ChrisLenaMD,JamesAlvarezPAC

ArthroscopicandReconstructiveSurgeryoftheShoulderandKneeSportsMedicineMEA’sKarenSmith,JackieZuidema,AnnmarieFiore

Tel:(860)549-8249-FAX:(860)244-8813www.oahct.com

Zimmer®GenderSolutions™Patello-FemoralJoint(PFJ)System

Rememberwhensimpleroutinetasksweresomethingyoutookforgranted?Ifkneepainischangingyourlifestyle,andonlyonecompartmentofthethreecompartmentsisaffected.Thenewconceptinjointreplacementsurgeryistoonlyreplacethewornoutportionofthearthriticjoint.

InHospitalCareandPhysicalTherapy:Earlyeffortsatmobilizingthepatientaremadeonthedayofsurgery.UsuallyaContinuousPassiveMotionmachine(CPMmachine)isappliedtotheoperativelegonthedayofsurgerytostartearlyrangeofmotion.Thepatientishelpeduptoachairtheeveningofsurgery.Extensivewalkingisavoidedfor12to18hourspost-operativelytilltheeffectsofthenerveblockswearoffandmuscularcontroloftheleghasreturned(asmallpricetopayforthecomfortprovided).Onthedayfollowingsurgery,thesurgicaldrain(ifutilized)isremoved.Thepost-opcompressivedressingischangedtoalightdressingonpost-opday#2.Immediatefullweightbearingisallowed.Rangeofmotionandstrengtheningexercisesarebegun.Ambulationisencouraged.Stairclimbingistaught.Thegoaloftherapyistoreduceswellingandpain,normalizegait,restorestrength,rangeofmotionandbalance.HospitalStay:Thehospitalstayisbrief.Manypatientsareusuallydischargedhomethedayaftersurgery.Veryrarelyisatwonighthospitalstayrequiredtomeetgoalsofindependentcare.ShoweringPost-operatively:Itissafetogetthewoundwetafterthesutures/stapleshavebeenremovedatthe1stpost-opvisit,untilthenshowersareallowedwithawaterproofdressing.Ifanydrainagepersists,thewoundshouldbekeptcleananddrywithasterilegauzedressingappliedandchangedasnecessaryandtheincisioncleanedwithalcoholtillitcompletelystops.

OrthopedicAssociatesofHartford•Tel:(860)549-8249•Fax:(860)244-8813•oahct.com

PhysicalTherapyafterHospitalDischarge:Twooptionsareavailableforposthospitaltherapy.1.Hometherapy–Thisisnowthemostcommonlyemployedoption.Mostpatientshaveinsurancecoverageforhometherapy.Thequalityofhometherapyisquiteexcellent.Durationvaries,butisgenerallyemployedfor1to2weeks.2.Outpatienttherapy-Outpatienttherapyinaphysicaltherapydepartmenthastheadvantageofbetterequipmentvs.whatisavailableinhome.Moremobilepatientsoftenoptforoutpatientcare.Patientsoftenmigratefromhometooutpatienttherapyastheybecomemoremobile.PreventionofBloodClots:Sometypeofbloodthinnerisusedinalmostallcasestopreventtheformationofbloodclots.Themostcommonoptionutilizedistheoraladministrationofentericcoatedaspirin(ECASA)325MG1tabletonceadayfor1monthaftersurgeryalongwithcompressivestockings(TEDS).Ifyouareathighriskforbloodclots,oralCoumadin(Warfarin)orfractionatedHeparin(Fragmin)subcutaneousinjectionsfor2weekswillbeutilized.IfCoumadinisusedtwiceweeklybloodworkisperformedtoensurethatthebloodisnot“toothin”andthedosingiscorrecttoreducetheriskofbloodclots.ECASA325mgtwicedailyisrecommendedforthenext2weeksaftertheCoumadinorFragminisstopped.TimeonWalkerorCrutches:Fullweightbearingisallowedimmediatelyaftersurgery.Mostpatientscanweanoffthewalkerorcrutchesastheirmusclefunction,swellingandsorenessallows.Manypatientshavemovedtotheuseofacaneby5to7dayspost-op.TimeonaCane:Onceoffthewalkerorcrutches,theuseofacaneintheoppositehandishelpfulforanotherweek.Mostphysicallyfitpatientsareoffallambulatoryaidsincludingacaneby2weekspost-op.TimeuntilReturntoDriving:Patientsshouldnotreturntodrivinguntilclearedtodosopost-op.Inpartthisisduetoliabilityissuesifanaccidentshouldoccur.Itisgenerallysafetoreturntodriving2to4weekspost-operatively(shorterforaleftknee,longerforarightknee)TimeuntilReturningtoWork:Predictingareturntoworkdateisdifficult.Motivationalissuesplayanimportantrole.Greatvariabilityexists.Ingeneral,patientsreturningtoasedentaryjobtendtoreturntowork2to4weekspost-opandthosewithmorephysicallydemandingjobstendtoreturnat2to3monthspost-op.TimeuntilReturningtoRecreationalAthletics:Patientscanbegintoreturntolightrecreationalsportssuchasgolfby4to6weekspost-op.Morestrenuoussports,suchastennismayrequire12weeksbeforeareturnispossible.