🏥 Upcoming Discharge Instructions

🦴 About Your Hip Replacement

You are recovering from a total hip replacement. Your damaged hip joint was replaced with an artificial joint, called a prosthesis. The hip is a ball-and-socket joint. A cut was made, giving the surgeon access to your hip joint. The damaged ball was removed, and the socket was prepared to hold the prosthesis.

After the new joint is in place, the incision is closed with staples or stitches. An artificial ball replaces the head of the thighbone, and an artificial cup replaces the worn socket. A stem is inserted into the thigh bone to keep the ball in place. These parts connect to create your new artificial hip. A plastic liner is placed between the metal ball and cup to create a smooth surface for comfortable movement once you have healed.

This surgery almost always lessens joint pain and improves your quality of life.

💊 Medications and Pain Management After Surgery

Understanding Pain After Surgery

Some pain is acceptable and should be expected after most surgical procedures. Accepting some pain is beneficial because:

• Less medication needed: Using fewer opioids helps avoid harmful side effects like constipation or feeling woozy
• Activity guidance: Pain tells your body how much activity you can do as you recover
• Reduced dependency risk: Taking fewer opioids lowers your risk of becoming dependent

🎯 Multi-Modal Pain Management

The best approach uses multiple methods to minimize pain, often working better than a single medication while reducing opioid exposure.

Drug-Free Pain Relief Techniques

• Movement: Shorter walks more often, physical therapy exercises
• Ice Therapy: Cold pack wrapped in thin cloth, 20 minutes every 3-4 hours (never put ice directly on skin)
• Elevation: Elevate operated area above heart level when possible to reduce swelling
• Relaxation Techniques:
  • Visualization or guided imagery
  • Progressive body relaxation
  • Deep breathing (including incentive spirometer)
  • Distraction (reading, movies, talking to friends, games)

💊 Non-Opioid Medications

• Acetaminophen (Tylenol, APAP): The most gentle and safe pain medication
• Anti-inflammatory (NSAIDs): Ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex). Can be taken with Tylenol, but avoid if you have stomach ulcers or kidney disease
• Gabapentin (Neurontin) and pregabalin (Lyrica): For nerve pain or neuropathic pain
• Lidocaine patch: Applied to skin, available prescription or over-the-counter

⚠️ Opioids (Narcotics)

Very strong pain medications with serious side effects, including addiction risk.

Types of Opioids

• Morphine
• Dilaudid
• Oxycontin IR (Immediate Release)
• Oxycodone (Percocet)
• Hydrocodone (Norco)
• Tramadol

Side Effects of Opioids

• Constipation
• Feeling woozy or confused
• Hallucinations
• Nausea or vomiting
• Increased risk of falls and accidents
• Breathing problems
• Addiction

📋 If You Are Prescribed Opioids

Best Practices

• Use other pain management options (ice, activity, other medications) before taking opioids
• Ask your doctor how long you'll need opioids and set a goal for stopping
• If given 1-2 tablet options, start with the lower dose
• Most patients stop opioids within 3 days
• Try to take opioids less frequently each day
• Taper off gradually rather than stopping suddenly
• Ask for a tapering schedule if needed longer than 3 days
• Report side effects like nausea or constipation

🗑️ Proper Disposal

Store medications safely where no one else can access them. For disposal:

• Federal (FDA) guidelines: Flush leftover opioids down the toilet
• San Diego County preference: Mix with compost, coffee grounds, or kitty litter, or take to approved disposal site

🩸 Blood Thinners (Anticoagulants)

Medicines that help prevent blood clots from forming.

Types Include:

• Aspirin
• Heparin
• Rivaroxaban (Xarelto)
• Apixaban (Eliquis)
• Warfarin (Coumadin)

⚠️ Tell Your Healthcare Provider If You Have:

• Stomach ulcer (now or in the past)
• Vomiting of blood
• Blood in stool (black or red color)
• Aneurysm
• Pericarditis
• Pericardial effusion
• Blood disorder
• Stroke or mini-stroke (TIA)
• Kidney or liver disease
• Uncontrolled high blood pressure
• Diabetes
• Vasculitis

🚫 Medicines That Interact With Blood Thinners

• Antibiotic medicine
• Heart medicine
• Cimetidine
• Anti-inflammatory medicines (aspirin, ibuprofen, naproxen, ketoprofen, arthritis medicine)
• Medicines for depression, cancer, HIV, diabetes, seizures, gout, high cholesterol, thyroid
• Multi-vitamins with Vitamin K
• Herbs (ginkgo, Co-Q10, garlic, St. John's Wort)

🛡️ Taking Blood Thinners Safely

• Tell all healthcare providers you take blood thinners (dentist, chiropractor, nurses, doctors)
• Inform providers about all medicines, supplements, and herbal remedies
• Don't take any medicine your healthcare provider doesn't know about

🔒 Injury Prevention

• Don't do activities that may cause injury
• Use soft-bristle toothbrush and waxed dental floss
• Shave with electric razor, not blade
• Don't go barefoot
• Don't trim corns or calluses yourself

🍽️ Watch What You Eat

Talk with healthcare providers about foods that can affect blood thinner levels, including:

• Grapefruit juice
• Cranberries and cranberry juice
• Fish oil
• Garlic, ginger, licorice, turmeric
• Herbal teas and supplements

🚨 When to Call Your Healthcare Provider

Call right away if you have:

• Bleeding that doesn't stop in 10 minutes
• Coughing up or vomiting blood
• Bloody diarrhea
• Bleeding hemorrhoids
• Dark-colored urine
• Black stools
• Red or black-and-blue marks on skin that get larger
• Dizziness
• Chest pain
• Trouble breathing
• Rash, itching, swelling
• Trouble swallowing

💊 Tips for Taking Medicines

📅 Stay on Schedule

• Take medicines at set times, being mindful of specific timing requirements
• Use reminders: pillbox, 7-day organizer, phone alarms
• Refill prescriptions when you still have plenty left
• When traveling, keep meds in carry-on bag and bring prescription copies

🛡️ Safety Tips

• Read warning labels and usage instructions
• Get help organizing pills if needed
• Use same pharmacy for all prescriptions when possible
• Ask pharmacist for fact sheets on new medications
• Tell doctor and pharmacist about medication allergies
• Don't split pills to save money - talk to doctor about cost concerns
• Never share medications
• Ask pharmacy about disposal of old/expired medications
• Give medication list copy to family member or friend for emergencies
• Store medications in cool, dry, dark place (not steamy bathroom)

🔐 Opioid Storage

• In locked container
• In original package
• Out of reach of children
• Do not share with others
• Safely dispose of unused pills

🍽️ Diet After Surgery

You may resume your normal diet. For optimal healing, maintain a healthy diet.

💩 Preventing Constipation

Constipation can be a problem after surgery due to anesthesia, pain medications, and decreased activity.

Dietary Recommendations

• High Fiber Diet: Fresh fruits, fresh vegetables, bran
• Plenty of Fluids: Preferably water

Medication Options

• Stool Softeners (Peri-colace, Sennokot-S): Softens stool, lubricates intestine
• Laxatives (Miralax, Milk of Magnesia, Dulcolax, Magnesium Citrate): Stimulates intestine (can cause diarrhea if too much)
• Suppository: Physically/chemically stimulates bowel (helpful within 30 minutes of eating)
• Enema: Physically stimulates bowel movement (use as last resort due to possible dependency)

📋 Narcotic-Related Constipation Regimen