Additional Information

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.

  • Frequently used NSAIDs include Aspirin, Aleve, Advil, Motrin, Indocin, Naprosyn, Voltaren, Celebrex, and Mobic. They are prescribed to treat pain and various inflammatory conditions.
  • These drugs share some common side effects:
    • Heartburn
    • Upset stomach
    • Diarrhea
    • Headache
    • Dizziness
  • It is recommended that you take these medications immediately after meals to reduce the occurrence of these side effects.
  • NSAIDs may also increase the risk for abnormal bleeding. If you have a history of ulcers or take another blood thinning medication, you should not take these medications unless your primary care doctor approves of their use.
  • Patients taking high blood pressure medication(s) and those patients with heart or kidney problems, should notify their primary care doctor that they are taking NSAIDs, in case additional monitoring or tests are required.
  • If you experience any side effects other than those listed above, stop taking the medication and notify your primary care physician.
  • Corticosteroids (“cortisone” or “steroids”) are commonly injected into joints and tissues, along with local anesthetic drugs like lidocaine, to treat pain and reduce inflammation.
  • The local anesthetic in the injection works immediately and will last for several hours. If it improves your symptoms temporarily, then the medicine was injected into the area responsible for your pain.
  • The effectiveness of steroid injections is not predictable. The positive effects of corticosteroids usually take several days to become evident, but then their effects may last for several weeks to months or longer. Some people get long lasting pain relief while others do not.
  • Steroid injections can raise blood sugar levels. Diabetic patients should check their blood sugars more frequently for the first 48 hours after injection and adjust medication doses as directed by a primary care doctor.
  • Minor pain, swelling, scant bleeding, and numbness around the injection site can be normal in the first 24 hours after an injection.
  • Rare complications from steroid injections include:
    • Deep or superficial infection.
    • “Cortisone flare” is a reaction to the steroid itself. This reaction happens in about 2% of patients. There is often redness around the injection site and worse pain, but these symptoms resolve within 12 to 48 hours.
    • Fat atrophy, or thinning of the fatty layer just under the skin, can appear as a sunken area or dimple around the injection site.
    • Loss of skin pigmentation, or lightening of the skin, at the injection site occurs more frequently in patients with dark skin tones.
    • Weakening of tendon or ligament leading to rupture.
  • If you experience swelling, redness, heat, or pain at the injection site, apply a cold pack to the area and take Tylenol or a NSAID to reduce inflammation. If symptoms persist for more than 24 hours, please contact the office.
  • After an injection, please keep a record of the injection effects, including degree of symptom relief and duration of relief, so that you can communicate this to Dr. McLawhorn at your next visit.
  • Recent evidence suggests that the risk of a joint replacement infection is increased, if patients receive joint injections within the 3 months prior to their joint replacement surgery. Therefore, Dr. McLawhorn recommends delaying joint replacement for at least 3 months after hip and knee injections.
  • Viscosupplementation injections are an alternative injection to steroids, and may be useful for patients who do not achieve adequate pain relief from steroid injections and/or NSAIDs.
  • Trade names for these injections include Synvisc, Orthovisc, Supartz, Euflexxa, and others.
  • Some injections are given as a one-time dose, while others require a series of 3 weekly injections.
  • All contain hyaluronic acid, which is a naturally occurring substance found in many joints, including the hip and knee.
  • The efficacy of these injections is controversial and unpredictable, and several agencies have recommended against their use because of insufficient evidence in their support. However, many patients report significant pain relief after viscosupplementation injections.
  • Viscosupplementation will not reverse or delay the progression of osteoarthritis.
  • Dr. McLawhorn and HSS do not stock these medications, and they may not be a covered benefit under your insurance plan.
  • The steps to obtain gel injections are:
    • Contact your medical insurance provider to find out who your Specialty Pharmacy is that will supply you with the medication. These medications are expensive and not available at local pharmacies. You will need to obtain the name and fax number of your Specialty Pharmacy and ask which of the viscosupplementation medications is a “preferred drug” for your plan. You will then provide the information to our office so that your prescription can be submitted for you.
    • Complete the enrollment process with your Specialty Pharmacy by providing your demographic and insurance information. The Specialty Pharmacy will verify your benefits and can explain your financial responsibility for the medication. Prior to shipping the medication, they will contact you to inform you of any payment necessary and to get your consent to ship the medication. Once you have made the necessary payment, the medication will be shipped to our office. Please provide the office address at which you plan to receive your injection (Manhattan, Westchester, or Stamford).
    • It can take 2-6 weeks to receive the gel injections in the office. Please follow up with your Specialty Pharmacy in regards to the status of your gel injections.
    • Once the medication is delivered, we will contact you to schedule your appointment(s).
  • Recent evidence suggests that the risk of a joint replacement infection is increased, if patients receive joint injections within the 3 months prior to their joint replacement surgery. Therefore, Dr. McLawhorn recommends delaying joint replacement for at least 3 months after hip and knee injections.

While the risk of complications following elective hip and knee replacement surgery are generally low, there are many possible surgical and medical complications to be aware of. You always have the option to NOT have surgery.

  • 1-5% risk of an immediate postoperative complication, such as heart attack, stroke, pulmonary embolism, and kidney failure. Death is exceedingly rare, occurring in less than 0.1% of patients.
  • Occasional mild pain or discomfort in up to 5% of hip replacement patients and 5-10% of knee replacement patients.
  • Infection is one of the most devastating complications after joint replacement, requiring additional surgical procedures and prolonged antibiotics to eradicate the infection. The risk of infection at HSS is 0.3%.
  • A blood clot in the leg (deep vein thrombosis) or lungs (pulmonary embolism) occurs in approximately 1-2% of patients despite the use of blood thinning medications following surgery.
  • The implants used can fail over time due to wear of the bearing components or loosening of the components from the bone, both of which usually occur over many years.
  • Hip dislocation can occur after hip replacement surgery, and may require additional surgery if dislocation becomes recurring. The short-term risk of dislocation in most patients is 0.5% to 1%. The lifetime risk is probably between 2% and 3%.
  • For total knee patients, there is a risk for stiffness or loss of motion. Patients with very poor preoperative range of motion, active smokers, and patients with diabetes are at the highest risk for this complication.
  • Leg length differences following surgery are possible and may be difficult to avoid. For hip replacement patients, additional leg length may be necessary to achieve a stable hip replacement that does not dislocate. Often leg length discrepancy is mild and rarely requires treatment. Most frequently, the difference is leg length is merely a perception, because of soft tissue and muscle contractures around the operated hip. As the soft tissues adjust to the reconstructed hip, the sensation of different leg lengths usually goes away.
  • Risk of major nerve injury is very low. Certain conditions in the hip and knee may increase the risk, and Dr. McLawhorn will discuss these with you, if you have those risk factors.
  • Injury to major blood vessels is possible but exceedingly rare.
  • Minor nerve dysfunction after surgery is common, and the symptoms are usually temporary, resolving over several weeks to months. Knee replacement patients will experience numbness around the front of the knee, and hip replacement patients, particularly those receiving the anterior approach, may also experience numbness around the incision. For the anterior approach, numbness on the outside of the thigh is common,usually resulting from temporary stretch to the lateral femoral cutaneous nerve (LFCN).
  • Your anesthesiologist will review the specific risks related to anesthesia on the day of your surgery.

One of the most common complaints after total joint replacement is difficulty sleeping. The most common cause of sleep disruption is pain.

Here are some simple tips to improve your sleep quality after joint replacement:

  • Take your pain medication an hour before bed to achieve better comfort and help restore your sleep cycle.
  • Take a few days off from strenuous activity or physical therapy; this will not inhibit your recovery, but can have a tremendous effect on your ability to fall asleep and stay asleep.
  • Avoid naps during the day, if possible.
  • Refrain from evening use of alcohol, caffeine, and nicotine.
  • Ice is an effective treatment to reduce pain and inflammation, particularly after partial and total knee replacement surgery.
  • Research performed at HSS showed that after total knee replacement, ice machines can help minimize the need for narcotic medications and potentially expedite recovery.
  • Patient satisfaction was also higher in patients using an ice machine.
  • If you wish to rent one of the commercially available ice machines (for example, the GameReady), we can arrange for a vendor to contact you prior to surgery.
  • Please note that insurance frequently does not cover the cost of cryo-pneumatic devices.
  • Dr. McLawhorn does not have a financial interest in any cryo-pneumatic device.

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