Initial Postoperative Instructions for Knee Arthroscopy

Transcription

1 Initial Pstperative Instructins fr Knee Arthrscpy Dr. Mia S. Hagen Medicatin: Yu will receive the fllwing prescriptins: Nrc this is a narctic cmbined with Tylenl. The narctic can have side effects such as cnstipatin, nausea, vmiting, itchy rash, and it can make yur head feel full/lightheaded/weird. D nt take with alchl r additinal Tylenl as it can put yu at risk f liver damage. Yu can take 1-2 pills every 4 hurs as needed fr pain. Naprxen this is an anti- inflammatry. Yu will take a prescriptin- strength dse f this fr 10 days and then yu can taper. Take with fd and d nt cntinue taking if it causes pain in yur stmach. Yu will take this twice a day. Clace this prevents cnstipatin caused by Perccet. Yu can take this twice a day. Zfran this is t prevent nausea/vmiting caused by Perccet. Als taking the Perccet with fd can help. Yu can take ne pill every 6 r 8 hurs. If yu experience itchiness yu can take ver- the- cunter Benadryl. Yu can take ne 25 mg tablet every 6 r 8 hurs. If yu are at an increased risk f bld clts yu will likely receive a 2- week prescriptin f lw- dse Aspirin, ne pill taken daily. Dressing: Yu may remve yur dressing after 48 hurs. It is nrmal t see bldy bandages when yu take ff the dressing. Leave the tape strips ( Steri- Strips ) ver yur incisins. D nt remve. They will stay n fr 1-2 weeks and slwly peel ff. Yu can apply gauze r Band- aids ver the wunds, make sure yu change them daily. Yu may shwer and let the water run ver yur incisins (and white tape strips) 48 hurs after yur surgery. D nt scrub the incisins. Gently pat dry. D nt sak the incisins in a bath, ht tub, r pl until at least 3 weeks after surgery. Yur stitches are absrbable and will nt need t be remved. DO NOT APPLY LOTION/OINTMENT TO YOUR INCISION. Yu will be given thigh- high cmpressin stckings after surgery. These are t reduce the risk f bld clts. They als decrease swelling in yur feet after surgery. Yu shuld wear these at all times fr the first 2 weeks after surgery. Yu may take them ff t sleep, shwer r t clean them (hand wash then air dry). Alternatively yu can use an ace wrap. Weight bearing & activities: Fr the first 24 hurs after surgery yu shuld use crutches and try nt t put any weight n yur leg. After 24 hurs yu can prgressively put mre weight n yur leg with the crutches. Yur therapist will help yu get ff f the crutches when yu are ready. University f Washingtn Department f Orthpaedics & Sprts Medicine Page 1 f 7

2 Meniscus repair: yu must stay nn- weight bearing with brace and crutches. Keep the brace lcked in extensin when ambulating. Yu will wear the brace fr 6 weeks. Yu may remve it fr shwering. Rest and elevate yur leg (abve the level f yur heart if pssible) fr the first 24 hurs by placing a pillw under yur calf and/r ankle. D NOT place a pillw under yur knee as it will keep yu frm straightening yur knee. IT IS VERY IMPORTANT TO GET YOUR LEG AS STRAIGHT AS POSSIBLE AS SOON AS POSSIBLE. Start physical therapy (PT) within the few days after surgery. Please give the Pst- Operative Knee Scpe Rehabilitatin guidelines (pages 5-7 f this packet) t yur PT. Ice/Ice Cling Unit:! Icing will help a lt with pain.! Ice up t 20 minutes every hur. Use rutinely fr the first 2 days. Then yu can taper t at least 3 times per day fr 2 weeks, and then as needed after that.! D nt put ice in direct cntact with skin. If yu have an ice cling unit, d nt place the pad in direct cntact with skin.! D nt wear ice r cling unit when yu are sleeping it can burn yur skin and lead t serius injury. Fllw- up: Yu will be seen by Travis, ur physician assistant at 1-2 weeks after surgery fr a wund check and remval r trimming f stitches. Yu will be seen by Dr. Hagen at 4-6 weeks after surgery. Timing and length f additinal fllw- ups will be determined by yur prgress. Crutch Use T walk with crutches: Pull crutches under yur arms and press them int yur ribs Mve the crutches ahead f yu 6-12 inches Push dwn n the handgrips as yu step up t r slightly past yur crutches Make sure t bear weight n yur hands, nt under yur arms Check yur balance befre yu cntinue T sit dwn in a chair: Back int the chair until yu feel it n yur legs Put bth crutches in yur hand n the affected side, reach back fr the chair with the ther hand Lwer yurself int the chair T get up frm the chair: Hld bth crutches n yur affected side Slide t the edge f the chair Push dwn n the arm f the chair n the gd side Stand up and check yur balance Put crutches under yur arms, pressing crutches int ribs Ging upstairs: Start clse t the bttm step, and push dwn thrugh yur hands Step up t the first step, remember t gd ft ges up first! Next, step up t the same step with the ther ft, making sure t keep the crutches with yur affect leg Check yur balance befre yu prceed t the next step Make sure smene is there if yu need it Ging dwnstairs: Start at the edge f the step, keeping yur hips beneath yu. Slwly bring the crutches with yur affected limb dwn t the next step (the perative leg ges dwn first!) Be sure t bend at the hips and knees t prevent leaning t far frward, which culd cause yu t fall Make sure smene is there if yu need it University f Washingtn Department f Orthpaedics & Sprts Medicine Page 2 f 7

3 Initial Pstperative Exercises t help yu achieve yur mtin: Slide heel back as far as pssible Heel Slides flexin Slide heel back, bending the knee Seated Knee extensin Pillw under calf r ankle (nt under knee!) fr minutes Initial Pstperative Exercises t help yur leg strength: Quad sets Tighten quad, push knee dwn Raise Lift leg as demnstrated Straight Leg Lift leg as demnstrated Adductin Abductin Lift leg as demnstrated Initial Pstperative Exercises t help prevent bld clts: University f Washingtn Department f Orthpaedics & Sprts Medicine Page 3 f 7

4 Pump ankle up and dwn Ankle Pumps After Surgery, Call the Clinic if yu have A fever higher than 101 (38.3 C) Changes in yur incisin: Opening Drainage Redness Numbness, tingling, r lss f functin f yur leg. Increased pain in the knee that is nt helped by yur medicatins. Increased pain r swelling in yur calf. Nausea r ther side effect nt cntrlled by the medicatins yu are given. Any symptm yu d nt fully understand. Call immediately if yu have: Chest pain Shrtness f breath Number t call during business hurs (8 am 5 pm, M- F, excluding hlidays): (206) Wait fr Optin 8 and ask t speak t a nurse. Number t call after hurs: (206) Yu shuld receive a call back within 30 minutes. If nt, call again. Please d nt hesitate t call us if yu have any questins r cncerns!! Prescriptin Refills: Call (206) x8. Call befre running ut f yur medicatin please allw 3 business days fr refills. D nt have yur pharmacy call us, we must speak directly t yu. Perccet and ther narctic pain prescriptins cannt be faxed/mailed t the pharmacy they must be picked up frm the clinic r mailed t yur hme. University f Washingtn Department f Orthpaedics & Sprts Medicine Page 4 f 7

5 Day 1 instructins: Pst- Operative Knee Scpe Rehabilitatin Dr. Mia S. Hagen Please give this handut t yur therapist Fr first 4 weeks, 2-3 visits per week + 5x/week hme prgram Gals Cntrl pain and swelling Nrmal extensin POD 1 Full WB n POD 1 Exercise Suggestins " Keep knee extended with leg n pillw under calf and ankle fr min, 4-6x/day " D nt put pillw under knee " Heel slides & seated flexin exercises " Quad sets: 5-10 per hur " Straight leg raise (SLR): 5 per hur " Hip abductin & adductin Ankle pumps Phase 1: Week 1 Gals Exercise Suggestins Days 1-3 Exercise Suggestins Days 3-6 University f Washingtn Department f Orthpaedics & Sprts Medicine Page 5 f 7

6 Restre full ROM Perfrm daily activities pain free Initiate gd strength and prpriceptin Nrmal gait pattern " Crutch wean " T D/C crutches: Must be able t perfrm SLR withut lag and ambulate withut limp Phase 2: Weeks 2-3 " AROM & PROM in supine and sitting as tlerated t flexin " Gentle stretching, prne lying " Standing TheraBand (TB) " Cntinue with SLR and quad sets " May use e- stim (increase # visits/week if quad inhibited) " Terminal knee extensin with TB: 2x15 reps (1-2x/day) Prpriceptin: " Balance n flr with ne ft 2 x 20 secnds (2x/day) Treatment: " Ice with elevatin minutes with ankle pumps " Patellar mbilizatin " AROM & PROM (t full) " Add seated & standing calf raises: 2x12 reps Prpriceptin: " Balance n flr with ne ft 2 x 60 secnds (2x/day) Treatment: " Ice with elevatin minutes with ankle pumps Gals Exercise Suggestins Days 1-4 Exercise Suggestins Days 4- end Exercise in full/pain free range Begin clsed chain exercises Please cntact surgen if gait is nt nrmal by 3 weeks " Passive, heel slides (maintain) " Flexibility stretching all majr grups " Shrt arc quads 2x10 (weight as tlerated) " Duble leg mini squats 2x20 " Step- ups: frward & lateral 2x12 " Hamstring curls " Te raises with weights Prpriceptin: " Balance n flr with ne leg 3 x 45 secnds Treatment: " Ice minutes " Maintain " Add varius duble leg mini- squats (stagger, ballet) 2x20 " Add step- ups: frward & lateral 3x15 " Advanced: single leg mini- squats, duble leg mini- squats n uneven surface (per PT) Prpriceptin: " Balance n flr with ne leg 3 x 1 minute " Advanced: balance n uneven surface, jump and balance n ne ft (per PT) Treatment: " As needed University f Washingtn Department f Orthpaedics & Sprts Medicine Page 6 f 7

7 Phase 3: 3+ weeks Additinal clsed- chain exercises (leg presses, step- ups, mini- squats, leg extensins, hamstring curls with light weights and high reps). Smth & slw: NO explsive reps. May advance t swimming at 1 mnth Endurance clsed- chain: Stairmaster, statinary bike, elliptical trainer, NrdicTrack. Begin slw jgging if ROM full, patient has full quad cntrl, and surgen allws impact exercises (n OA). Jg in cntrlled scenari. N cutting, jumping, r pivting. See separate Return t Running prgram. If indicated # Phase 4: Return- t- Sprt (Weeks 4+) Advanced strengthening with weights Plymetric prgram Functinal training exercises: fast straight running, backward running, cutting, crss- vers, carica, etc. Begin gradual return t previus sprts/activities/wrk duties under cntrlled cnditins Final clearance per treatment team (PT, ATC, PA- C, and surgen): Nrmal muscle strength in the invlved lwer extremity Jg and full speed run withut limp Full ROM N effusin r quad atrphy RESTRICTIONS: Synvitis: May use crutches 3-4 days. Prgress slwer per symptm reslutin. Meniscal repair: Hinged knee brace set 0-90, btain 90 flexin by 2 weeks NWB with crutches x2 weeks, then te tuch x2 weeks, then wean ff crutches at 4 weeks pstp Hinged knee brace lcked in 0 extensin when ambulating x 4 weeks then unlck when ambulating Unlck brace fr PT, sitting, sleep After 4 weeks can pen brace t full ROM Dc brace after 6 weeks N deep squatting x 3 mnths, avid frce hyperflexin f knee x 3 mnths Return t 3 mnths University f Washingtn Department f Orthpaedics & Sprts Medicine Page 7 f 7

8 Return- t- Sprt 4 mnths+ Please cntact Dr. Hagen with any cncerns. Mia S. Hagen, M.D Mntlake Blvd NE Bx Seattle, WA Phne: pt 8 Fax: smia@uw.edu University f Washingtn Department f Orthpaedics & Sprts Medicine Page 8 f 7