Surgical options for early arthritis in young persons and athletes: the role of meniscus transplants, microfracture, Osteoarticular Transplants (OATs), Autologous Chondrocyte Implantation (ACI) and osteotomy
Edited By: Christopher J. Wahl, M.D., Suzanne L. Slaney, PA-C, ATC, MMS
Last updated Friday, June 30, 2006
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Recovering from surgery
Pain and pain management
Recovery of comfort and function following cartilage
restoration continues over a few months.
Initially, the knee must be protected from overuse while it heals. A
very strict rehabilitation program and, occasionally, a protective brace, can
help with this healing. Ironically, many
patients who undergo these procedures feel very comfortable long before the
definitive healing has taken place, so strict adherence to limits on activity
is critical.
Immediately after surgery, the patient is given strong
medications (such as morphine) to help with tissue pain and discomfort from
swelling. Most patients are discharged
with a prescription for oral pain medications (such as hydrocodone or Tylenol
with codeine).
Use of medications
Immediately after surgery, pain medications are given
through an intravenous (IV) line.
Patients who require a hospital stay are placed on patient-controlled
anesthesia (PCA) to allow them to administer their own medication as it is
needed. Oral pain medications are rarely
required after the first few weeks following the procedure.
Effectiveness of medications
Pain medications are very powerful and effective. Their proper use lies in the balancing of
their pain-relieving effect and their other, less desirable effects. Good pain control is an important part of
appropriate postoperative management.Important side effects
Other pain medications (taken through the IV or orally)
can cause drowsiness, slowness of breathing, difficulties in emptying the
bladder or bowel, nausea, vomiting, itching, or allergic reactions. Patients who have been on pain medications
for a long time prior to surgery may find that the usual doses of pain
medication are less effective. For some patients,
balancing the benefits and side effects of medications is challenging. Patients should notify their surgeon if they
have had previous difficulties with pain medications or pain control.Hospital stay
Some patients will require a hospital stay after a complex
articular or meniscal cartilage restoration procedure. Prior to discharge from the hospital,
detailed instructions for the care of their knee, activity restrictions,
bathing, use of medications and potential problems are explained to the patient
and their family prior to discharge.Recovery and rehabilitation in the hospital
RECOVERY AND RECOUPERATION IN THE FIRST FEW WEEKS
When the patient is ready for discharge they should have
had explained to them:
- What home exercises are appropriate and how often to do
them
- How to take their medications
- When and how to remove the postoperative dressing
- How to use their postoperative brace (if required)
- How and how often to use the continuous passive motion
(CPM) machine
- How to care for their incisions
- How to recognize potential problems and what is normal
and abnormal
- Who to call if there is a question
Because fluid is used to expand the knee joint during
arthroscopic procedures, the knee is frequently swollen for a day or so
following surgery. Also, the incisions
will “weep” fluid for a couple of days postoperatively, and the dressing can
become damp.
The patient is asked to refrain from weight bearing on a
knee or ankle EVEN IF IT FEELS GOOD for 4 to 6 weeks after the procedure and
remove the brace only to perform a strict set of limited exercises. These exercises will be explained prior to
discharge.
For the first 2 weeks, a home program of rest and limited
self-therapy is usually recommended, including use of the CPM machine. Then, after the wounds have healed, the
patient is referred to an experienced team of physical therapists,
rehabilitation specialists, and athletic trainers to guide and monitor the
rehabilitation. This is almost always
possible on an outpatient basis.
Surgery for Arthritis, osteochondral defects (OCD lesions), meniscus transplantation and cartilage loss in the knee. at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington
If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-543-1552 or 425-646-7777 to make an appointment. Our clinical center is located in Seattle Washington, USA
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