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Knee Arthroscopy Post-Operative Care

The following are post-operative instructions for patients who have undergone arthroscopic surgery to their knee. Please refer to this reference sheet, which should probably answer most of the questions you might have. If you have further questions that need immediate answering, contact our office.
Following many knee procedures, you could walk out of the hospital bearing fully on your operative leg. On your discharge directions the exact amount of weight bearing will be specified. Even if it states full weight bearing we prefer that you unload the leg by using a pair of crutches for a couple of days. We feel you will be more comfortable, with less pain and swelling, if you utilize the crutches for a few days to lessen or avoid the weight bearing impact to your knee.
You will have a bulky dressing over your knee. Although it is very unlikely, you may notice some bloody spotting coming through the outer Ace wrap. It is important for you to watch this area, and contact us if it continues to spread. Otherwise, any small area of spotting will dry and can be ignored until you remove the dressings.
The sutures utilized in closing any wounds are usually an absorbable type buried under the skin, and will not need to be removed unless you are told otherwise. With a routine arthroscopy these are covered with a small tape strip (Steristrip). If a more extensive surgery was done there will be nonabsorbable sutures or staples.
Ice and elevation will help minimize the pain and swelling after surgery, especially during the first few days.  You can keep ice packs on the knee for 30 minutes every 1-2 hours during the first few days without risk of frostbite injury to the underlying skin as long as the original dressings are in place. The initial post-operative wrap involves multiple layers of cotton gauze and padding, therefore insulating the skin surface reasonably well. Once you have removed the original dressing I would recommend ice applications to the region for only 20 minutes at a time every 2 hours as needed for pain and swelling.
You can remove your dressings to shower on the second day following surgery (i.e., surgery on Thursday, shower on Saturday). Remove the dressings to the steristrips (which are small tapes glued to the skin). You can remove the dressings including the yellow guaze. The steristrips can get wet and do not require changing unless there is drainage from the wound. Use the Ace wrap for swelling. If there is any noticeable or persistent drainage from the incision sites, or any surrounding red areas, please contact us immediately.
Depending on the type of surgery you underwent you may be provided a prescription for formal physical therapy when you leave the hospital. All of the different therapy firms in our area are excellent with knee rehabilitation, so you are free to select your therapist. Although formal physical therapy is not 100% essential to obtain a good result with arthroscopic knee surgery, we believe it is definitely helpful in achieving the quickest and smoothest course to full recovery. Please schedule your therapy to begin within a few days following surgery. If you want to avoid a course of formal supervised rehab, please inform us so that we can discuss some independent home rehab options and techniques with you. Here are a few simple exercises that everyone can begin immediately.
Isometric Quadriceps Setting: Hold your knee straight and tighten your thigh as much as possible. Hold for three to five seconds, and repeat several sets. You can do this frequently throughout the day, whether sitting, standing, or lying down.
Straight Leg Raising: While lying on your back, hold your knee straight with the opposite knee bent and tighten your thigh. Then lift your leg a few inches off the floor and hold for several seconds.
Range of motion: Unless instructed otherwise, we encourage you to increase motion of your knee as soon as possible, within your comfort range. Bend and straighten your knee while sitting, standing, or lying down. Increase motion as tolerated. In the sitting position, you may do heel slides with the foot supported by the floor. You may have a brace for support and we will specify if it to be removed for motion exercises.
Ankle pumps:  Bend and straighten your toes frequently.  Pump your ankle up and down frequently.
Please call our office within a few days following surgery to schedule your first follow-up visit for 1-2 weeks after surgery. This can vary plus or minus depending on your schedule and ours, as there are no sutures to be removed.
You will be provided with a prescription for a pain medication when you are ready to leave the hospital. Usually we will prescribe hydrocodone, hydromorphone, or oxycodone. These are generic names for three different narcotic pain relievers. If you are aware of a certain pain medication that you have previously had problems with, or one that you normally respond favorably to, please inform us so that we can give you the appropriate prescription. You may have the prescription prior to surgery to avoid filling it the day of surgery.
You might also be given a prescription for an anti-inflammatory medication Toradol (ketorolac) that will help lessen pain and swelling. If not, you are welcome to use an over-the-counter anti-inflammatory such as Ibuprofen (Advil, Nuprin, etc.). These come in 200-mg tablets. The usual maximum adult prescription dosage is 600-800 mg three times per day, usually taken with food. This would amount to taking 9-12 store tabs per day. The anti-inflammatory medicine can be taken on a regular basis along with the prescription pain medication, which is utilized on an as needed basis. You will find that the combination will lessen your need for the prescription pain pill. If you have a history of ulcers or of stomach irritation with aspirin or anti-inflammatory drugs, then you should avoid taking these medications. If you have high blood pressure you should check your blood pressure to be sure these medications do not cause an elevation in your pressure.  If you have kidney problems you should avoid these medications.
Plain tylenol is OK if you have no liver disease. Remember, the short acting pain pills often have acetaminophen (Tylenol) in them. The maximum daily dose of Tylenol if you have a normal liver is 3500-4000 mg.  If your narcotic pain medicine is not lasting long enough you can use a little more or use if less often as long as you do not overuse the maximum daily acetaminophen dose.
If you have a history of nausea with surgery we can prescribe an anti-nausea medication (Phenergan or Zofran).  Try to take this medication regularly at first and prior to taking the narcotic pain pills to allow it to be most effective.
Please try to anticipate the need for any refills on your pain medication, and contact our office early in the day the day before running out completely. We strongly discourage calls for refills after business hours or on weekends.
Arthroscopic knee surgery is a fairly simple and minimally invasive outpatient surgery, so postoperative complications are fortunately quite rare. The incidence of an infection deep within the joint is literally one out of thousands. Onset of symptoms would be approximately 5-7 days following surgery, and would consist of a significant increase in pain, swelling, warmth, and redness of the extremity, fever, chills or night sweats. A small superficial infection or irritation at one of the skin incisions can occur. There can also be a very small incidence of a blood clot developing deep within your arm veins or leg veins. If you have had a previous blood clot, use estrogen, or have a family history of blood clots in the legs, arms or lungs you should probably be protected with TED hose and a blood thinner.  If we did not start this let us know.  If we recommended aspirin for blood clot protection you should use a single aspirin twice a day for 2 weeks or as long as the leg is immobilized.  A blood clot would be characterized by a sudden onset of new pain (usually different from your surgical lower extremity pain) or tightness in the upper arm or more commonly the leg. This usually begins about 5-7 days from the day of surgery. The presence or absence of a clot can usually be determined by a simple non-invasive ultrasound test at the hospital. Contact our office for any concems.