Post Operative Instructions

Please read the information below, which explains what you need to know after treatment/surgery.


Medication

Some pain medications will be prescribed: Percocet (Hydrocodone), Darvocet, Dilaudid, Tylenol #3 and Oxycontin are typical medications. You are to take 1 or 2 pills every 4 to 6 hours as needed for pain. Follow the instructions for each medication as written on the prescription bottle.

It is recommended that you take the pain medication with food as it may cause nausea on an empty stomach. It is not uncommon to develop constipation when taking prescription pain medication. You may take an over-the-counter stool softener or laxative, if needed.

If you have a nerve block, begin taking the pills as you feel your sensation returning to prevent a sudden onset of extreme pain.

Do NOT drive or operate heavy equipment when taking your prescription pain medication.

Do NOT take any additional prescription or over-the-counter Advil (Ibuprofen) or Aleve (Naproxen Sodium) anti-inflammatory medication unless specifically advised to do so after surgery. Taking this type of medication during the first six (6) weeks post-surgery may impair tendon (or soft tissue grafts) healing to bone.

An antibiotic may also be prescribed depending on your type of incision. Also, patients with rotator cuff repairs may be placed on Doxycycline to aid in healing of the cuff (tendon) to bone.

Ambien or Lunesta may also be prescribed to assist with sleeping.

Resume all normally prescribed medications unless otherwise instructed.

If you have an adverse reaction while taking your medication, please contact the office at (201) 343-1717.


In general, dressings may be removed completely by 48 hours following surgery. Please refer to the specific procedure's post-op instruction sheet for details.

If your dressing gets EXCESSIVELY wet prior to your first post-op visit, meaning "soaked through," please contact the office for instructions.

If you feel that the dressing may be too tight, you may loosen the elastic bandage only. Do NOT remove any of the sterile padding or gauze until 24-36 hours post-op, as this may expose you to an infection.

Before showering, wrap your leg in a large plastic bag with closure at both ends. You can use tape at both ends for closure. You can also wrap the bag with plastic clear wrap for additional protection.

NO submersion of wounds (bath, hot tub, pool, etc.) is allowed until a minimum of 2 weeks after surgery to allow ample time for incisions to close and heal properly.

Your smaller portal incisions have absorbable sutures beneath the skin. Your larger, longer incision requires an external suture to keep it tightly closed to promote faster healing. These external sutures will be removed or clipped 10 to 14 days after surgery at your 2-week or second post-op appointment. Your steri-strips should remain on for one additional week.


Cryotherapy or Cold Therapy is used to control pain and swelling. The use of ice or other cryotherapy device such as the Game Ready or Cryo-Cuff should be constantly applied for the first 24 hours. Place the cryotherapy device on top of the post-op surgical dressings. Do NOT remove your post-op bandages. To help reduce the likelihood of your initial post-op dressing getting wet, you can place a barrier of saran wrap or a piece of plastic, i.e. plastic zip-loc bag, between the device and your dressing.

If a cryotherapy device such as the Game Ready or Cryo-Cuff is not applicable, a very easy and inexpensive way to ice is to use frozen peas. Go to the grocery store and buy several bags of frozen peas. Take them out of the bag they come in and place in a gallon sized zip-lock freezer bag making them about an inch thick. Try to get as much air out of the bag as possible and make a good seal. When you are done, return them to your freezer and lay flat. Now you have a light, inexpensive ice bag that can be reused numerous times. Frozen pea ice packs are also helpful to use on the lower leg to reduce swelling and can be done while in your CPM unit.

After the first week, use cryotherapy for 20 to 30 minutes every 1-2 hours. Always use cryotherapy after physical therapy and home exercises to help with swelling and pain.


This section is for Autologous Chondrocyte Implantation ONLY

Your knee is a joint. All joints are designed to move. Your CPM unit moves your knee through a specified range of motion. This passive motion stimulates the healing process of your knee and helps to limit excessive scar tissue adhesions that may hinder your recovery.

The CPM machine should be used for 4 to 6 hours a day, usually in 1 to 2 hour increments three times a day as tolerated for 2 weeks after surgery until a goal of full flexion has been achieved comfortably. Some of the ACI protocols will require longer use of CPM.

Your specific surgical procedure may require modifications to this goal. Limits in range of motion vary depending upon specific procedures performed and protocols. Dr. Longobardi will give these instructions to your caregiver following surgery.

The initial setting for the CPM may vary according to specific procedures that may have been necessary during your surgery. Typically begin with a flexion setting of 45 degrees and progress as tolerated, increasing to full flexion unless instructed otherwise by Dr. Longobardi. Attempt to maintain at least a 0 to 90 degree range of motion. If this becomes too painful, you may decrease the flexion to a tolerated degree.

Do NOT sleep while in the CPM machine.

If you feel that you are not getting to full extension, you can set the CPM extension setting to a negative number (0 to -5 degrees only!)


Dr. Longobardi will instruct your caregivers on your specific weight bearing status after surgery. Generally, partial weight bearing on the involved leg is allowed unless otherwise instructed by Dr. Longobardi after surgery. Crutches will be necessary to assist with balance and stability. Please refer to specific weight-bearing instructions at the time of discharge.

Crutches are assistive devices, so it is important to walk with as normal a gait pattern as possible within your brace range of motion limitations.

Crutches will be needed until Dr. Longobardi deems them unnecessary based upon strength in the involved leg and your ability to walk with a normal gait pattern. Most patients are full weight bearing and off crutches within 7 to 14 days for simple knee arthroscopy and often by 6 weeks for ACL reconstructions. Dr. Longobardi will give you instructions specific to your surgery.

If you need to use stairs while you are walking with crutches, a simple rule to follow is "Up with the good, down with the bad". You want to lead up stairs with your uninvolved leg first, followed by the crutches and involved leg to the same step. On the way down, you want to lead with the crutches and involved leg first, then the uninvolved leg to the same step. Always be cautious using stairs.

Sleeping at Night

Nighttime will probably be the most uncomfortable time. Blood circulation increases when you sleep and can cause discomfort, especially when you have swelling. This is normal. You may choose to use the prescribed sleep aid to assist you in resting well.

Bruising

Bruising around the area of the surgery is normal; bruising of the lower leg is normal. This is a result of the fluid and blood in the knee or shoulder moving down the leg or arm due to gravity and should resolve in 10 to 14 days.

It is not uncommon to develop tenderness along the shin bone area. This is due to swelling and edema that is normally not present. If you experience severe calf pain or swelling, call the office immediately (201) 343-1717.


Physical therapy is a key component of recovery and usually starts the day following surgery. If your surgery is on a Friday, you should begin on the next business day. Beginning physical therapy as soon as you can after surgery will help you achieve the primary goals. Our primary objective following knee surgery is to obtain full knee extension. This is very important to achieve early post-operatively as it may become increasingly difficult to obtain, the more time that passes after surgery.

Full knee extension can only be achieved by activating and contracting your quadriceps muscles, the muscles on the front of your thigh. The most important of the four quadriceps muscles is the vastus medialis oblique or VMO, the innermost (medial) of the four. The VMO muscle is crucial for full extension and patellofemoral tracking.

When you are not performing your home exercise program, keeping the leg elevated for the first few days will help control swelling.

DO NOT put pillows under the knee at any time immediately following surgery. Placing pillows under your knee will keep the knee from obtaining full extension, one of your primary goals following surgery.

To help gain full knee extension the first exercise is to do a Quad Set. Sit upright with your involved leg out straight and your uninvolved leg bent with foot flat on the floor or flat surface. Place a small rolled up towel under your ankle. Now contract your quadriceps muscles and try to touch the back of your knee to the flat surface you are on. Try not to push your leg down toward the flat surface but instead tighten your quads and act as if you are going to do a straight leg raise but without actually lifting. Pushing down will use your hamstrings, the muscles on the back of your thigh. The only way to actively achieve full extension is to tighten your quadriceps.

Depending upon your limitations after surgery, several exercises will be beneficial for you to do initially at home until instructed at physical therapy. These include: Quad Sets (described above), Ankle Pumps (moving your foot up and down like a gas pedal motion, and Straight Leg Raises. It is important to do these exercises at home 3 to 4 times per day.

Moving around after surgery will help diminish the risk of blood clots. Try to be as independent as possible without compromising your safety. The key to preventing blood clots is to avoid excessive bed rest.

Post-Op Office Appointments

Your post-op appointments will be scheduled typically 3-5 days following surgery. If for any reason they have not been scheduled, please contact our office at 201-343-1717.

Typically, your first post-op appointment should be on the first available day following surgery. It is important to make each of your post-op visits, especially your first visit where you will have your initial dressing changed.

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