• Dressing: A dressing has been applied to your incision following surgery. This dressing should be left on until your first office visit, unless otherwise specified by your physician or physician assistant. Do not be alarmed if the dressing becomes moist or bloodstained. However, if the area in question is large or continues to bleed, you should call the office.
  If the hand or foot below the area which was operated on develops swelling, you may need to loosen the bandage. However, you should check with your physician first.
  
• Wounds: Your wound should be kept clean and dry. You should not allow your incisions to get wet in a shower or bath unless otherwise specified by your physician or physician assistant.
  
• Activity: Specific recommendations concerning activity and rehabilitation will be given to you by your physician or physician assistant.
  
• Pain: You have been given a prescription for pain medication which you may take as directed. You should not drive or drink alcohol while taking pain medications. Follow the guidelines as directed by your physician. Please inform us if you have any allergies to medications. If a rash develops, or nausea and vomiting occurs, notify our office at (509) 344-BONE (2663) for an alternative medication.
  
• Diet: Begin with light meals and progress your diet as tolerated. Carbohydrates will generally have a lower incidence of nausea and vomiting.
  
• Precautions: If you develop a fever (temperature greater than 101 F) or chills, or any undue symptoms such as unexpected pain, redness, swelling in your legs, rash, blisters, numbness, tingling, itching, hives or shortness of breath, please contact our office. If you have a problem or question, do not hesitate to call the office. The answering service will handle your calls after hours and on weekends. One of the NWOS physicians is on-call at all times.
  
• Return Appointment: A post-operative appointment is typically arranged for you prior to surgery. If not, please call the office to arrange for a follow-up appointment.
  
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Arthroscopic Knee Surgery
Your operation was performed through a small anterior incision. The interior of your joint was visualized with a small telescopic device. Reconstruction of the anterior cruciate ligament and either a repair or removal of the meniscus cartilage, if appropriate, was performed. You may experience fluid or swelling in the joint. This is usually due to fluid used during your surgery or bleeding into the joint. This fluid is usually re-absorbed by your body over time. If it is significantly painful, this fluid may be removed at the time of your first post-operative appointment.

• Cryo/Cuff® (blue ice pack): Use the Autochill pump as directed with your Cryo/Cuff® for the first 24 hours after surgery. The Cryo/Cuff® should be used for two to three hours at a time with a one- to two-hour break with the compressive straps undone (but keep the cold pack in place so you still get chilled down). Bedtime use is optional - wear it if you like, but you may find it easier to sleep without it. The intermittent, rather than continuous, use of the Cryo/Cuff® pressure is intended to minimize swelling of the leg below the knee. The Cryo/Cuff® is yours to keep.
  
• Immobilizer (gray brace): The immobilizer should be worn whenever you are up and while sleeping for the first seven to 14 days. You may remove the brace if you are resting on the couch or bed, or to perform your exercises.
  
• Elastic stocking or Ace wrap: The stocking or wrap may be removed any time the Cryo/Cuff® straps have been undone (out of "squeeze" mode) to allow your skin to get some fresh air and to allow your circulation to re-equilibrate. Otherwise the stocking or Ace wrap needs to be on at all times for the first five to seven days after your surgery.
  
• Drain (if applicable): You should empty your drain as necessary over the 12-hour period following your surgery. Follow these steps to empty your drain: 1) clamp; 2) unplug; 3) empty drain; 4) compress drain; 5) replace plug; 6) unclamp. When you return to the NWOS office the following day for your follow-up visit, the drain will be removed.
  
• Bandage: There is a soft compression dressing around your knee. This dressing should feel comfortable and will absorb any drainage from your knee. Your physician or physician assistant will give you specific instructions concerning your dressing. The dressing is changed at your first post-operative visit and replaced with a less bulky bandage. It is also very important that the first-week dressing stay dry. Do not be alarmed if the dressing becomes moist from blood or arthroscopic fluid. If the area in question is exceptionally large or continues to bleed, please call the office. If it should get wet for any reason, you need to contact our office to have it changed. If you live locally you may come into the office and we will replace it. If you live out of the area, we can help you change the bandages yourself by giving you detailed instructions over the phone.
  
• Wounds: The wound is closed using dissolvable stitches that have knots at each end. These knots will be cut at your two-week visit. There are also tape strips across your wound (Steri-Strips), which help the incision heal properly. These strips and dressing are changed as needed at your post-operative visit.
  
• Crutches: Crutches must be used for at least the first week after your surgery; however, you may gradually put as much weight as you can tolerate on your surgical leg in the immobilizer. Patients who have had a simultaneous meniscal repair or other delicate surgery may be instructed by their surgeon to remain non-weightbearing on crutches for longer periods. The crutches are yours to keep.
  
• Bathing: Do not get your operative site wet until permitted by your physician. You can shower one week after the date of surgery. You can bathe or swim two weeks after surgery.
  
• Post-operative exercises: To relieve pain and reduce swelling, keep your leg elevated above your heart. Once you have been directed to begin your exercises, you should perform them three times per day. Some degree of increased pain is expected during these exercises, but you should return to your baseline comfort level shortly after stopping. Be sure to ice with the Cryo/Cuff® after exercising. If you find all of the exercises difficult, try to focus on the quad sets, straight leg raises and gravity-assisted hangs.
  
• Nutrition: Drink at least 64 ounces of fluids daily (eight 8-ounce glasses). Water, juice, milk, coffee, tea and soda are all fine. You should not drink alcoholic beverages while on your pain medicine. Please take a multi-vitamin with iron and 500-1000 mg of Vitamin C daily. Fiber-rich foods can help minimize constipation (which is caused by pain medication and being sedentary).
  
• Sleep: It is important to try to maintain your normal routine. Try not to sleep too much during the day; get up at your normal time and go to bed according to your usual schedule. This will help you to quickly restore your normal sleep patterns. It will also help you maintain your normal energy level.
  
• Pain medication: Oxycodone 5 mg may be taken (one or two pills) as frequently as every two hours with food to help control pain - in addition to the Tylenol and anti-inflammatory medication (Ibuprofen or Celebrex, depending on your physician's recommendation). Patients who are concerned about using Oxycodone may want to take one tablet, and if no pain relief occurs in 30 minutes, take a second pill. You should evaluate your pain while resting. The goal is to have bearable resting pain (you can anticipate increased pain with movement and activity). Remember, it is much easier and requires less medication to keep pain under control than it does to regain control of pain. Follow the guidelines as directed by your physician. You should not hesitate to use the medication as long as you stay within the dose guidelines. Oxycodone is only available with a written prescription and cannot be called in over the phone by your physician. You should never drink alcohol or drive when taking Oxycodone. 
  
• Pain: If you have severe pain which is not controlled by the Oxycodone protocol, please call our office at (509) 344-BONE (2663). You should also call us if you have any problems or questions with your recovery.
  
• Other precautions: If you develop a fever (temperature greater than 101 F) or chills, or symptoms such as unexpected pain, redness, swelling in legs, rash, blisters, numbness, tingling, itching, hives or shortness of breath, please contact our office. Problems following this type of surgery are minimal; however, if you have a problem or questions, do not hesitate to call the office. The answering service will handle your call after hours or on the weekend. One of the NWOS physicians is on-call at all times.
  
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Arthroscopic (non-ACL) Surgery
Your operation was performed through two or three small incisions. The interior of your joint was visualized with a small telescopic device. Either a repair or removal of the meniscus cartilage, if appropriate, was performed. You may experience fluid or swelling in the joint. This is usually due to fluid used during your surgery or bleeding into the joint. This fluid is usually re-absorbed by your body over time. If it is significantly painful, this fluid may be removed at the time of your first post-operative appointment.

• Dressing: There is a soft compression dressing around your knee. This dressing should feel comfortable and will absorb any drainage from your knee. Do not be alarmed if the dressing becomes moist from blood or arthroscopic fluid. If the area in question is exceptionally large or continues to bleed, please call the office. Your physician or physician assistant will give you specific instructions concerning your dressing. You can remove the dressing three days after surgery. You may use Band-Aids to cover the incisions.
  
• Cryo/Cuff®: The Cryo/Cuff® is worn for the three days. Wear the cuff for three hours and take it off for two-hour intervals. Change the water in the Cryo/Cuff® hourly. You may remove the Ace wrap on your lower leg when the Cryo/Cuff® is off. Rewrap the Ace when you reapply your Cryo/Cuff®. The Cryo/Cuff® is yours to keep.
  
• Wounds: There may be small stitches in the incisions. The incisions may be sore and may bruise. Keep the incisions clean and treat them like any small cut in the skin. If you have Steri-Strips over the incisions, leave them on until instructed to remove them.
  
• Activity: Crutches or a cane may be necessary during the first 24-48 hours or longer following surgery until you are able to walk without limping. To relieve pain and reduce swelling, keep your leg elevated above your heart. Do ankle range-of-motion exercises frequently. Use your crutches, and put as much weight as is comfortable on the operative leg. Do not run, jog or engage in any sports until you receive permission and instructions from the physician or physician assistant.
  
• Bathing: Do not get the operative site wet for three days after the date of surgery unless permitted by your physician. At that point you may shower, but don't bathe or swim until two weeks after surgery.
  
• Pain: Upon discharge, you should have a prescription for pain medication. Please take the pain medication with food. Follow the guidelines as directed by your physician. Do not drink alcoholic beverages or drive if you are using pain medications.
  
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Shoulder Surgery

• Dressing: A dressing has been applied to your incision. Do not be alarmed if the dressing becomes moist from blood or drainage. However, if the drainage from the incision soaks through the dressing, please call the office. Do not remove the Steri-Strips that are directly on the wound. The incision may be left open to air or a small dressing applied.
  
• Sling & Cryo/Cuff®: The sling is worn for your comfort and protection. It should be taken off only as directed. The Cryo/Cuff is worn to minimize swelling and pain. It should be worn for the first three days, three hours on, three hours off, for comfort.
  Wounds: Your wound should be kept clean and dry. Do not remove the Steri-Strips. You may shower once the dressing has been removed, unless otherwise directed by your physician.
  
• Activity: Specific recommendations concerning activity and rehabilitation will be given to you by your physician or physician assistant.
  Pain: Upon discharge, you should have a prescription for pain medication. Please take the pain medication with food. Follow the as directed by your physician. Do not drink alcoholic beverages or drive if you are using pain medications.
  
• Precautions: If you develop a fever (temperature greater than 101 F) or chills, or any undue symptoms such as unexpected pain, redness, swelling in legs, rash, blisters, numbness, tingling, itching, hives or shortness of breath, please contact our office. If you have a problem or question, do not hesitate to call the office. The answering service will handle your calls after hours and on weekends. One of the NWOS physicians is on-call at all times.
  
• Diet: Start off with light meals and progress your diet as tolerated. Carbohydrates will generally have a lower incidence of nausea and vomiting.
  
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Hand/Wrist Surgery

• Dressing: A dressing has been applied to your incision. The dressing is left on until your first office visit, unless otherwise specified by the physician or physician assistant. Do not be alarmed if the dressing becomes moist from blood or drainage. However, if the drainage soaks through the dressing, please call the office. If there is an Ace wrap on your hand, you may loosen or tighten it as needed.
  
• Wounds: The wound is closed using stitches. Also, there may be tape strips (Steri-Strips) across your incision to enhance healing. These strips and dressing are changed as needed at your post-operative visit.
  
• Activity: Elevate your hand above your heart at all times. This will reduce pain and swelling. If you use a sling, make sure your hand DOES NOT slip down below heart level.
  
• Exercises: Remember to move your shoulder and elbow three to four times a day to keep them loose. You may raise your arm above your head to stretch your shoulder and move your elbow back and forth as much as your dressing will allow. You are encouraged to move your fingers as much as your dressing will allow.
  
• Bathing: Keep your wound clean and dry. Do not allow your incision to get wet unless otherwise specified by the physician or physician assistant.
  
• Pain: Upon discharge, you should have a prescription for pain medication. Please take the pain medication with food. Follow the guidelines as directed by your physician. Do not drink alcoholic beverages or drive if you are using pain medications.
  
• Precautions: If you develop a fever (temperature greater than 101 F) or chills, or any undue symptoms such as unexpected pain, redness, swelling in legs, rash, blisters, numbness, tingling, itching, hives or shortness of breath, please contact our office. Problems following this type of surgery are minimal; however, if you have a problem or question, do not hesitate to call the office. The answering service will handle your call after hours or on the weekend. One of the NWOS physicians is on-call at all times.
  If you had regional anesthesia (block), especially of the arm, the anesthesia or numbness may persist for some time. Special care should be taken against such injuries as burns from hot surfaces and cuts from knives until sensation has returned.
  
• Diet: Start with light meals and progress your diet as tolerated. Carbohydrates will generally have a lower incidence of nausea and vomiting.
  
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Spine Surgery

• Dressing: Please keep your dressing as clean as possible. If you have had your coccyx removed, it will be necessary to wipe from back to front after urinating and bowel movements. This is necessary to avoid possible contamination of your dressing.
  
• Wounds: The wound is closed using stitches. Also, there may be tape strips (Steri-Strips) across your incision. These strips and dressing are changed as needed at your post-operative visit.
  
• Activity: Limit your activities over the first two to three days following your surgery. You may walk for short periods the first day after your surgery. You may slowly increase both distance and duration of the walk. Do not drive until instructed by your physician. Avoid heavy lifting, straining or strenuous activities. Avoid any activity that involves stooping, bending or twisting. Avoid sitting in a straight-back chair for more than 15 minutes at a time. Wear your TED stockings for 10 days or until you resume your pre-op normal level of activity. Your TEDs may be removed for brief periods while up. Use lumbar sacral support for all out-of-bed activities (does not apply to coccyx surgery).
  
• Resting and Sleeping Position: The best position for sleeping or resting is on your side, knees bent, with a small pillow between your knees. Lie on the most comfortable side, or the unaffected side. If you sleep on your back, make sure your knees remain bent with a pillow under your knees. Avoid sleeping on your stomach.
  
• Exercises: Use proper body mechanics when engaged in any activity. For example, keep your spine straight and use your legs when getting up and down from a chair. Proper body mechanics include these three basic rules for all activities: 1) stomach in; 2) knees bent; 3) back straight.
  
• Bathing: You may shower after two days with your dressing on. Apply a new dressing after showering. Keep a dressing on your incision until your follow-up visit. You will need to change the dressing every two to three days.
  
• Pain: Upon discharge, you should have a prescription for pain medication. Please take the pain medication with food. Follow the guidelines as directed by your physician. Do not drink alcoholic beverages or drive if you are using pain medications. It is not uncommon to experience muscle spasms and soreness at the affected spinal level and at the incision site. This should diminish within two weeks. Leg pain and/or numbness will decrease with time, but the nerve root may be irritated from prolonged pressure, so it will take time for the inflammation/irritation to subside. You can apply ice for 20 minutes at a time, up to three times a day, especially for the first 24 hours. After the first 48 hours, a heating pad may be of comfort to you.
  
• Diet: Start off with light meals and progress your diet as tolerated. Carbohydrates will generally have a lower incidence of nausea and vomiting.
  
• Precautions: If you develop a fever (temperature greater than 101 F) or chills, or any undue symptoms such as unexpected pain, redness, swelling in legs, rash, blisters, numbness, tingling, itching, hives or shortness of breath, please do not hesitate to contact our office. Problems following this type of surgery are minimal; however, if you have a problem or questions, do not hesitate to call the office. The answering service will handle your call after hours or on the weekend. One of the NWOS physicians is on-call at all times.
  
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Total Joint Surgery: Infection Precautions and Antibiotics
If you have had a total joint replacement, certain precautions must be taken to reduce the chance that infection develops in the bone or around the implant. These precautions should be followed for the rest of your lifetime. ALL patients who have had total joint replacement and undergo any dental procedure should receive antibiotic prophylaxis for the following:

• Dental antibiotic prophylaxis regimen:
  
  • Patients not allergic to penicillin: Cephalexin or amoxicillin, 2 gm orally one hour prior to dental procedure.
    
  • Patients not allergic to penicillin and unable to take oral medications: Cefazolin 1 gm; or ampicillin, 2 gm IM/IV one hour prior to the procedure.
    
  • Patients allergic to penicillin: Clindamycin, 600 mg orally one hour prior to dental procedure.
    
  • Patients allergic to penicillin and unable to take oral medications: Clindamycin, 600 mg IM/IV one hour prior to the procedure.
    
    
• Patients who will have genito-urinary manipulations or instrumentation (cystoscopy, TURP, etc.), gastrointestinal or biliary surgery, or any gynecological procedures:
  Advise your doctor that you have had a prosthesis inserted and that you need to have antibiotic prophylaxis (protection).
  
  
• If you need to have a skin abscess (boil or furuncle) drained or have a skin infection:
  Advise your doctor that you have had a prosthesis inserted and that you need to have antibiotic prophylaxis.
  
  
• If you suspect any infection, you should be seen promptly by your physician and treated.
  
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