Post Operative Instructions
Osteochondral Autograft Transplantation (OATS) Procedure
You have undergone transplantation of osetochondral (bone and cartilage) autograft (your tissue) plugs. In this procedure an incision is made in the front of your knee, and size and shaped-matched graft(s) are inserted into the area of cartilage surface damage.
Your knee has been immobilized with a compressive dressing reinforced by an immobilizer. The immobilizer provides initial comfort by minimizing any motion at the surgical site. Occasionally, A CPM (Continuous Passive Motion machine) will be used to help restore/maintain your motion. If you have a CPM, the immobilizer is to be used when up and walking around.
Some degree of swelling of your foot and toes is normal. Swelling can be minimized by elevating your leg. Try to keep your leg up elevated upon a few pillows consistently for the first 48 hours, and intermittently thereafter. The goal is for the leg to be above the level of your heart. Swelling can be further controlled by use of ice or cold therapy directly over the site of surgery. Place a bag of ice or package of frozen vegetables (which nicely conforms to the surgical site), usually 20 minutes on and 20 minutes off. If you have a Cold Therapy® pad and cooler (arranged pre-operatively for this use), keep the sleeve directly over the dressings. Use it continuously for the first week.
Because bleeding from the surgical site cannot escape, it typically travels under the skin to the most "dependent" part of the extremity. An evolving bruising of the foot and/or toes, which can increase over the first few weeks, is normal, and will ultimately resolve.
Keep your dressing in place until your post-op visit. You may shower (NO baths), but keep the dressing dry, through use of a plastic bag (such as a clean garbage bag) as a cover. Secure it with tape above the dressing to prevent getting it wet. If taking a shower, you should use a plastic chair or some other means of sitting, both for balance and to avoid placing any weight on your leg. As an alternative you may want to try a bath and keep your leg hanging over the side of the tub (as to keep your incision dry).
A low grade fever (less than 101°) is fairly common within the first 3-5 days following surgery. If the fever is higher or lasts longer, this could reflect infection and warrants contacting our office.
CPM (Continuous Passive Motion) Machine
A CPM machine may have been arranged for you to use to improve restoration of knee flexion (bending). The machine is set such that it gently and passively moves your knee through a range of motion, beginning at full extension (fully straight or zero°) to about 50° (~ halfway bent). The CPM device should be comfortable and as a guideline, is increased by 10° each day. Small increases of 5° at a time, each morning and each afternoon, may be easier than increasing by the 10°. Use the CPM approximately 8-10 hours/day. You may use it in any comfortable combination (such as on for 3 hours, off for one hour, on for another 3, etc.), until you have reached your 8-10 hour minimum. You may use it at night. Call the CPM rep with any equipment questions (703-281-1200).
Begin your post-operative exercises the night of surgery. The exercises are illustrated on the following pages. For the first week try to minimize how much you're up and about. The more your leg is "dependent" the greater degree of discomfort. Do not put weight on your surgical leg.
Vicodin® (Hydrocodone) or Percocet ® (oxycodone) narcotic pain killers, have been prescribed for pain. Take one to two every six hours as needed for pain, which is typically needed for the first week or so after surgery. All narcotic pain medications can cause side effects, the most common of which is nausea. We have prescribed Phenergan to help with the nausea – take it as you need every 6 hours. If you have known side effects to any of these medications please let us know and we will call in a substitute. Tylenol can be used in place of a narcotic, but NOT in addition to the narcotic. Use Tylenol when pain is less severe. NSAIDs are also a good alternative option.
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.
DVT (BLOOD CLOT) PRECAUTIONS
Deep Venous Thrombosis (DVT, aka blood clot) is an uncommon complication that can occur following lower extremity surgery. Starting the day after your surgery, take an enteric coated 325mg aspirin (which acts as a blood thinner) once a day for three weeks. Because aspirin can cause stomach upset, you may want to take it with food. If you have an allergy to Aspirin, please inform us so we can consider alternative precautions. Remember that Tylenol®, Motrin®, Alleve®, and other Non-steroidal Anti-Inflammatory (NSAID) medications do not protect against DVT, and should not be used for this purpose.
You should be scheduled for a post-op appointment 10 - 14 days following surgery, at which time we will review your post-operative program and answer any of your questions. Your post-operative appointment is scheduled on: ______________________________________________________________.
If you need to verify or change your post-op appointment, please call 703-277-BONE (2663).
Physical therapy is usually started within the first week of your surgery. We will help you in identifying an appropriate therapist if you need assistance.
IN CASE OF EMERGENCY
You may reach me 24 hours/day through either office (703) 810-5215 Option 3 (Arlington) or (703) 810-5213 Option 3 (Tysons). You should contact me for any of the following symptoms:
- Fever greater then 101.5 degrees F
- Numbness, loss of color or coolness in hand
- Severe pain unresponsive to narcotic medication
- Excessive bleeding or vomiting
- Difficulty breathing or shortness of breath – Call 911
Knee Arthroscopy Exercise Guide
Regular exercise to restore your knee mobility and strength is necessary. For the most part this can be carried out at home. Your orthopaedic surgeon may recommend that you exercise approximately 20 to 30 minutes two or three times a day. You also may be advised to engage in a walking program. Your orthopaedic physician may suggest some of the following exercises. The following guide can help you better understand your exercise or activity program that may be supervised by a therapist at the direction of your orthopaedic surgeon. As you increase the intensity of your exercise program, you may experience temporary set-backs. If your knee swells or hurts after a particular exercise activity, you should lessen or stop the activity until you feel better. You should Rest, Ice, Compress (with an elastic bandage), and Elevate your knee (R.I.C.E.). Contact your surgeon if the symptoms persist.
Initial Exercise Program
Hamstring Contraction, 10 Repetitions - No movement should occur in this exercise. Lie or sit with your knees bent to about 10 degrees. Pull your heel into the floor, tightening the muscles on the back of your thigh. Hold 5 seconds, then relax.Repeat 10 times.
Quadriceps Contraction, 10 Repetitions - Lie on stomach with a towel roll under the ankle of your operated knee. Push ankle down into the towel roll. Your leg should straighten as much as possible. Hold for 5 seconds. Relax. Repeat 10 times.
Straight Leg Raises, 10 Repetitions - Lie on your back, with uninvolved knee bent, straighten your involved knee. Slowly lift about 6 inches and hold for 5 seconds. Continue lifting in 6-inch increments, hold each time. Reverse the procedure, and return to the starting position. Repeat 10 times. Advanced: Before starting, add weights to your ankle, starting with 1 pound of weight and building up to a maximum of 5 pounds of weight over 4 weeks.
Buttock Tucks, 10 Repetitions - While lying down on your back, tighten your buttock muscles. Hold tightly for 5 seconds. Repeat 10 times.