Click here to watch a video on How to Stay Ahead of the Pain After Surgery

Click here for downloadable and printable post-operative instructions

Diet:

• You may resume clear liquids and light foods after surgery (jello, soup, etc.)
• Progress to your normal diet as tolerated as long as you are not nauseated.
• Many surgeries are done without general anesthesia. This allows you to resume a diet quicker with less nausea.

Managing the pain:

There’s no two ways about it, knee surgery is painful. I am going to describe the best ways I have found to try to manage that pain. The first 1-2 days are the hardest. Don’t worry, it will improve. 

Before surgery you will be offered a nerve block which helps greatly with pain control and decreases your need to take narcotic medications. I would strongly encourage you to have the block as it does significantly help with pain after the procedure. Additionally, during surgery I will often inject a numbing medicine like novocaine that will give some pain relief for several hours after surgery. 

It is important to begin taking your pain medication before this medicine wears off. This is usually about 8 to 12 hours after the procedure. However, it may be long as 16 to 24 hours. It is important to stay on top of the pain as it is more difficult to catch up. 

I do not use a “pain pump” which drips the numbing medicine continually into the joint for several days after the surgery. Several recent studies have shown an increased risk of damage to the joint cartilage and subsequent arthritis as a result of prolonged exposure to this medication. 

I believe in using multiple different ways to reduce pain. Our goal is to reduce the amount of narcotics required to control the pain. Narcotic medications (morphine, Percocet (oxycodone), Vicodin (hydrocodone), codeine and Dilaudid) have significant side effects. They can easily become addictive. They can be overdosed, especially in patients already taking other sedating medication such as sleeping pills. Narcotics decrease the body’s trigger to breathe and I may prescribe a medication to reverse this narcotic side effect (Narcan) if you are currently taking anti-anxiety or sleeping medication. It is best to avoid these drugs (and alcohol) while on pain medication. Narcotics cause constipation. They alter your ability to concentrate, cause drowsiness and should not be taken while driving. They can cause hallucinations. They frequently cause constipation and a stool softener, such as Metamucil of Sennokot DS, should be taken daily while on them. They often cause nausea and a medication for nausea, such as Phenergan or Zofran, is often prescribed with them. 

Patients with significant reactions to all narcotics, may benefit from a newer drug called Nucynta (tapentadol) that does not typically have the same side effects. However, it may not be covered by many insurance formularies. 

If you experience itching, take over the counter Benadryl one half hour before your narcotic. 

Surgery pain stems from multiple factors and you should address each of these to control the pain. Below is a chart to explain our multimodal pain control plan. I have also enclosed a QR code for a video on pain control. If you have a history of prolonged nausea you are likely going to be prescribed an anti-nausea medication.

Preoperative pain management 

1. Nerve block – anesthesia injections numbing medication around the nerves that go to the shoulder

2. Local injection of numbing medication at the surgery site

3. Anti-nausea medication such as Zofran or Scopolamine patch is given

4. Tylenol or an anti-inflammatory such as Celebrex may be given

Postoperative pain management

1. Tylenol 1000 mg every 8 hours around the clock. Limit to 3000 mg daily and avoid if history of liver disease. Use continuously for 3 days and then as needed.

2. Ibuprofen 800 (4 Advil) every 8 hours. Take with food and avoid if history of ulcers, severe reflux or kidney disease. Continue for 5 days and then as needed. You may take Tylenol and ibuprofen at the same time.

3. Oxycodone 5 mg 1-2 every 4 hours as needed. This is the narcotic and should be used sparingly. However, if pain is severe and uncontrolled with other methods, you may take 3 pills at a time for the first 24 hours. Percocet and Vicodin (Norco) already have Tylenol in them so do not take Tylenol if you are on these medications. Straight Oxycodone does not.

4. Ice (see below) is very helpful

5. Physical therapy – stiffness is a common source of pain and therapy is often started several days postop

6. You should take 325 mg Enteric coated Aspirin twice a day for three weeks to help prevent blood clot formation.

Bandages & Sling:

• Your post-operative dressing is a large, white fluffy dressing and absorbent pads that are held in place with an Ace bandage.

• Unless directed otherwise, remove this dressing 2 days after surgery and place band-aids and a small gauze pad over the incisions.

• Because the surgery is performed arthroscopically, occasionally there will be water with a small amount of blood on this dressing. This is nothing to worry about. However, if you see a lot of bleeding, please call Dr. Payne.

Washing & Bathing:

• You should be careful to keep the wound clean and dry for the first 7 days after surgery.

• Beginning on the third day after surgery, it is OK to shower as long as the incisions are kept dry with plastic wrap. Remove the wrap after showering.

• Do not go into a swimming pool until 3 weeks after the surgery and do not go in lakes or the ocean until six weeks after surgery.

Ice & Activity:

• One important goal following surgery is to minimize swelling around your surgery site. The best way to achieve this is with the frequent application of ice. This is most important the first 48 hours following surgery. The ice pack should be large (like a big zip-lock bag or bag of peas) and held firmly on the area of your surgery. Apply for 20 minutes three to four times per day if possible.

• Unless there was a meniscal tear repair, you may put weight on the operated leg as tolerated. Most people use crutches for about 1 week until the leg feels stronger. You will be in a brace to support the knee and keep it straight while walking. You may discontinue the brace after the first week if the knee supports you well such that you will not fall. You may bend the knee and place weight on the leg as tolerated. In fact, I encourage you to try to move around after surgery. This helps avoid blood clots and knee stiffness.

• If the meniscus was also repaired, you will be on crutches for 3-4 weeks and can only touch the weight of the leg to the ground (not your full weight). You will be in the brace for about 4 weeks to protect the meniscal repair.

• Do not place pillows under the operated knee as this can lead to stiffness. Instead place pillow under the heel to keep knee straight.

• Place a towel roll under your ankle and tighten your thigh muscles to get your knee to straighten out. This is very important and should be done at least four times a day for twenty minutes if tolerated.

• Move your ankle back and forth many times during the day to help your circulation.

• You may return to sedentary work only or school in 3-4 days after surgery if your pain is tolerable.

• Avoid long distance traveling in cars or by airplane during the first week after surgery to avoid increasing your risk of developing blood clots.

Follow up appointment:

• We try to give all of our patients a follow-up office visit at the same time we schedule your surgery.

• Typically I want to see my patients in the office 2 weeks after surgery.

Physical Therapy:

• The goal of physical therapy is to first assess how your body responded to the surgical procedure. They help you feel comfortable with your surgery and make sure you aren't afraid to start doing things. Your therapist will start range of motion and strengthening exercises on your first visit.

• You will start physical therapy four to five days after the surgery. This appointment is usually arranged at the time your surgery was scheduled.

What to watch out for:

• Pain that is increasing every hour in spite of the pain medication

• Drainage from the wound more than 2 days after surgery

• Increasing redness around the surgical site

• Fever greater than 101.5degrees

• Unable to keep food or water down for more than one day