Ortho Surgery Misc

Question 1

What meds are given preop

Answer 1

• 1000 mg tylenol
• Celebrex 400 mg if CrCl >50
• Famotidine 20 mg
• Nasal decolonization with Providone-Iodine
• Single shot adductor canal block for primary and revision TKA

Question 2

what meds are given intraop

Answer 2

Weight based Ancef, unless documented allergy to cephalosporin

TXA – 1 g at incision and 1 g at closure

Decadron 8 mg prior to incision

Gentamicin in cement

Arthroplasty block

Dilute Proviodine soak

Question 3

intraop x rays?

Answer 3

Intra-op AP pelvis x-ray for all hips (primary and revision)

AP/LAT knee for all revision knees

Question 4

When would a patient start 1 week of PO abx after 24 hour IV antibiotics?

Answer 4

BMI>40

Revision THA/TKA

Reimplantation THA/TKA

Question 5

for revisions or BMI >40 what is the antibiotic protocol

Answer 5

Cefadroxil 500 mg BID for 7 days

if allergy or CrCl<50 then Doxycycline 100 mg BID for 7 days

Question 6

what is the DVT prophylaxis post op?

Answer 6

Aspirin 81 mg BID x 6 wks unless high risk

Question 7

what DVT prophylaxis if patient high risk or on anticoagulation preop?

Answer 7

discuss with Bedard but usually Eliquis 2.5 mg BID x 6 weeks

Question 8

POst op pain regimen?

Answer 8

1000 mg Tylenol q6

Celebrex 200 mg BID - do not order if CrCl <50, CAD, Hx peptic ulcer

PRN Tramadol 50-100 mg q6
PRN oxy 5-10 mg q4

Question 9

Weight bear status for primary THA

Answer 9

WBAT

Question 10

weight bearing status for TKA

Answer 10

WBAT

Question 11

weight bearing status for revision TKA?

Answer 11

WBAT

Question 12

weight bearing status for revision THA

Answer 12

50% weight bearing for 6 weeks

Question 13

weight bearing status for articulating hip or knee abx spacer

Answer 13

TTWB for 6 wks then 50% weight bearing (may only touch toes to floor for balance)

Question 14

weight bearing status for non-articulating (static or girdlestone) abx spacer

Answer 14

TTWB

Question 15

Dressing?

Answer 15

Prineo and Aquacel

Knees will have compressive ACE wrap. Okay to take down POD1 and send home wrap with patient to use PRN for swelling

Question 16

what is aquacel dressing

Answer 16

antimicrobial dressing – silver component

Question 17

physical therapy?

Answer 17

primary and revision knees

okay with self directed PT if patient prefers/requests

no PT for primary or revision hips

Question 18

Discharge meds?

Answer 18

Aspirin 81 BID x 6 wks (unless high risk or on anticoagulation preop)

BMI > 40 OR revision THA/TKA

• Cefadroxil 500 mg BID for 7 days
• If allergy or CrCl < 50 then give Doxycycline 100 mg BID for 7 days

Tylenol 1000 mg Q 6 hrs

Celebrex 200 mg BID 4 weeks 
-Do not order if: 
CrCl < 50 
CAD 
Hx of peptic ulcer 

If on Rx NSAID preop, OK to go home on that instead of Celebrex

Tramadol 50-100 mg Q 6 hrs PRN

Oxycodone 5-10 mg Q 4 hrs PRN

Question 19

Follow up?

Answer 19

All patients will get 6-week phone call and 3 months clinic appointment with x-rays, unless otherwise indicated

Please place a scheduled message to the service box for 6-week phone call

If discharge same day, will need phone call on POD1

If sutures or staples, OK to have them removed at 2-3 weeks locally