead of their planned surgery. Please allow two weeks for the forms to be completed from the date it was submitted to our office. The sooner you provide the forms you need completed the better.
Please email them to taylorsam@hss.edu or they can be faxed to our office at 917-260-3897.