Patient Resources

Dr. Denis Nam performs over 1,000 hip and knee replacements and revisions annually including some of Rush University Medical Center’s most complex cases. His minimally invasive techniques reduce pain during recovery and have patients walking the same day.

Table of Contents

Your First Visit

From scheduling necessary appointments to one-on-one education, our care team is with you every step of the way. Please come prepared for your first visit with the following:

  • Prior to your visit, please complete your online registration forms (OBERD) through Midwest Orthopedics.
  • Bring any imaging (x-rays, MRI, CT on discs) and medical history and records from outside institutions.
  • Your Photo ID.
  • Any additional paperwork requested by our care team.

Educational Resources

Deciding to proceed with hip or knee replacement surgery can raise many questions. Our team emphasizes education beginning with a personalized teaching session to answer questions and prepare you for the surgical process.

Text Services

We are able to coach our patients step by step through your surgical journey through a text-based program.

Patients are assigned to customized pre and post-op messages and videos.

This will answer many of your day to day questions.

Sign up for video messages, words of encouragement, and daily updates by texting JOIN to 312-313-0322.

You will receive two text messages per day customized to Dr. Nam’s protocols for hip and knee replacement starting 10 days prior to surgery and for 6 weeks after your procedure.

Patient Forms

When you schedule your appointment, you will be prompted to complete relevant forms prior to your appointment. Please help us streamline your visit by completing all forms that you receive via email prior to arrival of your scheduled visit. If you do not have an email or are unable to complete the form before your visit, please plan on arriving 45 minutes in advance of your visit to complete the forms.

Insurance Information

Accepted Insurance Plans Include:

PLAN

PRODUCT

Aetna

Beech Street

Blue Cross Blue Shield – HMO Illinois

Blue Cross Blue Shield of Illinois

Blue Cross Blue Shield Medicare Advantage PPO

CIGNA Healthplan of Illinois, Inc.

HMO/PPO/POS/EPO

PPO

HMO*

PPO

Medicare FFS/PPO

HMO/POS/PPO

Great West

Health Network

Healthcare’s Finest Network

HFN

Humana Health Care Plans

PPO

PPO

PPO

PPO/EPO

PPO/POS/HMO*

Multiplan

PPONext

Preferred Network Access

PPO

PPO

PPO

Private Healthcare Systems

Three River Provider Network

UnitedHealthcare

United Healthcare Group Medicare Advantage

(Medicare State of IL Retirees)

*for selected HMO sites

PPO

PPO

HMO/PPO

Medicare FFS/PPO

If you do not see your health plan listed above, please contact our office at 312-432-2340 for further clarification.

Pre-Operative Medical Clearance

It is very important that you are medically optimized prior to your elective total joint replacement surgery.

Several weeks prior to your surgery, you will receive a surgical information packet by mail. You will be seeing a Rush Internal Medicine physician for medical clearance. This appointment will be made for you and listed in your surgical packet.

You will be directed as to what other medical clearances may be required for you prior to your surgery.

Pre-Operative Infection Prevention

Patients play a key role in preventing surgical site infections. Dental: Please complete all dental work (fillings, root canals, extractions, routine cleanings) 2-3 weeks prior to surgery. Nasal bacteria decolonization: You will be given a prescription prior to surgery for Mupirocin. This is a nasal ointment to remove bacteria from inside your nose.  Apply inside the tip of your nostril once daily for five days before surgery. Skin Preparation:
  • During the week prior to your surgical procedure, do not remove any body hair on the operative leg to avoid cuts around the surgical area.
  • You will need to purchase a soap that contains Chlorhexidine Gluconate (CHG). Hibiclens and Betasept are the most commonly available products and can be purchased over the counter at your local pharmacy.
  • Shower or bathe with the CHG soap for five days before surgery following these instructions:
    • CHG is not to be used on the head, face, or genital area. Keep away from eyes, ears, and mouth.
    • Wash your hair and face with your normal conditioner and soap. Rinse completely.
    • Pour a quarter-sized amount of liquid CHG soap onto a clean, wet washcloth and apply to your entire body from the neck down. Apply additional soap to the washcloth as needed.
    • Rub the soap-filled washcloth over your entire body for three minutes.
    • Stop using the CHG soap and call your doctor if you have a skin reaction such as severe redness, blistering, peeling, or noticeable rash.
    • 24 hours prior to surgery, do not apply lotions or powders to the surgical area.
    • The night before surgery sleep in fresh, clean sheets and garments.
    • The morning of surgery, wear fresh, clean clothes.
Other:
  • Do not eat or drink after midnight before surgery, other than a specific pre-operative hydration protocol you will be instructed about.
  • Please bring a pair of non-slip shoes or slippers to your hospital/surgical center.
  • If you have your own crutches or walker, please bring them to the hospital/surgical center labeled with your name.

Medications to Stop Before Surgery

7 Days Prior to Surgery:

  • Aspirin (Bufferin, ASA, Ecotrin, Bayer)
  • Clopidogrel (Plavix)
  • Ibuprofen (Motrin, Advil, Nuprin, Midol, Pamprin)
  • Naproxen (Aleve, Naprosyn, Anaprox)
  • Indomethacin (Indocin)
  • Meloxicam (Mobic)
  • Diclofenac (Voltaren)
  • Nabumetone (Relafen)
  • All herbal supplements

5 Days Prior to Surgery:

  • Warfarin (Coumadin)

3 Days Prior to Surgery:

  • Xarelto
  • Eliquis

You May Continue to Take:

  • Acetaminophen (Tylenol)
  • Celecoxib (Celebrex)
  • Tramadol (Ultram, Ultracet)
  • Hydrocodone (Vicodin, Norco)

Postoperative Instructions

  • Elevate the leg above the level of your heart as much as possible.
  • Ice the joint 20-30 minutes at a time three times per day.
  • Take pain medications as directed. Be aware it can take an hour for the medication to start working.
  • Use crutches or a walker to help with balance and stability as directed by your therapist. This is usually for 1-2 weeks after surgery.
  • You may shower as long as the dressing remains intact (it is waterproof).
  • Home health services may have been arranged for the first 2-3 weeks after surgery. This includes a nurse (two total visits) and a physical therapist (usually 3x per week). However, we encourage patients to start physical therapy outside of their home at either a Midwest Orthopaedics at Rush location or local facility as soon as they feel comfortable to do so. A physical therapy prescription can be faxed to the location of your choice.
  • Your dressing should be changed one week after surgery. If you are receiving home health care services, the nurse will do this for you. If you are not having home health care services, you may do this yourself. If you have not purchased a second waterproof dressing and instead will have a dry dressing in place (gauze and tape), cover the dressing while showering to keep the incision dry until your first post-op appointment.
  • For knee replacement patients, you can bear weight as tolerated on the affected leg unless instructed otherwise. Place pillows underneath the ankle to help elevate your leg and straighten the knee. Do not place pillows underneath the knee.

Post-Op Medication Regimens

Aspirin

  • Take one tablet twice daily for six weeks after surgery. It’s best to take with food.
  • This is a required medication for six weeks to prevent blood clots.
  • You may be prescribed Eliquis, Xarelto, or Coumadin in place of aspirin.

Tramadol (50mg tablet)

  • Take two tablets every eight hours around the clock with Tylenol for pain relief.

Oxycodone (5mg tablet)

  • Take one tablet every four to six hours as needed for pain (for use with physical therapy sessions or at night when pain is particularly bad).

Gabapentin (100mg capsule)

  • Take one capsule three times per day for nerve pain.
  • This is a one-time prescription and does not need to be refilled once finished.
  • If you were taking Gabapentin prior to surgery please contact your doctor for a refill if needed.

Meloxicam (15mg tablet)

  • Take one anti-inflammatory tablet once daily.
  • This is a one-time prescription and does not need to be refilled once finished.

Acetaminophen, also known as Tylenol (500mg tablet)

  • Take two tablets every eight hours around the clock with Tramadol for pain relief

Senna Lax (8.6mg tablet)

  • Take two tablets twice daily as needed for constipation

Aquacel Waterproof Dressing Instructions

  • The Aquacel waterproof dressing may stay on for seven days at a time. Your home nurse will change it on the seventh day. You have the option of purchasing a second Aquacel dressing at the DME store in the MOR Orthopedic Building. If you have purchased an additional Aquacel dressing, the nurse will put it on for you.
  • If you see that your dressing is more than 80% filled with drainage, please have the home health nurse remove the Aquacel dressing and apply a new, dry non-Aquacel dressing. Please have the home health nurse call our office as soon as possible to inform us that the Aquacel dressing was removed due to increased drainage.
  • The dressing is waterproof, so you may shower with it on.
  • Make certain the dressing is fully attached to the skin at all times.
  • If you decide to remove the waterproof dressing, place a dry gauze dressing over your incision. The dry dressing should be changed daily as it is not waterproof. You will need to keep your incision covered and dry when showering. Please wrap your incision in plastic wrap to prevent water exposure.
  • Keep your incision dry and covered for three weeks. After your initial postoperative visit, you may shower with soap and water. But, please avoid pools, baths, and hot tubs for six weeks after surgery.

Cold Therapy

  • You will be given a wrap-around sleeve with gel ice packs to take home.
  • Another option is to utilize iceless cold therapy. You have information in your surgical packet about the Integrated Orthopedics Recovery Plus system. Please call Katie Andersen (630-715-2332) with Integrated Orthopedics if you are interested in this device and to check if you have insurance coverage.

Frequently Asked Questions

After Total Hip Replacement Surgery

When do I see the doctor after surgery?

You will see Dr. Nam 2-3 weeks after surgery. Your appointment will be listed in the surgical packet of information you will receive.

When can I shower?

You can shower when you get home from the hospital. You will have a waterproof dressing on for 1 week after surgery.

After this dressing is removed, cover your new gauze dressing with plastic for showering until you come back to the office for your 2-3 week post-operative visit.

After this visit, you are normally allowed to start washing your incision with soap and water.

Avoid soaking the incision in a bath or swimming pool or hot tub for 6 weeks after surgery.

How do I care for my incision?

Keep a dry dressing over your incision for the first 2-3 weeks after surgery. After your first postoperative appointment, you most likely will be given permission to allow your incision to get wet as instructed by Dr. Nam and his team. After 6 weeks, as long as the incision is well-healed, you can begin to use cocoa butter or vitamin E lotion on your incision. If there is any wound drainage, place a dry dressing over the incision and notify Dr. Nam’s office at 312-432-2340.

When can I drive?

You can resume driving after you are off all narcotic pain medication and you and your Physical Therapist feel you are capable of driving safely; meaning you can push on the gas and brake with force if needed. This is usually between 3 and 6 weeks after surgery. You can discuss this further with Dr. Nam at your post-operative visit.

What are my hip precautions?

There are three main precautions (Physical and Occupational therapy will review)

  • Avoid bending your hip more than 90 degrees
  • Do not cross your legs
  • Avoid excessive rotation of your leg, either in or out

How long do I have hip precautions for?

You may start to relax your hip precautions 6 weeks after surgery. However, it is in your best interest to remain careful as dislocation of the hip can occur if these precautions are violated haphazardly.

When do I start physical therapy?

Physical therapy typically begins in your home 1-2 days after discharge. Home therapy will be 3 times a week for 2-3 weeks. You will then transition to outpatient physical therapy at a location close to your home beginning about 3 weeks after surgery. This will be approximately 2-3 times per week and continue for an additional 6-8 weeks. If you would prefer to begin outpatient therapy sooner, please contact our office and we can arrange for an expedited timeline. You will get your prescription for outpatient therapy at your first postoperative visit with Dr Nam.

What are the signs of infection?

It is common for the hip to be bruised, red, and warm after surgery. Signs and symptoms of infection may include the following; Pus like discharge from the incision, redness of incision. Temperature > 101.5, Increased or uncontrolled pain. If any of these occur, please contact our office immediately at 312-432-2340 or 312-432-2477. If after hours dial “zero” to talk with the physician on call.

Are there position restrictions when sleeping at night?

You may sleep on your opposite side from surgery as long as there is a pillow between your legs. Avoid sleeping on your stomach for 6 weeks after surgery.

When can I return to work? FMLA / Disability Papers

This is dependent upon your occupation, but approximately 4-12 weeks after surgery. If you have FMLA /Disability Forms that need to be completed, please let us know. Forms can be dropped off or faxed to 708-409-5179. There is a charge of $20.00 prior to returning the completed paperwork. Please allow 7-10 business days for completion.

How do I get a refill on my pain medications?

Please call Dr Nam’s office and request a refill. Have your pharmacy information available.

Will my hip replacement set off a metal detector at the airport?

Most likely you will set off a metal detector. You do not need a note, card, or picture of your hip to get you through security. Let the security agent know you have a hip replacement and they will scan you as necessary per security guidelines.

After Total Knee Replacement Surgery

When do I see the doctor after surgery?

You will see Dr. Nam for your first post-op visit 2-3 weeks after surgery. Your appointment will be listed in the surgical packet of information you will receive.

When can I shower?

You may shower as soon as you get home from the hospital/surgery center. A waterproof dressing was placed over your incision in the operating room. Once the waterproof dressing is removed one week after surgery, if you do not place a new waterproof dressing, you must wrap your dressing with plastic wrap to keep the incision dry in the shower. Avoid soaking the incision in a bath, pool, hot tub, or other body of water for 6 weeks after surgery.

How do I care for my incision?

After your first postoperative appointment, you most likely will be given permission to allow your incision to get wet as instructed by Dr. Nam and his team. After 6 weeks, as long as the incision is well-healed, you can begin to use cocoa butter or vitamin E lotion on your incision. Prior to 6 weeks post-op, you may use these products around the incision but not directly on it. If there is any wound drainage, place a dry dressing over the incision and notify Dr. Nam’s office at 312-432-2340.

When can I drive?

You may resume driving after you are off all narcotic pain medications (ie: hydrocodone, oxycodone, tramadol, etc.) and you, your physical therapist, and Dr. Nam feel you are capable of driving safely. Do not resume driving until at least after your first post-op visit to our office. Patients usually resume driving 3-6 weeks after surgery.

How much should my knee bend?

You should be able to bend your knee to at least 90 degrees and fully extend the knee to 0 degrees by your first post-op visit 2-3 weeks after surgery. You should be able to bend to at least 110 degrees and fully extend to 0 degrees by your second post-op visit 6 weeks after surgery. The average range of motion after knee replacement surgery is 0-120 degrees, which you should try to achieve by 3 months post-op. However, if you had a very stiff knee with reduced range of motion pre-operatively, these goals will need to be adjusted.

Do I need to wear Ted hose/compression stockings?

No, Dr. Nam does not require these.

When do I start physical therapy?

Physical therapy typically begins in your home 1-2 days after discharge. Home therapy will be 3 times a week for 2-3 weeks. You will then transition to outpatient physical therapy at a location close to your home beginning about 3 weeks after surgery. This will be approximately 2-3 times per week and continue for an additional 6-8 weeks. If you would prefer to begin outpatient therapy sooner, please contact our office and we can arrange for an expedited timeline. You will get your prescription for outpatient therapy at your first postoperative visit with Dr Nam.

What are the signs of infection?

It is common for the knee to be red, warm, and swollen after surgery. It is not normal to have pus-like discharge from the incision, excessive redness around the incision, a temperature >101 degrees, or uncontrolled pain. If any of these occur, please call our office ASAP (312-432- 2340). If after hours, dial “0” when you reach the operator, which will link you to the Physician on call.

When can I return to work?

This depends on your occupation, but typically patients return to work 3-12 weeks after surgery.

Do you have a Disability Form Policy?

If you have FMLA/Disability forms that require completion by our office, there will be a $20.00 charge that will need to be paid prior to us completing the forms. Please allow 7-10 business days for completion.

How do I get refills on my medications?

Please call our office to request refills. Please do not go through the pharmacy to request the refill. We will not refill any of the medications automatically. Typically we do not refill the gabapentin or meloxicam, as these are one-time prescriptions that patients take until the prescription is finished and do not need to continue. If you feel you need refill(s) of the tramadol and/or oxycodone, we need to discuss this with you individually. Unless there is an extenuating circumstance, we typically will not fill narcotic/opioid prescriptions past 6 weeks post-op.

Will my knee replacement set off metal detectors at the airport?

Most likely you will set off a metal detector. You do not need a note or card to get through security; we will not provide you with one. Let the security agent know you have a knee replacement, and they will scan you as necessary per security guidelines.