Postoperative Instructions for Knee Arthroscopy
Christopher D. Casscells, M.D. and David K. Solacoff, M.D.
R.I.C.E.: You should plan to spend the first two to four days following your arthroscopy resting with the leg elevated, an ice pack or cold unit on the knee, and an Ace bandage for compression. This is all to prevent bleeding and swelling. You recovery will be much faster if you have less bleeding and less swelling. Furthermore, swelling causes pain. In order to minimize swelling, we use the mnemonic RICE for Rest, Ice, Compression and Elevation. Please note that alcohol, aspirin, Motrin or ibuprofen, and Aleve will all increase bleeding and possibly make your swelling and pain worse. After several days of rest, you may begin to move around progressively more. If you have an increase in pain and/or swelling—you are doing too much.
Dressings and Bandages: If your knee has a simple bandage on, it may be removed in three days. Afterwards, if you feel more comfortable with an Ace bandage or some other protection over the wounds, feel free to cover them as needed, but make sure that whatever dressing you choose is loosely wrapped so that you do not develop distal swelling and edema. In general, keep the wounds clean and dry and do not touch them. The chief role of postoperative dressings is to protect the vulnerable wounds from curious fingers. If you sense that the adhesive on the Steri-Strips is causing itching, you may be allergic to it and they should be removed. A little cortisone cream or Benadryl cream will relieve the itching promptly. If the wound is dry, you may shower taking care not to scrub the wound. Steri-Strips on the wounds should be left alone and blotted dry and/or air dried if they are wet. (You may use a hair dryer if necessary.) The wounds should be covered when dry with an over-the-counter triple antibiotic ointment or Neosporin for protection. Usually, your stitches will be buried beneath the skin and do not need to be removed. If your wound begins to get a lot of redness around it like an intense sun burn, you should call the office immediately. You may need some antibiotics. Please try to check your temperature before you call.
Braces: If your knee is in a brace following surgery, it is there either to hold your leg still and keep it from bending or to provide you with some support as an aid to ambulation. In general, the brace should be on when you are bearing weight and moving around, but it can be loosened or removed when you are non-weight bearing. Often the brace must be loosened or removed in order to get adequate cold from the ice packs or cooling unit.
Swelling: Swelling in the knee is fairly normal, especially early on after surgery. It can cause quite intense pain in the knee, especially as the numbing medicine wears off and sensation returns with a crescendo-type discomfort. If the pain does not resolve with cool compresses such as the EBI ice unit, ice bags or a cryo cuff, along with pain medication, you should call the office and arrange to have the knee drained. This will relieve the pain abruptly. Swelling in the knee will often give the sensation of the knee buckling backwards. So if you have a sense of back knee instability, it may be because of a collection of fluid in your knee—“water on the knee.” If you are in a lot of discomfort, call the office to have the knee drained.
Pain Medication: If you have pain, take your medicine. Some people require very little pain medicine and some require a great deal more. This is highly variable. Some people “do not like pills” and tend to remain excessively inactive in order to avoid pain. Pain medicine can help you mobilize during the recovery. You may take as much as two pain pills every three hours provided you are in a great deal of pain. After a few days you should require very little, if any, pain medication. If you take a lot of pain medication in anticipation of pain but do not, in fact, have any pain, the medication will be overly sedating and unsafe. If you require more than two pain pills every three hours and you have attempted rest, ice, compression, and elevation, then you should call the doctor on call since this represents an abnormal amount of pain and might require different measures. Please do not take any other home remedies or illegal drugs or alcohol in attempts to relieve the pain. This could be fatal.
Anesthesia: Whether you had general anesthesia, local anesthesia, or a spinal anesthetic, your knee will have been injected with a Novocaine-like medicine which should prevent most of your pain for several hours. Occasionally, we will also use a femoral nerve block for this effect. Some of the numbing effect may extend down your leg as well. This is normal. Even though your knee does not hurt, you should go home and rest, keeping the knee cool with an ice bag or cooling unit to prevent swelling, and elevate the leg. As the numbing medicine wears off, you may take the pain medication prescribed for you in your preoperative office visit.
In most cases, you will remember most of the procedure if you had local anesthesia. In some cases, some of the medications given to help you relax will cause a loss of short term memory. This is normal. If you had general anesthesia, you may not remember any of the operation and even forget some things from shortly before the operation and have spotty memories of some of the time after the operation. It is important to have a companion or family member with you to help remember instructions given to you postoperatively. Otherwise refer to this document, rather than other instructions you may have been given by hospital employees.
Nausea: Some narcotic pain medication may cause nausea and most will cause constipation. In general, if you take pain medication in the absence of pain you will be more likely to feel nausea. The side effect of nausea can be alleviated by taking a smaller dose of the medication, breaking the pills in half, switching to a different preparation of medication, or substituting a medication known to be tolerated like Tylenol or Advil. Nausea may also be relieved by taking 25 mg of Benadryl every four hours, but be prepared to be a little sleep y from this medication. Benadryl, Tylenol and Advil can be obtained without a prescription. By taking your narcotic medication with a little bit of peanut butter you may also alleviate the nausea reaction.
Fevers: It is not unusual for bleeding inside a joint to cause a fever of 101°F or even 101.5°F. This will usually be accompanied by a warm sensation in the knee which will feel hot to the touch. This is fairly normal and usually does not represent an infection. However, if you have repeated fevers to 101.5°F or higher, you should contact our office immediately. Other signs of infection would be redness around the wound or purulent material draining from the wounds. We rarely see infection within the first 48 hours following surgery. Abnormal swelling or red appearance of the wounds accompanied by a fever after the first 48 hours is worrisome and you should call the doctor and potentially start some antibiotics.
Stitches: Your stitches are buried beneath the skin and do not need to be removed. On occasion, your body may have some difficulty dissolving the stitches, in which case you may “spit a stitch.” This is nothing g more than your body trying to extrude a stitch and its knot. This usually occurs after a few weeks and is accompanied by a small red pimple in the area of the stitch. If you are comfortable, you can grab a knot, cut and remove the stitch, and apply an over-the-counter triple antibiotic ointment to the area. The irritation will resolve immediately. If you are not comfortable with this, then come to the office and we can remove the stitch.
Returning to Work: If you are not confident about your ability to do your job or return to work safely, call the office and we will discuss whatever documentation you feel necessary to validate your absence from work.
Driving: You should not drive until your pain has decreased to a level where you do not have sharp pains when moving and you are not taking any narcotic medicines.
Running out of Medicine: Some medications such as OxyContin or oxycodone (which is the active narcotic ingredient in Percocet, Endocet and Roxicet) are Schedule II narcotics and cannot be telephoned into a pharmacy. They cannot be renewed or given refills. They can only be prescribed individually by paper prescription. However, there are several adequately strong pain medications which can be telephoned into your pharmacy if you run out of medication. We only renew narcotic prescriptions during working hours 8 a.m. to 5 p.m. Monday through Friday. We do not authorize the on-call physician to renew narcotic medications at night or on weekends. As such, you must keep track of your pills to make sure you do not run out during off hours or weekends. You may leave a message to renew your medication with our nurse by dialing Glasgow at 302-832-6220 or Concord Plaza at 302-477-0900 and following the prompts for the nurse. The nurse will review your chart and, if appropriate, renew your prescription after consultation with the physician.
When in Doubt: If you have an emergency after hours, call the doctor on-call at 302-477-0900 and follow the prompts for emergencies. Please leave a message and your callback number. This is for emergencies only, so please be considerate of the on-call physician who may be preoccupied with surgery or another emergency. This is not to be used for routine daily business or non-emergent questions. Please leave your message and telephone number and when you can be reached and we will return the call.
Follow-up Appointments: In most cases, you should see your doctor and have the wound examined within two to three weeks after surgery. If you feel it is necessary, certainly call and see the doctor earlier. In the meantime, if you require assistance at home, we may be able to arrange to have a visiting nurse provide you with nursing care and even physical therapy at home if you are having trouble getting around. This can be arranged on the telephone by simply calling one of the nurses in the office.