After any surgery you may be tired and drowsy. Rest and elevate the leg or use the sling if given. Slowly advance your diet starting with liquids. Be sure to take your medications as directed. Try to get a restful sleep and begin more normal activities in the morning.
The dressing may be removed on the first or second day after surgery. You may take a quick shower, and even get the sutures wet. After showering, dry the area and either cover with Band-Aids or leave open. Antibiotic ointment (Neosporin) may be applied. Call the office and you will be given a follow-up appointment.
After arthroscopic surgery of the knee or shoulder, and even joint replacement, it is important to remember that performing daily activities (like walking around, going up and down stairs, carrying light groceries, performing desk work and most nonstrenuous work tasks) will not cause any damage to your joint. Returning to normal activities will actually improve your recovery, by using your joint in a functional manner. Of course, if you had complex surgery like rotator cuff repair, ACL or joint replacement surgery, healing must take place and your recovery to normal activities will take more time.
Ice and elevation make the arm or leg less painful and swollen. Ice therapy often works better than oral pain medication and that is why we recommend the ice therapy machine. Apply ice therapy as often as possible while you are awake and especially after activities such as bike riding or swimming or exercises. Using a cold therapy device or an ice pack is recommended several times a day for 20 minutes at a time. Discontinue the ice therapy when it no longer reduces discomfort. Once the dressing comes off, ice application will be more effective.
It is normal to have some swelling after surgery. It gradually subsides but may be present for several days to weeks. Elevation, icing and wearing an elastic sleeve or ace bandage will help to reduce the swelling more rapidly. It is not unusual to have some redness around the wound and some clear, yellow or blood-tinged drainage. Bruising (black and blue) about the arm or leg is normal. Occasionally blisters may develop. They may open by themselves or we may open them in the office. If so, a dressing will be applied. Despite great care, any wound may become infected. The signs of infection are increasing pain, a lot of drainage or pus coming from the wound, with redness and fever. If infection is suspected, please call the office or go to your nearest hospital or the emergency department at Beth Israel Medical Center.
All medications prescribed should be taken as directed. I routinely prescribe an anti-inflammatory medication like Celebrex or Relafen. Do not take it if you are allergic to it or aspirin (hives or breathing difficulties). Check with your medical doctor if you have asthma, kidney, liver or heart problems. All medications of this type can have side effects such as bleeding, stomach upset, headaches, dizziness, etc. If you have any problem, stop the medication and call the office. I also prescribe a codeine-like painkiller. If you are allergic to codeine, please inform us and we will prescribe a different drug. If you have little pain, you may simply take Tylenol or nothing at all.
You may return to an office-type job within a few days after simple arthroscopic surgery of the knee or shoulder. The only restriction would be your own motivation and pain tolerance. If your job requires vigorous activities, or if you have to use public transportation (like the subway), then you must be the judge as to when you feel capable to return. You may go up and down stairs without injuring your knee but use a cane if you feel the need for more support.
As a general rule, you may resume driving as soon as comfortable after arthroscopic surgery and 4 weeks after joint replacement surgery, provided you feel capable and secure. Remember that the hip, knee or shoulder will not be damaged, but you must be comfortable enough not to put yourself or others at risk. You may take the train as soon as you are comfortable. Air travel is allowed as soon as you feel capable. However, if you had a joint replacement you should not fly before 6 weeks because of the increased risk of blood clots.
I recommend a therapy program under the supervision of a professional physical therapist for all my patients. You may start to exercise on your own, especially if you have access to a stationary bicycle, gym or pool. A prescription for physical therapy is provided for you. All complex procedures, such as rotator cuff repair, ACL surgery and joint replacement, require supervised physical therapy.
Knee: You may begin using a stationary or recumbent bicycle after surgery. Start with minimal tension and increase according to your comfort. Use a regular bike when you feel comfortable and safe. Adjust the seat to your comfort. If you have had a knee replacement, begin range of motion exercises and make sure you maintain 90° or more. Follow the instructions given by my office.
Hip: Begin walking, range of motion and muscle strengthening as taught in hospital. Follow the instructions given by my office. Abduction exercises with resistance are not to be done until seeing me 6 weeks after surgery.
Shoulder: For simple arthroscopic surgery you may remove your sling and begin pendulum and active exercises to regain your range of motion. If you had an arthroscopic rotator cuff repair or labral repair, no PT is prescribed until 6 weeks after surgery. You may remove the sling for eating, dressing and washing. It must be worn at night for sleeping. For complex repairs, in some cases physical therapy may be prescribed for passive motion only. No active lifting or moving of the arm is allowed for rotator cuff or labral repairs for at least 6 weeks.
Swimming: If you have access to a pool, you can swim as long as the wound has no drainage. Swim for 5-10 minutes and then dry the incisions. Do not swim in water over your head until certain of your capability. A Jacuzzi is permitted as long as the water is not too hot (less than 85º).Do not do any other type of exercising without checking with me.
-Steven F. Harwin, MD, FACS
By Dr. Steven Harwin