Post-Surgery

Important Things to Know

 

Your Dressing

The dressing should be removed on the second day after your surgery. In other words, if you had surgery on Tuesday, you can take the bandages off on Thursday morning. If the wound is dry and does not leak from the second postoperative day until the third postoperative day. You can shower on the third day and get the incision wet if it is not draining any fluid. We do not recommend that you take a bath or go swimming until the sutures are removed. If you have a knee or shoulder replacement, we do not recommend showering until 1 week after surgery and not until there has been no drainage at all from the wound for 72 hours.

Showering without the shoulder immobilizer (sling) after shoulder surgery can compromise the surgical repair. We recommend purchasing a second sling to be used in the shower which can be left in the bathroom to dry between showers. You should change slings while lying flat on your back on a bed.

Sleeping After Shoulder Surgery

Sleeping is often uncomfortable after shoulder surgery. You may use pillows around the shoulder to make a support for it in order to get comfortable. Alternatively, to find a more comfortable position, you may elect to sleep in a reclining chair.

How To Wear Your Shoulder Immobilizer/Sling After Shoulder Surgery

You should wear the strap around your neck in the most comfortable position on your shoulders. The waist strap must only be worn at night when you sleep and can be removed during the day. The sling can be removed while lying on your back to bend and straighten the elbow. The sling can be removed for short periods if you are awake and the arm is well supported. Typing is generally allowed in the first two weeks postoperatively as long as the arm is supported, it is not used away from the body, and you do not type excessively. If you had arthroscopic rotator cuff repair, labrum repair, or shoulder stabilization, we generally do not recommend physical therapy before 4 weeks and do not recommend that you do any exercises until after that time. However, there are exceptions to these rules on an individual basis.

Using Your Cryocuff

The cryocuff will not be very effective until the second morning after surgery when you remove the bulky dressing. After that, you can place the cryocuff on the skin and it will be helpful to reduce pain and swelling. You can use it continuously, or as much as you like, providing you change the water every 45-60 minutes.

Antibiotics After Joint Replacement

Please let your doctor or dentist know you have a total joint replacement. While not known with certainty to be needed or to be effective for all patients, I recommend antibiotics for dental and oral procedures, as well as gastrointestinal and genitourinary procedures. Please call the office to get a prescription prior to any of the appointments mentioned above.

Post-Surgery

Anterior Cruciate Ligament

ACL surgery is generally done as out-patient surgery, which means you go home the same day as the operation. In some cases, if the operation is more complex and other ligaments are reconstructed, patients may stay overnight. Anesthesia for the surgery involves regional anesthetic with intravenous sedation. In some cases, a femoral or saphenous nerve block is used as well, which involves injecting anesthesia around a major nerve to the knee. General anesthesia is not required for the operation. The operation is performed by inserting a tendon graft into the knee arthroscopically that replaces the anterior cruciate ligament (ACL) . This graft may be either harvested from the patient (patellar tendon or hamstring tendons) or allograft tissue may be used (usually Achilles tendon transplanted from a donor). There are pros and cons to all graft choices and the operation is performed in the same manner, regardless of which tissue is used. Dr. Marx performs the procedure with each of the graft options and decides individually with each patient which is best for them. The graft is fixed in the knee with the use of screws, ligament buttons and/or staples, depending on which graft is selected.

After the surgery, the patient is kept in a brace for the first 5 days after surgery. Generally, we recommend to discontinue using the brace 5 days after surgery. An exception is if the meniscus is repaired (sutured to fix a tear), you will generally be non-weightbearing on the leg for 2-3 weeks and motion will be limited to 90 degrees for a total of 4-6 weeks after surgery. If you only required a meniscectomy (removing the torn meniscal tissue) and/or you have had an isolated ACL reconstruction (no other ligament reconstructions), then rehabilitation can start after 1 week so call to schedule your first physical therapy appointment 1 week after surgery. Physical therapy is recommended 2-3 times weekly for 6-12several months. Most patients who have isolated ACL reconstructions can walk normally by 4 weeks and can run and perform agility exercises by 4 months. Return to sport is between 6 and 12 months.

Risks of surgery include, but are not limited to, anesthesia, infection, re-operation, nerve or blood vessel injury, stiffness, graft rupture, deep venous thrombosis (blood clot in the veins of the legs) and pain.

Meniscus Surgery

Meniscus surgery is performed as an out-patient procedure, which means you come into the hospital for your surgery and go home the same day. The procedure is performed under regional anesthesia, which means the legs are frozen and you will receive intravenous sedation. No general anesthesia is required. The operation is performed using two small holes in the front of the knee, each measuring less than 1 cm. Depending on the type of tear in the meniscus, the meniscus is either repaired with sutures or the torn part is removed. The operation usually takes approximately 30 minutes. However, you must allow for the entire day due to pre-operative processing and post-operative recovery.

After surgery, if a meniscectomy (removal of meniscus tissue) is performed, crutches are recommended for 2 days or until you are walking perfectly, without a limp. The dressing is removed on the second day after surgery. That means if surgery is on Tuesday, you can remove the dressing on Thursday. If there is no leakage from the incisions on the third day after surgery, you can take a shower. Baths or pools are not recommended until the sutures are removed. Most patients can walk normally within 3-14 days after surgery. If the meniscus is repaired with sutures, in most cases you must use crutches for 2-3 weeks and not put weight through the leg. Range of motion is generally limited from 0-90 degrees after a repair for 4-6 weeks, followed by full range of motion.

After meniscectomy (removal of meniscus tissue), patients are generally allowed to start a very gradual return to sports between 6 and 8 weeks with return to full activity usually between 3 and 4 months. If a meniscal repair is performed, running and light sports begin at 3 to 4 months with full recovery at 5 to 6 months. After a meniscal repair, full squatting is not allowed until 6 months to protect the repair and allow it to heal.

Risks of surgery include, but are not limited to, anesthesia, infection, re-operation, meniscus re-tear, pain and stiffness.

Post-Surgery

Rotator Cuff Surgery

Rotator cuff surgery is performed as an outpatient procedure, which means you come to the hospital and go home on the same day as the operation. The procedure is done arthroscopically with a few small incisions (less than 1 cm) around the shoulder region. Regional anesthesia is utilized, which involves freezing the shoulder and intravenous sedation. General anesthesia is not required. The operation is done arthroscopically, which means that a camera is inserted into the shoulder through one of the small incisions, and instruments are used through other small incisions to perform the procedure. If your rotator cuff is intact or not completely torn, the operation will consist of removing bursa (inflamed tissue in the shoulder) and subacromial decompression (removal of a bone spur). If your rotator cuff is torn, it will be repaired to the bone using sutures. A small metal screw (anchor) is inserted into the bone, which has sutures attached to it. The sutures will be passed through the rotator cuff tissue, and a knot will be tied that holds the rotator cuff down to the bone. Over time, the rotator cuff will heal to the bone. It takes at least 6 weeks for the rotator cuff to heal to the bone, so you are not allowed to lift your arm (or even try to lift your arm) for 6 weeks. At 6 weeks, you can begin to lift your arm against gravity, but not lift any objects. At 12 weeks, you can start lifting light objects with your operated arm.

If your rotator cuff is not torn, then the recovery is much quicker and you can start using the arm as soon as it is comfortable. The use of a sling is generally recommended for 2 weeks, for comfort only. If the rotator cuff is repaired, you must keep your arm in a sling for 6 weeks and physical therapy is started at 4 weeks. Physical therapy is continued for several months to allow you to regain motion and strength in the shoulder. By 3-4 months, most people feel better than before the surgery and the improvement continues until 6 months after surgery. At 6 months, patients are allowed to return to all activities. Most patients continue to improve until 12 months after surgery.

Risks of surgery include, but are not limited to, anesthesia, infection, re-operation, stiffness, re-tear of the cuff (if repaired), nerve or blood vessel injury and pain.

Post-Surgery

Shoulder Stabilization

Your surgery will be done as an outpatient procedure, which means you come to the hospital and go home on the same day as the operation. Your operation is done under regional anesthesia, which means the shoulder is frozen with anesthesia, and you are given intravenous sedation. No general anesthesia is required. The procedure is done arthroscopically, which means a few small incisions are made about the shoulder, which are less than 1 cm in length each. The labrum (a cuff of cartilage on the shoulder joint) is repaired to the glenoid bone by suturing it. A small suture anchor (1 cm x 3.5 mm piece of plastic) is inserted into the bone and sutures attached to the anchor are passed through the labrum tissue. A knot is tied, repairing the labrum securely to the bone, which stabilizes the shoulder and repairs the labrum. If your shoulder is unstable and the labrum is not torn, the shoulder capsule will be tightened to prevent future instability with the use of multiple sutures placed arthroscopically.

After surgery, your arm is placed in a shoulder immobilizer (sling), which you use for 4 weeks. It is recommended that you sleep in the sling for a total of 6 weeks after surgery, but you only have to wear it during the day for 4 weeks after surgery. Physical therapy starts at 4 weeks, and you begin to regain range of motion. Full range of motion is regained by 2-3 months after surgery although it can take longer in some cases. Light weight-training can usually begin at 2 months after surgery, and full return to all activities is usually at 6 months after surgery.

Risks of surgery include, but are not limited to, anesthesia, infection, re-operation, stiffness, recurrent instability, nerve or blood vessel injury and pain

Post-Surgery

Labrum Repair

Your surgery will be done as an outpatient procedure, which means you come to the hospital and go home on the same day as the operation. Your operation is done under regional anesthesia, which means the shoulder is frozen, and you are given intravenous sedation. No general anesthesia is required. The procedure is done arthroscopically, which means a few small incisions are made about the shoulder, which are less than 1 cm in length each. The labrum (a cuff of cartilage on the shoulder joint)is repaired to the glenoid bone by suturing it. A small suture anchor (1 cm x 3.5 mm piece of plastic) is inserted into the bone and sutures attached to the anchor are passed through the labrum tissue. A knot is tied, repairing the labrum securely to the bone, which stabilizes the shoulder and repairs the labrum. If your shoulder is unstable and the labrum is not torn, the shoulder capsule will be tightened to prevent future instability with the use of multiple sutures placed arthroscopically.

After surgery, your arm is placed in a shoulder immobilizer (sling), which you use for 4 weeks. It is recommended that you sleep in the sling for a total of 6 weeks after surgery, but you only have to wear it during the day for 4 weeks after surgery. Physical therapy starts at 4 weeks, and you begin to regain range of motion. Full range of motion is regained by 2-3 months after surgery, although it can take longer for some cases. Light weight-training can usually begin at 2 months after surgery, and full return to all activities is usually at 6 months after surgery.

Risks of surgery include, but are not limited to, anesthesia, infection, re-operation, stiffness, recurrent instability, nerve or blood vessel injury and pain.

Post-Surgery

Total Knee Replacement

You arrive at the hospital on the day of your knee replacement and stay in the hospital 3 nights. After surgery, you can be discharged to your home or to a rehabilitation facility. If you elect to go home, physical therapy can be arranged at your home until you are able to travel to see a physical therapist at an out-patient facility.

Regional anesthesia will be used for your procedure, which involves freezing the legs as well as the use of a femoral nerve block (using local anesthetic to freeze the main nerve to the knee). You are also sedated for the procedure with intravenous medication. No general anesthetic is required.

The operation is performed using an incision in the front of the knee. The operation involves replacing the end of the thigh bone and the top of the lower leg bone as well as the back of the knee cap with metal and plastic implants. This eliminates the pain generated from the degenerative arthritic joint. Your rehabilitation starts the day after surgery and you are encouraged to get up and put full weight on the leg as well as begin bending it and straightening it immediately. It is critical to start bending and straightening the knee as soon as possible after surgery to regain range of motion. Range of motion must be regained by 6-8 weeks after surgery, because after that time, scar tissue forms and regaining motion becomes more difficult. Although it is uncomfortable to bend and straighten the knee in the first few weeks after surgery, this is critical to a successful result. The use of pain medication as required is encouraged to allow you to regain motion.

Recovery time varies greatly among patients, but most are able to get around well with the assistance of a cane or walker after a few days. Between 2 and 3 months, most patients begin to feel much better, and by the end of 3 months after surgery, almost all patients feel much better than before the surgery. Patients continue to improve until 6 months after surgery, and some continue to improve even after that point.

Risks of surgery include, but are not limited to, anesthesia, infection, re-operation, nerve or blood vessel injury, stiffness, implant loosening, instability and pain.

Post-Surgery

Total Shoulder Replacement

Your total shoulder replacement will be done the day you arrive at the hospital. Patients generally stay in the hospital for 2 days following their procedure. After 2 days, you can go home. The operation is performed under general anesthesia to fully relax the muscles around the shoulder which requires a breathing tube and a regional nerve block is also used to help prevent postoperative pain. An incision is made in the front of the shoulder to perform the operation. The operation involves replacing the top of the arm bone (humerus) with a metal ball attached to a pin that is inserted into the arm bone. The socket part of the shoulder (glenoid) is replaced by a plastic piece that is cemented into the bone. If the operation is being performed for a recent fracture, the glenoid is generally not replaced.

On the first day after surgery, physical therapy is started to begin moving the shoulder. A sling is worn for 8 weeks total. The therapy is done passively for the first 8 weeks, which means that you do not lift your arm on your own. Recovery time varies among patients but by 1 to 3 months, most patients feel much better than before the surgery, and by 3 months, almost all patients can use the arm well. Improvement continues, and by 6 months, function is normal in most cases.

Risks of surgery include, but are not limited to, anesthesia, infection, re-operation, stiffness, instability, nerve or blood vessel injury, implant loosening and pain.