a. Stop taking any anti-inflammatories (aleve, ibuprofen, aspirin, motrin, etc) 1 week prior to surgery, as these medications increase your risk of bleeding. You MAY take Tylenol as needed for pain. If you are on a prescribed blood thinner (Plavix, Coumadin, Xarelto, etc), you should consult the prescribing provider prior to discontinuing these medications.

b. Stop any capsule supplements, such as fish oil, as these increase your risk of bleeding.

c. Stop any estrogen hormone treatment – if possible – two to four weeks prior to surgery, as estrogens increase the risk of blood clot (DVT) after surgery. We recommend not restarting these medications until approximately 2 weeks after surgery. Please consult Dr. Ranawat’s team and/or your medication prescriber if there are any concerns with stopping current medication.

d. For clarification of prescription medications you should or should not take on the day of surgery, please call your prescribing provider.

a. You will get a call from the hospital call center after 2pm on the business day before surgery. They will provide you with the following information:
i. Instructions for eating and drinking the day of surgery.
ii. Time of arrival to the hospital.
iii. What to bring and wear to go.

b. The number to the call center is 212-606-1710. Please do not call them unless you have missed their phone call or have an additional question. They will not be able to tell you any information about your surgery time prior to 2 pm.

c. While we will try our best to honor requests for a certain time frame for your procedure, we cannot make any guarantees, as surgery order is determined by multiple factors such as type of surgery, patient age, comorbidities, etc.

a. Time of arrival is generally two hours prior to the scheduled surgery time. You will check in at registration and then proceed to the OR waiting area.

b. You will then be called in to the pre-operative holding area, where you will have a general work-up by a nurse and physician assistant. An IV will be placed. If necessary, the area to be operated on will be shaved and cleaned. You will also meet the anesthesiologist and Dr. Ranawat prior to going to the OR. The surgical site will be confirmed multiple times and initialed by Dr. Ranawat.

c. After surgery, you will recover in the post-anesthesia care unit (PACU). You will be here for about 2 hours, but this can vary depending on your response to anesthesia and recovery. Once you are ready for discharge, you will be wheeled out to the hospital entrance by a patient care assistant where you will be helped into your vehicle.

d. While you may arrive by yourself, you must have an escort to take you home from the hospital after surgery.

a. We recommend regional anesthesia. This is where the anesthesiologist performs a nerve block or spinal which will numb the area where surgery will be performed. You will also get medication to let you go to sleep; however, you will still be able to breath on your own. This is different from traditional general anesthesia where multiple medicines are used to keep you from moving, feeling, and reducing pain during surgery, and you are also put on a breathing machine.

b. Benefits of regional anesthesia include better pain control post-surgery, less medication side effects such as nausea, lower risk of pneumonia or other airway issues. It has a lower overall risk profile when compared to general anesthesia.

c. You will be able to meet with the anesthesiologist the day of surgery and discuss options and ask questions. Regional anesthesia may not be indicated for everyone, but we do try to use it in most cases.

d. If you have prior issues with anesthesia or want to meet with the anesthesiologist prior to surgery, please let Dr. Ranawat’s team know so we can schedule a pre-operative anesthesia consultation.

You will most likely start with a walker and then progress to a cane with the guidance of PT and Dr. Ranawat. Length of time will vary from patient to patient.

This varies vastly based on each individual’s commute, type of work, and ability of the job to make accommodations. It can range from several weeks to several months.

Generally, one can drive 4-6 weeks after surgery. After total hip replacement, driving is not advised until 6 weeks post-operative in order to maintain hip precautions. You may have someone else drive while you are a passenger. After knee replacement you may drive earlier than 6 weeks if cleared by physical therapy. When beginning to drive again, start with short distances and routes that are familiar.

You will be given a waterproof dressing which will allow you to shower immediately. After 10 days, the dressing can come off and you can also shower after.

For the majority of our procedures, we recommend starting outpatient physical therapy within several days of your discharge from the hospital. The hospital will set up home PT for you. They will come to your home for several days to weeks depending on your progress and then you can call the office to get a PT prescription for outpatient therapy. You can go to any therapist that is convenient for you and takes your insurance.

Flying is recommended 6 weeks post surgery.

1. The following medications should be stopped prior to surgery.
• Plavix: 7 days prior to surgery
• Coumadin: 7 days prior to surgery. your INR level must be 1.2 or lower at least 2 days before your operation. If it is not 1.2 when pre-operative labs are drawn, we may ask you to have it drawn again to confirm it is within range.
• Effient: 10 days prior to surgery
• Regular aspirin, anti-inflammatories & oil vitamins: stop 1 week prior to surgery (7 days)

2. Do you have any medication allergies?

3. Do you normally urinate more than twice a night? (for men only)

4. Home care services:
You will meet with a social worker after surgery to arrange for visiting nurse services with physical therapy at home. our patients go home after surgery unless Dr. Ranawat specifically suggests transfer to in-patient rehabilitation.

Please contact Laura Jasphy (about one month prior to your surgery date) for questions regarding discharge care. Her phone number is: (646) 797-8266. Her email is jasphyl@hss.edu. Her hours are from 11am-7pm, monday through friday (excluding holidays)

To obtain the time of your surgery, please call 212-606-1710 after 4pm on the business day before your surgery.

Hospital Stay
• Most patients are in the hospital for 1-2 nights. Once you clear physical therapy
and you are medically stable, the doctor signs your discharge orders. A visiting
nurse as well as a physical therapist will continue to work with you at home.
(Contact the Discharge Planning Team with any home health care questions: 212-606-1920)
• A physical therapist will begin working with you on the day of surgery if you are
alert. In order to clear physical therapy, you will learn how to get in and out of
bed on your own, walk about 1 00 feet, and walk up and down stairs.

Pain Control after Joint Replacement Surgery
• Dr. Amar Ranawat uses the “Ranawat Cocktail” injection in your joint space
during surgery.
• After the injection wears off, you will continue to receive scheduled pain relief
medication.
• We use a Numeric Rating Scale to assess your pain relief. A numeric value of 0
symbolizes no pain and a numeric value of 10 symbolizes the worst pain
imaginable.
• If your pain is not controlled, alert your assigned hospital nurse and he/she
can provide additional medication. If you continue to have unrelieved pain,
alert the nurse and he/she will inform Dr. Ranawat.
• Pain tends to increase after physical therapy and overnight. If you have an
existing pain level of 4/10 one hour prior to these activities, ask for additional
pain medication from your nurse. Pain medication takes around one hour to begin
working.

Typical Pain Management for Total Hip Replacement Patients
• Celebrex 200 mg daily xlO days
• Oxycodone 5 mg every 4 to 6 hours as needed for pain
• Tylenol 650 mg every 6 hours as needed
• Dilaudid as needed for breakthrough pain (not all patients receive this
prescription)
• Ultram 50 mg every 6 hours as needed for pain.
• Aspirin 325 mg twice daily OR Coumadin daily x6 weeks for blood clot
Prevention

Typical Pain Management for Total Knee Replacement Patients
• Celebrex 200 mg daily x6 weeks
• Oxycodone 5 mg every 4 to 6 hours as needed for pain
• Tylenol 650 mg every 6 hours as needed
• Dilaudid 500-5 mg as needed for breakthrough pain
• Ultram 50 mg every 6 hours as needed for pain.
• Aspirin 325 mg twice daily OR Coumadin daily x6 weeks for blood clot
Prevention

Take two Advil a day for persistent pain past six weeks post surgery.

Both hip and knee replacement patients should elevate the operative leg above the level of the heart for one to two hours during the day to decrease swelling.

• Bruising on the thigh and knee is normal after surgery and this may increase once
you return home.
• Swelling may occur throughout your entire leg down to your ankle. To reduce
swelling, elevate your leg on two pillows while lying down face up. Swelling may
wax and wane for several months.
• Numbness on the outside of the knee can occur.
• Your knee/hip may feel warm to touch. This is part of your body’s natural
inflammatory response to surgery which, may last for several months.
• Hearing/feeling a clicking sensation in the joint is normal.

You may shower with the dressing that is on your incision once your
return home. The visiting nurse will remove this dressing 10 days after
surgery. You do not have sutures or staples.

You can drive 4-6 weeks after surgery. After a total hip replacement, driving is not
advised until 6 weeks post-operative in order to maintain hip precautions. You may have
someone else drive while you are a passenger using your hip cushion to maintain hip
precautions. After knee replacement surgery, you may drive earlier than 6 weeks if the
physical therapist clears you to do so and if you are comfortable moving your foot from
the gas pedal to the brake.

• If you would like to fly in an airplane, please call the office to discuss.
• Hip precautions should be maintained for 6 weeks to prevent dislocation
• Your first follow up appointment with Dr. Ranawat is 6 weeks after surgery.

• Narcotics are controlled substances and they cannot be phoned into the
pharmacy. These prescriptions need to be escribed to your home.
• Check your temperature daily and call the doctor if it is greater than 101.0 F
• If you notice drainage from your incision, clean it with alcohol and sterile
gauze, cover the incision and call the office.
• If you develop calf pain please call the office to discuss.
• If you are constipated for three days or more you should take an over the
counter laxative. If you are still unable to have a bowel movement, call for
prescription medication.
• If you develop an infection somewhere else in your body, see your primary care
physician and call the office.

Contact Information:
Julie Pate PA for Amar Ranawat
Telephone: 646-797-8704
Email: patej@hss.edu fax 646-797-8777

Our office will be able to prescribe pain medication (ie. Percocet, Oxycodone, OxyContin, Tramadol, Nucynta, Dilaudid) for up to 3 months after your surgery.

During this time period, patients are encouraged to wean off the narcotic medication and manage pain with anti-inflammatories (ie. Celebrex, Mabie, Naprosyn, AI eve, Advit Motrin) or Tylenol.

If narcotic use exceeds the 3 month post-operative period, patients will be referred to a Pain Management specialist for further care.