Post-operative instructions for achilles tendon repair

Surgery and Anesthesia

The surgical procedure takes approximately 45-60 minutes and is done under general anesthesia.An incision is made on the back of the lower leg. The surgical procedure involves sewing the torn ends of the ruptured Achilles tendon back together using strong suture material.

Dressing

Following surgery, the operative area will be wrapped in a hard splint for immobilization. The splint is to remain in place until your first post-operative appointment. Please do not attempt to remove it. You may shower; however, the entire splint must be wrapped in a bag to keep it completely dry. If the splint accidentally becomes wet for any reason, please contact the office immediately. You will be required to use crutches which will be given to you at the time of surgery. You may not place any weight on the operative leg.

Rest, Ice and Elevation

Use an ice pack or bag of frozen veggies for the first few days following surgery to help with pain control. Ice is helpful in reducing swelling which minimizes the requirements for narcotics. Place the ice directly over the painful areas.

Medication

You will be prescribed two medications following surgery: A pain medication and an anti-nausea medication.

Medication Tips

• Do not drive or drink alcohol beverages while taking pain medications.
• Pain medication should be taken with food to help prevent any stomach upset. You may also take the prescribed anti-nausea medication.
• Often pain medications will cause constipation. Eat high fiber foods and increase your water intake. You may also purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
• You should resume taking your normally prescribed medications unless otherwise directed.

Post-Op Appointment and Physical Therapy

Your first post-operative appointment will be 7-10 days following surgery. At this appointment, we will remove the splint and check your incision site to be sure it is healing properly. You will be transitioned into a hard walking boot. We will slowly progress your weight-bearing over the first few weeks until you are able to walk freely in the boot. Physical therapy will begin approximately 4 weeks after surgery once the tendon has had adequate time to heal. It is important to protect the repair during the first few weeks to allow for maximum recovery.

Questions/Concerns

Please contact the office by calling 703-810-5223 for any of the following symptoms:

• Fever greater than 101.5 degrees F for 24 hours.
• Severe pain unresponsive to narcotic medication.
• Numbness, loss of color, or coolness to touch in hand.
• Redness or swelling in the calf that does not resolve overnight.
• Difficulty breathing or shortness of breath, CALL 911.

Post-operative instructions for arthroscopic anterior cruciate ligament (ACL) reconstruction

Surgery and Anesthesia

The surgical procedure takes approximately 60-90 minutes and is done under general anesthesia. Two small incisions are made around the knee joint to accommodate the instruments. A third incision is made just below the knee to harvest the hamstring tendon and/or pull the new ACL graft into the knee.The arthroscope is attached to a camera to visualize and magnify the knee structures. During the procedure, the entire knee is examined including all the ligaments, bones, and cartilage. Repairs and corrections are performed as necessary.

• Autograft vs. Allograft: There are several options for ACL grafts. The most common graft used is a hamstring autograft (the patient’s own tissue). This graft requires a smaller incision and is less painful to harvest than the patellar autograft. Patients typically do better in the initial post-operative phase using a hamstring autograft. The anterior tibialis allograft (cadaver tissue) is used for patients who require revision surgeries or are not a candidate for an autograft.
• Meniscal Repair vs. Removal: The meniscus is a semi-lunar shaped piece of cartilage that acts as a “shock absorber” in the knee. Treatment options for a torn meniscus depend on the location of the tear, age and health of the patient, and activity level. The meniscus is repaired by stitching the torn edges together using suture material attached to a very small anchor. In order for a meniscal repair to heal, the tear must be near the outer edge of the meniscus where the blood supply is located. This is called the red-red or red-white zone. Patients undergoing meniscal repairs will be required to remain non-weight bearing for 4-6 weeks following surgery to allow the cartilage to heal. Meniscal tears in the central portion of the meniscus will not heal if a repair is performed due to the lack of an adequate blood supply. In these cases, a meniscetomy (removal of the torn segment) is performed. These patients are able to bear full weight on the operative leg immediately following surgery.

Dressing

Following surgery, the leg will be wrapped in a dressing from mid-thigh to the foot. A T-scope brace is fitted on top of the dressing and is locked in the extended position. A small amount of bloody drainage on the dressing is not unusual in the first day or two. If this occurs, the dressing can be reinforced with clean 4X4 gauze and an ACE wrap. The dressing is to remain in place for 48 hours and must stay completely dry. You may shower; however, the knee must be covered with plastic wrap before doing so. After 48 hours, you may remove the dressing down to the white tape strips that stick to the skin. These are Steri-strips and must remain in place. If the Steri-strips fall off before your first post-operative appointment, place Band-Aids over the incision sites and remaining Steri-strips. No baths, hot tubs, or swimming for 3 weeks following surgery to allow the incisions to fully close. After removing the dressing, place the brace back on the leg and tighten the straps, if necessary.

Rest, Ice and Elevation

Elevate your leg under the heel, not the knee, to prevent a flexion contracture or stiffness in the knee.The Cold Therapy unit is helpful in reducing swelling which minimizes the requirements for narcotics. Follow the instructions given at the time of discharge and use the cooling system a minimum of 12 hours/day for the first few days. Continuous use is allowed and encouraged as long as it is not uncomfortable. Do not let the cooling pad touch the skin. There should always be a dressing or cloth between the skin and the cooling pad.

Crutches and Brace

Full weight bearing on the operative leg with the brace in the locked position is allowed unless otherwise instructed following surgery. Crutches may be helpful for the first several days for stability and help with getting around.

Exercise

Begin the following exercises the night of surgery. Repeat the exercises 3-5 times per day and complete 10-15 repetitions.

• Quad sets: Push the back of the knee into bed and hold for the count of 10.
• Straight leg raises: Sitting in a seated position with the leg out straight in front of you, lift the leg off the bed a few inches and hold for a count of 10.
• Ankle pumps: Move the ankle up and down multiple times to encourage blood flow in the leg.
• Flexion exercises: With the leg in a fully straightened position, bend the knee to pain tolerance. Try to bend the knee a little more each time you complete the exercise.

Medication

You will be prescribed three medications following surgery: A pain medication, an anti-nausea medication, and Aspirin.

Medication Tips

• Do not drive or drink alcohol beverages while taking pain medications.
• Pain medication should be taken with food to help prevent any stomach upset. You may also take the prescribed anti-nausea medication.
• Often pain medications will cause constipation. Eat high fiber foods and increase your water intake. You may also purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
• You should resume taking your normally prescribed medications unless otherwise directed.
• Aspirin 325 mg has been prescribed to help prevent a blood clot in your lower leg. This medication should be taken twice daily (once in the morning and once in the evening) for 2 weeks following surgery.

Post-Op Appointment and Physical Therapy

Your first post-operative appointment will be 7-10 days following surgery. At this appointment, we will check your incision sites to be sure they are healing properly as well as your range of motion and your overall post-operative progress. You will also be given a prescription for physical therapy to begin as soon as possible. Appointments for physical therapy should be twice a week for 2-3 months. We recommend that you call to schedule those appointments prior to surgery since physical therapy offices fill quickly.

Driving

You may resume driving a vehicle when you have stopped your narcotic pain medication and you can comfortably bend and straighten your operative knee.

Questions/Concerns

Please contact the office by calling 703-810-5223 for any of the following symptoms:

• Fever greater than 101.5 degrees F for 24 hours.
• Severe pain unresponsive to narcotic medication.
• Excessive bleeding or vomiting.
• Numbness, loss of color, or coolness to touch in the foot.
• Redness or swelling in the calf that does not resolve overnight.
• Difficulty breathing or shortness of breath, CALL 911.

Post-operative instructions for arthroscopic labral repair

Surgery and Anesthesia

The surgical procedure takes approximately 60-90 minutes and is done under general anesthesia. Several small incisions are made around the shoulder joint to accommodate the instruments.The arthroscope is attached to a camera to visualize and magnify the shoulders tructures. During the procedure, the entire shoulder is examined including all the ligaments, bones, and cartilage. Repairs and corrections are performed as necessary.

• Labral Repair: The labrum is a soft fibrous tissue rim that surrounds the glenoid (socket) portion of the shoulder joint. The labrum helps to keep the head of the humerus (ball) in the socket and stabilize the joint. It also serves as an attachment point for several ligaments and tendons. A torn labrum is repaired by placing a small, plastic, bio-absorbable anchor with attached suture material into the rim of the glenoid. The suture is then weaved through the torn labrum and tied down pulling the torn tissue back down to the bone. In the case of a large tear and increased instability, multiple anchors are used.

Nerve Block

In most cases, anesthesia will offer to perform a nerve block prior to surgery. The purpose of the block is to help control the acute pain in the first 12-18 hours following surgery. The block is administered by the anesthesiologist in the pre-operative bay. It takes about 5-10 minutes and numbs the nerves of the operative shoulder and arm. The nerve block not only helps with post-operative pain, but also helps to decrease the amount of anesthesia needed during the surgical procedure.

Dressing

Following surgery, the shoulder will be wrapped in a dressing and a special sling is placed to protect the arm. A small amount of bloody drainage on the dressing is not unusual in the first day or two. If this occurs, the dressing can be reinforced with clean 4X4 gauze and tape. The dressing is to remain in place for 48 hours and must stay completely dry. You may shower; however, the shoulder must be covered with plastic wrap before doing so. After 48 hours, you may remove the dressing down to the white tape strips that stick to the skin. These are Steri-strips and must remain in place. If the Steri-strips fall off before your first post-operative appointment, place Band-Aids over the incision sites and remaining Steri-strips. No baths, hot tubs, or swimming for 3 weeks following surgery to allow the incisions to fully close.

Rest, Ice and Elevation

Use an ice pack, bag of frozen veggies, or cold therapy unit for the first few days following surgery to help with pain control. Ice is helpful in reducing swelling which minimizes the requirements for narcotics. If using the Cold Therapy unit, follow the instructions given at the time of discharge and use the cooling system a minimum of 12 hours/day for the first few days. Continuous use is allowed and encouraged as long as it is not uncomfortable. Do not let the cooling pad touch the skin. There should always be a dressing or cloth between the skin and the cooling pad.Lying flat in bed will be uncomfortable for several days. Sleeping with your back elevated on several pillows can be helpful.

Sling

Shoulder surgery requires a sling for post-operative protection. The sling is to be worn for the first month following surgery. You may remove the sling to allow elbow, wrist and hand motion only. No movement at the shoulder joint. No lifting of any kind with the operative arm. You should sleep with the sling on.

Medication

You will be prescribed two medications following surgery: A pain medication and an anti-nausea medication.

Medication Tips

• Do not drive or drink alcohol beverages while taking pain medications.
• Pain medication should be taken with food to help prevent any stomach upset. You may also take the prescribed anti-nausea medication.
• Often pain medications will cause constipation. Eat high fiber foods and increase your water intake. You may also purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
• You should resume taking your normally prescribed medications unless otherwise directed.

Post-Op Appointment and Physical Therapy

Your first post-operative appointment will be 7-10 days following surgery. At this appointment, we will check your incision sites to be sure they are healing properly as well as your range of motion and your overall post-operative progress. You will also be given a prescription for physical therapy to begin as soon as possible. Appointments for physical therapy should be twice a week for 2-3 months. We recommend that you call to schedule those appointments prior to surgery since physical therapy offices fill quickly.

Driving

You may resume driving a vehicle when you have stopped your narcotic pain medication and you are cleared by Dr. Novak.

Questions/Concerns

Please contact the office by calling 703-810-5223 for any of the following symptoms:

• Fever greater than 101.5 degrees F for 24 hours.
• Severe pain unresponsive to narcotic medication.
• Excessive bleeding or vomiting.
• Numbness, loss of color, or coolness to touch in hand.
• Redness or swelling in the calf that does not resolve overnight.
• Difficulty breathing or shortness of breath, CALL 911.

Post-operative instructions for arthroscopic rotator cuff repair

Surgery and Anesthesia

The surgical procedure takes approximately 60-90 minutes and is done under general anesthesia. Several small incisions are made around the shoulder joint to accommodate the instruments.The arthroscope is attached to a camera to visualize and magnify the shoulder structures. During the procedure, the entire shoulder is examined including all the ligaments, bones, and cartilage. Repairs and corrections are performed as necessary.

• Rotator Cuff Repair: The rotator cuff is a group of four tendons and muscles that help stabilize and rotate the shoulder joint. Tears in the tendon(s) cause pain and weakness with limitations in range of motion. A torn rotator cuff is repaired by placing a small, plastic, bio-absorbable anchor with attached suture material into the head of the humerus bone. The suture is then weaved through the torn tendon and tied down pulling the torn tissue back down to the bone. In the case of a large tear, multiple anchors are used.
• Subacromial Decompression: This procedure is performed in conjunction with repair of the rotator cuff to alleviate pain from inflammation and/or bone spur formation. Using a shaving instrument, the inflamed tissue is removed and the bone spurs are smoothed down.
• Distal Clavicle Excision: The AC joint is comprised of the junction between the acromion and end of the clavicle bone. Degenerative changes or arthritis of this joint causes pain and irritation. If these symptoms are present during your office visit, this procedure may be performed at the time of surgery to reduce the pain. A burring instrument is used to remove the end portion of the clavicle to allow for pain-free movement of the shoulder.

Nerve Block

In most cases, anesthesia will offer to perform a nerve block prior to surgery. The purpose of the block is to help control the acute pain in the first 12-18 hours following surgery. The block is administered by the anesthesiologist in the pre-operative bay. It takes about 5-10 minutes and numbs the nerves of the operative shoulder and arm. The nerve block not only helps with post-operative pain, but also helps to decrease the amount of anesthesia needed during the surgical procedure.

Dressing

Following surgery, the shoulder will be wrapped in a dressing and a special sling is placed to protect the arm. A small amount of bloody drainage on the dressing is not unusual in the first day or two. If this occurs, the dressing can be reinforced with clean 4X4 gauze and tape. The dressing is to remain in place for 48 hours and must stay completely dry. You may shower; however, the shoulder must be covered with plastic wrap before doing so. After 48 hours, you may remove the dressing down to the white tape strips that stick to the skin. These are Steri-strips and must remain in place. If the Steri-strips fall off before your first post-operative appointment, place Band-Aids over the incision sites and remaining Steri-strips. No baths, hot tubs, or swimming for 3 weeks following surgery to allow the incisions to fully close.

Rest, Ice and Elevation

Use an ice pack, bag of frozen veggies, or cold therapy unit for the first few days following surgery to help with pain control. Ice is helpful in reducing swelling which minimizes the requirements for narcotics. If using the Cold Therapy unit, follow the instructions given at the time of discharge and use the cooling system a minimum of 12 hours/day for the first few days. Continuous use is allowed and encouraged as long as it is not uncomfortable. Do not let the cooling pad touch the skin. There should always be a dressing or cloth between the skin and the cooling pad.Lying flat in bed will be uncomfortable for several days. Sleeping with your back elevated on several pillows can be helpful.

Sling

Shoulder surgery requires a sling for post-operative protection. The sling is to be worn for the first month following surgery. You may remove the sling to allow elbow, wrist and hand motion only. No movement at the shoulder joint. No lifting of any kind with the operative arm. You should sleep with the sling on.

Medication

You will be prescribed two medications following surgery: a pain medication and an anti-nausea medication.

Medication Tips

• Do not drive or drink alcohol beverages while taking pain medications.
• Pain medication should be taken with food to help prevent any stomach upset. You may also take the prescribed anti-nausea medication.
• Often pain medications will cause constipation. Eat high fiber foods and increase your water intake. You may also purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
• You should resume taking your normally prescribed medications unless otherwise directed.

Post-Op Appointment and Physical Therapy

Your first post-operative appointment will be 7-10 days following surgery. At this appointment, we will check your incision sites to be sure they are healing properly as well as your range of motion and your overall post-operative progress. You will also be given a prescription for physical therapy to begin as soon as possible. Appointments for physical therapy should be twice a week for 3-4 months. We recommend that you call to schedule those appointments prior to surgery since physical therapy offices fill quickly.

Driving

You may resume driving a vehicle when you have stopped your narcotic pain medication and you are cleared by Dr. Novak.

Questions/Concerns

Please contact the office by calling 703-810-5223 for any of the following symptoms:

• Fever greater than 101.5 degrees F for 24 hours.
• Severe pain unresponsive to narcotic medication.
• Excessive bleeding or vomiting.
• Numbness, loss of color, or coolness to touch in hand.
• Redness or swelling in the calf that does not resolve overnight.
• Difficulty breathing or shortness of breath, CALL 911.

Post-operative instructions for distal biceps tendon repair

Surgery and Anesthesia

The surgical procedure takes approximately 45-60 minutes and is done under general anesthesia.An incision is made where the elbow joint bends. The surgical procedure involves sewing the torn end of the ruptured biceps tendon and securing it back down to its insertion site on the radius bone.

Dressing

Following surgery, the operative arm will be wrapped in a hard splint from the hand to just below the shoulder for immobilization. The splint is to remain in place until your first post-operative appointment. Please do not attempt to remove it. You may shower; however, the entire splint must be wrapped in a bag to keep it completely dry. If the splint accidentally becomes wet for any reason, please contact the office immediately.

Rest, Ice and Elevation

Use an ice pack or bag of frozen veggies for the first few days following surgery to help with pain control. Ice is helpful in reducing swelling which minimizes the requirements for narcotics. Place the ice directly over the elbow area.

Medication

You will be prescribed two medications following surgery: a pain medication and an anti-nausea medication.

Medication Tips

• Do not drive or drink alcohol beverages while taking pain medications.
• Pain medication should be taken with food to help prevent any stomach upset. You may also take the prescribed anti-nausea medication.
• Often pain medications will cause constipation. Eat high fiber foods and increase your water intake. You may also purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
• You should resume taking your normally prescribed medications unless otherwise directed.

Post-Op Appointment and Physical Therapy

Your first post-operative appointment will be 7-10 days following surgery. At this appointment, we will remove the splint and check your incision site to be sure it is healing properly. You will be transitioned into a range of motion brace.Physical therapy will begin approximately 4 weeks after surgery once the tendon has had adequate time to heal. It is important to protect the repair during the first few weeks to allow for maximum recovery.

Questions/Concerns

Please contact the office by calling 703-810-5223 for any of the following symptoms:

• Fever greater than 101.5 degrees F for 24 hours.
• Severe pain, numbness, loss of color, or coolness to touch in hand.
• Redness or swelling in the calf that does not resolve overnight.
• Difficulty breathing or shortness of breath, CALL 911.

Post-operative instructions for fracture care

Surgery and Anesthesia

The surgical procedure takes approximately 60-120 minutes and is done under general anesthesia.

Dressing

Following surgery, the operative area will be wrapped in a splint for immobilization. If the upper extremity is affected, you will also receive a sling for comfort. The splint is to remain in place until your first post-operative appointment. Please do not attempt to remove it. You may shower; however, the entire splint must be wrapped in a bag to keep it completely dry. If the splint accidentally becomes wet for any reason, please contact the office immediately. For all lower extremity surgeries, you will be required to use crutches which will be given to you at the time of surgery. You may not place any weight on the operative leg.

Rest, Ice and Elevation

Use an ice pack or bag of frozen veggies for the first few days following surgery to help with pain control. Ice is helpful in reducing swelling which minimizes the requirements for narcotics. Place the ice directly over the painful areas.

Medication

You will be prescribed two medications following surgery: a pain medication and an anti-nausea medication.

Medication Tips

• Do not drive or drink alcohol beverages while taking pain medications.
• Pain medication should be taken with food to help prevent any stomach upset. You may also take the prescribed anti-nausea medication.
• Often pain medications will cause constipation. Eat high fiber foods and increase your water intake. You may also purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
• You should resume taking your normally prescribed medications unless otherwise directed.

Post-Op Appointment and Physical Therapy

Your first post-operative appointment will be 7-10 days following surgery. At this appointment, we will remove the splint and check your incision site(s) to be sure they are healing properly. You may be transitioned into a cast or type of brace. Physical therapy will begin approximately 4-6 weeks after surgery once the bone has had adequate time to heal.

Questions/Concerns

Please contact the office by calling 703-810-5223 for any of the following symptoms:

• Fever greater than 101.5 degrees F for 24 hours.
• Severe pain unresponsive to narcotic medication.
• Numbness, loss of color, or coolness to touch in hand/foot.
• Redness or swelling in the calf that does not resolve overnight.
• Difficulty breathing or shortness of breath, CALL 911.

Post-operative instructions for Makoplasty

Surgery and Anesthesia

A partial knee replacement utilizing the Makoplasty procedure is a safe and effective way to reduce pain due to arthritis when medications, exercises, and modification of activities are no longer helpful. The surgical procedure takes approximately 90 minutes and is done under general anesthesia. A vertical incision is made in the front of the knee to access the joint. During the procedure, the arthritic parts of the femur, tibia, and/or kneecap are removed and replaced with artificial components called a prosthesis. This procedure is typically performed as an outpatient. Some medical conditions or special circumstances may require a one night stay in the hospital after surgery.

Nerve Block

In most cases, anesthesia will offer to perform a nerve block prior to surgery. The purpose of the block is to help control the acute pain in the first two to three days following surgery. The block is administered by the anesthesiologist in the pre-operative bay. It takes about 10 minutes and numbs the nerves of the operative leg. The nerve block not only helps with post-operative pain, but also helps to decrease the amount of anesthesia needed during the surgical procedure.

Dressing and Compression Stockings

Following surgery, the leg will be wrapped in a dressing from mid-thigh down to the foot. A small amount of bloody drainage on the dressing is not unusual in the first day or two. If this occurs, the dressing may be reinforced with gauze. The dressing is to remain in place for 48 hours and must stay completely dry. You may shower; however, the knee must be covered with plastic wrap before doing so. After 48 hours, you may remove the dressing down to the white tape strips that stick to the skin. These are Steri-strips and must remain in place. If the Steri-strips fall off before your first post-operative appointment, place Band-Aids over the incision sites, visible stitches, and remaining Steri-strips. No baths, hot tubs, or swimming for 3 weeks following surgery to allow the incisions to fully close. The knee immobilizer must also be worn until the nerve block completely wears off. The compression stockings must be worn on both legs for the first 3 weeks following surgery to help decrease the risk of blood clots.

Rest, Ice and Elevation

Elevate your leg under the heel, not the knee, to prevent a flexion contracture or stiffness in the knee.The Cold Therapy unit is helpful in reducing swelling which minimizes the requirements for narcotics. Follow the instructions given at the time of discharge and use the cooling system a minimum of 12 hours/day for the first few days. Continuous use is allowed and encouraged as long as it is not uncomfortable. Do not let the cooling pad touch the skin. There should always be a dressing or cloth between the skin and the cooling pad.

Crutches/Walker/Cane

Full weight bearing on the operative leg is allowed and encouraged. Crutches, cane, or a walker may be helpful for the first several days to weeks for stability and help with getting around.

Post-Op appointment and Physical Therapy

Your first post-operative appointment will be approximately 7-10 days following surgery. At this appointment, we will check your incision site to be sure it is healing properly as well as your range of motion and your overall post-operative progress.

You will be given a prescription for outpatient physical therapy at the time of surgery that should be scheduled to begin within 4-5 days of surgery. Appointments for physical therapy should be twice a week for 2-3 months. We recommend that you call to schedule those appointments prior to surgery since physical therapy offices fill quickly.

Medication

You will be prescribed three medications following surgery: a pain medication, an anti-nausea medication, and Xarelto.

Medication Tips

• Do not drive or drink alcohol beverages while taking pain medications.
• Pain medication should be taken with food to help prevent any stomach upset. You may also take the prescribed anti-nausea medication.
• Often pain medications will cause constipation. Eat high fiber foods and increase your water intake. You may also purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
• You should resume taking your normally prescribed medications unless otherwise directed.
• Xarelto 10 mg has been prescribed to help prevent a blood clot in your lower leg. This medication should be taken once daily for 2 weeks following surgery.

Driving

You may resume driving a vehicle when you have stopped your narcotic pain medication and you are cleared by Dr. Novak.

Questions/Concerns

Please contact the office by calling 703-810-5223 for any of the following symptoms:

• Fever greater than 101.5 degrees F for 24 hours.
• Severe pain unresponsive to narcotic medication.
• Excessive bleeding or vomiting.
• Numbness, loss of color, or coolness to touch in hand.
• Redness or swelling in the calf that does not resolve overnight.
• Difficulty breathing or shortness of breath, CALL 911.

Post-operative instructions for medial patellofemoral ligament (MPFL) reconstruction

Dressing

Following surgery, the leg will be wrapped in a dressing from mid-thigh to the foot. A T-scope brace is fitted on top of the dressing and is locked in the extended position. A small amount of bloody drainage on the dressing is not unusual in the first day or two. If this occurs, the dressing can be reinforced with clean 4X4 gauze and an ACE wrap. The dressing is to remain in place for 48 hours and must stay completely dry. You may shower; however, the knee must be covered with plastic wrap before doing so. After 48 hours, you may remove the dressing down to the white tape strips that stick to the skin. These are Steri-strips and must remain in place. If the Steri-strips fall off before your first post-operative appointment, place Band-Aids over the incision sites and remaining Steri-strips. No baths, hot tubs, or swimming for 3 weeks following surgery to allow the incisions to fully close. After removing the dressing, place the brace back on the leg and tighten the straps, if necessary.

Rest, Ice and Elevation

Elevate your leg under the heel, not the knee, to prevent a flexion contracture or stiffness in the knee.The Cold Therapy unit is helpful in reducing swelling which minimizes the requirements for narcotics. Follow the instructions given at the time of discharge and use the cooling system a minimum of 12 hours/day for the first few days. Continuous use is allowed and encouraged as long as it is not uncomfortable. Do not let the cooling pad touch the skin. There should always be a dressing or cloth between the skin and the cooling pad.

Crutches and Brace

Crutches are to be used for the first 4-6 weeks. You may not place any weight on the operative leg until cleared to do so by Dr. Novak. The brace must remain in the extended, locked position and must be worn at all times.You may not bend your knee until you are evaluated at your first post-operative appointment. You may remove the brace for showering only.

Medication

You will be prescribed three medications following surgery: a pain medication, an anti-nausea medication, and Aspirin.

Medication Tips

• Do not drive or drink alcohol beverages while taking pain medications.
• Pain medication should be taken with food to help prevent any stomach upset. You may also take the prescribed anti-nausea medication.
• Often pain medications will cause constipation. Eat high fiber foods and increase your water intake. You may also purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
• You should resume taking your normally prescribed medications unless otherwise directed.
• Aspirin 325 mg has been prescribed to help prevent a blood clot in your lower leg. This medication should be taken twice daily (once in the morning and once in the evening) for 2 weeks following surgery.

Post-Op Appointment and Physical Therapy

Your first post-operative appointment will be 7-10 days following surgery. At this appointment, we will check your incision sites to be sure they are healing properly as well as your range of motion and your overall post-operative progress. You will also be given a prescription for physical therapy to begin as soon as possible. Appointments for physical therapy should be twice a week for 2-3 months. We recommend that you call to schedule those appointments prior to surgery since physical therapy offices fill quickly.

Driving

You may resume driving a vehicle when you have stopped your narcotic pain medication and you can comfortably bend and straighten your operative knee. This typically occurs approximately 4-6 weeks after surgery.

Questions/Concerns

Please contact the office by calling 703-810-5223 for any of the following symptoms:

• Fever greater than 101.5 degrees F for 24 hours.
• Severe pain unresponsive to narcotic medication.
• Excessive bleeding or vomiting.
• Numbness, loss of color, or coolness to touch in the foot.
• Redness or swelling in the calf that does not resolve overnight.
• Difficulty breathing or shortness of breath, CALL 911.

Post-operative instructions for open subpectoral biceps tenodesis

Surgery and Anesthesia

The surgical procedure takes approximately 60-90 minutes and is done under general anesthesia. First, several small incisions are made around the shoulder joint to accommodate the instruments.The arthroscope is attached to a camera to visualize and magnify the shoulder structures. During the procedure, the entire shoulder is examined including all the ligaments, bones, and cartilage. Repairs and corrections are performed as necessary.A subacromial decompression is often performed along with the biceps tenodesis. This procedure is performed to alleviate pain from inflammation and/or bone spur formation. Using a shaving instrument, the inflamed tissue is removed and the bone spurs are smoothed down.An additional incision is then made in the axilla area for the biceps tenodesis and is approximately one inch in length. The torn biceps tendon is detached from its insertion site inside the shoulder and is cleaned up and reattached lower in the arm in the bicipital groove.

Nerve Block

In most cases, anesthesia will offer to perform a nerve block prior to surgery. The purpose of the block is to help control the acute pain in the first 12-18 hours following surgery. The block is administered by the anesthesiologist in the pre-operative bay. It takes about 5-10 minutes and numbs the nerves of the operative shoulder and arm. The nerve block not only helps with post-operative pain, but also helps to decrease the amount of anesthesia needed during the surgical procedure.

Dressing

Following surgery, the shoulder will be wrapped in a dressing and a special sling is placed to protect the arm. A small amount of bloody drainage on the dressing is not unusual in the first day or two. If this occurs, the dressing can be reinforced with clean 4X4 gauze and tape. The dressing is to remain in place for 48 hours and must stay completely dry. You may shower; however, the shoulder must be covered with plastic wrap before doing so. After 48 hours, you may remove the dressing down to the white tape strips that stick to the skin. These are Steri-strips and must remain in place. If the Steri-strips fall off before your first post-operative appointment, place Band-Aids over the incision sites and remaining Steri-strips. No baths, hot tubs, or swimming for 3 weeks following surgery to allow the incisions to fully close.

Rest, Ice, and Elevation

Use an ice pack, bag of frozen veggies, or cold therapy unit for the first few days following surgery to help with pain control. Ice is helpful in reducing swelling which minimizes the requirements for narcotics. If using the Cold Therapy unit, follow the instructions given at the time of discharge and use the cooling system a minimum of 12 hours/day for the first few days. Continuous use is allowed and encouraged as long as it is not uncomfortable. Do not let the cooling pad touch the skin. There should always be a dressing or cloth between the skin and the cooling pad. Lying flat in bed will be uncomfortable for several days. Sleeping with your back elevated on several pillows can be helpful.

Sling

Shoulder surgery requires a sling for post-operative protection. The sling is to be worn for the first month following surgery. You may remove the sling to allow elbow, wrist and hand motion only. No movement at the shoulder joint. No lifting of any kind with the operative arm. You should sleep with the sling on.

Medication

You will be prescribed two medications following surgery: a pain medication and an anti-nausea medication.

Medication Tips

• Do not drive or drink alcohol beverages while taking pain medications.
• Pain medication should be taken with food to help prevent any stomach upset. You may also take the prescribed anti-nausea medication.
• Often pain medications will cause constipation. Eat high fiber foods and increase your water intake. You may also purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
• You should resume taking your normally prescribed medications unless otherwise directed.

Post-Op Appointment and Physical Therapy

Your first post-operative appointment will be 7-10 days following surgery. At this appointment, we will check your incision sites to be sure they are healing properly as well as your range of motion and your overall post-operative progress. You will also be given a prescription for physical therapy to begin as soon as possible. Appointments for physical therapy should be twice a week for 3-4 months. We recommend that you call to schedule those appointments prior to surgery since physical therapy offices fill quickly.

Driving

You may resume driving a vehicle when you have stopped your narcotic pain medication and you are cleared by Dr. Novak.

Questions/Concerns

Please contact the office by calling 703-810-5223 for any of the following symptoms:

• Fever greater than 101.5 degrees F for 24 hours.
• Severe pain unresponsive to narcotic medication.
• Excessive bleeding or vomiting.
• Numbness, loss of color, or coolness to touch in hand.
• Redness or swelling in the calf that does not resolve overnight.
• Difficulty breathing or shortness of breath, CALL 911.

Post-operative instructions for total knee replacement

Surgery and Anesthesia

A total knee replacement is a safe and effective way to reduce pain due to arthritis when medications, exercises, and modification of activities are no longer helpful. The surgical procedure takes approximately 120 minutes and is done under general anesthesia. A vertical incision is made in the front of the knee to access the joint. The knee joint is comprised of the distal end of the femur, upper portion of the tibia, and the patella. During the procedure, the arthritic parts of the femur, tibia, and kneecap are removed and replaced with artificial components called a prosthesis. This procedure is performed in the hospital and requires a two night stay for pain control and monitoring.

Nerve Block

In most cases, anesthesia will offer to perform a nerve block prior to surgery. The purpose of the block is to help control the acute pain in the first two to three days following surgery. The block is administered by the anesthesiologist in the pre-operative bay. It takes about 10 minutes and numbs the nerves of the operative leg. The nerve block not only helps with post-operative pain, but also helps to decrease the amount of anesthesia needed during the surgical procedure.

Dressing and Compression Stockings

Following surgery, the leg will be wrapped in a dressing from mid-thigh down to the foot. A small amount of bloody drainage on the dressing is not unusual in the first day or two. If this occurs, the dressing will be reinforced by the nurse. The dressing is to remain in place for 48 hours and must stay completely dry. It will be changed by my physician assistant prior to discharge from the hospital. After leaving the hospital, you may shower; however, the knee must be covered with plastic wrap before doing so. If the Steri-strips fall off before your first post-operative appointment, place Band-Aids over the incision sites. No baths, hot tubs, or swimming for 3 weeks following surgery to allow the incisions to fully close. The compression stockings must be worn on both legs for the first 3-4 weeks following surgery to help decrease the risk of blood clots.

Rest, Ice and Elevation

Elevate your leg under the heel, not the knee, to prevent a flexion contracture or stiffness in the knee.The Cold Therapy unit is helpful in reducing swelling which minimizes the requirements for narcotics. Follow the instructions given at the time of discharge and use the cooling system a minimum of 12 hours/day for the first few days. Continuous use is allowed and encouraged as long as it is not uncomfortable. Do not let the cooling pad touch the skin. There should always be a dressing or cloth between the skin and the cooling pad.

Crutches/Walker/Cane

Full weight bearing on the operative leg is allowed and encouraged. Crutches, cane, or a walker may be helpful for the first several days to weeks for stability and help with getting around.

Post-Op Appointment and Physical Therapy

Your first post-operative appointment will be approximately 14 days following surgery. At this appointment, we will check your incision site to be sure it is healing properly as well as your range of motion and your overall post-operative progress.

You will receive one-on-one and group physical therapy while in the hospital. Following discharge from the hospital, home physical therapy will be set up for you twice a week for 2 weeks. You will be given a prescription for outpatient physical therapy at your first post-operative appointment to begin once the home physical therapy is complete. Appointments for physical therapy should be twice a week for 2-3 months. We recommend that you call to schedule those appointments prior to surgery since physical therapy offices fill quickly.

Medication

You will be prescribed three medications following surgery: a pain medication, an anti-nausea medication, and Xarelto.

Medication Tips

• Do not drive or drink alcohol beverages while taking pain medications.
• Pain medication should be taken with food to help prevent any stomach upset. You may also take the prescribed anti-nausea medication.
• Often pain medications will cause constipation. Eat high fiber foods and increase your water intake. You may also purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
• You should resume taking your normally prescribed medications unless otherwise directed.
• Xarelto 10 mg has been prescribed to help prevent a blood clot in your lower leg. This medication should be taken once daily for 2 weeks following surgery.

Driving

You may resume driving a vehicle when you have stopped your narcotic pain medication and you are cleared by Dr. Novak.

Questions/Concerns

Please contact the office by calling 703-810-5223 for any of the following symptoms:

• Fever greater than 101.5 degrees F for 24 hours.
• Severe pain unresponsive to narcotic medication.
• Excessive bleeding or vomiting.
• Numbness, loss of color, or coolness to touch in hand.
• Redness or swelling in the calf that does not resolve overnight.
• Difficulty breathing or shortness of breath, CALL 911.

Post-operative instructions for total shoulder replacement

Surgery and Anesthesia

A total knee replacement is a safe and effective way to reduce pain due to arthritis when medications, exercises, and modification of activities are no longer helpful. The surgical procedure takes approximately 120 minutes and is done under general anesthesia. A vertical incision is made in the front of the knee to access the joint. The knee joint is comprised of the distal end of the femur, upper portion of the tibia, and the patella. During the procedure, the arthritic parts of the femur, tibia, and kneecap are removed and replaced with artificial components called a prosthesis. This procedure is performed in the hospital and requires a two night stay for pain control and monitoring.

Nerve Block

In most cases, anesthesia will offer to perform a nerve block prior to surgery. The purpose of the block is to help control the acute pain in the first two to three days following surgery. The block is administered by the anesthesiologist in the pre-operative bay. It takes about 10 minutes and numbs the nerves of the operative leg. The nerve block not only helps with post-operative pain, but also helps to decrease the amount of anesthesia needed during the surgical procedure.

Dressing and Compression Stockings

Following surgery, the leg will be wrapped in a dressing from mid-thigh down to the foot. A small amount of bloody drainage on the dressing is not unusual in the first day or two. If this occurs, the dressing will be reinforced by the nurse. The dressing is to remain in place for 48 hours and must stay completely dry. It will be changed by my physician assistant prior to discharge from the hospital. After leaving the hospital, you may shower; however, the knee must be covered with plastic wrap before doing so. If the Steri-strips fall off before your first post-operative appointment, place Band-Aids over the incision sites. No baths, hot tubs, or swimming for 3 weeks following surgery to allow the incisions to fully close. The compression stockings must be worn on both legs for the first 3-4 weeks following surgery to help decrease the risk of blood clots.

Rest, Ice and Elevation

Elevate your leg under the heel, not the knee, to prevent a flexion contracture or stiffness in the knee.The Cold Therapy unit is helpful in reducing swelling which minimizes the requirements for narcotics. Follow the instructions given at the time of discharge and use the cooling system a minimum of 12 hours/day for the first few days. Continuous use is allowed and encouraged as long as it is not uncomfortable. Do not let the cooling pad touch the skin. There should always be a dressing or cloth between the skin and the cooling pad.

Crutches/Walker/Cane

Full weight bearing on the operative leg is allowed and encouraged. Crutches, cane, or a walker may be helpful for the first several days to weeks for stability and help with getting around.

Post-Op Appointment and Physical Therapy

Your first post-operative appointment will be approximately 14 days following surgery. At this appointment, we will check your incision site to be sure it is healing properly as well as your range of motion and your overall post-operative progress.

You will receive one-on-one and group physical therapy while in the hospital. Following discharge from the hospital, home physical therapy will be set up for you twice a week for 2 weeks. You will be given a prescription for outpatient physical therapy at your first post-operative appointment to begin once the home physical therapy is complete. Appointments for physical therapy should be twice a week for 2-3 months. We recommend that you call to schedule those appointments prior to surgery since physical therapy offices fill quickly.

Medication

You will be prescribed three medications following surgery: a pain medication, an anti-nausea medication, and Xarelto.

Medication Tips

• Do not drive or drink alcohol beverages while taking pain medications.
• Pain medication should be taken with food to help prevent any stomach upset. You may also take the prescribed anti-nausea medication.
• Often pain medications will cause constipation. Eat high fiber foods and increase your water intake. You may also purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
• You should resume taking your normally prescribed medications unless otherwise directed.
• Xarelto 10 mg has been prescribed to help prevent a blood clot in your lower leg. This medication should be taken once daily for 2 weeks following surgery.

Driving

You may resume driving a vehicle when you have stopped your narcotic pain medication and you are cleared by Dr. Novak.

Questions/Concerns

Please contact the office by calling 703-810-5223 for any of the following symptoms:

• Fever greater than 101.5 degrees F for 24 hours.
• Severe pain unresponsive to narcotic medication.
• Excessive bleeding or vomiting.
• Numbness, loss of color, or coolness to touch in hand.
• Redness or swelling in the calf that does not resolve overnight.
• Difficulty breathing or shortness of breath, CALL 911.