After Surgery

Rehab Protocols can be found in the Documents section of the website

Thank you for choosing Dr Ben Petre and the team at OSMC for your orthopedic surgery. To ensure a successful outcome Dr. Petre recommends that you follow a specific set of post-operative instructions and guidelines set forth by his medical and rehabilitation team.  You will find your post-operative rehabilitation protocol included in this packet that provides detailed instructions concerning your post-operative care.

Typically, Dr. Petre will have you schedule a follow-up medical appointment at 2, 6, and 12 weeks after your surgery date.  At these appointments Dr. Petre will re-evaluate your progress, assess range of motion, and possibly strength in order to determine if you are appropriate for progressing to the next phase of your post-operative rehabilitation.

Before your surgery, you should schedule your first appointments with physical therapy to begin the day after your surgery unless otherwise instructed.  Please let Dr. Petre’s team know when and where your post operative rehab will be so he can see you in rehab if he is available.   At your first PT visit, your physical therapist will meet with you to answer your questions, review your progress, modify your current program if needed, and progress you to the next phase of your post-operative rehabilitation program if appropriate.  This appointment is a valuable and important component of your post-operative recovery to ensure a successful outcome following your orthopedic surgery.

The best way I can grow my practice is by word of mouth from happy patients.  If you have had a good experience, please share with others.  If you would like to share online, there are many resources for this now including healthgrades.com, vitals.com and angieslist.com.

Thank you and we look forward to helping you during your recovery and return to activity !

Sincerely,

 

Ben Petre

 

 

After Surgery Care and Information

THESE ARE GENERAL GUIDLINES.  IF YOU HAVE SPECIFIC QUESTIONS NOT CLEARLY ADDRESSED HERE, CALL THE OFFICE

Many questions arise during the first week after surgery.  There are many new sensations felt in the body, especially in the operative knee and leg.  The following will help answer many of your questions to help relieve normal anxiety.

General Instructions

Take your medications only as prescribed.  If they are not working call Dr Petre’s team at 410.280.4717 during business hours or the on call physician at 410.268.8862 after hours.

You should try to drink plenty of water after surgery.

Your responsible adult caregiver should stay with you for the first 24 hours after surgery to help you with medications, movement, encourage fluids, activities of daily living, and to help observe you for any possible complications.

Follow your weight bearing and movement restrictions closely.

Elevate your extremity to help reduce swelling.

Use ice to help with pain control and swelling control.

 

Active calf Pumps:  do 10 up and down pumps of your feet every hour while awake.

Foot pump and calf pump rational:  Compression of plantar venous plexus causing return of the blood in your lower legs to your heart.

Stockings: Use the stockings on both legs at all times except showering for the first 2 weeks to help reduce the chance of getting a blood clot.

**Please use the incentive spirometer or 10 deep breaths every one hour while awake.  Continue for first week post-op.

**When lying on back (supine) in bed during days 1-3 post-op, please place 3 pillows behind head and neck to raise head and improve ability to cough and deep breath.

Call us immediately if you have:

  • Pain not controlled by your pain medication (you will always have some pain after surgery, however severe pain not controlled by medication is abnormal)
  • Fever more than 101.5.  A low grade temperature is normal after surgery.  Fevers over 101.5 are abnormal.  You do not need to routinely take your temperature, only do this if you feel that you have a fever.
  • An increase in leg swelling, redness or foul smelling drainage from wounds.
  • Chest pain, shortness of breath or other medical emergency should call 911 and inform our office after the emergency is over.

Returning to work or school:

You may return to work or school light duty only in the immediate days after surgery if pain is tolerable.  You must take the time to honor your commitments to physical therapy and office visits.  Returning to heavy labor will be determined by your progression through physical therapy and the type of surgery you had.

 

brace/sling:

Some patients will require a brace or sling, some will not.  If you have a brace on in the recovery room, you will need to wear the brace for 2 weeks or more depending upon the type of surgery you had.  Your rehab protocol will have a specific time in the brace. You should sleep in the brace unless otherwise noted.  For most patients it will come off for physical therapy daily.

 

Risk: There are several risks to any surgery that must be taken into account…

Infection: is decreased with a sterile operating environment and antibiotics. Also, careful handling of the incision sites following surgery reduces the risk of infection.

DVT: (deep vein thrombosis, blood clot) is decreased through instituting early motion, mechanical means (foot/ankle pumps) and occasionally medication. Following the pre-operative and post-operative instructions will reduce the risk of deep vein clots.

Pain: with any surgical procedure there is a potential complication of pain.  Medication, ice, rest, compression, elevation and therapy reduce post-operative pain.

Numbness: with surgery, there is a small chance of numbness in the extremity briefly postoperatively.  The numbness should resolve over time, but may take weeks.

 

Wound Care Instructions

Care of your wounds after surgery is very important to ensure a quick recovery and to minimize the chance of infection.  Here is a list of good practices:

  • Keep your incisions clean and dry
  • Elevation minimizes swelling which helps wound healing
  • Change your dressing every other day to maintain a clean environment unless otherwise instructed
  • Leave “steri-strips” or butterfly bandages in place

Here are things you should avoid

  • Do not let your extremity dangle or swell
  • Do not remove the “steri-strips”
  • Do not adjust or remove any sutures or staples
  • Do not use creams, ointments, vitamins, scar reducers or other products on the wounds
  • Do not take a bath, swim, go in a pool/hot tub or otherwise submerge the wound until you are instructed that you can or at least 2 weeks have passed
  • by day 3 if no drainage is present the incision should remain uncovered and keep clean clothing only covering the sites.
  • Do not allow pets to sit on your lap or sleep in your bed for at least 6 weeks following surgery.  Pets may harbor fleas or mites or other organisms that may cause a wound infection!

 

The original dressing should be removed 24 hours after surgery.    Apply an opsite, water-proof dressing over the incision site until you have stopped draining.  After drainage has stopped, apply band aids over the incisions. Do this daily or as needed throughout the day if the op-sites or band-aid becomes soiled or wet.  Do not put any ointments or lotions over the incisions.

Showering: You may start showering as soon as your first dressing is removed if waterproof bandages or “op-site” dressings are covering your wound to keep them dry.  If you do not have waterproof dressings, you may get the wounds wet 3 days after surgery with running water in the shower as long as they are no longer draining any fluid.  At this point you may use mild soap on the wounds such as Dial Soap.  Do not scrub the wounds.  Pat them dry with a clean towel after showering and place a fresh clean bandage.

If you should have any questions or concerns regarding you incisions, the best thing to do is to take a digital picture of the incision and e-mail it to a member of Dr. Petre’s team.

 

Medications After Surgery

New Prescriptions:  Dr Petre will provide you at least two if not more prescriptions for after surgery.  These will include:

  • A narcotic pain medicine (percocet, vicodin, oxycodone, etc).  This medication should only be taken “as needed” for pain.  You will likely have some pain after surgery, this medication will help with your pain but will likely not take 100% of the pain away.  These medications last 4-6 hours, if you are not experiencing pain, do not take them as they can have side effects such as constipation, nausea, vomiting and respiratory depression.  DO NOT DRIVE if you are taking narcotics. .  It will help to take your pain medication thirty minutes before therapy if you are experiencing any pain.  You should plan to wean yourself from pain medicine by the time your 2 week visit is to occur.
  • A blood thinner such as lovenox, aspirin or coumadin.  Depending upon your risk of getting a blood clot after surgery (also called a DVT), Dr. Petre will prescribe you a blood thinner to minimize this risk.  Every patient will receive TED stockings to help minimize the risk of clots, these need to be worn on BOTH legs for 2 weeks after surgery
    • High risk patients (lower extremity fractures, joint replacements): Lovenox injections for 2 weeks followed by 4 weeks of aspirin 325mg daily
    • Medium Risk patients (lower extremity arthroscopy or small procedures): Aspirin 325mg daily for 4 weeks
    • Low Risk Patients (shoulder arthroscopy, upper extremity fractures): Early mobilization and ambulation.
  • Anti-inflammatory medications:  These can be added as needed for additional pain control.  Routine daily use can slow down certain type of healing and daily use should be avoided in: Fracture healing, rotator cuff repairs, ligament reconstructions, meniscal repairs.  Specific anti-inflammatories may be prescribed in certain surgeries such as hip arthroscopy to prevent the formation of heterotopic ossification.
  • Your previous home medications: You should resume any/all blood pressure medications, heart medications, thyroid medications, diabetes medications.  Please refrain from taking non-prescribed supplements or over the counter medications until 2 weeks after surgery.  Please refrain from taking gout medicines or rheumatoid medicines for 2 weeks after surgery if possible.

Other prescriptions you may receive:

  • Ambien: this will aid in sleep and may be prescribed for certain procedures.  Only take this medicine at night if you are having troble sleeping
  • Oxycontin: This is a long acting narcotic medication and should only be taken twice a day as prescribed
  • Zofran: Zofran is a nausea medication that helps with some of the side effects of narcotics
  • Antibiotic: If you were prescribed an anti-biotic after surgery, you should take this exactly as directed.  Try not to miss any pills and take the entire prescription until it runs out.

 

Over the Counter Medications you may want to consider taking:

  • Colace or Senna (Senna Kot): Many people get constipation from pain medicine, these medications will help with constipation
  • Tylenol (acetaminophen): Tylenol is a good adjunct for pain control because it works in a different way than narcotics and anti-inflammatories.  Some narcotics will have tylenol built into the pill already.  If your narcotic prescription has acetaminophen, APAP, or tylenol listed on it, DO NOT TAKE ADDITIONAL TYLENOL.  There is a 4000mg limit per day for tylenol in adults, it can damage your liver if you take more than this amount. 

Ice After Surgery and Ice Devices

Ice after surgery is a great way to decrease your pain and reduce swelling.  It will speed your recovery and is recommended.

Ice Technique:  If you are using ice or ice packs from your freezer, it is most convenient to apply the ice for 20 minutes on and then 20 minutes off.  Place a thin piece of cloth between the ice pack and your skin.

Ice with a splint or cast:  Ice will help if it is cold enough to penetrate.  If you can feel it, then it is working.  With a cast or splint, you need to use extra caution to prevent water from leaking into the cast/splint.

Ice and Nerve Blocks: Use caution if you have had a nerve block when using ice in the first 24-72 hours as you may not be able to sense how cold your skin is getting.  This puts you at risk of getting frostbite.

Ice Device:  You may be prescribed a cooler with a bladder to circulate ice water after surgery.  These devices do a great job of keeping your surgical site iced down.  If you have difficulty with your device, please call the technical assistance number on the device as the on-call doctor at the office will not likely be able to talk you through trouble shooting the machine. 

Physical Therapy

Physical Therapy is a crucial part of your recovery.  Most patients will start physical therapy directly after surgery.  You should call to schedule your physical therapy appointment now.  Therapy can start the day after surgery unless otherwise directed.  Please see the attached therapy prescription for office numbers and locations.  Please ask your therapist to follow the included protocol, we are always happy to discuss treatment modalities, progress and questions with your therapist.  If these questions arise, you can encourage them to contact the office anytime via phone or email..