Contact:     Dr. Van Flandern    |    617-277-1205

What to Expect

Office Consultation:

Office locations are at the main office in Chestnut Hill or the Dedham office. The initial office visit will either be with the Nurse Practitioner Brian Johnson or Dr. Van Flandern. The office visit will necessitate x-rays, which will be performed at the office, or x-rays or other imaging brought by the patient. Images provided by the patient will be uploaded and kept on the DICOM server.

The initial consultation is conducted per the scheduled times. Occasionally for many reasons, there may be a wait. Thank you for understanding.

Prescreening:

Prescreening for surgery is a prerequisite to the procedure. For the more advanced patients at North Atlantic Surgical, the prescreening is done through the patient’s own Primary Care Physician.

For the inpatient stays at the New England Baptist Hospital, prescreening must take place at the actual hospital. The prescreening will involve an interview with one of the nurse practitioners. Through the day, blood is drawn, x-rays, and further evaluation accomplished. The appointment may include additional consults with cardiology, hematology or infectious disease.

The process is long and oftentimes frustrating; your patience is appreciated.

Pre-operative care:

During the office visit, we will determine if surgery is necessary. After the patient decides to move ahead, Kathy Morgan will be in charge of performing the scheduling and logistics for the eventual operation.

Prescreening will be scheduled as well as a pre-operative teaching class for hip and knee replacement if desired.

During this time, the office consult and the patient review the information, and further questions or reviews are welcome.

The day before surgery, the hospital, as well as Dr. Van Flandern, will call to confirm times and answer further questions.

The day prior and the morning of the surgery, you will be instructed to bath with ‘Hibiclens’ soap at the region of the operation.

Day of the Surgery:

At the New England Baptist — Patients are asked to arrive 3 hours before the surgical time. Insurance is confirmed followed by a comprehensive review of patient medical condition and medications, and visit with anesthesia, and then the surgical intervention.

Patients then spend approximately two hours in the recovery room and then to the floor. Activities start as soon as the patient reaches the level.

At the North Atlantic Surgical Suite — Patients are asked to arrive 2 hours before the surgery. Anesthesia reviews medical issues and medications. Following the operation, approximately 3 hours is spent in the recovery area, physical therapy, and discharge to home when stable.

Post Operative Information:

We provide a tremendous amount of information at the time of discharge from both the North Atlantic Surgical Suite and the New England Baptist Hospital. Upon arriving home, physical therapy and infrequently, even nursing will visit the home for help with exercise, mobilization, and also answer questions. Patients will revisit with Brian Johnson in our office at four weeks for knees and six weeks for hips; for an x-ray and further recommendations.

Patients are encouraged to engage this website for further information and details. If additional questions are unanswered, please contact the office.

Frequently Asked Questions

Post Operative Questions

Pain
  • Oxycodone 5 mg tablets: Use one, two or three tablets at a time for pain up to every 3 hours.
  • Dilaudid 2 mg tablets: Use one, two or three tablets at a time for pain up to  every 3 hours
  • Tramadol 50mg tablet: Use up to two times per day for pain
  • Vicodin 5mg/325mg: One to two tablets every 4 hours for pain
  • Tylenol 325 mg or 500 mg over the counter: One to two tablets every 6 hours. Do not to exceed 3000 mg in a day
Anticoagulation
  • Total Hip: 1 mg coumadin daily for 6 weeks – no monitoring necessary
  • Total Hip – High Risk:
    • Adjusted-dose coumadin for 4 weeks: Blood draws twice per week and dosing adjusted with the New England Baptist Coumadin Hot Line
    • Eliquis 2.5 mg: Two times per day for 4 weeks.
  • Total Knee: ECASA 325 mg two times per day for 4 weeks
  • Total Knee – High Risk
    • Adjusted-dose coumadin for 4 weeks: Blood draws twice per week and dosing adjusted by the New England Baptist Coumadin Hot Line
    • Eliquis 2.5 mg: Two times per day for 4 weeks.
Nausea
  • Zofran 8 mg: By mouth as needed for nausea up to three times per day.
Constipation
  • Colace 100 mg: One tablet per day for 4 weeks to prevent constipation
  • Opioid narcotic pain medication is useful for pain management and dangerous in the face of inappropriate prescribing. Use the narcotic pain medications provided in a gradual and potentially escalating fashion. The maximum doses noted above, but we recommend a gradual ascent to that level.
  • If medications are not tolerated or are found to be too strong – please contact the office for alternatives.
  • Refills are available in that first four weeks. PLEASE DO NOT CALL THE OFFICE ON FRIDAY AFTERNOON FOR RX REFILLS. BE AWARE OF HOLIDAY WEEKENDS OR WHEN MEDICATIONS MIGHT RUN OUT.
  • Narcotic medications are provided for the first four weeks after the surgery. After that time, other pain medication techniques will be recommended.
Total Hip Arthroplasty
  • Aquacel: Applied at the time of the surgery.
  • Removed 7 days after the surgery.
  • Very thick and aggressive adhesive. Take care when removing.
  • Can shower and get wet. Do not submerge in a pool or tub.
  • May cause an allergic reaction
  • Can shower uncovered after the Aquacel removed – do not scrub
Total Knee Arthroplasty
  • Dry gauze and 6 in ‘Ace’ wrap on the knee AT ALL TIMES FOR 4 WEEKS.
  • Change dressing daily or more often as needed.
  • Keep incision dry with plastic cover. Do not submerge.
  • Medications provided after the surgery help to prevent clot
  • Gentle but continuing walking and ambulation help prevent a clot.
  • We provide ThromoEmbolic Deterrent (TED) stockings for use at all times except for sleep for four weeks.