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:

Weightbearing 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 contactDr. 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 isdraining please keep a waterproof dressing on the incisions during the shower. After drainage has stopped youmay 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, takepain 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 concernsat 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.

  1. Quad sets: push the back of your knee into the bed and hold for a count of 10.
  2. 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 theblood 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 undercontrol. 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 relaxand allow others to assist you as much as possible the first week.)

MEDICATIONS:

Your post-operative regimen consists of several of the following medications.

Please take the following as needed 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)

Please take the following as needed 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)

Please take the following 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.

Please take the following SCHEDULED medications 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:

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SPECIFIC QUESTIONS / PROBLEMS:

There are several risks to kneesurgery that should be acknowledged:

  • Infection:The risk of infection is decreased with a sterile operative environment, prophylactic antibiotics, andappropriate 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 andpost-operative instructions will reduce the risk of deep vein clots.
  • Pain: There is a potential for painwith 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 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:

Your follow-up appointment has been schedule on _____________________ at the Reston Office.

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.