A Patient Guide to Surgery
Preparing for Knee Surgery
General Preparation
Preparing your home for Knee surgery is essential to ensure a smooth and comfortable recovery. Here are some steps you can take to get your home ready:
1. Create a Comfortable Recovery Space
Bed Accessibility: Set up a bed on the first floor if your bedroom is upstairs to avoid climbing stairs frequently.
Change bed linens: Clean bed linens can help with decreasing infection post-surgery.
Supportive Seating: Arrange a comfortable chair with a firm seat and back support. Ensure it’s easy to get in and out of, preferably with armrests.
Keep Essentials Within Reach: Place items like your phone, medications, water, snacks, and remote controls within easy reach of your recovery space.
2. Enhance Mobility and Safety
Clear Pathways: Remove any clutter, rugs, or obstacles from hallways and rooms to prevent tripping.
Install Handrails: Add handrails in the bathroom, along stairs, and near any steps to provide extra support.
Bathroom Safety: Place a non-slip mat in the shower or tub. Consider installing a shower chair or handheld showerhead.
Night Lighting: Ensure that your home has adequate lighting, especially for nighttime bathroom trips. Consider nightlights in hallways and the bathroom.
3. Prepare for Limited Mobility
Kitchen Setup: Arrange frequently used kitchen items (like utensils, cups, and dishes) at counter level to avoid bending or stretching.
Meal Preparation: Prepare and freeze meals in advance or stock up on easy-to-prepare foods.
Easy Access to Clothes: Keep comfortable, loose clothing easily accessible. Consider using a reacher or dressing aid if bending is difficult.
4. Arrange for Assistance
Mobility Aids: Have crutches, a walker, or a cane ready, as advised by your doctor.
Plan for Help: Coordinate with family or friends to help with daily tasks like grocery shopping, cooking, cleaning, or laundry.
Pet Care: If you have pets, arrange for someone to help with walking or feeding them.
5. Optimize Bathroom Access
Toilet Riser: Install a raised toilet seat to make sitting and standing easier.
Grab Bars: Install grab bars near the toilet and in the shower to provide additional support.
Shower/Bath Access: Consider using a shower stool or bath bench to avoid standing for long periods.
6. Prepare for Rest and Relaxation
Entertainment: Set up easy access to books, a TV, or a tablet with shows, movies, or games to keep you entertained during recovery.
Comfort Items: Have pillows, blankets, and ice packs available to keep you comfortable and to help with swelling.
7. Prepare for Emergency Situations
Emergency Contacts: Keep a list of emergency contacts easily accessible.
First Aid Kit: Ensure you have a stocked first aid kit in an accessible location.
Phone Access: Keep a phone with you at all times to call for help if needed.
8. Coordinate Post-Surgery Care
Schedule Physical Therapy: Set up any necessary physical therapy sessions in advance and plan for transportation if needed.
Arrange for Transportation: If you’re not allowed to drive, arrange rides to doctor’s appointments or other necessary outings.
Remember that your specific needs may vary based on the type of shoulder surgery and your individual circumstances. Consult with your Doctor or your physical therapist for personalized advice on preparing your home for a successful recovery.
What to Wear for Knee Surgery
For ACL surgery, it's important to wear comfortable, loose-fitting clothing that is easy to remove and put on. Here’s what you should consider wearing:
1. Comfortable, Loose-Fitting Clothing
T-Shirt or Loose Top: Wear a soft, loose-fitting T-shirt or top. Make sure it's easy to put on and take off.
Loose Shorts or Sweatpants: Choose shorts or sweatpants that are loose around the knee area. This is important because your knee will be bandaged after the surgery, and you’ll need room for that dressing.
Easy-to-Remove Shoes: Wear slip-on shoes or sandals that you can easily remove and put on without bending down. Avoid shoes with laces or anything that requires too much effort to wear.
2. Avoid These Items
Tight Clothing: Avoid tight-fitting pants, leggings, or any clothing that could put pressure on your knee.
Jewelry: Leave all jewelry at home, including rings, necklaces, and earrings.
Makeup and Nail Polish: It’s best to avoid wearing makeup or nail polish, as the medical team needs to monitor your natural skin color as part of your vital signs.
3. Prepare for Post-Surgery
Post-Surgery Clothing: Have a set of comfortable, loose-fitting clothes to wear home. You'll still have bandages and possibly a brace, so loose shorts, sweatpants, or a loose dress/skirt are good options.
Warm Layers: Hospitals can be chilly, so consider bringing a light jacket, sweater, or blanket to keep warm.
Comfort and ease of access are key, so choose clothing that accommodates these needs before, during, and after your ACL surgery.
Skin Preparation - Before Surgery
Using Chlorhexadine (CHG) wipes before surgery is a common practice to reduce the risk of infection. Here are general instructions on how to use the wipes properly before surgery:
Instructions for Using Chlorhexadine Wipes Before Surgery
1. Timing
Use Hibiclens wipes on the morning of your surgery.
2. Preparing
Shower First: Take a shower with regular soap and water before using the Hibiclens wipes. Ensure you rinse off all the soap thoroughly as Hibiclens should not be mixed with regular soap.
Dry Your Skin: Pat your skin dry with a clean towel before using the wipes.
3. Using the Hibiclens Wipes
Wipe Down Surgical Area: Use the wipes to gently cleanse the area where the surgery will be performed. This typically should include the front and back of the knee, along with half way up thigh and down calf. If instructed, you may need to wipe other areas as well, such as the torso or limbs.
Avoid Sensitive Areas: Do not use the wipes on your face, eyes, ears, mouth, genital area, or any open wounds. Hibiclens can be irritating to these areas. Wash your hands after use.
4. After Application
Let the Skin Air Dry: Allow the area to air dry completely. Do not rinse the skin after using Hibiclens wipes.
Wear Clean Clothing: After using the wipes, put on clean, loose-fitting clothing. Ensure that your bed linens are also clean.
5. Precautions
Do Not Use on Broken Skin: Avoid using Hibiclens on any broken skin, open wounds, or rashes unless instructed by your doctor.
Avoid Applying Lotions or Deodorants: After using the Hibiclens wipes, do not apply any lotions, creams, powders, or deodorants as these can interfere with the antiseptic effect.
By following these instructions, you can help reduce the risk of infection during and after surgery. If you have any questions or concerns, it’s best to contact your healthcare provider.
Cryotherapy
Cryotherapy or cold therapy, is an important and effective way to decrease pain and swelling following surgical intervention. “Ice Machines” are very popular for patients, but unfortunately are rarely covered by insurance (please check with your physician and DME office to check for availability). Typically, HSA/FSA funds can be utilized for purchasing. Research studies have shown that ice packs can be equally effective at the intended effect, but lack the convenience that ice machines can offer. If you elect to use an ice machine, please be sure to follow the appropriate guidelines to avoid injury such as frostbite.
General recommendations for use:
Follow Manufacturer's Instructions: Always read and adhere to the manufacturer's guidelines and instructions provided with the ice machine. These instructions typically include information on assembly, operation, and maintenance.
Check for Damage: Before each use, inspect the ice machine and its components for any signs of damage, such as cracks or leaks. Do not use the machine if it appears damaged.
Cleanliness: Ensure that the ice machine, its hoses, and any accessories are clean before each use. Use mild soap and water to clean them, and thoroughly rinse to remove any soap residue.
Proper Placement: Place the ice machine on a stable surface near an electrical outlet. Make sure the machine is level to prevent any spills or leaks.
Monitor Skin Sensation: Pay attention to how your skin feels during icing sessions. It's normal to feel numbness and cold, but if you experience any discomfort, numbness, or skin irritation, stop the icing session immediately.
Limit Duration: Avoid prolonged or continuous use of the ice machine. Follow your healthcare provider's recommendations regarding the duration and frequency of icing sessions. Generally sessions should be limited to 20-30 minutes with sessions every 2-3 hours for the first few days following surgery.
Use a Barrier: Place a cloth or towel between the skin and the ice pack to prevent direct contact and potential skin damage, such as frostbite.
Monitor Temperature: Keep an eye on the temperature of the ice water or air produced by the machine. Extreme cold can cause tissue damage, so ensure that the temperature is comfortable and not too cold for your skin.
Take Breaks: If using the ice machine for an extended period, take breaks to allow your skin to warm up and prevent overexposure to cold temperatures.
Discontinue Use if Problems Arise: If you experience any adverse reactions, such as increased pain, swelling, or skin irritation, discontinue use of the ice machine and consult your healthcare provider for further guidance.
Post Surgical Range of Motion
Maintaining range of motion (ROM) after knee surgery is crucial for a successful recovery and long-term knee function. Early and consistent efforts to preserve and restore ROM help prevent the formation of scar tissue, which can lead to stiffness and limited mobility. Engaging in prescribed physical therapy and exercises allows the knee joint to remain flexible, reducing the risk of complications like joint contracture, where the muscles and tissues surrounding the knee become permanently shortened. Restoring ROM early also plays a significant role in regaining the ability to perform daily activities, such as walking, climbing stairs, and bending, which are essential for independent living.
In addition to preventing stiffness, maintaining ROM after knee surgery is vital for overall muscle health and strength around the knee joint. When the knee can move through its full range of motion, the surrounding muscles—especially the quadriceps and hamstrings—are engaged and strengthened more effectively. This helps in stabilizing the knee and providing better support as the joint heals. A well-maintained ROM also contributes to reducing pain and inflammation by promoting better circulation and joint lubrication. This proactive approach to rehabilitation not only improves short-term outcomes but also enhances the long-term durability of the knee, allowing for a more active and pain-free lifestyle.
Immediately after surgery, emphasis is primarily placed upon maintaining knee extension (straightening). If you are unable to obtain full extension by your first postop appointment you will be instructed to begin exercises and consider devices to aid with regaining motion:
How to Perform Prone Knee Hang Exercises:
Starting Position:
Lie face down on a firm, flat surface such as a bed, table, or exercise mat.
Position yourself so that your legs are hanging off the edge of the surface from just above the knees, allowing your lower legs to dangle freely.
Exercise Execution:
Relax your legs completely, letting gravity gently pull your knees into full extension. You should feel a stretch in the back of your knee and thigh.
Hold this position for the duration recommended by your physical therapist, typically starting with 1-2 minutes and gradually increasing as tolerated.
Ensure that your hips remain flat on the surface, with your pelvis aligned, and avoid any tension in your lower back.
Progression and Adjustment:
As you progress, you may add a light weight (like an ankle weight) to your lower legs to increase the stretch and challenge your knee extension further.
Perform the exercise as part of your daily rehabilitation routine, and consult with your healthcare provider on the appropriate frequency and duration.
BEAR Procedure
The BEAR Procedure (Bridge-Enhanced ACL Restoration) is a technique for ACL surgery that involves insertion of a Type 1 Bovine Collagen implant around the surgically repaired ACL.
Meniscus Root Repair
Meniscus root repair surgery is performed arthroscopically, meaning a camera is placed into the knee. The meniscus root inserts into the tibia bone and aids with shock absorption of the knee. This animation demonstrates a common method for root repair surgery, involving use of sutures shuttled through a bone tunnel and secured into the tibia bone.
ACL Reconstruction
The anterior cruciate ligament (ACL) is located in the middle of the knee joint and helps stabilize the knee in both front to back and rotational motions at the joint. A common injury to the ACL is a sprain or a tear. The ACL is surgically reconstructed in this video using a graft. Graft tissue can include: Autograft (patient’s own tissue) or Allograft (Cadaver tissues).
Meniscus Repair
The Knee has two meniscus, a medial and lateral. Tears can occur in different patterns, some of which can be treated with repairs by placement of sutures. Sutures can be passed with All-inside repair devices as depicted in this video, or by utilization of needles that pass from inside-to-outside of the knee, or from outside-to-inside of the knee. Ultimately, the surgical technique is dependent upon the pattern of meniscus tear.
Microfracture
Microfracture surgery is performed for cartilage defects within the knee joint. This surgery is typically performed arthroscopically and involves make small holes inside the exposed bone. These holes will bleed into the cartilage defect forming a clot, which can eventually turn into fibrocartilage which can fill the injured area. Occasionally, the cartilage defect is supplemented with additional cartilage material, such as with a “biocartilage” procedure.
OATs
OATs surgery is a type of “cartilage restoration” surgery. This can be performed by taking cartilage and bone from a healthy portion of a patients knee and transferring it into a damaged or diseased area of cartilage. This is called an Autograft. An alternative is to utilize Allograft (cadaver donor) tissue transplanted into the cartialge defect. Allograft tissue is typically reserved for larger cartilage defects. This video depicts allograft surgery.
Partial Meniscectomy
This surgery is performed arthroscopically, meaning a camera is placed into the knee joint. Typically, in this surgery the meniscus tissue is not amenable to repair. Instruments are inserted into the knee to remove the damaged portions of the meniscus and smooth the edges.
Medial Patellofemoral Ligament Stabilization
MPFL (Medial Patellofemoral Ligament) and/or MQTFL (Medial Quadriceps-Tendon-Femoral Ligament) reconstruction surgeries are commonly performed for history of patellar dislocation. This surgery involves using graft tissue to reconstruct ligaments on the inside or medial aspect of the knee that aid in patellar stability. The technique depicted includes suture anchors utilize to fixate the graft to the bone. Alternative fixation methods exist and your surgeon will utilize the method best determined for your case.
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