Most medications have potential side effects. It is important that you read literature that accompanies your medications or talk with your pharmacist to familiarize yourself with the side effects. In most cases, side effects are rare and if they do occur they will subside after the medication is discontinued. In general, your primary care physician is the best person to monitor you overall general health and prescribe your long-term medications. This will enable them to monitor any changes or potential medication interactions.

Refills of all medications will only be given Monday through Friday, 8:00 a.m. - 5:00 p.m. Refills are not dispensed after hours or on weekends. This is designed to prevent medication errors and allow for proper documentation of medications. All refills may take up to 48 hours to be called in. When you call to request a refill, you should provide your name, birth date, the pharmacy to be called, the phone number of that pharmacy, and a telephone number where you can be reached. You should also have the exact name and dosage of your medication.

If you have questions about your bill from Dr. Arnold, you should call our office at 479-966-4187 or 1-866-443-5633, weekdays from 8:00 a.m. to 5:00 p.m. If your billing questions are concerning a third party, you should contact the billing office of that facility.

You should be prepared to answer all questions about your past medical history (Previous/Current medical problems, all surgeries, medications, etc). Your appointment will be made much easier if you have you history organized. You should bring ALL diagnostic studies such as CT, MRI, or X-rays that you may have had that relate to your current problem. If you have had any previous orthopaedic surgeries that could relate to your current problem, you should contact that surgeon's office and have them fax the operative reports to our office. Please have all current insurance information available so that our office can assist you with your claim process.

Initially a variety of non-operative treatments will be used including rest, medications, injections, and avoiding the activities that are causing the irritation. We will generally begin with a conservative protocol. There are however, times when non-operative treatment may not be successful. Surgery will be recommended when you have failed a non-operative protocol, or if it is felt that you have an injury that will more than likely lead to a more significant problem if not treated surgically. In either case, it is a decision that will be made by you and your physician.

Any surgical procedure will involve some risk. It would be impossible to inform you of all the potential complications or risks of a surgical procedure; however, we do want to make you aware of some of the potential risks. Typical complications can include infection, nerve damage, damage to blood vessels, blood clots, recurrence of the problem, onset of other medical problems (such as heart attack, stroke or even death), or complications related to anesthesia. Most of these risks are unlikely and the chances can vary depending on your particular surgery. Dr. Arnold is aware that these risks exist, and each preoperative process is designed to limit all risks. Therefore, it is important to fulfill all preoperative items. If any problems do occur, it is important to notify Dr. Arnold immediately so that he can work to resolve any problems.

Total joints are typically made from meal alloys (cobalt-chrome, or titanium), or a ceramic portion. They also consist of polyethylene (plastic) as a liner or insert. Occasionally, the metal components may trigger airport security devices. You will be given a card to show that you have an implanted total joint. You should also wear loose clothing and be prepared to show the personnel your scar.

You should take antibiotics before and after you have any invasive procedure. This includes dental work. This is for as long as you have the total joint in place, in other words, the rest of your life. Any procedure can potentially release bacteria into your bloodstream; therefore, the antibiotics can assist in preventing infection. You should notify your doctor or dentist of your total joint before any procedure. Dr. Arnold's office can prescribe the antibiotics if you provide at least 24 hours notice before your procedure.

The anchors or screws that are used are typically made of an absorbable material that dissolves in several years, and will be filled in with your body's own tissue.

You will be given a preoperative checklist specific to your surgery. It is imperative that you complete ALL of the items on that checklist. You should ensure that you do not get any scratches or blemishes on the operative site before your procedure, as any scratches or blemishes could cause your surgery to be postponed. It may be necessary for you to see you primary medical physician and/or specialist (cardiologist, pulmonologist, etc) before your procedure. If you have any questions before you procedure then you should call our office. Be sure to read your entire surgery packet in full before your procedure.

If you feel ill before your surgery please let our office know. We may ask that you see your medical physician for clearance. If you are running a fever or if you have significant medical reasons then your surgery may be delayed for your safety.

If you are having a total joint replacement then yes, you will have to see your primary care physician (PCP). If your surgery is scheduled to be outpatient and it is felt to be in your best medical interest for safety then you may have to see your PCP. In these cases you be notified. In either of these cases, we must have a statement from you physician (s) before your surgery. If you do not have a specific PCP, then you will need to choose one that is available to you.

Dr. Arnold operates in a variety of locations. Many times this may be determined by your insurance coverage and the network benefits of your insurance policy. He operates at the Physician's Specialty Hospital for both inpatient and outpatient procedures as well as the Physician's Surgery Center in Fayetteville for outpatient procedures. He also operates at Washington Regional Medical Center in Fayetteville for both inpatient and outpatient procedures and the North Hills Surgery Center for outpatient procedures.

Yes, depending on the facility you may have to participate in a pre-admission process that would require you to go by the facility before your surgery date. Even if you do not have to pre-admit, you should contact the surgery center before your surgery date to ensure that all questions are answered to your satisfaction. There may be a deposit required from the surgery center, therefore be sure that you are aware of all expectations from the surgery center before your surgery date.

Although our office will take care of all pre-certification procedures that your insurance requires, it is a good idea that you contact your insurance company before your procedure to confirm your benefits and to ensure that all of your questions are answered.

For all outpatient procedures you will likely be seen by Dr. Arnold's nurse 7-10 after your operation for a wound check. You will then be seen three to four weeks following your procedure by Dr. Arnold. For most operations requiring you to be an inpatient at the hospital, you will follow up approximately three to four weeks after your discharge with Dr. Arnold, although the exact time will depend on your surgical procedure. If you have any questions before your first post-op visit you may call our office. Patients who have undergone Total Joint Replacements will be seen annually for X-rays.

You should remove your dressings 48 hours following surgery. You should cover any arthroscopy portal sites with Band-Aids. It is normal for clear or red-tinged fluid to drain from the arthroscopy sites for several days because of the fluid used for the procedure. If you have any incisions that are closed with staples or sutures, then you should keep these sites covered at all times until the sutures/staples are removed. Do not put any antibiotic ointments or lotions on your incisions until they are healed, usually for four weeks after the surgery.

If you have increasing redness, or increasing pain at your incision site, or if you have persistent, thick drainage, please call our office immediately. If you begin running a fever of more than 101°, or if you begin having chills please let us know.

Generally you may shower on the second to third day following all arthroscopic procedures. If you have had an open procedure requiring closure, you must wait until 24 hours after the sutures/staples have been removed before getting the area wet. Many times your incision will be closed with a suture that is below the skin that you cannot see, if you have an incision and cannot see any sutures you should not get that incision wet for seven days after your surgery. You should not immerse incisions (i.e. bathtub, pool) for 3-4 weeks following your procedure and then only if all drainage has stopped. Make sure that you have a stable environment for your shower if you have had knee or hip surgery. This would include a shower chair or handle bars for stability and support.

You will be given a prescription for a narcotic pain medicine and medicine for nausea. It is important that our office is aware of all your drug allergies before your surgery. Narcotic pain medicine may make you nauseous, lightheaded, or even constipated to name a few side effects. The most important thing is to wean yourself off of your pain medications as soon as you can as your pain allows. Most narcotic pain medications have Tylenol (Acetaminophen) so you should not take extra Tylenol. You may take an over the counter anti-inflammatory medication such as Motrin (Ibuprofen) or Aleve (Naproxen Sodium) if you are able to tolerate them. You should read all inserts accompanying your medications to have a full understanding of your medicines. Depending on your choice for post operative blood thinning medications you will either receive a prescription for injectable blood thinner or you will need to take one Aspirin (325 mg) daily unless you have an allergy or another medical condition that would prohibit you from taking the Aspirin.

Most procedures will allow you to put full weight on your affected leg the day of your surgery. There are certain procedures that you would need to limit your weight bearing following your surgery and you will be notified accordingly. Crutches may be used for a few days for comfort and stability. For an ACL reconstruction, although you can put as much weight on your affected leg, you should use your crutches for at least one week. After an ACL or TKA surgery you will have a brace on your affected leg and should wear this until you are able to perform a straight leg raise with full strength. For shoulder surgeries involving a bone spur, a sling is worn for one week then may be discontinued. For surgeries involving the rotator cuff, the sling is worn for 4-5 weeks then discontinued within physical therapy.

Ice is most useful in the first 2-3 days. You should apply the ice for 2-3 hours then take a 30-minute break. After the first three days, use ice as you want to. Many people find it beneficial to use ice longer if necessary. Avoid using heat after surgery.

This ultimately depends on the type of surgery that you have. Your safety is our most important concern. Your return to driving depends on which side your surgery was on, your comfort level post operatively, and if your are still requiring narcotic pain medications. You should not drive until your physician clears you. From a knee scope, it could be up to three to four weeks before you drive if your surgery was on the right knee. For a joint replacement it could be several months before you could comfortably drive. For the left leg our criteria is that you are off narcotic pain medications (assuming you are driving a vehicle with an automatic transmission). For the right leg you must be off of the narcotics, have full range of motion of the affected joint and have good strength. For a knee scope it can be 1-3 weeks, after an ACL reconstruction it may be 3-6 weeks, and after a TKA it is an average of 4-6 weeks before the average person can drive.

Your procedure may require you to participate in a formal physical therapy program. We understand that there are some occasions where a busy schedule may not permit you to see a therapist on a regular basis. If it were felt that therapy would benefit you, then you would be set up with the appropriate therapy on you first post-operative visit. Even if you are felt to be a good candidate for a home exercise program, an initial visit with a therapist may facilitate your understanding of the exercises. For a knee arthroscopy a home exercise program is sufficient. For shoulder procedures a therapy program is required. Also, with ACL surgeries or Total joint surgeries, a therapy program is vital to your recovery and will be required.

Returning to your activities is an individual process and depends on your specific rehab, your injury or your particular surgery. Dr. Arnold will speak to you as to an expected return time frame.

This will ultimately depend on the type of surgery you have had and the job duties at your workplace. For most outpatient cases you can return to a desk job in 5-7 days, a standing job can be returned to in 7-14 days and a laborious job can be returned to in approximately 3 weeks. For total joints, one can typically return to a desk job in 3-6 weeks, a standing job in 4-10 weeks, and a laborious job it may take up to 3 months. Individual restrictions will determine the exact time of return to work.

Success is typically measured by the ability to answer "yes" to the following three questions:

• Are you glad you had the operation?
• Did it fulfill your expectations?
• Would you do it again?

Approximately 98% of patients at 1 year will answer yes to these three questions.

Everyone heals at a different pace. For most individuals they will use a walker for 3-4 weeks for 1 month after your operation. You will then progress to a cane for outdoors and use of the furniture for support around the house. By 2-3 months, most will return to normal function without any assistance. By 6 months, most people have returned to their normal activities. By one full year, most people have reached their maximum benefit and will perform most activities and not think about their joint.

Many people are able to go home after their operation. However, you may go to a rehabilitation facility in order to gain the skills you need to safely return home. Many factors will be considered in this decision. These factors include proximity of family or friends to assist, home environment, and safety considerations such as functional status.

For surgery on the right knee, driving will probably not be performed for 4-6 weeks. You should have good strength and full motion. If you have surgery on the left leg you may return to driving as soon as you are comfortable if you have an automatic transmission. Do not drive if you are taking narcotics. You should also check with your insurance to see if there are any coverage limitations regarding your postoperative period.

It is recommended to stay close to home for the first month. Short trips can be made when you are comfortable. If you have a long trip in the postoperative period you should wear your TED stockings, and also perform your ankle pumps every hour in the car/plane. You should also get out and walk every hour to hour-and-half to assist in preventing blood clots.

You may return to most activities as tolerated including walking, gardening, and golf. Some of the best activities to help with motion and strengthening are swimming and using a stationary bicycle. You should avoid high-impact activities such as running and jumping, vigorous sports such as singles tennis or squash.

This varies from patient to patient. Laboratory studies show us that today the average joint replacement may last approximately 15-20 years.

The average patient may shower and let water cascade over the incision at about one week after their surgery. Do not submerse the knee. You may generally immerse the knee at about 3-4 weeks after the surgery. If you are having any drainage or redness to the incision site, you should not get the knee wet.

You should wear the knee immobilizer when you are walking until you are able to independently perform a straight leg raise, this will be measured and assisted by your physical therapist. Many patients are able to discontinue the use of the immobilizer 1-2 weeks after their surgery.

You will start the machine the day after your surgery. You should use the machine a total of 6-8 hours a day. Start with 1-2 hours in the morning, and 4-6 hours in the afternoon/evening. Gradually increase the bend of the machine approximately every hour or two.

A bandage is used for approximately one week and changed daily to new, dry, sterile gauze. As you return home, if you are in a particularly dusty environment or if you have any drainage at the incision site, you should continue to keep the incision covered.

It is not unusual to require some form of pain medication for about 3 months. Initially, the medication will be strong (such as a narcotic). Most people are able to discontinue their strong pain medication after about a month and switch to an over-the counter medication such as acetaminophen or ibuprofen.

Typically you will be on an injectable blood thinner for 7-10 days. This will require you to administer these to yourself upon discharge from the hospital. Once the blood thinner is discontinued you should take one aspirin a day (unless you have a medical condition or an allergy to aspirin) for one month. For those with higher risk factors, this may require a prolonged course of oral blood thinner. This will be discussed with you for your particular needs.

If you are taking a blood thinner you should avoid alcohol intake because alcohol can modify the effect of this medication. You should also avoid alcohol if you are taking narcotics. Beyond this, you can use alcohol in moderation at your own discretion.

Four weeks of iron after surgery is usually sufficient. These supplements help your body replenish its iron supply and build up your blood count.

Initially, ice is most helpful to keep down swelling. After several weeks, you may also try using heat and choose what works best for you.

You should wear the stockings until you are up and around more than you are down at rest. If you have discontinued the stockings and notice additional swelling the stocking can be reapplied to assist in reducing that swelling. You should wear the stockings for several months when you travel in a car or plane.

Yes. The physical therapist plays a very important role in your recovery. You will be seen by a physical therapist in the hospital. Once you are home, you will go to therapy 2-3 times a week to assist with your exercise program. You will also be taught a series of exercises that you can perform on your own without supervision.

It is generally good practice to have somebody with you for the first few weeks after the surgery. Your independence is decreased and although your are mobile it is good practice not to put yourself in a position where you may injure yourself.

As soon as you are comfortable. For hip replacement patients you should maintain your hip precautions.

It is not uncommon to have feelings of depression after knee replacement surgery. This may be due to a variety of factors, such as limited mobility, discomfort, increased dependency on others, and medication side effects. Feelings of depression will typically fade as you begin to return to regular activities. If your feelings of depression persist, consult your internist.

Insomnia is a very common complaint following knee replacement surgery. Over-the-counter remedies such as Benadryl or melatonin may be effective. If this continues to be a problem, prescription medication may be necessary.

It is very common to have constipation after surgery. This is due to a number of factors and is aggravated by the need to take narcotic pain medications. It is best to increase your fiber intake after your surgery. Also, a simple over-the-counter medication stool softener (Colace) is also good preventions for this problem. In rare cases you may require a suppository or enema.

Most people require 70 degrees of flexion to walk normally on level ground, 90 degrees to ascend stairs, 100 degrees to descend stairs, and 105 degrees to get out of a low chair. To walk or stand efficiently, your knee should come to within 10 degrees of being fully straight. The biggest factor of postoperative range of motion is your preoperative range of motion or sometimes lack of. The average patient achieves approximately 115 degrees of flexion by 1 year after surgery. Some patients achieve less and others much more.

For total knee replacements, in the majority of cases, your leg length will essentially be unchanged. In some cases, however, the sensation is usually the result of straightening out a knee that preoperatively had a significant bow. At first, the increases length may feel awkward. Most people become accustomed to the difference, but occasionally a shoe lift may be necessary in the opposite extremity. In total hip replacements there are times where, in order to ensure stability of the joint to prevent dislocation, the leg length is either longer or shorter. In these cases a shoe lift can be prescribed.

Generally weights are not used for the first 2 months after surgery. As you progress with your physical therapy program, your physical therapist may recommend the use of weights. These should be limited to light weights progressing from one pound to a maximum of five pounds.

You probably will set off the alarm as you progress through the security checkpoint. Be proactive and inform the security personnel that you have had a knee replacement and will most likely set off the alarm. Wear clothing that will allow you to show them your knee incision without difficulty. A wallet card is no longer of any help when passing through security checkpoints.

Yes. Avoid any dental cleaning and other nonurgent procedures for 6 weeks following knee replacement surgery. You should inform your dentist or other physicians of your knee replacement.

After several months, you may try to kneel. It may be painful at first but will not harm or damage your knee replacement. Much of the discomfort comes from kneeling on your recent incision and the healing local tissues. Kneeling generally becomes more comfortable as times pass. You should always wear a pad under your knee for comfort.

Follow up appointments are usually made postoperatively 4-5 weeks after surgery. 4-6 months after surgery and annually for the first few years, then every other year for the life of your prosthesis. These follow up visits are necessary to monitor the fixation of the prostheses and the potential wearing out of the plastic.

It is generally a good idea to follow up with your PCP within 2-4 weeks following your surgery. This ensures that he/she is aware of any medical needs or changes following your total joint surgery.