Wound Care

• Do not remove bulky dressing unless Dr. Pettit has told you to do so
• There is Dermabond glue overlying the incision, along with Steri-strips, do not remove
• You may shower 3 days after your surgery; be sure to pat the incision dry afterwards.
• Do not scrub the area; just allow water/soap to wash over you. Do not bathe or swim.

Ice

• We recommend that you use ice on a consistent basis for the first 24–48 hours. This will help reduce post-operative swelling. After that, use as necessary.
• Use a cloth between the ice and your skin. DO NOT place ice directly on skin as this may cause frostbite. Do not leave ice wrap or cold therapy on for more than 20 minutes without checking your skin.

Sling & Weight bearing status

• With a Hardware Removal you will be weight bearing as tolerated, with crutches as needed.

Please note: the empty screw holes left behind act as temporary stress risers that weaken the bone, so avoid running, jumping, and other impact loading until Dr. Pettit clears you (typically 6 or more weeks) because of the risk of refracture.

Physical Therapy

• Formal physical therapy will be ordered by your orthopedic surgeon in the form of a written prescription prior to surgery. Following a Hardware Removal, you should start formal physical therapy 1-5 days after your surgery. The prescription and protocol should be given to a physical therapist of your choice so you can begin your program as directed under close supervision of your surgeon.
• Once you schedule surgery, you should contact your physical therapy facility to schedule your first PT appointments within 1-5 days.
• Until you begin working with a therapist, you can do some exercises at home, such as: quad sets, straight leg raises, calf pumps, and heel slides (see pictures below). You should start these exercises the day following your surgery.

Pain Control and Medications

1. Pain Medication: Tylenol 1000mg every 8 hours and, unless discussed otherwise, you have been prescribed a narcotic pain medication (Oxycodone 5mg) to take every 4-6 hours as needed.
• DO NOT drive/use any heavy machinery, drink alcohol, make any life-changing or legal decisions (i.e. sign a will), or participate in activities that require a lot of physical skill, as narcotics may change your mental acuity. On rare occasions they may cause confusion or disorientation, we advise you to discontinue this medication should that occur.
• Narcotics can be addictive. Dispose of any excess medication at a police/fire station.
• Take a stool softener (e.g. Colace) while taking narcotic medication, as narcotics may cause constipation.  If this does not help alleviate your constipation, you can try adding miralax or milk of magnesia. Please call our office if this regimen does not alleviate your constipation.
• If you have any questions or concerns about narcotic strength medications, please contact us.
• Journavx (suzetrigine): If Journavx has been prescribed, take it in place of the Oxycodone. Start with a loading dose of 100 mg (two 50 mg tablets), then take one 50 mg tablet twice a day (every 12 hours) for two weeks. If you are not getting adequate pain control with Journavx, you may take Oxycodone instead. Do not take Journavx and Oxycodone at the same time, and avoid grapefruit while taking Journavx.
2. Anti-nausea: Zofran (Ondansetron): Take as prescribed if needed for nausea
3. Anti-Inflammatory: Unless contraindicated due to other health reasons, you have been prescribed a non-steroidal anti-inflammatory drug (Ibuprofen 800mg) for use postoperatively. If you have no personal history of adverse response to anti-inflammatories (NSAIDs), take as prescribed every 8 hours with food to help reduce swelling and pain. Do not take other NSAIDs (Advil, Aleve, etc) with Ibuprofen.
4. Muscle relaxer: Flexeril (Cyclobenzaprine) for muscle spasms. Take this as needed, it will make you drowsy.

Tylenol and Ibuprofen are the foundation for your pain control regimen

Example dosing: 1000mg Tylenol then 4 hours later 800mg Ibuprofen then 4 hours later repeat- every 4 hours alternate between Tylenol and Ibuprofen. Oxycodone as needed for breakthrough pain.

*You should not exceed 3,000mg of Tylenol or 3,200mg of Ibuprofen in 24 hours.

Driving

• Driving may resume when you are no longer taking narcotics, and have enough motion to get into the drivers seat. You must feel safe to operate a vehicle. We recommend you practice driving in an open parking lot before returning to the road. If you have to drive for long periods of time within 2-4 weeks after surgery, we recommend taking frequent breaks to walk and stretch, to decrease the risk of a blood clot.

Return to Work

• You may return to work as soon as you are comfortable. This is dependent on your job type. You may return to most activities by about 6 weeks as tolerated; higher-impact or torsional loading may be limited for up to about 4 months for larger implants, per Dr. Pettit. Return to work notes can be obtained at your first post-op appointment.

Follow-up Appointment

• Your first post-operative appointment will be scheduled 7-10 days following your surgical procedure. If you do not have a post-operative appointment scheduled when you leave following surgery, please call 513-441-5639 to make the appointment.

****Signs & Symptoms to Immediately Report****

Call 911 and go to the nearest hospital if you are having chest pain or trouble breathing.