Joint replacement: The pharmacist weighs in

As we age many of us will need to undergo a joint replacement surgery. Around 1 million total knee replacements and hip replacements are performed each year in the United States, and the numbers are on the rise. Surgery centers and orthopedic practices across the nation, with the support of the Centers for Medicare and Medicaid Services (CMS), are developing new and innovative ways to improve joint replacement outcomes and expand their services to meet demand.

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Although medication concerns may not initially seem to be involved here, there are actually quite a few.

If you are one of the many people considering having a joint replacement surgery, here are a few important medication management tips from your pharmacist:

1. Get your medications filled at least a week before your surgery. If your doctor prescribed a drug that your insurance company requires prior authorization (extra paperwork the doctor’s office fills out to get the medication covered), you’ll not want to find this out on your way home from the hospital. Many of the medications that are prescribed for use after joint replacement are very expensive, and prior authorization can take up to a week.

2.  If you take medications that increase the likelihood of bleeding problems (such as aspirin, clopidogrel, Eliquis, warfarin, or ibuprofen to name a few),your doctor may advise you to stop taking these up to a week before the surgery.  If you forget to follow these instructions, your surgery may need to be rescheduled for your safety. Be sure to carefully read all of the planning instructions your orthopedic surgeon sends you home with before the procedure!

3.  Pain management is key after undergoing surgery. Some people wait to take pain medication until their pain is unmanageable.  However, waiting to take your medication makes it more difficult to get the pain under control. Most pharmacists will recommend taking a dose of the prescribed pain medication as soon as you start to feel the effects of the medication you received at the hospital wear off. On the other hand, it’s important to only take the pain medication as prescribed, not at a higher dose nor more often than the bottle states, unless you’ve first discussed it with your doctor.  Narcotic pain medication is often prescribed after joint replacement surgery and comes with its own risks: taking too much can slow your breathing (this is how people accidentally over dose), taking more than prescribed can give you a euphoric (high) feeling and increase the likelihood of creating a substance abuse problem (addiction).

  • By using non-narcotic pain medications and pain-relieving measures to supplement narcotic pain medication, the risk of over-use and dependence is reduced.  This strategy includes using Tylenol (acetaminophen) on a schedule around the clock for several weeks and icing the joint on a schedule, if advised by your doctor.
  • Another pharmacy note: some insurance companies and some states only allow a one week supply of narcotic pain medications to be dispensed at a time. This means that if you need more than one week of medication you’ll need a brand new prescription from your doctor, since narcotic medications cannot be refilled.

4.  Blood clot prevention after surgery requires using either an injectable medication like Lovenox (enoxaparin) for 2-5 weeks after surgery or an oral anticoagulant medication like Eliquis (apixaban).  These medications prevent deep vein thrombosis (DVT), dangerous blood clots that can form in your legs.  It’s important to take them for the entire course of therapy that your doctor has prescribed – don’t stop taking them because you feel better.

5.  Make sure each of your doctors know all of the prescription medications, over the counter medications, herbal supplements, and vitamins that you take. Your pharmacist can provide you with a personal medication list ( aka your reconciled medication list) that you can then share with each of your providers.  Medication reconciliation post-discharge is an important tool to prevent adverse drug events, complications, and re-hospitalization.

The final take away: correct and appropriate use of medications after hip replacement surgery or knee replacement surgery can significantly decrease the risk of having knee or hip replacement complications, so be sure to discuss your medications with your health care team beforehand.

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If you found this helpful, you may want to check out the following:

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Pharmacy Costs and Open Enrollment: What to Consider When Picking a Plan
The Top 3 Medication Problems in the Elderly

Kristen Engelen, PharmD
Kristen Engelen, PharmD, is the chief pharmacy officer of RxLive and a certified consultant pharmacist; she has over a decade of experience in retail pharmacy settings. Kristen became an RxLive co-founder because of her passion for geriatric pharmacy, with a focus on the intersection of pharmacy and aging.