Postoperative Instructions
Open Procedure

These instructions are for open procedures (non-arthroscopic), like total shoulder replacement, elbow surgery, open knee surgery, etc.

What to Expect After Surgery?

You may feel groggy, sleepy, have some discomfort and potentially be nauseous. You will need someone to drive you home from surgery and be with you for at least the first 24 hours following surgery. Please plan for this prior to your day of surgery.

Surgical Details

It is common to not remember much that happens following surgery due to the anesthesia. Thus, Dr. Takenishi will not explain surgical details with you the same day of surgery but he will talk to the person taking you home from surgery. Dr. Takenishi will go over the full details of your surgery at your post-operative visit.

Follow up Appointment:

You should have scheduled a follow up appointment within 10-14 days following surgery. If you do not have any appointment, please call our office at 916-732-3005 to schedule your post-operative appointment.

What to Eat and Drink after Surgery?

After undergoing surgery, it is common to feel nauseous due to the anesthesia. Please start by eating plain foods (saltines, toast, etc) and drinking clear liquids. As you feel more normal throughout the day, you can increase the amount of food. We recommend avoiding dairy products within the first day or two after surgery because it may make you more nauseous and cause vomiting. Please remember to stay hydrated with water and clear liquids.

Bandages and Incisions

Please keep all your dressings in place for 3 days following surgery or until advised by Dr. Takenishi. Do not get your dressings wet. On the 3rd day after surgery, you may take off all your bandages, except the steri-stripes (white tapes) on your skin covering the incisions. You may shower and get the incisions wet on the 3rd day after surgery. Do not soak or submerge your incisions in water (No baths, no pools, no hot tubs, etc) at all until Dr. Takenishi determines this is safe for you. Following the shower, you do not have to cover the incisions. If your wounds are draining, then please cover with a gauze or Band-Aids to protect your clothing. It is common to have some draining fluid from the wounds after surgery.

In surgery, the surgical site and oftentimes the entire extremity is sterilized with a fluid preparation. Commonly, this is chlorhexidine which is orange in color or betadine which is yellowish brown. Do not be alarmed if you notice your skin are these colors as this is from the sterilization fluid and will disappear with showering.

TED hose stocking and ACE bandages

If you had knee surgery, a thigh high TED hose stocking will be applied after your surgery if available. We recommend using the thigh high TED hose stocking for most of the day for 2 weeks. Please roll down the top of the stocking every 3-4 hours for 20 minutes, to prevent it from making a mark on your skin.

If the TED hose stockings are not available, your leg will be wrapped with ACE bandages. Please remember to re-wrap the ACE bandages after showering, from the foot to above your knee to help with the swelling.

Aftercare

Icing is very important for the first 5-7 days after surgery. You should ice as much as possible in the first few days following surgery. Make sure to ice for 30 minutes at a time and give your skin some rest for 20 minutes. Do not place the ice bags directly on your skin as this can cause an ice burn and you may not feel it. Cover the ice with a thin cloth or towel to avoid frostbite.

If you purchase an ice machine, please use this continuously but stop the ice machine for 10-20 minutes every hour to give your skin a break. Do not place the ice machine pad directly on the skin. Always use a thin cloth or towel under the ice pad to prevent a skin burn.

If your bandages get wet by applying ice, replace the bandage with a sterile dressing which you can obtain from any drug store or pharmacy.

Swelling of your entire extremity is common after arthroscopic surgery. Elevating your extremity and using ice are important to minimize swelling, especially in the first 72 hours after surgery.

Numbness is common and expected over the surgery site and even within the entire extremity following surgery.

Bruising is common following surgery and you should not be alarmed. This can extend down the entire extremity due to gravity causing the blood to travel down the arm/leg. The bruising can last for several weeks but will improve over time.

Weight Bearing, braces and slings

Follow the weight bearing instructions and restrictions provided at discharge. This will be included in your physical therapy referral sheet as well.

Crutches may be required to assist with walking.

Knee braces and shoulder slings may be applied after surgery depending on the type of surgery performed. The length of duration will be on your discharge instructions. You will be instructed on how to use the braces by the post-operative nurse prior to discharge. This should be worn at all times except during therapy and while showering. During showering, remove the brace/sling and keep your knee/arm in the same position as it was in the brace/sling. After showering, replace the brace/sling after covering your incisions if the wounds are draining.

Sleeping

Sleeping is often difficult within the first week of surgery due to the discomfort from the procedure and wearing a sling/brace. Please remember to wear your sling/brace while sleeping unless otherwise directed by Dr. Takenishi. This is to protect healing of the surgical site while you sleep and to avoid injury to the repair site while you are asleep. While wearing a sling, you may find it easier to sleep in a recliner or sleeping upright and supported by several pillows. If you have a knee brace on, please sleep with the brace and keep your leg elevated on pillows at night time. We do not recommend using sleep medications as they can have combined effects with narcotics affecting your ability to breathe.

Driving

We do not recommend driving after surgery until you can safely control your vehicle and you must be off all narcotics medications. You should not drive if you had surgery on the right leg as this affects your ability to accelerate/brake. If you had shoulder surgery and are in a sling, we do not recommend driving for at least 6-8 weeks. You should be out of your sling by the time you start to drive and be able to follow the DMV guidelines on holding the steering wheel.

Medications

Narcotic/Opioid: You were most likely prescribed a narcotic medication (ie. Norco, Percocet, etc). It is easier to manage your pain as it develops rather than attempting to “catch up” when the pain becomes severe. You may have also received a nerve block in surgery. Thus, it is important to take the pain medications before going to sleep, even if you still have no pain after surgery. The medications are typically prescribed 1-2 pills every 4-6 hours as needed for pain. For significant pain, take 2 pills every 4 hours in the first two days after surgery. After 2 days, your pain should improve and you should decrease the use and frequency of the narcotic. It is recommended to stop all narcotics as soon as your pain has improved. Prolonged use of narcotics can cause dependency, constipation, difficulty breathing, altered mental status and increased risk of falls. Do not drink alcohol or drive while taking narcotic medication.

Anti-inflammatory: As long as you do not have a contraindication (kidney problems, stomach ulcers, etc) you should be taking this medication along with the narcotic pain medication to help with your swelling and discomfort. Start this medication the same day of surgery and be sure to take it with food. You can take Naprosyn/Naproxen (Aleve) 500 mg two a day or Ibuprofen (Motrin) 800 mg three times a day. Only take one of these types of medications and always take it with food.

If you had an osteotomy procedure (cutting the bone) or a surgery to repair a fracture, do not take anti-inflammatory medications in the 1st 6 weeks after surgery, as this will cause the bone healing to slow. Dr. Takenishi will review this with you on the day of surgery.

Tylenol: You may take additional Tylenol along with the narcotic and anti-inflammatory. The typical over the counter Tylenol medication has 500 mg in each pill. Narcotics, like Norco and Percocet, have 325 mg of Tylenol within each pill. You can only take 4,000 mg of Tylenol per day, so do not exceed this amount.

Blood Clot Medication: You may restart your blood thinner medications the same day of surgery. You may also be recommended to take aspirin 81 mg once a day depending on your procedure. Dr. Takenishi will provide this information on your discharge instruction sheet.

Nausea:  The anesthesia medications used during surgery may cause nausea. Narcotics/opioids can also cause nausea. This is most commonly encountered within the first 24-48 hours following surgery. If encountered, please drink clear liquids to stay hydrated (water, Gatorade, 7-up, etc). If nausea is severe, you can take Zofran 4-8 mg every 8 hours. If you were not prescribed this medication and have significant nausea, please contact the clinic for a prescription. If nausea and vomiting become so severe that the patient shows signs of dehydration (lack of urination), please go to the local emergency room/urgent care.

Constipation: Narcotics/opioids can cause constipation. You should take Colace 100 mg twice a day while taking the narcotics. If you have not had a bowel movement in 2 days after surgery, you can try over the counter medication like milk of magnesia or magnesium citrate. These can be purchases at any pharmacy, grocery store or Target. If you still have not had a bowel movement after trying these remedies, please contact your primary care physician and notify our clinic.

Other Medications: You should resume all your normal home medications that you routinely take unless specified by Dr. Takenishi.

School/Work

Your ability to return to school or work will depend on the type of procedure you had and the degree of your post-operative discomfort. You can return to school or work any time after surgery as long as you feel up to it. Dr. Takenishi will discuss this specifically for each individual patient. School and work notes must be obtained in advance and cannot be requested afterward for dates missed previously, so plan accordingly and contact our office.

Physical Therapy

Most patients will be referred to formal physical therapy after surgery. This will usually begin from 3-4 days after surgery but sometimes will be delayed until 2-6 weeks after surgery, depending on the procedure performed. All patients should contact our office and the physical therapy office, if physical therapy is not started within 10 days after surgery. Therapy protocols are available on Dr. Takenishi’s website, www.sacorthosports.com. Please take a copy of your protocol with you to your first physical therapy appointment. If there are any questions regarding your physical therapy protocol, please contact the orthopedic clinic.

Questions or Concerns

Please call the orthopedic office at 916-732-3000 for any concerns regarding fevers, persistent pain, drainage from the wound, increased swelling or redness, or for any concerns related to your surgery. For any emergent concerns, chest pain, shortness of breath, difficulty breathing, please head to the nearest local emergency room.