I am now at 4 weeks after the surgery. The journey of healing is really amazing. Its not a straight, linear experience. There are quite a few ups and downs- during the ups, everything feels great and during the downs even I, as a surgeon, was getting worried. The ups and down are either in function, motion, general vitality, and pain. Those seem to be the major categories. Let me start with how I am at 4 weeks.
- I am walking well with no pain.
- I can walk up steps in a normal manner barely the need for using the railing
- Walking down steps is still difficult and I use the railing and hold my hand on a wall on the other side. Sometimes I walk down steps one at a time
- I walked around my neighborhood- over 1/4 mile walk. I have not needed a cane since the end of week 1.
- My leg is fully straight and I bend to 121° (according to my physical therapist
- I starting driving this week without problems
Here is my protocol:
- Since I came home from Seattle to New York 8 days after surgery I went to physical therapy 3 times a week- I stay for about 90 minutes.
- Moist heat
- Manual massage
- Quad sets- a number of different exercises
- Stretching to extension and flexion
- Stationary bicycle
- Hamstring stretches
- Compressive cooling device
When I am home I go on the stationary bicycle I have and continue exercises I learned in both preop and postop physical therapy. I heat up the knee a couple of times a day and ice it down about 3 times a day.
I start my day with one 325 mg aspirin, 660 mg Aleve, and 650 mg Tylenol. I take no more Tylenol or Aleve the rest of the day. The aspirin is for anticoagulation so I take another one at night.
As previously mentioned in the post “Thinking About Pain,” I have not taken any opioids since the second and third day of surgery and even then only 3 separate 10 mg doses of oxycodone. This really surprised me and definitely will be changing my patient protocols moving forward.
I think the keys to opioid reduction are:
- Preoperative patient education (this is Number 1!). Really getting the patient to know what to expect, pain wise, is critical
- Preoperative caregiver education- almost as important as Number 1
- Multimodal Pain techniques- specifically
- IV Tylenol (Ofirmev)
- Injections during surgery that include liposomal bupivacaine (Exparel) that extends the pain relief 2-3 days
- NSAIDS (I used Aleve, some people use Celebrex- depends on whether your stomach can tolerate these)
- Tylenol 650 mg every 4 hours
- Surgical techniques that protect excess tissue damage
- Early activity and range of motion
- Frequent ice packs/cooling
I will be returning to work the first week in October. Since I cam the Chairman of the Department my entire staff is pleased mainly because I am spending too much time while I am home emailing all of them!