FAQs

This content provides only general information, and it should not be interpreted as advice for care for a particular patient, unless otherwise specified by Dr. McLawhorn in a face-to-face consultation.

Office Visits Questions

You can call the office or submit an appointment request form through this website. When you call, a representative in the office will ask you a few questions to make sure that Dr. McLawhorn is the best doctor for your problem.

Please refer to the insurance page to see in which insurances Dr. McLawhorn participates. It is always advised to verify your benefits with your insurance provider prior to scheduling an appointment or surgery. If your particular insurance plan is not listed, you may still have coverage, subject to the availability of “out-of-network” benefits. Please do not hesitate to contact the office if you have questions regarding your insurance coverage.

  1. Please bring your insurance card(s), referral letter (if required), government-issued photo identification, any prior surgical or medical records, including office notes and operative reports, prior imaging and associated reports, and your list of current medications and allergies.
  2. Please bring any imaging on a disc or in hard copy.
  3. Please bring completed copies of your New Patient Form, if you do not complete it through the MyHSS web portal.
  • If you do not have current imaging of the affected joint, you will be scheduled for appropriate X-rays prior to your appointment with Dr. McLawhorn. Please arrive at least 15 minutes prior to your first scheduled appointment (either with radiology or with Dr. McLawhorn) to complete requisite forms and registration.
  • Nursing staff will see you in the exam room first, take your height, weight, and vital signs. They will also ask you about some basic clinical information. Shorts will be provided for you to change into, so that Dr. McLawhorn can examine your lower extremities.
  • Your first visit with Dr. McLawhorn will be scheduled for 30 minutes, which will allow him to take a thorough clinical history, perform an exam, review your imaging with you, and formulate a plan for your care.
  • We recognize that your time is valuable. Although, we make every effort to see patients at their scheduled time. Occasionally emergencies or clinical issues require more time than we anticipate, and these cases may cause scheduling delays beyond our control. We apologize for any unintended waiting time, and we appreciate your understanding.

Unfortunately, x-rays taken in many physicians’ offices and radiology centers are low quality and do not permit visualization of the critical structures and anatomical details that are essential for making an accurate diagnosis. In addition, the x-rays taken at HSS have special features required for preoperative planning, if you require surgery.

Please call the office during regular business hours at least 1 day in advance of your scheduled appointment, so that we are able to offer your appointment time to other patients on our waiting list.

 

Preoperative Questions

Hospital for Special Surgery is a unique collection of health care professionals across all medical disciplines concerned with caring for patients with musculoskeletal conditions. Their unparalleled focus allows HSS to achieve superior surgical outcomes, including the lowest rate of postoperative infection for hip and knee replacement. More joint replacements are performed at HSS than at any other hospital in the world. This allows us to optimize your care in every way. It is well established that fewer postoperative complications occur if joint replacement surgery is performed at a specialized joint replacement center. For more information, please visit: https://www.hss.edu/why-choose-hss.asp.

0.3% for primary total joint replacement surgery.

  • We will schedule one day with a number of requisite pre-surgical tests and medical appointments to make sure your health is optimized prior to surgery. Testing usually involves a chest X-ray, routine blood work, an electrocardiogram (EKG), and any special imaging you may require for your surgery, such as a CT scan. You will meet a medical internist who will review your tests and health history. This same internist will care for you during your hospital stay at HSS after surgery.
  • If you have any major medical conditions, such as heart disease, Dr. McLawhorn strongly recommends that you schedule appointments with your primary care doctor and any of your medical specialists in advance of your pre-surgical testing appointments. Up-to-date records from these doctors should be provided to medical doctors at HSS for your pre-surgical evaluation. Your final medical assessment prior to surgery at HSS must be performed by a medical doctor at HSS.
  • If you are scheduled for a total hip or total knee replacement, you will be scheduled for a pre-surgical “joint class” to learn more about the expectations for your surgery, hospital stay, and recovery.
  • If you are scheduled for a hip resurfacing, Dr. McLawhorn encourages you to participate in one of the weekly webinars on Wednesdays at 12 PM noon:

Since infections of hip and knee implants are devastating for the outcome of these procedures, any preoperative infections in your body must be cured prior to joint replacement surgery.

Please let Dr. McLawhorn know about any areas of concern well in advance of your surgery.

  • Baby aspirin (81 mg daily) may be continued
  • Higher doses of aspirin and NSAIDS, including medications like naproxen, meloxicam, and ibuprofen, should be stopped 7 days prior to surgery. Dr. McLawhorn will recommend specific anti-inflammatory medications after surgery.
  • Plavix should be held 7 days prior to surgery. It will be restarted after surgery, when it is deemed safe by Dr. McLawhorn and your medical internist.
  • Coumadin should be held 7 days prior to surgery. You may require “bridging” medication, like Lovenox, thereafter. Your INR must be less than 1.2 for elective surgery. Coumadin will be restarted after your surgery.
  • Lovenox should be held 24 hours (1 day) prior to surgery.
  • If you are on novel oral anti-coagulants, which include drugs like Pradaxa and Xarelto, they will need to be held prior to surgery. When to stop these medications will be determined by your clearing medical doctor at HSS. An alternative blood thinner may be used for 6 weeks after surgery, or Dr. McLawhorn will discuss restarting your medication with your medical doctor.
  • Finally, many over-the-counter supplements, may influence bleeding and/or the way in which your blood clots. All dietary supplements that are not medically necessary should be held at least 7 days prior to surgery.

Please don’t hesitate to call the office with any question regarding the preoperative management of medications you’re taking.

Staying in your best condition before surgery is important. Ideally, you can maintain the strength of the muscles around your hip or knee prior to replacement. However, it can be difficult to perform strengthening exercises when you have pain.

Dr. McLawhorn strongly recommends a single, one-on-one, pre-operative physical therapy session with one of the therapists at HSS. This session can be scheduled on the same day as your other pre-surgical testing appointments. If you have limited therapy benefits through your insurance, please be advised that this session will count against those benefits, but it is well worth it. Please call 212-606-1213 to schedule the appointment. The sessions are located at the HSS Orthopedic Physical Therapy Center in the Main Hospital Building located at 535 East 70th Street, 2nd Floor, New York, NY 10021.

  • The practice of donating your own blood prior to joint replacement is largely unnecessary with current surgical techniques, anesthetic techniques, and medications. Additionally, Dr. McLawhorn uses tranexamic acid during surgery, which greatly reduces blood loss and the risk for blood transfusion after hip and knee replacement surgery.
  • Blood donation from family members is strongly discouraged.
  • Special circumstances may be addressed with Dr. McLawhorn on a case-by-case basis.

 

Hospital Stay Questions

The day before your scheduled procedure, a representative from the hospital will contact you and give you the arrival information you need for the day of surgery.

You will be admitted to the hospital on the day of your surgery.

The total surgical time, including the time necessary for anesthesia, positioning you for surgery, and safely performing the surgery, depends on many factors, but primary hip and knee replacement procedures, including hip resurfacing and partial knee replacement, usually take 2 to 3 hours.

  • Almost all patients receive either spinal and/or epidural anesthesia, which involves a small shot into the back with or without a small catheter. This type of anesthesia, formally called “neuraxial anesthesia” or “regional anesthesia”, is better tolerated than general anesthesia, and numerous studies have shown that postoperative outcomes are better with neuraxial anesthesia compared to general anesthesia.
  • Dr. McLawhorn also uses an injection into the soft tissues around the surgical site to further minimize pain.
  • Knee replacement patients will usually receive a nerve block around the knee to help with postoperative pain.
  • All patients will receive intravenous sedation, too, so that you are asleep during surgery but breathing on your own, without a breathing tube.

Yes, Dr. McLawhorn performs all of his surgeries. However, since HSS is a teaching hospital, orthopedic surgical residents or fellows (surgeons-in-training) may assist Dr. McLawhorn during his surgical procedures, and these trainees may participate in your aftercare while you’re admitted to the hospital.

All total joint replacement patients receive 24 hours of intravenous antibiotics. The first dose is given around 30 minutes prior to the skin incision, and 1 to 2 additional doses are given after surgery, depending on the type of antibiotic you need.

  • All joint replacement patients are at increased risk for blood clot after surgery. Therefore, you will receive a medication to thin your blood after surgery. The choice of medication is dependent on your additional risk factors for developing a blood clot, which can include your weight, other medical conditions, other medications you take, and prior history of blood clot.
  • Low-risk patients receive enteric coated Aspirin 325 mg orally twice per day for 6 weeks.
  • Early mobilization after surgery is essential to reducing your risk for blood clot.
  • Patients requiring Coumadin will need intermittent blood monitoring to make sure the daily dose of Coumadin is optimal. Care coordination for Coumadin is typically managed by the internist who cleared you for surgery or by your primary care doctor.

Most patients are able to place their full weight on their operated leg on the day of surgery. You will begin walking with the physical therapists in the hospital starting the day of surgery or the day after your surgery.

In general, patients are able to climb some stairs before leaving the hospital. However, stair climbing will be difficult at first. Although this soon improves, most patients are happiest if initially they are able to stay on one floor after returning home from surgery.

  • Many efforts are ongoing to reduce post-surgical pain have after joint replacement. However, most patients require some prescription pain medications for the first few weeks after surgery.
  • You should expect tolerable postoperative pain that allows you to participate in your physical therapy.
  • Your length of stay in the hospital is dependent on the surgery you have, your general health, and your progression with physical therapy.
  • In general, partial knee replacements may go home the same day of surgery or stay one night.
  • Total hip replacement and hip resurfacing patients stay 1 to 2 nights in the hospital.
  • Total knee replacement patients stay 2 nights in the hospital.
  • Length of stay after revision hip and knee replacement will depend on the reason(s) for revision and the extent of your surgery.
  • Most patients can be safely discharged directly home after most hip and knee replacement procedures.
  • Dr. McLawhorn strongly encourages that patients recover in the comfort of their homes, and not in a rehabilitation or other skilled care-type facility.
  • Research performed by Dr. McLawhorn has shown that post-surgical outcomes, including the risk for blood clots and readmission to the hospital, are better for patients who recover at home than for patients who spend part of their recovery in a skilled care facility.
  • Other research has demonstrated that there is no functional benefit gained from rehabilitation facilities.
  • Social workers and members of the hospital case management team will work with you while you are in the hospital to arrange a safe discharge to your home.
  • In rare cases, discharge to a skilled care facility may be necessary for patient safety.
  • If you would like to discuss your discharge planning prior to surgery, please call the Division of Patient Care & Quality Management, Case Management Department at (646) 797-8503.

 

Postoperative Recovery Questions

At the time of discharge from the hospital, most patients are walking with a cane or walker, and most patients are able to walk without an aid within 4 weeks of surgery.

Hip resurfacing patients may use crutches for 2-3 weeks after surgery, while their bone adjusts to the new implant.

  • Although patients recover at different rates, most patients require intermittent physical therapy sessions for 4 to 6 weeks after their surgery. Initially, we will arrange for a therapist to come to your home, but between 2 and 4 weeks after surgery we expect that you will be able to attend outpatient therapy.
  • Walking is generally the best therapy after your hip or knee replacement.
  • For knee replacement patients, Dr. McLawhorn recommends focusing first on keeping the knee straight (achieving “full knee extension”) and performing isometric exercises to strengthen the quadriceps (for example, isometric quad sets and straight leg raises). It is important to keep the knee straight when resting or lying down, and not to rest with the knee in a flexed or bent position. Place a rolled up towel beneath your heel to keep the knee straight. After 2 weeks, once your wound is healed and the inflammation from surgery has significantly decreased, more attention will be focused on regaining full knee range of motion (“flexion”). Dr. McLawhorn expects that you will have complete extension at 1 week, and nearly full flexion between 4 and 6 weeks.

HSS provides several “microsites” that have high-quality, instructional information about your post-surgical recovery. This information has been reviewed and approved by Dr. McLawhorn.

  • Nearly all patients will receive absorbable sutures that are buried beneath the skin and will never require removal. The skin is also covered with a glue (Dermabond) that makes it safe for you to shower after you are discharged from the hospital.
  • If you do require skin staples or non-absorbable sutures, these will be removed by 2 weeks after surgery. A visiting nurse may remove these safely in your home.
  • If you have allergies or sensitivities to absorbable suture material, tapes and/or adhesives, please inform Dr. McLawhorn prior to your surgery.
  • Swelling and bruising around the operative site and down the operated leg are common after hip and knee replacement surgery. As you become more mobile and spend more time standing and walking, the swelling and bruising will travel further down the operated leg, oftentimes to the foot.
  • Swelling and warmth around total knee replacements can occur for several months after surgery.
  • Avoid sitting or standing for longer than 15 to 20 minutes at a time, and avoid letting your legs dangle when seated.
  • Perform gentle, controlled, “ankle pump” exercises, moving the foot up and down through the ankle joint, for a few minutes every hour.
  • Rest for at least one hour per day. Elevate your legs when lying down with two pillows, raising your feet slightly higher than the level of your heart. Additionally, compression stockings over the calves can help.
  • It is our expectation that your requirement for prescription pain medication will diminish rapidly in the first 2 to 3 weeks after your surgery. Many patients can manage their pain with Tylenol and other over-the-counter medications at this point.
  • However, if you have an ongoing need for prescription medication, it is recommended that you call Dr. McLawhorn’s office several days prior to running out of your pain medication, so that there is enough time to mail a paper prescription, if necessary. Please do not wait until your medication runs out to call, as this may result in a delay for your obtaining medication.
  • Scarless joint replacement surgery is not possible.
  • Patients who develop keloids or have developed thick scars in the past after surgery or injury to the skin should expect a similar scar reaction following joint replacement.
  • There are steps you can take after surgery that may minimize scarring:
    • There are many topical creams and gels sold to minimize scar formation after surgery. For example, Mederma, which is a gel containing an onion extract that may minimize scarring. This gel can be applied after the wound is completely healed, usually 2 to 3 weeks after surgery, and it can be applied for 8 weeks.
    • Alternatively, silicone strips or sheets can be applied, once the wound is healed.
    • Mederma and silicone products cannot be used at the same time.
  • In addition, it is important to use high-SPF sunblock or avoid direct sunlight on the scar during the first 6-12 months after surgery to prevent scar discoloration.

The clicking is a result of the soft tissue moving across the joint, or the metal parts coming into contact with one another. This sensation usually diminishes as your muscles strengthen and recover from surgery.

Routine postoperative visits are scheduled at 6 weeks, 12 weeks, and 1 year after surgery. However, Dr. McLawhorn will see you as often as is necessary to make sure you obtain your desired outcome from surgery.

  • Most patients are able to drive by 6 weeks after surgery, and sometimes sooner if the operative leg is the left leg and they drive a vehicle with an automatic transmission.
  • Return to driving is dependent on when your reaction time (how quickly you can react to apply the brake pedal) returns to normal. Some literature suggests that this takes 6 weeks.
  • You should not drive while taking narcotic pain medications.
  • Returning to work is highly dependent on your general health, activity level, and the specific demands of your job.
  • If you have a sedentary job, such as computer work, you can expect to return to work between 2 and 6 weeks.
  • It is generally recommended that you plan for 6 weeks away from work after a joint replacement.
  • If you have a more physically demanding job, you may need up to 3 months for full recovery.
  • Yes, Dr. McLawhorn recommends that you take antibiotics prior to the dentist and prior to having any type of potentially invasive procedure, particularly those that involve cutting skin. Even routine dental cleanings require antibiotics in the first 2 years after joint replacement, and it is advised to delay routine dental cleanings for at least 3 months after joint replacement surgery.
  • The American Academy of Orthopedic Surgery (AAOS) and American Dental Association (ADA) have recommended antibiotics for up to 2 years after your joint replacement. After 2 years, antibiotics are not required for routine dental cleanings. However, Dr. McLawhorn and many other joint replacement surgeons strongly recommend antibiotics for life for more invasive dental work or other procedures, since the consequences of a joint replacement infection are devastating.
  • If you are NOT allergic to Penicillin, 2 grams of Amoxicillin, Cephalexin, or Cephradine taken one hour prior to the procedure.
  • If you ARE allergic to Penicillin, 600mg of Clindamycin taken one hour prior to the procedure.
  • You can call the office for a prescription prior to any planned procedure(s).

The risk for a blood clot is elevated for approximately 3 months after joint replacement. In general, you may fly 6 weeks after surgery. Between 6 weeks and 3 months, Dr. McLawhorn recommends taking a baby Aspirin (81 mg) prior to your flight(s). If you must fly sooner than 6 weeks, Dr. McLawhorn will likely recommend Lovenox injections for the flight(s).

Additional in-flight recommendations include:

  • Do not place baggage underneath the seat in front of you which may inhibit moving your legs.
  • Wear compression stockings but otherwise loose-fitting clothes.
  • Avoid crossing your legs at your ankles or knees.
  • Regularly change leg position, exercise the leg muscles, and perform ankle pumps while seated.
  • Whenever it is safe to do so, walk about the cabin periodically.
  • Avoid sleeping in a cramped position.
  • Ensure adequate hydration, and avoid dehydrating drinks containing alcohol or caffeine.

Joint replacements can set off metal detectors. You can inform the screening agent that you have had a joint replacement, but you will still require screening and will need to follow the directions of the screening agent.

Special cards are not required to prove that you have had a joint replacement and will not prevent required screening at airports and other facilities.

  • Yes, the metals used in joint replacements are safe for these tests.
  • MRI of the area of the joint replacement will not yield good pictures because of imaging artifact created by the metal.
  • If an MRI of a joint replacement is required, it should be performed at a facility like HSS with experience in MRI techniques that suppress metal artifact.

Most joint replacements weigh between one and two pounds.

Dr. McLawhorn advises avoiding running, jumping, and other impact sports after surgery. Avoidance of these activities should increase the longevity of your joint implant. High impact activities should certainly be avoided in the first 6 months after surgery.

If you have clinical questions, please call the office at 212-606-1065. Alternatively, you can contact Dr. McLawhorn and his staff via email: McLawhornOffice@hss.edu.

  • Your medical records contain government-protected health information subject to the HIPAA Privacy Rule. To request that Dr. McLawhorn send your medical records to you or to a third party, you must complete a release form and fax or mail it to the office. It takes 5 to 10 business days for these requests.
  • Please note that all imaging must be obtained separately through the Radiology Records Room at HSS. Please call 212-606-1135 during their business hours to inquire about their process for obtaining copies of your imaging.

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