Post-operative instructions: ankle surgery
Congratulations! You have just completed the surgical phase and entered the recovery/rehabilitation phase of your operative experience. In order to achieve the best possible result, active patient participation is extremely important during this period of time. The following instructions are designed to help you achieve the best possible outcome following your surgery.
Many questions arise during the first week after surgery. There are many new sensations felt in the body, especially in the operative extremity. The following will help answer many of your questions to help relieve normal anxiety.
Activity
Weightbearing and motion restrictions
Your weight bearing status and range of motion restrictions (if applicable) are detailed in the accompanying physical therapy protocol.
Ankle Brace
Some patients will require a brace. If you have a brace on in the recovery room, you will need to wear the brace until your follow-up appointment and potentially longer depending upon the type of surgery you had. Your rehabilitation protocol will have a specific instructions regarding the time necessary in the brace. You should sleep in the brace unless otherwise noted. For most patients it will come off for physical therapy daily.
Cold Therapy Unit/Ice
Ice should be applied to the outside of your dressing frequently during the first 48 hours after surgery (30 minutes ON/30 minutes OFF), and during the first week following surgery. After the first week, you may consider ice after rehabilitation sessions or when swelling occurs. Do not apply ice directly to the skin.
Dressing
The original dressing should left in place until your follow-up appointment in one week.A small amount of bloody drainage on the dressing is not unusual.If you should have any questions or concerns regarding your incisions, the best thing to do is to contact Dr. Mook or a member of his team.
Bathing/Showering
Do not submerge your lower extremity in water (e.g. baths, pools, or hot tubs) while your stitches are in place. You may resume regular showers on the third day following your surgery. While the wound is draining please keep a waterproof dressing on the incisions during the shower. After drainage has stopped you may allow water to run over the incision sites. When complete, pat the incision dry.
Sutures
Your sutures will be removed approximately 14-21 days following your surgery.
Physical Therapy (PT)
Appropriate PT is critical to the success of your surgery.Most patients will start physical therapy immediately after surgery. You should call to schedule your physical therapy appointment as soon as you know your surgical date. Therapy can begin the day after surgery unless otherwise directed. Please see accompanying therapy prescription for the specifics of your rehabilitation protocol.Please ask your therapist to follow the included protocol. If you are experiencing pain, take pain medication and/or a muscle relaxant and proceed to PT. Participation in therapy exercises will often help ease the pain. Attending PT will allow your therapist can assess your situation and provide appropriate guidance. We are always happy to discuss treatment modalities, progress, and any questions/concerns with your therapist. Do not hesitate to contact Dr. Mook’s office with any questions or concerns at any time. Your attendance of supervised physical therapy and completion of your home exercise program are paramount to your success.
Pain Control
A prescription for pain medication will be given to you upon discharge from the hospital/surgery center. Pain medication should be taken as prescribed until your pain is under control. It will help to take your pain medication thirty minutes before therapy if you are experiencing any pain. Most patients are able to discontinue their use of pain medication prior to their first follow-up appointment.
(Tip: Applying ice and elevating the leg as much as possible will help alleviate pain. Try to relax and allow others to assist you as much as possible the first week.)
Medications
Your post-operative regimen consists of several of the following medications.
You will be told which of the following medications to take for pain:
Roxicodone (Oxycodone) 5mg: 1-2 tablets every 3-4hrs as needed for pain. (Narcotic)
OR
Dilaudid (Hydromorphone) 2mg: 1-2 tablets every 3-4hrs as needed for pain. (Narcotic)
OR
Norco 5mg (Hydrocodone/APAP): 1-2 every 4-6hrs as needed for pain. (Narcotic)
You will be told which of the following medications to take for muscle spasm (will cause drowsiness):
Diazepam (Valium)2mg tabs: 1 every 6hrs as needed fro muscle spasms. (Muscle relaxer)
OR
Robaxin750mg (Methocarbamol): 1 every 6hrs as needed for muscle spasms. (Muscle relaxer)
You will be told which of the following medications to take as needed for nausea/vomiting:
Zofran 4mg (Ondansetron) oral dissolving tablets: 1 every 6-8hrs sublingually as needed for nausea.
OR
Phenergan 25mg tablets (Promethazine): 1 every 6 hours as needed for nausea.
You will be told which of the following SCHEDULED medications to take as directed:
DVT Prophylaxis (i.e. blood clot prevention):
Enteric Coated Aspirin 325mg (ECASA) – 1 daily for 4 weeks
OR
Xarelto (Rivaroxaban) 10mg tablets- 1 daily for 2 weeks
OR
Lovenox (enoxaparin) 40mg injections – 1 injection subcutaneously daily for 2 weeks
Gastrointestinal protection: Omeprazole (Prilosec) 20 mg tablets: 1 daily for 6 weeks (while taking NSAIDs)
Pain Medication Tips
- Do not drive while taking pain medications.
- Do not drink alcoholic beverages while taking pain medications.
- Pain medication should be taken with food as this will help prevent any stomach upset.
- Often pain medications will cause constipation. Eat high fiber foods and increase your fluid intake if possible. To alleviate constipation, purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
You should resume taking your normally prescribed medications unless otherwise directed.
Specific Questions/Problems
There are several risks to knee surgery that should be acknowledged:
- Infection: The risk of infection is decreased with a sterile operative environment, prophylactic antibiotics, and appropriate wound care.
- DVT: The risk of DVT (deep vein thrombosis, blood clot) is decreased by instituting early motion, mechanical means (ambulation, compression stockings), and medication. Following the pre-operative and post-operative instructions will reduce the risk of deep vein clots.
- Pain: There is a potential for pain with any surgical procedure. Medication, ice, rest,compression, elevation, and therapy can reduce the chances of excessive post-operative pain.
- Numbness: There is a small chance of numbness about the foot and ankle postoperatively. The incisions are in close proximity to superficial sensory nerves. As such, you may also experience numbness of the areas surrounding your incisions of your operative leg after surgery. This is normal and the numbness will likely resolve over time.
- Scarring: Superficial and deep scarring can occur following surgery. Following the rehabilitation restrictions and recommendations can reduce this risk. To minimize the appearance of superficial scars of the skin, it is important to avoid exposure to UV light (e.g. sunlight, tanning lights) as the scars mature.
Please contact my office for further instruction if you develop fevers greater than 101.5 degrees Fahrenheit, persistent drainage from your surgical incisions, intractable pain, or persistent numbness/tingling in your leg.
Follow-Up Appointment
You will be told when and where your follow-up appointment will be.
If you need to verify or change your post-op appointment, please call 703-277-2663.
Please feel free to contact my office at anytime if you have any questions or concerns regarding your post-operative course.
Post-operative instructions: hip arthroscopy (with microfracture)
Congratulations! You have just completed the surgical phase and entered the recovery/rehabilitation phase of your operative experience. In order to achieve the best possible result, active patient participation is extremely important during this period of time. The following instructions are designed to help you achieve the best possible outcome following your surgery.
Many questions arise during the first week after surgery. There are many new sensations felt in the body, especially in the operative hip and leg. The following will help answer many of your questions to help relieve normal anxiety.
Activity
Crutch use
You are restricted to flat foot weight bearing for seven weeks. Start weaning off of your crutches post-operative day 43 with 50% weight bearing. Continue this for one week. After surgery, you will be flat foot (heel to toe) weight bearing with 20 pounds of pressure with the aid of crutches with a goal of returning to full activity as soon as possible (remember proper flat foot (heel to toe) weight bearing assists in decreasing your risk of developing a DVT or blood clot).
Hip Brace
You will need to wear the hip brace for three weeks. Place it securely around your waist and thigh; this serves as a reminder to control hyperextension and abduction. You will need to wear this brace when you are walking with crutches and flat foot weight bearing. You will not need it when you are sitting, lying down, or sleeping.
CPM (Continuous Passive Motion) Machine
Recommended usage- 8 Weeks for 6-8 hours/day
Range of motion settings:
- Week 1- 10-45 degrees
- Week 2- 0-60 degrees
- Week 3- 0-70 degrees
- Week 4-8-0-80 degrees
You will need assistance to get into the CPM for the first couple of days after surgery. You may want to set the CPM at a 10 degree angle away from your midline.
(Tip: To help in the prevent lower back pain, try and maintain normal spine alignment while in the CPM. You may want to place a rolled towel or a small pillow behind your lower back. Place the CPM unit in the middle of the bed to prevent the machine and your leg falling off the bed. Avoid placing the unit on a couch or narrowed place while reclining.)
Cold Therapy Unit/Ice
Ice should be applied to the outside of your dressing frequently during the first 48 hours after surgery (30 minutes ON/30 minutes OFF), and during the first week following surgery. After the first week, you may consider ice after rehabilitation sessions or when swelling occurs. Do not apply ice directly to the skin.
Range of Motion Restrictions
Abduction 0- 45 degrees for 2 weeks
Flexion: No restrictions. Avoid resting with the hip at 90 degrees for the 1st two weeks.
(Tip: To avoid hip flexion at 90 degrees for the 1st two weeks: use a higher chair, a recliner chair, or while sitting you can slouch forward or backward. Please have the physical therapist do all circumduction exercises in 70 degrees of flexion.)
Extension greater than 0 allowed after day 21.
Extension goal is to gain full extension to 0 by the end of the 1st week.
No prone therapy
Dressing
You will have a large waterproof dressing covering your surgical sites when you are discharged from the hospital. You may shower with this dressing in place. A small amount of bloody drainage on the dressing is not unusual. You may remove your dressing on the third day following your surgery. Once you have removed your dressing, please keep your incisions covered with Band-aids. Change as necessary throughout the day if the Band-aids become soiled or wet.
Do not put any ointments or lotions over the incisions.
Do not allow pets to sit on your lap or sleep in your bed for at least 6 weeks following surgery. Pets may harbor fleas, mites, or other organisms that may cause a wound infection.
If you should have any questions or concerns regarding your incisions, the best thing to do is to contact Dr. Mook or a member of his team.
Bathing/Showering
Do not submerge your hip in water (e.g. baths, pools, or hot tubs) while your stitches are in place. Pool therapy is okay with a waterproof dressing (i.e. Op-site) in place. You may resume regular showers after the initial dressing is removed on the third day following your surgery. While the wound is draining please keep a waterproof dressing on the incisions during the shower. After drainage has stopped you may allow water to run over the incision sites. When complete, pat the incision dry.
Sutures
Your sutures will be removed approximately 14 days following your surgery at your first follow-up appointment.
Physical Therapy (PT)
Appropriate PT is critical to the success of your surgery.You are expected to begin PT 3-5 days following your surgery. If you are experiencing pain, take pain medication and/or a muscle relaxant and proceed to PT. Participation in therapy exercises will often help ease the pain. Attending PT will allow your therapist can assess your situation and provide appropriate guidance. Do not hesitate to contact Dr. Mook’s office with any questions or concerns at any time. Your attendance of supervised physical therapy and completion of your home exercise program are paramount to your success.You should plan on working with a therapist 1-2 times per week for the first 3 months after surgery. This schedule may be adjusted based on your individual progress.
Home Exercise
You may begin the following home exercises the day after surgery. These should be performed several times per day when you are not sleeping.
- Hamstring sets: push heel into bed for count of 10.
- Heel slides: sit on a firm surface with your leg straight in front of you. Slowly slide the heel of your operative leg toward your buttock by pulling your knee to your chest as you slide.
- You may also utilize a stationary bike with no resistance to encourage early motion in your hip joint. Begin with small sessions of approximately 10 minutes at a time twice daily.
- Active Foot/Calf Pumps: Do 10 up and down pumps of your feet every hour while awake. Also remember to do these when riding in a vehicle for any length of time or on an airplane.
(Foot pump and calf pump rationale: Compression of calf muscles causing return of the blood in your lower legs to your heart.)
Note: Spare the Hip Flexors for 2 weeks
In order to NOT irritate your hip flexors (and have them bother you for weeks/months) do not actively lift your operative leg against gravity initially. This means when lying on your back, getting off the bed/table, or getting into the CPM, someone must lift your leg for you the first 2 weeks. When getting in/out of a vehicle,or turning sideways in a chair, the leg needs help – for this you can use the brace near the knee as a handle to lift/move your thigh. After you are feeling and moving more comfortably, you may be able to use your other foot/leg to move the operative leg about if comfortable.
Pain Control
A prescription for pain medication will be given to you upon discharge from the hospital/surgery center. Pain medication should be taken as prescribed until your pain is under control. It will help to take your pain medication thirty minutes beforetherapy if you are experiencing any pain. Most patients are able to discontinue their use of pain medication prior to their first follow-up appointment.
(Tip: Applying ice and elevating the leg as much as possible will help alleviate pain. Try to relax and allow others to assist you as much as possible the first week.)
Medications
Your post-operative regimen consists of several of the following medications.
You will be told which of the following medications to take for pain.
Roxicodone (Oxycoodone) 5mg: 1-2 tablets every 3-4hrs as needed for pain. (Narcotic)
OR
Dilaudid (Hydromorphone) 2mg: 1-2 tablets every 3-4hrs as needed for pain. (Narcotic)
OR
Norco 5mg (Hydrocodone/APAP): 1-2 every 4-6hrs as needed for pain. (Narcotic)
You will be told which of the following medications to take for muscle spasm (will cause drowsiness):
Diazepam (Valium)2mg tabs: 1 every 6hrs as needed fro muscle spasms. (Muscle relaxer)
OR
Robaxin750mg (Methocarbamol): 1 every 6hrs as needed for muscle spasms. (Muscle relaxer)
You will be told which of the following medications to take as needed for nausea/vomiting:
Zofran 4mg (Ondansetron) oral dissolving tablets: 1 every 6-8hrs sublingually as needed for nausea.
OR
Phenergan 25mg tablets (Promethazine): 1 every 6 hours as needed for nausea.
You will be told which of the following SCHEDULED medications to take as directed:
Heterotopic Ossification Prophylaxis: Voltaren DR 75mg (Diclofenac) – 1 capsule every 12 hrs for 6 weeks
Potentiation of Cartilage Repair (matrix-metalloproteinase inhibitor): Doxy 20mg (Doxycycline) – 1 tablet daily for 4 weeks
DVT Prophylaxis (i.e. blood clot prevention):
Enteric Coated Aspirin 325mg (ECASA) – 1 daily for 4 weeks
OR
Xarelto (Rivaroxaban) 10mg tablets- 1 daily for 4 weeks
Gastrointestinal protection: Omeprazole (Prilosec) 20 mg tablets: 1 daily for 6 weeks (while taking NSAIDs)
Pain Medication Tips
- Do not drive while taking pain medications.
- Do not drink alcoholic beverages while taking pain medications.
- Pain medication should be taken with food as this will help prevent any stomach upset.
- Often pain medications will cause constipation. Eat high fiber foods and increase your fluid intake if possible. To alleviate constipation, purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
You should resume taking your normally prescribed medications unless otherwise directed. In some circumstances, additional/alternative medications are prescribed.
Specific Questions/Problems
There are several risks to hip arthroscopy surgery that should be acknowledged:
Infection: The risk of infection is decreased with a sterile operative environment, prophylactic antibiotics, and appropriate wound care.
DVT: The risk of DVT (deep vein thrombosis, blood clot) is decreased by instituting early motion(CPM), mechanical means (foot pumps, ambulation), and medication. Following the pre-operative and post-operative instructions will reduce the risk of deep vein clots.
Pain: There is a potential for pain with any surgical procedure. Motion, medication, ice, rest,compression, elevation, and therapy can reduce the chances of excessive post-operative pain.
Numbness: There is a small chance of numbness in the perineal (groin) region postoperatively. This can be caused by the pressure placed in the groin by a post necessary to distract (pull) the femoral head (ball) from the hip socket to allow for the procedure to be performed safely. The arthroscopic incisions are in close proximity to the course of the lateral femoral cutaneous nerve. As such, you may also experience numbness of the upper outer portion of the thigh on the operative leg after surgery. This is normal and the numbness will likely resolve over time.
Scarring: Superficial and deep scarring can occur following surgery. Following the rehabilitation restrictions and recommendations can reduce this risk. To minimize the appearance of superficial scars of the skin, it is important to avoid exposure to UV light (e.g. sunlight, tanning lights) as the scars mature.
Please contact my office for further instruction if you develop fevers greater than 101.5 degrees Fahrenheit, persistent drainage from your surgical incisions, intractable pain, or persistent numbness/tingling in your leg.
Follow-Up Appointment
You will be told when and where your follow-up appointment will be.
If you need to verify or change your post-op appointment, please call 703-277-2663.
You may schedule physical therapy to begin approximately 3-5 days following your surgery.
Please feel free to contact my office at anytime if you have any questions or concerns regarding your post-operative course.
Dr. Mook would like to thank Dr. Marc Philippon and his support team in Vail, Colorado for the creation of these rehabilitation recommendations. They have been updated and modified to suit the needs of Dr. Mook’s patients.
Post-operative instructions: hip arthroscopy (without microfracture)
Congratulations! You have just completed the surgical phase and entered the recovery/rehabilitation phase of your operative experience. In order to achieve the best possible result, active patient participation is extremely important during this period of time. The following instructions are designed to help you achieve the best possible outcome following your surgery.
Many questions arise during the first week after surgery. There are many new sensations felt in the body, especially in the operative hip and leg. The following will help answer many of your questions to help relieve normal anxiety.
Activity
Crutch use
You are restricted to flat foot weight bearing for three weeks. Start weaning off of your crutches post-operative day 22 with 50% weight bearing. Continue this for one week. After surgery, you will be flat foot (heel to toe) weight bearing with 20 pounds of pressure with the aid of crutches with a goal of returning to full activity as soon as possible (remember proper flat foot (heel to toe) weight bearing assists in decreasing your risk of developing a DVT or blood clot).
Hip Brace
You will need to wear the hip brace for three weeks. Place it securely around your waist and thigh; this serves as a reminder to control hyperextension and abduction. You will need to wear this brace when you are walking with crutches and flat foot weight bearing. You will not need it when you are sitting, lying down, or sleeping.
CPM (Continuous Passive Motion) Machine
Recommended usage- 4 Weeks for 6-8 hours/day
Range of motion settings:
- Week 1- 10-45 degrees
- Week 2- 0-60 degrees
- Week 3- 0-70 degrees
- Week 4- 0-80 degrees
You will need assistance to get into the CPM for the first couple of days aftersurgery. You may want to set the CPM at a 10 degree angle away from your midline.
(Tip: To help in the prevent lower back pain, try and maintain normal spine alignment while in the CPM. You may want to place a rolled towel or a small pillow behind your lower back. Place the CPM unit in the middle of the bed to prevent the machine and your leg falling off the bed. Avoid placing the unit on a couch or narrowed place while reclining.)
Cold Therapy Unit/Ice
Ice should be applied to the outside of your dressing frequently during the first 48 hours after surgery (30 minutes ON/30 minutes OFF), and during the first week following surgery. After the first week, you may consider ice after rehabilitation sessions or when swelling occurs. Do not apply ice directly to the skin.
Range of Motion Restrictions:
Abduction 0- 45 degrees for 2 weeks
Flexion: No restrictions. Avoid resting with the hip at 90 degrees for the 1st two weeks.
(Tip: To avoid hip flexion at 90 degrees for the 1st two weeks: use a higher chair, a recliner chair, or while sitting you can slouch forward or backward. Please have the physical therapist do all circumduction exercises in 70 degrees of flexion.)
Extension greater than 0 allowed after day 21.
Extension goal is to gain full extension to 0 by the end of the 1st week.
No prone therapy
Dressing
You will have a large waterproof dressing covering your surgical sites when you are discharged from the hospital. You may shower with this dressing in place. A small amount of bloody drainage on the dressing is not unusual. You may remove your dressing on the third day following your surgery. Once you have removed your dressing, please keep your incisions covered with Band-aids. Change as necessary throughout the day if the Band-aids become soiled or wet.
Do not put any ointments or lotions over the incisions.
Do not allow pets to sit on your lap or sleep in your bed for at least 6 weeks following surgery. Pets may harbor fleas, mites, or other organisms that may cause a wound infection.
If you should have any questions or concerns regarding your incisions, the best thing to do is to contact Dr. Mook or a member of his team.
Bathing/Showering
Do not submerge your hip in water (e.g. baths, pools, or hot tubs) while your stitches are in place. Pool therapy is okay with a waterproof dressing (i.e. Op-site) in place. You may resume regular showers after the initial dressing is removed on the third day following your surgery. While the wound is draining please keep a waterproof dressing on the incisions during the shower. After drainage has stopped you may allow water to run over the incision sites. When complete, pat the incision dry.
Sutures
Your sutures will be removed approximately 14 days following your surgery at your first follow-up appointment.
Physical Therapy (PT)
Appropriate PT is critical to the success of your surgery.You are expected to begin PT 3-5 days following your surgery. If you are experiencing pain, take pain medication and/or a muscle relaxant and proceed to PT. Participation in therapy exercises will often help ease the pain. Attending PT will allow your therapist can assess your situation and provide appropriate guidance. Do not hesitate to contact Dr. Mook’s office with any questions or concerns at any time. Your attendance of supervised physical therapy and completion of your home exercise program are paramount to your success.You should plan on working with a therapist 1-2 times per week for the first 3 months after surgery. This schedule may be adjusted based on your individual progress.
Home Exercise
You may begin the following home exercises the day after surgery. These should be performed several times per day when you are not sleeping.
- Hamstring sets: push heel into bed for count of 10.
- Heel slides: sit on a firm surface with your leg straight in front of you. Slowly slide the heel of your operative leg toward your buttock by pulling your knee to your chest as you slide.
- You may also utilize a stationary bike with no resistance to encourage early motion in your hip joint. Begin with small sessions of approximately 10 minutes at a time twice daily.
- Active Foot/Calf Pumps: Do 10 up and down pumps of your feet every hour while awake. Also remember to do these when riding in a vehicle for any length of time or on an airplane.
(Foot pump and calf pump rationale: Compression of calf muscles causing return of the blood in your lower legs to your heart.)
Note: Spare the Hip Flexors for 2 weeks
In order to NOT irritate your hip flexors (and have them bother you for weeks/months) do not actively lift your operative leg against gravity initially. This means when lying on your back, getting off the bed/table, or getting into the CPM, someone must lift your leg for you the first 2 weeks. When getting in/out of a vehicle,or turning sideways in a chair, the leg needs help – for this you can use the brace near the knee as a handle to lift/move your thigh. After you are feeling and moving more comfortably, you may be able to use your other foot/leg to move the operative leg about if comfortable.
Pain Control
A prescription for pain medication will be given to you upon discharge from the hospital/surgery center. Pain medication should be taken as prescribed until your pain is under control. It will help to take your pain medication thirty minutes before therapy if you are experiencing any pain. Most patients are able to discontinue their use of pain medication prior to their first follow-up appointment.
(Tip: Applying ice and elevating the leg as much as possible will help alleviate pain. Try to relax and allow others to assist you as much as possible the first week.)
Medications
Your post-operative regimen consists of several of the following medications.
You will be told which of the following medications to take for pain.
Roxicodone (Oxycoodone) 5mg: 1-2 tablets every 3-4hrs as needed for pain. (Narcotic)
OR
Dilaudid (Hydromorphone) 2mg: 1-2 tablets every 3-4hrs as needed for pain. (Narcotic)
OR
Norco 5mg (Hydrocodone/APAP): 1-2 every 4-6hrs as needed for pain. (Narcotic)
You will be told which of the following medications to take for muscle spasm (will cause drowsiness):
Diazepam (Valium)2mg tabs: 1 every 6hrs as needed fro muscle spasms. (Muscle relaxer)
OR
Robaxin 750mg (Methocarbamol): 1 every 6hrs as needed for muscle spasms. (Muscle relaxer)
You will be told which of the following medications to take as needed for nausea/vomiting:
Zofran 4mg (Ondansetron) oral dissolving tablets: 1 every 6-8hrs sublingually as needed for nausea.
OR
Phenergan 25mg tablets (Promethazine): 1 every 6 hours as needed for nausea.
You will be told which of the following SCHEDULED medications to take as directed:
Heterotopic Ossification Prophylaxis: Voltaren DR 75mg (Diclofenac) – 1 capsule every 12 hrs for 6 weeks
Potentiation of Cartilage Repair (matrix-metalloproteinase inhibitor): Doxy 20mg (Doxycycline) – 1 tablet daily for 4 weeks
DVT Prophylaxis (i.e. blood clot prevention):
Enteric Coated Aspirin 325mg (ECASA) – 1 daily for 4 weeks
OR
Xarelto (Rivaroxaban) 10mg tablets- 1 daily for 4 weeks
Gastrointestinal protection: Omeprazole (Prilosec) 20 mg tablets: 1 daily for 6 weeks (while taking NSAIDs)
Pain Medication Tips
- Do not drive while taking pain medications.
- Do not drink alcoholic beverages while taking pain medications.
- Pain medication should be taken with food as this will help prevent any stomach upset.
- Often pain medications will cause constipation. Eat high fiber foods and increase your fluid intake if possible. To alleviate constipation, purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
You should resume taking your normally prescribed medications unless otherwise directed. In some circumstances, additional/alternative medications are prescribed.
Specific Questions/Problems
There are several risks to hip arthroscopy surgery that should be acknowledged:
Infection: The risk of infection is decreased with a sterile operative environment, prophylactic antibiotics, and appropriate wound care.
DVT: The risk of DVT (deep vein thrombosis, blood clot) is decreased by instituting early motion(CPM), mechanical means (foot pumps, ambulation), and medication. Following the pre-operative and post-operative instructions will reduce the risk of deep vein clots.
Pain: There is a potential for pain with any surgical procedure. Motion, medication, ice, rest,compression, elevation, and therapy can reduce the chances of excessive post-operative pain.
Numbness: There is a small chance of numbness in the perineal (groin) region postoperatively. This can be caused by the pressure placed in the groin by a post necessary to distract (pull) the femoral head (ball) from the hip socket to allow for the procedure to be performed safely. The arthroscopic incisions are in close proximity to the course of the lateral femoral cutaneous nerve. As such, you may also experience numbness of the upper outer portion of the thigh on the operative leg after surgery. This is normal and the numbness will likely resolve over time.
Scarring: Superficial and deep scarring can occur following surgery. Following the rehabilitation restrictions and recommendations can reduce this risk. To minimize the appearance of superficial scars of the skin, it is important to avoid exposure to UV light (e.g. sunlight, tanning lights) as the scars mature.
Please contact my office for further instruction if you develop fevers greater than 101.5 degrees Fahrenheit, persistent drainage from your surgical incisions, intractable pain, or persistent numbness/tingling in your leg.
Follow-Up Appointment
You will be told when and where your follow-up appointment will be.
If you need to verify or change your post-op appointment, please call 703-277-2663.
You may schedule physical therapy to begin approximately 3-5 days following your surgery.
Please feel free to contact my office at anytime if you have any questions or concerns regarding your post-operative course.
Dr. Mook would like to thank Dr. Marc Philippon and his support team in Vail, Colorado for the creation of these rehabilitation recommendations. They have been updated and modified to suit the needs of Dr. Mook’s patients.
Post-operative instructions: knee arthroscopy
Congratulations! You have just completed the surgical phase and entered the recovery/rehabilitation phase of your operative experience. In order to achieve the best possible result, active patient participation is extremely important during this period of time. The following instructions are designed to help you achieve the best possible outcome following your surgery.
Many questions arise during the first week after surgery. There are many new sensations felt in the body, especially in the operative extremity. The following will help answer many of your questions to help relieve normal anxiety.
Activity
Weight bearing and motion restrictions
Your weight bearing status and range of motion restrictions (if applicable) are detailed in the accompanying physical therapy protocol.
Knee Brace
Some patients will require a brace. If you have a brace on in the recovery room, you will need to wear the knee brace until your follow-up appointment and potentially longer depending upon the type of surgery you had. Your rehabilitation protocol will have a specific instructions regarding the time necessary in the brace. You should sleep in the brace unless otherwise noted. For most patients it will come off for physical therapy daily.
Cold Therapy Unit/Ice
Ice should be applied to the outside of your dressing frequently during the first 48 hours after surgery (30 minutes ON/30 minutes OFF), and during the first week following surgery. After the first week, you may consider ice after rehabilitation sessions or when swelling occurs. Do not apply ice directly to the skin.
Dressing
The original dressing should be removed 72 hours after surgery. Apply an opsite (waterproof dressing) over the incision sites until you have stopped draining. After drainage has stopped, apply band aids over the incisions.A small amount of bloody drainage on the dressing is not unusual. Please Leave “steri-strips” or butterfly bandages in place until your follow-up appointment. By day five if no drainage is present, the incisions may remain uncovered. Do not put any ointments or lotions over the incisions. If you should have any questions or concerns regarding your incisions, the best thing to do is to contact Dr. Mook or a member of his team.
Bathing/Showering
Do not submerge your lower extremity in water (e.g. baths, pools, or hot tubs) while your stitches are in place. You may resume regular showers on the third day following your surgery. While the wound is draining please keep a waterproof dressing on the incisions during the shower. After drainage has stopped you may allow water to run over the incision sites. When complete, pat the incision dry.
Sutures
Your sutures will be removed approximately 14 days following your surgery at your first follow-up appointment.
Physical Therapy (PT)
Appropriate PT is critical to the success of your surgery. Most patients will start physical therapy immediately after surgery. You should call to schedule your physical therapy appointment as soon as you know your surgical date. Therapy can begin the day after surgery unless otherwise directed. Please see accompanying therapy prescription for the specifics of your rehabilitation protocol.Please ask your therapist to follow the included protocol. If you are experiencing pain, take pain medication and/or a muscle relaxant and proceed to PT. Participation in therapy exercises will often help ease the pain. Attending PT will allow your therapist can assess your situation and provide appropriate guidance. We are always happy to discuss treatment modalities, progress, and any questions/concerns with your therapist. Do not hesitate to contact Dr. Mook’s office with any questions or concerns at any time. Your attendance of supervised physical therapy and completion of your home exercise program are paramount to your success.
Home Exercise
You may begin the following home exercises the day after surgery. These should be performed several times per day when you are not sleeping.
- Quad sets: push the back of your knee into the bed and hold for a count of 10.
- Active Foot/Calf Pumps: Do 10 up and down pumps of your feet every hour while awake. Also remember to do these when riding in a vehicle for any length of time or on an airplane.
(Foot pump and calf pump rationale: Compression of calf muscles causing return of the blood in your lower legs to your heart.)
Pain Control
A prescription for pain medication will be given to you upon discharge from the hospital/surgery center. Pain medication should be taken as prescribed until your pain is under control. It will help to take your pain medication thirty minutes before therapy if you are experiencing any pain. Most patients are able to discontinue their use of pain medication prior to their first follow-up appointment.
(Tip: Applying ice and elevating the leg as much as possible will help alleviate pain. Try to relax and allow others to assist you as much as possible the first week.)
Medications
Your post-operative regimen consists of several of the following medications.
You will be told which of the following medications to take for pain.
Roxicodone (Oxycodone) 5mg: 1-2 tablets every 3-4hrs as needed for pain. (Narcotic)
OR
Dilaudid (Hydromorphone) 2mg: 1-2 tablets every 3-4hrs as needed for pain. (Narcotic)
OR
Norco 5mg (Hydrocodone/APAP): 1-2 every 4-6hrs as needed for pain. (Narcotic)
You will be told which of the following medications to take for muscle spasm (will cause drowsiness):
Diazepam (Valium)2mg tabs: 1 every 6hrs as needed for muscle spasms. (Muscle relaxer)
OR
Robaxin750mg (Methocarbamol): 1 every 6hrs as needed for muscle spasms. (Muscle relaxer)
You will be told which of the following medications to take as needed for nausea/vomiting:
Zofran 4mg (Ondansetron) oral dissolving tablets: 1 every 6-8hrs sublingually as needed for nausea.
OR
Phenergan 25mg tablets (Promethazine): 1 every 6 hours as needed for nausea.
You will be told which of the following SCHEDULED medications to take as directed:
DVT Prophylaxis (i.e. blood clot prevention):
Enteric Coated Aspirin 325mg (ECASA) – 1 daily for 4 weeks
OR
Xarelto (Rivaroxaban) 10mg tablets- 1 daily for 2 weeks
OR
Lovenox (enoxaparin) 40mg injections – 1 injection subcutaneously daily for 2 weeks
Gastrointestinal protection: Omeprazole (Prilosec) 20 mg tablets: 1 daily for 6 weeks (while taking NSAIDs)
Pain Medication Tips
- Do not drive while taking pain medications.
- Do not drink alcoholic beverages while taking pain medications.
- Pain medication should be taken with food as this will help prevent any stomach upset.
- Often pain medications will cause constipation. Eat high fiber foods and increase your fluid intake if possible. To alleviate constipation, purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
You should resume taking your normally prescribed medications unless otherwise directed. In some circumstances, additional/alternative medications are prescribed.
Specific Questions/Problems
There are several risks to knee surgery that should be acknowledged:
Infection: The risk of infection is decreased with a sterile operative environment, prophylactic antibiotics, and appropriate wound care.
DVT: The risk of DVT (deep vein thrombosis, blood clot) is decreased by instituting early motion, mechanical means (foot pumps, ambulation, compression stockings), and medication. Following the pre-operative and post-operative instructions will reduce the risk of deep vein clots.
Pain: There is a potential for pain with any surgical procedure. Medication, ice, rest,compression, elevation, and therapy can reduce the chances of excessive post-operative pain.
Numbness: There is a small chance of numbness about the knee and leg post operatively. The arthroscopic incisions are in close proximity to superficial sensory nerves. As such, you may also experience numbness of the areas surrounding your incisions of your operative leg after surgery. This is normal and the numbness will likely resolve over time.
Scarring: Superficial and deep scarring can occur following surgery. Following the rehabilitation restrictions and recommendations can reduce this risk. To minimize the appearance of superficial scars of the skin, it is important to avoid exposure to UV light (e.g. sunlight, tanning lights) as the scars mature.
Please contact my office for further instruction if you develop fevers greater than 101.5 degrees Fahrenheit, persistent drainage from your surgical incisions, intractable pain, or persistent numbness/tingling in your leg.
Follow-Up Appointment
You will be told when and where your follow-up appointment will be.
If you need to verify or change your post-op appointment, please call 703-277-2663.
Please feel free to contact my office at anytime if you have any questions or concerns regarding your post-operative course.
Post-operative instructions: knee surgery
Congratulations! You have just completed the surgical phase and entered the recovery/rehabilitation phase of your operative experience. In order to achieve the best possible result, active patient participation is extremely important during this period of time. The following instructions are designed to help you achieve the best possible outcome following your surgery.
Many questions arise during the first week after surgery. There are many new sensations felt in the body, especially in the operative extremity. The following will help answer many of your questions to help relieve normal anxiety.
Activity
Weight bearing and motion restrictions
Your weight bearing status and range of motion restrictions (if applicable) are detailed in the accompanying physical therapy protocol.
Knee Brace
Some patients will require a brace. If you have a brace on in the recovery room, you will need to wear the knee brace until your follow-up appointment and potentially longer depending upon the type of surgery you had. Your rehabilitation protocol will have specific instructions regarding the time necessary in the brace. You should sleep in the brace unless otherwise noted. For most patients it will come off for physical therapy sessions.
Cold Therapy Unit/Ice
Ice should be applied to the outside of your dressing frequently during the first 48 hours after surgery (30 minutes ON/30 minutes OFF), and during the first week following surgery. After the first week, you may consider ice after rehabilitation sessions or when swelling occurs. Do not apply ice directly to the skin.
Dressing
The original dressing should be removed 72 hours after surgery. Apply an opsite (waterproof dressing) over the incision sites until you have stopped draining. After drainage has stopped, apply band aids over the incisions.A small amount of bloody drainage on the dressing is not unusual. Please Leave “steri-strips” or butterfly bandages in place until your follow-up appointment. By day five if no drainage is present, the incisions may remain uncovered. Do not put any ointments or lotions over the incisions. If you should have any questions or concerns regarding your incisions, the best thing to do is to contact Dr. Mook or a member of his team.
Bathing/Showering
Do not submerge your lower extremity in water (e.g. baths, pools, or hot tubs) while your stitches are in place. You may resume regular showers on the third day following your surgery. While the wound is draining please keep a waterproof dressing on the incisions during the shower. After drainage has stopped you may allow water to run over the incision sites. When complete, pat the incision dry.
Sutures
Your sutures will be removed approximately 14 days following your surgery at your first follow-up appointment.
Physical Therapy (PT)
Appropriate PT is critical to the success of your surgery.Most patients will start physical therapy immediately after surgery. You should call to schedule your physical therapy appointment as soon as you know your surgical date. Therapy can begin the day after surgery unless otherwise directed. Please see accompanying therapy prescription for the specifics of your rehabilitation protocol.Please ask your therapist to follow the included protocol. If you are experiencing pain, take pain medication and/or a muscle relaxant and proceed to PT. Participation in therapy exercises will often help ease the pain. Attending PT will allow your therapist can assess your situation and provide appropriate guidance. We are always happy to discuss treatment modalities, progress, and any questions/concerns with your therapist. Do not hesitate to contact Dr. Mook’s office with any questions or concerns at any time. Your attendance of supervised physical therapy and completion of your home exercise program are paramount to your success.
Home Exercise
You may begin the following home exercises the day after surgery. These should be performed several times per day when you are not sleeping.
- Quad sets: push the back of your knee into the bed and hold for a count of 10.
- Active Foot/Calf Pumps: Do 10 up and down pumps of your feet every hour while awake. Also remember to do these when riding in a vehicle for any length of time or on an airplane.
(Foot pump and calf pump rationale: Compression of calf muscles causing return of the blood in your lower legs to your heart.)
Pain Control
A prescription for pain medication will be given to you upon discharge from the hospital/surgery center. Pain medication should be taken as prescribed until your pain is under control. It will help to take your pain medication thirty minutes before therapy if you are experiencing any pain. Most patients are able to discontinue their use of pain medication prior to their first follow-up appointment.
(Tip: Applying ice and elevating the leg as much as possible will help alleviate pain. Try to relax and allow others to assist you as much as possible the first week.)
Medications
Your post-operative regimen consists of several of the following medications.
You will be told which of the following medications to take for pain.
Roxicodone (Oxycodone) 5mg: 1-2 tablets every 3-4hrs as needed for pain. (Narcotic)
OR
Dilaudid (Hydromorphone) 2mg: 1-2 tablets every 3-4hrs as needed for pain. (Narcotic)
OR
Norco 5mg (Hydrocodone/APAP): 1-2 every 4-6hrs as needed for pain. (Narcotic)
You will be told which of the following medications to take for muscle spasm (will cause drowsiness):
Diazepam (Valium)2mg tabs: 1 every 6hrs as needed for muscle spasms. (Muscle relaxer)
OR
Robaxin750mg (Methocarbamol): 1 every 6hrs as needed for muscle spasms. (Muscle relaxer)
You will be told which of the following medications to take as needed for nausea/vomiting:
Zofran 4mg (Ondansetron) oral dissolving tablets: 1 every 6-8hrs sublingually as needed for nausea.
OR
Phenergan 25mg tablets (Promethazine): 1 every 6 hours as needed for nausea.
You will be told which of the following SCHEDULED medications to take as directed:
DVT Prophylaxis (i.e. blood clot prevention):
Enteric Coated Aspirin 325mg (ECASA) – 1 daily for 4 weeks
OR
Xarelto (Rivaroxaban) 10mg tablets- 1 daily for 2 week
OR
Lovenox (enoxaparin) 40mg injections – 1 injection subcutaneously daily for 2 weeks
Gastrointestinal protection: Omeprazole (Prilosec) 20 mg tablets: 1 daily for 6 weeks (while taking NSAIDs)
Pain Medication Tips
- Do not drive while taking pain medications.
- Do not drink alcoholic beverages while taking pain medications.
- Pain medication should be taken with food as this will help prevent any stomach upset.
- Often pain medications will cause constipation. Eat high fiber foods and increase your fluid intake if possible. To alleviate constipation, purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
You should resume taking your normally prescribed medications unless otherwise directed. In some circumstances, additional/alternative medications are prescribed.
Specific Questions/Problems
There are several risks to knee surgery that should be acknowledged:
Infection: The risk of infection is decreased with a sterile operative environment, prophylactic antibiotics, and appropriate wound care.
DVT: The risk of DVT (deep vein thrombosis, blood clot) is decreased by instituting early motion, mechanical means (foot pumps, ambulation, compression stockings), and medication. Following the pre-operative and post-operative instructions will reduce the risk of deep vein clots.
Pain: There is a potential for pain with any surgical procedure. Medication, ice, rest,compression, elevation, and therapy can reduce the chances of excessive post-operative pain.
Numbness: There is a small chance of numbness about the knee and leg post operatively. The incisions are in close proximity to superficial sensory nerves. As such, you may also experience numbness of the areas surrounding your incisions of your operative leg after surgery. This is normal and the numbness will likely resolve over time.
Scarring: Superficial and deep scarring can occur following surgery. Following the rehabilitation restrictions and recommendations can reduce this risk. To minimize the appearance of superficial scars of the skin, it is important to avoid exposure to UV light (e.g. sunlight, tanning lights) as the scars mature.
Please contact my office for further instruction if you develop fevers greater than 101.5 degrees Fahrenheit, persistent drainage from your surgical incisions, intractable pain, or persistent numbness/tingling in your leg.
Follow-Up Appointment
You will be told when and where your follow-up appointment will be.
If you need to verify or change your post-op appointment, please call 703-277-2663.
Please feel free to contact my office at anytime if you have any questions or concerns regarding your post-operative course.
Post-operative instructions: shoulder surgery
Congratulations! You have just completed the surgical phase and entered the recovery/rehabilitation phase of your operative experience. In order to achieve the best possible result, active patient participation is extremely important during this period of time. The following instructions are designed to help you achieve the best possible outcome following your surgery.
Many questions arise during the first week after surgery. There are many new sensations felt in the body, especially in the operative extremity. The following will help answer many of your questions to help relieve normal anxiety.
Activity
You will need to wear the shoulder sling for two weeks or more depending upon the type of surgery you had. Place it securely around your waist and over the non-operative shoulder, this serves as a reminder to your shoulder. You should sleep in the brace unless otherwise noted. You may type on a keyboard or write on a desk as soon as you feel comfortable, as long as you remain in your sling. You may remove your sling for physical therapy and bathing/hygiene. The accompanying rehabilitation protocol will indicate a specific time in sling. Please follow the lifting and motion restrictions provided in your physical therapy protocol.
Cold Therapy Unit/Ice
Ice should be applied to the outside of your dressing frequently during the first 48 hours after surgery (30 minutes ON/30 minutes OFF), and during the first week following surgery. After the first week, you may consider ice after rehabilitation sessions or when swelling occurs. Do not apply ice directly to the skin.
Dressing
The original dressing should be removed 72 hours after surgery. Apply an opsite (waterproof dressing) over the incision sites until you have stopped draining. After drainage has stopped, apply band aids over the incisions.A small amount of bloody drainage on the dressing is not unusual. Please leave “steri-strips” or butterfly bandages in place until your follow-up appointment. By day five if no drainage is present, the incisions may remain uncovered. Do not put any ointments or lotions over the incisions. If you should have any questions or concerns regarding your incisions, the best thing to do is to contact Dr. Mook or a member of his team.
Bathing/Showering
Do not submerge your shoulder in water (e.g. baths, pools, or hot tubs) while your stitches are in place. You may resume regular showers on the third day following your surgery. While the wound is draining please keep a waterproof dressing on the incisions during the shower. After drainage has stopped you may allow water to run over the incision sites. When complete, pat the incision dry.
Sutures
If present, your sutures will be removed approximately 10 days following your surgery at your first follow-up appointment.
Physical Therapy (PT)
Appropriate PT is critical to the success of your surgery.Most patients will begin physical therapy after the first postoperative appointment (approximately 10 days from the time of surgery). You should call to schedule your physical therapy appointment as soon as you know your surgical date. Please see accompanying therapy prescription for the specifics of your rehabilitation protocol.We are always happy to discuss treatment modalities, progress, and any questions/concerns with your therapist. Do not hesitate to contact Dr. Mook’s office with any questions or concerns at any time. Your attendance of supervised physical therapy and completion of your home exercise program are paramount to your success.
Pain Control
A prescription for pain medication will be given to you upon discharge from the hospital/surgery center. Pain medication should be taken as prescribed until your pain is under control. It will help to take your pain medication thirty minutes before therapy if you are experiencing any pain. Most patients are able to discontinue their use of pain medication prior to their first follow-up appointment.
Medications
Your post-operative regimen consists of several of the following medications.
You will be told which of the following medications to take for pain.
Roxicodone (Oxycodone) 5mg: 1-2 tablets every 3-4hrs as needed for pain. (Narcotic)
OR
Dilaudid (Hydromorphone) 2mg: 1-2 tablets every 3-4hrs as needed for pain. (Narcotic)
OR
Norco 5mg (Hydrocodone/APAP): 1-2 every 4-6hrs as needed for pain. (Narcotic)
You will be told which of the following medications to take for muscle spasm (will cause drowsiness):
Diazepam (Valium)2mg tabs: 1 every 6hrs as needed fro muscle spasms. (Muscle relaxer)
OR
Robaxin750mg (Methocarbamol): 1 every 6hrs as needed for muscle spasms. (Muscle relaxer)
You will be told which of the following medications to take as needed for nausea/vomiting:
Zofran 4mg (Ondansetron) oral dissolving tablets: 1 every 6-8hrs sublingually as needed for nausea.
OR
Phenergan 25mg tablets (Promethazine): 1 every 6 hours as needed for nausea.
You will be told which of the following SCHEDULED medications to take as directed:
DVT Prophylaxis (i.e. blood clot prevention):
Enteric Coated Aspirin 325mg (ECASA) – 1 daily for 4 weeks
OR
Xarelto (Rivaroxaban) 10mg tablets- 1 daily for 2 weeks
OR
Lovenox (enoxaparin) 40mg injections – 1 injection subcutaneously daily for 2 weeks
Gastrointestinal protection: Omeprazole (Prilosec) 20 mg tablets: 1 daily for 6 weeks (while taking NSAIDs)
Pain Medication Tips
- Do not drive while taking pain medications.
- Do not drink alcoholic beverages while taking pain medications.
- Pain medication should be taken with food as this will help prevent any stomach upset.
- Often pain medications will cause constipation. Eat high fiber foods and increase your fluid intake if possible. To alleviate constipation, purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
You should resume taking your normally prescribed medications unless otherwise directed. In some circumstances, additional/alternative medications are prescribed.
Specific Questions/Problems
There are several risks to shoulder surgery that should be acknowledged:
Infection: The risk of infection is decreased with a sterile operative environment, prophylactic antibiotics, and appropriate wound care.
DVT: The risk of lower extremity DVT (deep vein thrombosis, blood clot) is decreased by instituting early motion, mechanical means (ambulation, compression stockings), and medication. Following the pre-operative and post-operative instructions will reduce the risk of deep vein clots.
Pain: There is a potential for pain with any surgical procedure. Medication, ice, rest,compression, elevation, and therapy can reduce the chances of excessive post-operative pain.
Numbness: There is a small chance of numbness about the upper extremity post-operatively. The incisions are in close proximity to superficial sensory nerves. As such, you may also experience numbness of the areas surrounding your incisions of your operative extremity after surgery. This is normal and the numbness will likely resolve over time.
Scarring: Superficial and deep scarring can occur following surgery. Following the rehabilitation restrictions and recommendations can reduce this risk. To minimize the appearance of superficial scars of the skin, it is important to avoid exposure to UV light (e.g. sunlight, tanning lights) as the scars mature.
Please contact my office for further instruction if you develop fevers greater than 101.5 degrees Fahrenheit, persistent drainage from your surgical incisions, intractable pain, or persistent numbness/tingling in your leg.
Follow-Up Appointment
You will be told when and where your follow-up appointment will be.
If you need to verify or change your post-op appointment, please call 703-277-BONE (2663).
Please feel free to contact my office at anytime if you have any questions or concerns regarding your post-operative course.