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After your procedure

 

Post-operative instructions

Pain:

The first few nights, we encourage you to use the pain medication prescribed for you as needed to maintain your pain relief at 3/10 or below.  Please call if you feel that the pain medication prescribed for you is not effective in relieving your pain.  Use the sleeping pills on an as-needed basis if you have difficulty getting to sleep.

Dressings:

Your dressings may become moist the first night as a result of the arthroscopic fluid that was administered during your procedure.  If you are concerned, please call our office.  We will change the dressing at your post-operative visit.  You may reinforce the dressing with a rolled bandage from the pharmacy if it is slipping down or wet.

Aspirin:

Take 325mg a day starting the day after surgery for 10 days or until you are weight bearing without the use of crutches or a cane, whichever is longer.   

Ice:

The ice machine will be given to you at the surgery center. This will aid in decreasing swelling and increasing comfort. Be careful not to freeze your skin. Icing instructions will be given to you post-operatively based on your specific needs.

Showering:

We request that you keep the incision dry for the first few days. Please purchase a shower bag (available at our office) if advised.  After the first few days, if your incisions are small, you may shower directly on them, drying them with a clean, dry towel.  For the longer incisions, you will be allowed to shower as soon as the wound is dry (usually 3 – 5 days). If the Steri-Strips become loose, please place new Steri-Strips on or return to the office for a dressing change. After showering, please pour Isopropyl alcohol directly over your steri-strips to keep your incisions clean.

Incision / portal care:

You will be instructed on wound care when you come in for your post-operative visit. Your portals (arthroscopy holes) and incisions, if you have them, will be covered with steri strips.  Steri strips are white pieces of tape which reinforce the skin closure. The steri strips will remain in place until two weeks after surgery when you have your sutures removed. You are permitted to allow shower water to run over the steri-strips in the shower. After showering, pat the area of surgery dry with a clean towel, spritz the area  with rubbing alcohol which will be provided to you at your post-operative visit, and apply a new bandage.

Nursing visits:

A home healthcare provider can be scheduled to come to your home if necessary.  They will contact you to arrange a convenient time.

Post operative appointments:

We will see you back in The Stone Clinic the day after surgery at your scheduled appointment time. You will be here at least two hours. We will also need to see you 14 days post-op, one month, three months, six months, one year, and then yearly thereafter.  Depending on the procedures performed, x-rays and/or an MRI may be required. Please be diligent about follow-up appointments so that we can assess your outcome and improve the quality of care for all patients.

Elective surgery during the post-operative period:

We do not recommend patients get ANY elective surgery including dental work and plastic surgery, for 6 months following any implant surgery which involve the placement of allografts, hardware, uni-lateral joint replacement and total joint replacement). The American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) no longer suggest antibiotics be given prior to dental procedures, regardless of what type of surgery was performed and we follow their guidelines. If your dentist provides antibiotics prior to dental procedures as part of his or her protocol, we defer to his or her protocol.

 

Physical therapy

Arrange for physical therapy appointments at our office or a prescription can be given for therapy close to your home.  If you arrange for physical therapy near your home, please ask your therapists to fax progress notes to our office at 415-563-3301. Because the therapist can book up in advance, please schedule your post-operative physical therapy visits with the surgery scheduler at the time you schedule your surgery.  You may elect for single daily visits or twice daily sessions.

Once you return home, we encourage you to arrange for physical therapy three times a week for six weeks and then a strengthening program with a strength coach until you are fitter, stronger, and faster than before you were injured.

Find a Stone trained PT

The Stone Clinic has trained many physical therapists (PTs) around the world in the post-operative protocols required for our biologic and robotic joint replacements.

If you are coming from out-of-town, find out if there is Stone trained PT near you.

Or, you would like to work with your own PT, we also offer a free online course in the Stone Clinic Method, should they be interested in taking advantage of that. 

Learn more

Ankle / knee patients

Elevate:

It is important to elevate your knee and foot above the heart, the higher the better.

Foot pumps:

To prevent blood clots, point and flex the foot of your operative leg 10 times per hour during your waking hours.  Leg lifts--straight up and down--are also encouraged.

CPM (Continuous Passive Motion Machine):

If we have prescribed a CPM for your knee, please use as advised by Dr. Stone or Ann.  The rental company will set it up for you and will most likely contact you prior to surgery.  Most patients sleep in the machine in order to decrease stiffness when they wake up.  Please leave the settings on the CPM as they are set for you, unless specifically instructed otherwise.  We encourage you to try to use the machine at a slow rate for 6 hours per 24-hour period.  The amount of days to be used will be instructed by the nurse or rehabilitation department.

Shoulder patients

Take your surgical arm out of the sling occasionally and move elbow. Your physical therapist with guide you on how best to do this.

Post-operative travel tips

If you will be flying soon after your surgery, following are suggestions for the prevention of blood clots:

  • Avoid constrictive clothing
  • Avoid leg crossing
  • Change positions frequently while seated
  • Move around in the plane seat and cabin as much as possible.  (Do isometric calf exercises by flexing and rotating the ankles and wiggling the toes for a few minutes every half hour to prevent blood from pooling in the feet.)
  • Request bulkhead seating where there is more room to stretch your legs.  We can provide a letter to the airline.
  • Stay well-hydrated with water or non-caffeinated soft drinks or juices
  • Take only short naps, unless a normal sleeping position can be attained, such as in the business-class recliner seats
  • Wear compression stockings
  • Take a low dose aspirin before flying

Post-surgical icing routine 

Day of surgery:

The ice machine and wrap will be put onto your surgical site in the recovery room by the nursing staff. You will have a thick dressing of bandages between the ice pack and your body. Ice continuously with the surgical body part in elevation (if instructed to) until you see the clinical nurse for a bandage change the next day. You will also see a physical therapist at The Stone Clinic, where you will be instructed on a new icing schedule.

Please note: The post-surgical bandages are usually quite thick, inhibiting the amount of cold that can penetrate to the skin. This is the reason we allow continuous icing. The thick dressing will protect your skin from getting an ice burn! Most patients describe the icing over the thick dressing as “cool at best”. The icing should never be painful or make the skin turn white.

Day after surgery:

After the post-surgical bandages are removed, a much thinner bandage will be applied.. Your surgical body part will also be “waking up” from the anesthesia.

The new recommended icing schedule is 15 minutes on the body part, with 1 hour, 45 minutes or until the area being iced returns to room temperature with no ice pack on the body part. This cycle is continued throughout the waking hours.

The physiological effects of icing are reduction of inflammation/swelling and pain reduction. Icing causes constriction in the vessels, which decreases the blood flow to the area. It also slows down the conduction of the pain sensation in the nerves. As the ice pack is removed, the body reflexively dilates the vessels, causing blood to rush back to the body part. Therefore, the result of icing is vasopumping, which has been shown to be most effective in moving fluids and reducing inflammation.

It is not recommended to sleep with the ice, as the symptoms of an ice burn may go unnoticed. However, if you prefer to sleep with the ice, or have persistent swelling that causes your therapist to recommend sleeping with ice, you MUST place a towel between your skin and the ice pack. The sensation will be similar to the day-of surgery icing scenario.

The inflammatory process is most active in the first 24 hours after a surgery, persisting for up to 2 weeks. We recommend that you continue the aforementioned icing routine for the first 2 weeks after your surgery. This is a very effective way to maximize your healing environment.

Incision / portal care

It is important to keep the surgical portals as clean as possible. There are a few easy things that you can do to minimize the risk of an infection, which can complicate your surgery.

The Stone Clinic recommends that you keep the surgical portals dry until you are cleared to get them wet from the clinical nurse. It is generally recommended that you keep the portals dry until they stop oozing. This is usually 1-2 days. If oozing persists, a shower bag will be advised to use so that you can shower safely.

Once oozing stops, you can get your surgical portals running water wet. This includes a shower. However, please avoid immersion (pool, bath, hot tub) until the portals are completely closed and healed.

You will be provided with a spray bottle filled with 70% isopropyl alcohol to spritz the surgical sites with. The alcohol is applied after a shower, exercising, or any time you would like to clean the surgical area.

It is best to mirror the wound care that you observe at The Stone Clinic. Doing such will reduce the risk of a skin infection and optimize your healing environment. Please avoid touching the wound area, it will heal best if left alone.

Partial knee replacement / MAKOPLASTY post-operative instructions

Rest at home for the remainder of the day after surgery.

To minimize swelling and pain, we advise you to keep the affected limb elevated above the heart level and ice for the next 12 hours – 24 hours. Use pillows to help elevate the limb.

The bandages may become soiled due to post-operative drainage from the extremity. This is common. If this occurs, additional bandages can be added. However, in case of excessive drainage through the bandage, you can call the office and the answering service will contact Dr. Stone’s nurse practitioner, Ann Walgenbach, or Dr. Stone. The dressing will be changed at your post-operative appointment the day after surgery.).

If you have had general anesthesia or any sedation, you should not drive or operate complicated machinery. Start with light food or liquids and advance your diet as tolerated.

Notify Dr. Stone if you develop excessive pain, chest pain, swelling, bleeding, or develop a fever over 102 degrees.

For the management of pain at home use the following: for minimum pain (level 1-3) take 1-2 extra strength Tylenol; for moderate pain (level 4-6) take 1-2 tablets of your prescription pain medication; for severe pain (level 7-10) take 2 of your prescription medication. If the pain is not relieved approximately 60 minutes after taking your maximum dose of your pain medication, call the Stone Clinic office and the answering service will contact Ann or Dr. Stone.

Please take 325mg TWICE a day starting the day after surgery for one month. Please also take a stomach protector such as Pepcid, Zantac or Protonix while taking antiinflammatories to try to help prevent an ulcer.

Return to the Stone Clinic per your scheduled time (arranged through the office) for follow up.

The Z-Lig™ ACLR Device, invented by Kevin R. Stone, M.D. and subsequently developed by Aperion Biologics, has been cleared for marketing and distribution in the European Union and other markets which recognize the CE Mark.
Calm, happy patients make calmer, happier surgeons. It adds up to better outcomes. Though it’s hard to prove, the more the patient helps the surgeon relax, the better the surgeon perceives the patient and the job ahead. I know, having been both the surgeon and the patient.
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Kevin R. Stone · Jonathan R. Pelsis · Scott T. Surrette · Ann W. Walgenbach · Thomas J. Turek 

Stone, K.R., A.W. Walgenbach, T.J. Turek, A. Freyer, and M.D. Hill. 2006.