Orthopaedic Consultant Protocol (Otago)

Consultant: All consultants (Otago)

Operation: Shoulder Acromioplasty/ Subacromial Decompression/ Arthroscopy & Rotater Cuff Repair

Protocol

Blood Test: FBC & others if indicated.

Cross Match: Not required.

Urine Specimen: Not required.

X-rays: 1. AP view.
2. Suprascapular outlet view.
3. Axillary within 6 months.

Mr Chin Acromioplasty patients require AP shoulder, axillary view and 30 degree caudal tilt AP view.
Mr Dunbar AP shoulder, axillary view and 30 degree caudal tilt AP view.
Mr Matheson AP view, axillary & 30 degree caudal tilt view.
Mr McMahon Acromioplasty & rotator cuff patients require AP shoulder, axillary and suprascapular outlet view.
Prof Theis 30 degree caudal tilt AP view.
Mr McCoubrey Acromioplasty & rotator cuff patients require AP shoulder, axillary and suprascapular outlet views.

Skin Integrity: Check for infection, rash, broken skin especially axilla.

Medication: As medical condition indicates.

DVT Prophylaxis: Intermittent pneumatic compression devices for prolonged surgeries. (McMahon-foot pumps).

Length of Stay: 1-2 days.

Southern DHB 50203 V7 Page 1 of 16

Issued 13/07/2015 Released 13/07/2015
Consultant: All consultants (Otago)

Operation: Hand & Foot Surgery

Protocol

Blood Tests: As indicated.

Cross Match: Not required.

Urine Specimen: Not required.

X-rays: Check with consultant.

Hand - AP + lateral for bony surgery only (Prof Theis).
Foot - AP + lateral weight bearing foot (Prof Theis).
+ oblique weight bearing pre-op. (Mr Birks).

Skin Integrity: Hand: check skin creases and web of fingers for infection.
Foot: check for infection, rash, broken skin, especially between the toes.

Medication: As medical condition indicates.

DVT Prophylaxis: Not required. (Check with Mr Dunbar as may be appropriate with some surgeries).

Length of Stay: As advised by consultant.

Southern DHB 50203 V7 Page 2 of 16

Issued 13/07/2015 Released 13/07/2015
Consultant: All consultants (Otago)

Operation: Knee Arthroscopy.

Protocol

Blood Test: As medical condition indicates.

Cross Match: Not required.

Urine Specimen: Not required.

X-rays: AP & lateral weight bearing view. (No need for fresh X-rays).

Skin Integrity: Check for infection, rash, & broken skin.

Medication: Discuss stopping oral contraceptive 6 weeks before surgery. (Not necessary for Dunbar & Matheson
patients). Pre-operative anticoagulant if on oral contraceptive (McMahon). Intra-op 20mg clexane
(Dunbar, Birks and Mr Matheson).

DVT Prophylaxis: Not required.

Length of Stay: Day of surgery.

Patient Information: Post-operative Instruction for patients undergoing knee arthroscopy.

Southern DHB 50203 V7 Page 3 of 16

Issued 13/07/2015 Released 13/07/2015
Consultant: Hodgson, McMahon, Carstens

Operation: Cervical Discectomy.

Protocol

Blood Test: FBC, U&E, ESR, group & screen & others if indicated.

Urine Specimen: Not required.

X-rays: AP & lateral cervical spine. Check MRI/CT scan/myelogram available. Check with consultant if new
X-rays needed.

Brace: Fit for soft collar as instructed by consultant.

DVT Prophylaxis: Intermittent pneumatic compression devices for prolonged surgeries. (McMahon-foot pumps).

Skin Integrity: Check for infection, rash, & broken skin.

Medication: Stop hormone replacement treatment and oral contraception 6 weeks before surgery.

Length of Stay: 2-3 days.

Patient Information: Recovery Pathway for Patients undergoing Decompression & Fusion Surgery.
Royal Australasian College of Surgeons’ Guide.

Southern DHB 50203 V7 Page 4 of 16

Issued 13/07/2015 Released 13/07/2015
Consultant: Theis, Hodgson, McMahon & Carstens

Operation: Lumbar Spinal Fusion / Decompression.

Protocol

Blood Test: FBC, U&E, ESR, Group & Screen & others if indicated.

Urine Specimen: Not required.

X-rays: AP & Lateral lumber spine within 6 months.

Check MRI/CT scan available.
Check with consultant if new X-rays needed.

Skin Integrity: Check for infection, rash, and broken skin.

DVT Prophylaxis: Intermittent pneumatic compression devices for prolonged surgeries. (McMahon-foot pumps).

Medication: Advice to stop hormone replacement treatment and oral contraception 6 weeks before surgery.

Length of Stay: 3-4 days.

Patient Information: Recovery Pathway for Patients.

Royal Australasian College of Surgeons Guide.
To have stopped smoking 3 months prior to surgery and committed to be smoke free for 3 months post-
surgery (Hogdson/Carstens).

Southern DHB 50203 V7 Page 5 of 16

Issued 13/07/2015 Released 13/07/2015
Consultant Hodgson, McMahon & Carstens

Operation: Cervical Spinal Fusion.

Protocol

Blood Test: FBC, U&E, ESR, group and screen, others if indicated.

Urine: Not required.

X-rays: AP & flexion, extension views cervical spine. Lateral view cervical spine. Check that MRI / CT scan /
myelogram has been completed & available.

Brace: Fit for collar / brace as advised by consultant.

Skin Integrity: Check for infection, rash, & broken skin.

DVT Prophylaxis: Intermittent pneumatic compression devices for prolonged surgeries. (McMahon-foot pumps).

Medication: Stop hormone replacement treatment and oral contraception 6 weeks before surgery.

Length of Stay: 3-5 days.

Patient Information: Recovery Pathway for Patients.

Royal Australasian College of Surgeons Guide.
To have stopped smoking 3 months prior to surgery and committed to be smoke free for 3 months post-
surgery (Hodgson/Carstens).

Southern DHB 50203 V7 Page 6 of 16

Issued 13/07/2015 Released 13/07/2015

Consultant Blood Tests,
Specimens &
X-rays
Birks Pre-op:
FBC, U&E, ESR &
others if indicated.
(Above repeated 24
hours post op.) Group
& screen. MSU.
Weight-bearing AP
knees and lateral.
Revision-long tibia and
above views.
Post-op: Day 3 AP &
lateral.
Chin Pre-op:
FBC, U&E, ESR &
others if indicated.
(Above repeated 24
hours post op.) Cross
match if revision.
Group & screen. MSU.
AP tibia full length.
Weight-bearing AP,
lateral & skyline view.
Post-op: Day 2 AP &
lateral
Patient information:
Pre-operative Questionnaire, Guide to Blood Transfusion, The Bone Bank, Your Anaesthetic Guide, My Role and Responsibilities Total Knee Replacement,
PCA Information Sheet
Southern DHB 50203 V7
Issued 13/07/2015 Released 13/07/2015
Total Knee Replacement Surgery
Skin Integrity Pre-op Prep & IVAB Length of Bowel Wound
Medication & Stay & Manageme Dressing
Anti-coagulation Follow-up nt & IDC
No pillow under the Stop HRT & oral 3 post-op doses 3-5 days. IDC out as Wound will have
knee; can have contraception 6 weeks cephazolin. Aspirin 100mg Follow up 6 soon as mefix over it - this
pillow under ankle pre-op. daily & for 6 weeks on weeks possible, is not to be
or trough; nothing discharge. Clexane 40mg unless preferably out changed unless
that causes the Stop NSAIDs 10 days while an inpatient. otherwise day 1 post-op. absolutely
knee to bend. before surgery. Intermittent pneumatic specified. Enema night necessary during
Remove drain Day compression devices, foot before surgery the whole
1 post-op. Continue aspirin. pump operative side, calf if B.N.O. inpatient stay.
Shower using betadine pump other leg. Patients recently. Chart The op-site over it
to appropriate leg night with increased clotting risk laxatives from can be changed.
before & morning of (with no increased bleeding Day 1. Reduce
surgery. risk), warfarin or bandaging Day 1
dabigatran. post-op.
Shave in MOT.
No pillow under the Stop HRT 6 weeks pre- 3 post-op doses 4-5 days. IDC out as Padded op-site.
knee; can have op. Stop NSAIDs as cephazolin. Intermittent Follow up 6 soon as Reduce dressing
pillow under ankle advised by consultant. pneumatic compression weeks possible, day one or day
or trough. Stop DMARDs (e.g. devices, foot pump unless preferably Day two to facilitate
Remove drain Day methotrexate, anti-TNF) operative side, calf pump otherwise 1 post-op. mobilisation.
1 post-op if used. 1/52 pre-op; typically other leg. specified. Enema night Change every 3
miss 2 doses. One Clexane 20mg night of before surgery days as required.
immediately prior to surgery then 40mg daily if B.N.O.
surgery and one after until discharge. recently. Chart
surgery. Patients with increased laxatives from
Shower using betadine clotting risk (with no Day 1.
to appropriate leg night increased bleeding risk),
before & morning of consultant to advise
surgery. anticoagulation regime.
Continue low dose Typically dabigatran 110mg
Aspirin. bd for 2 weeks after
Shave in MOT. discharge. Adjust according
to age, renal function and
bleeding risk.
Page 7 of 16
 Total Knee Replacement Surgery
Consultant Blood Tests, Skin Pre-op Prep & IVAB Length of Bowel Wound
Specimens & X-rays Integrity Medication & Stay & Management Dressing
Anti-coagulation Follow-up & IDC
Carstens Pre-op: FBC, U&E, ESR No pillow Stop HRT & oral 3 post-op doses 4-5 days. IDC out as soon Duoderm
& others if indicated. under the contraception 6 weeks pre- cephazolin. Aspirin 100mg Follow up 6 as possible, thin, keep
(Above repeated 24 hours knee, can op. daily & for 6 weeks on weeks unless preferably Day 1. intact
post op.) Group & screen. have pillow discharge. Intermittent otherwise Enema night unless it
MSU. Weight-bearing AP under ankle or Stop NSAIDs 7 days before pneumatic compression specified. before surgery if needs to be
knees and lateral. trough, nothing surgery. devices, foot pump B.N.O. recently. changed.
Revision-long tibia views. that causes Continue aspirin operative side, calf pump Chart laxatives Reduce
Post-op: Day 3 AP & the knee to Shower using betadine to other leg. Patients with from Day 1. bandaging
lateral. bend. appropriate leg night before increased clotting risk (with Day 1 post-
Remove drain & morning of surgery. no increased bleeding risk), op.
Day 1 post-op. Shave in MOT. consultant to advise
anticoagulation regime.
Dunbar Pre-op: No pillow Stop HRT & oral 3 post-op doses 4-5 days. IDC out as soon Padded op-
FBC, U&E, CRP, LFT & under the contraception 6 weeks pre- Cephazolin. Follow up 6 as possible, site.
others if indicated. knee, can op. weeks unless preferably Day 1 Change
(Above repeated 24 hours have pillow Intermittent pneumatic otherwise post-op. every 3
post op.) Group & under ankle or Stop NSAIDs 7 days before compression devices, foot specified. Enema night days as
screen. MSU. Weight- trough, nothing surgery. pump operative side, calf before surgery if required.
bearing AP knees and that causes Continue aspirin pump other leg. B.N.O. recently.
lateral. Revision-long tibia the knee to Shower using betadine to Rivaroxaban post-op and Chart laxatives
views. bend. appropriate leg night before on discharge for 2/52. from Day 1.
Post-op: Day 3 AP & Remove drain & morning of surgery.
lateral. Day 1 post-op. Shave in MOT.
Gwynne- Pre-op: No pillow Stop HRT & oral 3 post-op doses 4-5 days. IDC - preferably Padded op-
Jones FBC, U&E & under the contraception 6 weeks pre- cephazolin. Follow up 6 Day 1 site.
others if indicated. knee; can op. Aspirin 100mg daily & for 6 weeks unless Enema night Change
(Above repeated 24 hours have pillow weeks on discharge. otherwise before surgery if every 2- 3
post op.) Group & under ankle or Stop NSAIDs 7 days before Intermittent pneumatic specified. B.N.O. recently. days as
screen. MSU Weight- trough; nothing surgery. compression devices, foot Chart laxatives required.
bearing AP knees and that causes Continue aspirin pump operative side, calf from Day 1.
lateral. Revision-long tibia the knee to Shower using betadine to pump other leg. Patients
& above views. bend. Remove appropriate leg night before with increased clotting risk
Post op: When drain Day 1 & morning of surgery. (with no increased bleeding
comfortable AP & lateral. post-op. Shave in MOT. risk), consultant to advise
anticoagulation regime.
Patient information:
Pre-operative Questionnaire, Guide to Blood Transfusion, The Bone Bank, Your Anaesthetic Guide, My Role and Responsibilities Total Knee Replacement, PCA
Information Sheet
Southern DHB 50203 V7 Page 8 of 16
Issued 13/07/2015 Released 13/07/2015
 Total Knee Replacement Surgery
Consultant Blood Tests, Skin Pre-op Prep & IVAB & Length of Stay Bowel Wound
Specimens & Integrity Medication Anti-coagulation & Follow-up Management Dressing
X-rays & IDC
Hodgson Pre-op: No pillow Stop HRT & oral 3 post op doses 4-5 days. IDC out as soon Padded op-
FBC, U&E, ESR, under the contraception 6 weeks Cephazolin. Follow up 6 weeks unless as possible, site.
INR & knee; can pre-op. Aspirin 100mg daily & otherwise preferably Day 1 Change
others if indicated. have pillow Stop NSAIDs as advised for 6 weeks on specified. post-op. every 3
(Above repeated 24 under by consultant. discharge. Intermittent Enema night days as
hours post-op.) ankle or Continue aspirin. Shower pneumatic compression before surgery if required.
Group & trough; using betadine to devices, foot pump B.N.O. recently.
screen. MSU. nothing appropriate leg night operative side, calf Chart laxatives
Weight-bearing AP that causes before & morning of pump other leg. from Day 1.
knees and lateral. the knee to surgery. Patients with increased
Revision-long tibia bend. clotting risk (with no
views. Remove Shave in ward. increased bleeding
Post-op: Day 3 AP drain Day 1 risk), consultant to
& lateral. post-op. advise anticoagulation
regime.
Matheson Pre-op: No pillow Stop NSAIDs as advised 3 post-op doses 4-5 days. IDC out Day 2 Reduce
FBC, U&E, LFT, under the by consultant. Cephazolin. Follow up 6 weeks unless post-op. and apply
glucose & knee; can Aspirin 100mg daily. otherwise Enema night padded op-
others if indicated. have pillow Stop methotrexate, Intermittent pneumatic specified. before surgery if site after
(Above repeated 24 under penicillamine & compression devices, B.N.O. recently. 48 hours.
hours post op.) ankle or azathioprine 2/52 pre-op. foot pump operative Chart laxatives
Group & trough; Continue aspirin. side, calf pump other from Day 1.
screen. MSU. nothing leg. Patients with
Weight-bearing AP that causes Shower using increased clotting risk
knees and lateral. the knee to chlorhexadine to (with no increased
Revision-long tibia bend. appropriate leg night bleeding risk),
& above views. Remove before & morning of consultant to advise
Post op: Day 3 AP drain Day 1 surgery. anticoagulation regime.
& lateral. post op. Shave in ward, day of
surgery

Patient information:
Pre-operative Questionnaire, Guide to Blood Transfusion, The Bone Bank, Your Anaesthetic Guide, My Role and Responsibilities Total Knee Replacement, PCA
Information Sheet

Southern DHB 50203 V7 Page 9 of 16

Issued 13/07/2015 Released 13/07/2015
 Total Knee Replacement Surgery
Consultant Blood Tests, Skin Pre-op Prep & IVAB Length of Bowel Wound
Specimens & Integrity Medication & Stay & Management Dressing
X-rays Anti-coagulation Follow-up & IDC
McMahon Pre-op: Remove Stop HRT & oral 3 post-op doses 4-5 days. IDC out as soon as Padded op-
FBC, U&E, ESR & drain Day 1 contraception 6 weeks cephazolin. Follow up 6 possible, preferably site. Change
others if indicated. post-op. pre-op. weeks unless Day 1 post-op. every 3 days
(Above repeated 24 Aspirin 100mg daily & for otherwise Enema night before as required.
hours post op.) Group Stop NSAIDs 10 days 6 weeks on discharge. specified. surgery if B.N.O.
& screen. MSU. before surgery. Intermittent pneumatic recently. Chart
Weight-bearing AP Continue aspirin. compression devices, laxatives from Day
knees and lateral. Shower using betadine foot pumps both feet. 1.
Revision-long tibia and to appropriate leg night Patients with increased
above views. before & morning of clotting risk (with no
Post-op: Day 3 AP & surgery. increased bleeding risk),
lateral. consultant to advise
Shave in MOT. anticoagulation regime.

Theis Pre-op: No pillow Stop HRT & oral 3 post-op doses 4-5 days. IDC out as soon as Padded op-
FBC, U&E, ESR & under the contraception 6 weeks cephazolin. Follow up 6 possible, preferably site. Change
Others if indicated. knee; can pre-op. weeks unless Day 1 post- op. every 3 days
(Above repeated 24 have pillow Aspirin 100mg daily & for otherwise Enema night before as required.
hours post op.) Group under ankle Stop NSAIDs as 6 weeks on discharge. specified. surgery if B.N.O
&screen. MSU. Weight- or trough; advised by consultant. Intermittent pneumatic recently. Chart
bearing AP knees and nothing that Shower using betadine compression devices, laxatives from Day
lateral. Revision-long causes the to appropriate leg night foot pump operative side, 1.
tibia and above views. knee to bend. before & morning of calf pump other leg.
Post op: Day 3 AP & surgery. Patients with increased
lateral. clotting risk (with no
Shave in ward. increased bleeding risk),
consultant to advise
anticoagulation regime.

Patient information:
Pre-operative Questionnaire, Guide to Blood Transfusion, The Bone Bank, Your Anaesthetic Guide, Your Role and Responsibilities Total Joint Replacement,
PCA Information Sheet

Southern DHB 50203 V7 Page 10 of 16

Issued 13/07/2015 Released 13/07/2015
 Total Hip Replacement Surgery
Consultant Blood Tests, Skin Pre-op Prep & IVAB & Length of Bowel Wound
Specimens & X-rays Integrity Medication Anti-coagulation Stay & Management Dressing
Follow-up & IDC
Birks Pre-op: Remove Stop HRT & oral 3 post-op doses 3-4 days. IDC out as soon Wound will
FBC, U&E, ESR & drain Day 1 contraception 6 weeks cephazolin. Follow up 6 as possible, have mefix
others if indicated. post-op. pre-op. weeks unless preferably Day 1 over it - this
(Above repeated 24 hours Aspirin 100mg daily & for otherwise post-op. is not to be
post op.) Group & Stop NSAIDs 10 days 6 weeks on discharge. specified. Enema night changed
screen. MSU. before surgery. Intermittent pneumatic before surgery if unless
Check if femoral head compression devices, B.N.O. recently. absolutely
required (only for revisions). Continue aspirin. foot pump operative side, Chart laxatives necessary
AP hips/femur and lateral Shower using betadine to calf pump other leg. from Day 1. during the
view hip. Revision-long appropriate leg night Patients with increased whole
femur and AP & lateral before & morning of clotting risk (with no inpatient
Post op: Day 3 AP & lateral. surgery. increased bleeding risk), stay. The op-
warfarin or Dabigatran. site over it
Shave in MOT. Clexane 40mg while an can be
inpatient. changed.
Chin Pre-op: No pillow Stop HRT 6 weeks pre- 3 post op doses 3-4 days. IDC out as soon Padded op-
FBC, U&E, LFT,CRP, ESR under the op. cephazolin. Follow up 6 as possible, site. Change
& knee; can Intermittent pneumatic weeks unless preferably Day 1 every 3 days
others if indicated. have pillow Stop NSAIDs as advised compression devices, otherwise post-op. as required.
(Above repeated 24 hours under ankle by consultant. foot pump operative side, specified. Enema night
post op.) Cross match if or trough; calf pump other leg. before surgery if
revision. Group & screen. nothing that Stop methotrexate, Clexane 20mg night of B.N.O. recently.
MSU. Check if femoral causes the penicillamine & surgery then 40mg daily Chart laxatives
head required (only for knee to bend. azathioprine 1/52 pre-op. until discharge. from Day 1.
revisions). Remove Continue aspirin. Shower Patients with increased
AP hips/femur and lateral drain Day 1 using betadine to clotting risk (with no
view hip. Revision-long post-op. appropriate leg night increased bleeding risk),
femur and AP & lateral. before & morning of consultant to advise
Post op: Day 2 AP & lateral. surgery. anticoagulation regime.
Revision Day 1. Typically Dabigatran
Shave in MOT. 110mg bd for 4 weeks
after discharge. Adjust
according to age, renal
function and bleeding
risk.
Patient information:
Pre-operative Questionnaire, Guide to Blood Transfusion, The Bone Bank, Your Anaesthetic Guide, Your Role and Responsibilities Total Joint Replacement, PCA
Information Sheet

Southern DHB 50203 V7 Page 11 of 16

Issued 13/07/2015 Released 13/07/2015
 Total Hip Replacement Surgery
Consultant Blood Tests, Skin Pre-op prep & IVAB & Length of Bowel Wound
Specimens & X-rays Integrity Medication Anti-coagulation Stay & Management Dressing
Follow-up & IDC
Carstens Pre-op: FBC, U&E, ESR No pillow under Stop HRT & oral 3 post-op doses cephazolin. 3-4 days. IDC out as soon Duoderm
&others if indicated. the knee; can contraception 6 Aspirin 100mg daily & for 6 Follow up 6 as possible, thin, keep
(Above repeated 24 hours have pillow weeks pre-op. weeks on discharge. weeks unless preferably Day 1 intact
post op.) Group & screen. under ankle or Stop NSAIDs 7 days Intermittent pneumatic otherwise post-op. Enema unless it
MSU. Check femoral head trough; nothing before surgery. compression devices, foot specified. night before needs to
required(revisions only). AP that causes the Continue aspirin. pump operative side, calf surgery if B.N.O. be
hips/ femur & lateral view knee to bend. Shower using pump other leg. Patients with recently. Chart changed.
hip. Revision-long femur Remove drain betadine to increased clotting risk (with laxatives from Reduce
views, no crests on films. Day 1 post-op. appropriate leg night no increased bleeding risk), Day 1. padding
Post-op: Day 3 AP & lateral before & morning of consultant to advise Day 1 post-
pelvis surgery. Shave in anticoagulation regime. op.
MOT.
Dunbar Pre-op: FBC, U&E, CRP, Can have Stop HRT & oral 3 post-op doses Cephazolin. 3-4 days. IDC out as soon Padded op-
LFT’s & pillow under contraception 6 Intermittent pneumatic Follow up 6 as possible, site.
others if indicated. ankle, knee or weeks pre-op. compression devices, foot weeks unless preferably Day 1 Change
(Above repeated 24 hours trough; nothing Stop NSAIDs 7 days pump operative side, calf otherwise post op. Enema every 3
post op.) Group & screen. that causes the before surgery. pump other leg. Patients with specified. night before days as
MSU. Check if femoral knee to bend Continue aspirin. increased clotting risk (with surgery if B.N.O. required.
head required(revisions much. Remove Shower using no increased bleeding risk), recently. Chart
only). AP hips/ femur & drain Day 1 betadine to consultant to advise laxatives from
lateral view hip. Revision- post op. if has appropriate leg night anticoagulation regime. Day 1.
long femur views, no crests one. before & morning of Rivaroxaban post-op and
on films. Post-op: Day 3 AP surgery. 4/52 on discharge.
& lateral pelvis. Shave in MOT.
Gwynne- Pre-op: FBC, U&E & others No pillow under Stop HRT & oral 3 post-op doses cephazolin. 3-4 days. IDC out as soon Padded op-
Jones & if indicated. (Above the knee; can contraception 6 Aspirin 100mg daily & for 6 Follow up 6-8 as possible, site.
McCoubrey repeated 24 hours post op.) have pillow weeks pre-op. weeks on discharge. weeks unless preferably Day 1 Change
Group & screen. MSU. under ankle or Stop NSAIDs 7 days Intermittent pneumatic otherwise post op. every 3
Check femoral head trough; nothing before surgery. compression devices, foot specified. Enema night days as
required(revisions only). AP that causes the Continue aspirin. pump operative side, calf before surgery if required.
hips/ femur & lateral view knee to bend. Shower using pump other leg. Patients with B.N.O. recently.
hip. Revision-long femur Remove drain betadine to increased clotting risk (with Chart laxatives
views, no crests on films. Day 1 post-op. appropriate leg night no increased bleeding risk), from Day 1.
Post-op: Day 3 AP & lateral before & morning of consultant to advise
pelvis. surgery. Shave in anticoagulation regime.
MOT.
Patient information: Pre-operative Questionnaire, Guide to Blood Transfusion, The Bone Bank, Your Anaesthetic Guide, Your Role & Responsibilities Total Joint
Replacement, PCA Information Sheet
Southern DHB 50203 V7 Page 12 of 16
Issued 13/07/2015 Released 13/07/2015
 Total Hip Replacement Surgery
Consultant Blood Tests, Skin Pre-op Prep & IVAB Length of Bowel Wound
Specimens & Integrity Medication & Stay Management Dressing
X-rays Anti-coagulation & & IDC
Follow-up
Hodgson Pre-op: No p Pillow under Stop HRT & oral 3 post-op doses 3-4 days. IDC out as soon Padded op-site.
FBC, U&E, ESR, INR the knee; can contraception 6 weeks cephazolin. Follow up 6 as possible, Change every 3
& others if indicated. have pillow pre-op. Aspirin 100mg daily & for 6 weeks preferably Day 1. days as
(Above repeated 24 under ankle weeks on discharge. unless Enema night required.
hours post op.) or trough; Stop NSAIDs as Intermittent pneumatic otherwise before surgery if
Group & nothing that advised by consultant. compression devices, foot specified. B.N.O. recently.
screen. MSU. AP causes the Continue aspirin. pump operative side, calf Chart laxatives
hips / femur & lateral knee to bend. Shower using betadine pump other leg. Patients from Day 1.
view hip. Revision- Remove to appropriate leg night with increased clotting risk
long femur & above drain Day 1 before & morning of (with no increased bleeding
views. post-op. surgery. risk), consultant to advise
Post-op: Day 3 AP & anticoagulation regime.
lateral pelvis. Shave in ward.
Matheson Pre-op: Pillow under Stop NSAIDs as 3 post-op doses 3-4 days. IDC out as soon Reduce
FBC, U&E, LFT, the knee & advised by consultant. cephazolin. Follow up 6 as possible bandage and
glucose & ankle. 160mg gentamycin prior to weeks preferably Day 1 apply padded
others if indicated. Remove Stop methotrexate, IDC removal (or oral unless post-op. Enema Opsite after 48
(Above repeated 24 drain Day 1 penicillamine & augmentin if no IV access otherwise night before hours.
hours post op.) post-op. azathioprine 2/52 pre- or allergies) specified. surgery if B.N.O.
Group & op. Aspirin 100mg daily. recently. Chart
screen. MSU. AP Shower using Intermittent pneumatic laxatives from
hips / femur. chlorhexadine to compression devices, calf Day 1.
Revision-long femur appropriate leg night pumps both sides. Patients
& AP & lateral. No before & morning of with increased clotting risk,
crests on films. surgery. consultant to advise
Post-op: Day 3 AP anticoagulation regime.
Shave in ward, day of
surgery.
Patient information:
Pre-operative Questionnaire, Guide to Blood Transfusion, The Bone Bank, Your Anaesthetic Guide, Your Role & Responsibilities Total Joint Replacement
Manual, PCA Information Sheet

Southern DHB 50203 V7 Page 13 of 16

Issued 13/07/2015 Released 13/07/2015
 Total Hip Replacement Surgery
Consultant Blood Tests, Skin Pre-op Prep & IVAB Length of Bowel Wound
Specimens & Integrity Medication & Stay Management Dressing
X-rays Anti-coagulation & & IDC
Follow-up
McMahon Pre-op: Remove Stop HRT & oral 3 post-op doses 3-4 days. IDC out as soon as Padded op-site.
FBC, U&E, ESR & drain Day 1 contraception 6 cephazolin. Follow up 6 possible, preferably Change every 3
others if indicated. post-op. weeks pre-op. Aspirin 100mg daily & for weeks unless Day 1 post op. days as required.
(Above repeated 24 6 weeks on discharge. otherwise Enema night before
hours post op.) Stop NSAIDs 10 days Intermittent pneumatic specified. surgery if B.N.O.
Group & before surgery. compression devices, recently. Chart
screen. MSU. AP Continue aspirin. foot pumps both feet. laxatives from Day
hips / femur & Shower using Patients with increased 1.
lateral view hip. betadine to clotting risk (with no
Revision-long appropriate leg night increased bleeding risk),
femur & above. No before & morning of consultant to advise
crests on films. surgery. anticoagulation regime.
Post-op: Day 3 AP Shave in MOT.
& lateral pelvis.
Theis Pre-op: Stop HRT & oral 3 post-op doses 3-4 days. IDC out as soon as Padded op-site.
FBC, U&E, ESR & contraception 6 cephazolin. Follow up 6 possible, preferably Change every 3
others if indicated. weeks pre-op. Aspirin 100mg daily & for weeks unless Day 1 post- op. days as required.
(Above repeated 24 6 weeks on discharge. otherwise
hours post op.) Stop NSAIDs as Intermittent pneumatic specified.
Group & advised by compression devices,
screen. MSU. AP consultant. Continue foot pump operative side,
hips / femur & aspirin. calf pump other leg.
lateral view hip. Shower using Patients with increased
No crests on films. betadine to clotting risk (with no
Post op: Day 3 AP appropriate leg night increased bleeding risk),
& lateral pelvis. before & morning of consultant to advise
surgery. anticoagulation regime.

Shave in ward.
Patient information:
Pre-operative Questionnaire, Guide to Blood Transfusion, The Bone Bank, Your Anaesthetic Guide, Your Role & Responsibilities Total Joint Replacement, PCA
Information Sheet

Southern DHB 50203 V7 Page 14 of 16

Issued 13/07/2015 Released 13/07/2015
Consultant: Chin & McMahon

Operation: Shoulder Replacement.

Protocol

Blood Test: FBC, U&E, LFT, CRP, ESR & others if indicated.

Cross Match: Group and screen.

Urine Specimen: MSU.

X-rays: 1. AP view.
2. Axillary within 6 months.

Skin Integrity: Check for infection, rash, broken skin especially axilla.

Medication: As medical condition indicates.

Anticoagulation: Nil on discharge.

Sling: As indicated by surgeon.

DVT Prophylaxis: Intermittent pneumatic compression devices. (McMahon-foot pumps).

Length of Stay: 2-3 days.

Patient Information: Recovery Pathway for Patients Undergoing Shoulder Replacement Surgery.
Recovery Pathway for Patients, Preoperative Questionnaire, Guide to Blood Transfusion.
The Bone Bank, Your Anaesthetic Guide, Royal Australasian College of Surgeons Guide.
PCA Information Sheet.

Southern DHB 50203 V7 Page 15 of 16

Issued 13/07/2015 Released 13/07/2015
Consultant: Birks

Operation: Total Ankle Replacement/Ankle Fusion/Hindfoot (subtalar/triple/midfoot) Fusion

Protocol

Blood Test: Pre-op FBC, U&E, ESR and others if indicated.

(Above repeated 24 hours post-op.)

Cross Match: Not required.

Urine Specimen: Pre-op MSU.

Anaesthetic: Prefer popliteal block in addition to spinal/GA.

IVAB: 3 doses post-op cephazolin.

X-rays: WB AP lateral ankle and foot.

Skin Integrity: Check for infection, rash, broken skin.

Medication: As medical condition indicates - stop HRT & oral contraception 6 weeks pre-op.
Stop warfarin & anticoagulants, but can continue aspirin. Stop NSAIDS 10 days pre-op.

DVT Prophylaxis: Intermittent pneumatic compression devices for prolonged surgeries.

Mobilisation: Bed rest 48H, elevation essential, then full mobilisation, NWB 6 weeks.
Pre-op- check crutches to ensure patient is able to hop prior to surgery.

ANTI-Coagulation: Clexane 40mg as an inpatient then for Aspirin for 6/52 on discharge. If high risk then for
Warfarin/Dabigatran

Follow-up: 2/52, wound check.

Length of Stay: 3 days. (Depends on mobility).

Southern DHB 50203 V7 Page 16 of 16

Issued 13/07/2015 Released 13/07/2015