Dr. Anthony A. Schepsis

Coastal Orthopedics
Beverly, MA
Professor of Orthopedic Surgery
Boston University School of Medicine

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Patellofemoral Arthroplasty


                                                          Anthony A. Schepsis, M.D.

Coastal Orthopedics

Beverly- Lahey Health


You have just undergone surgery replace your patello-femoral joint.  The post-operative instructions should answer most of your questions about caring for your knee from the time of discharge to your first follow-up appointment with Dr. Schepsis (10-14 days after surgery)


  1. Prescribed Medication:
    1. For pain:

1.Oxycodone (5mg) OR Vicodin (5/500mg) one to two tablets as needed every 4- 6 hours pain

2.  Toradol (ketorolac) 10 mg one tablet every 6 hours for 5 days (no refills).

Take the following only after Percocet and Toradol are finished (or for mild pain)


  1. Antibiotics:

1.  Keflex 500mg every 6 hours until completed (prevents infections)

  1. Fragmin (5000 units) one subcutaneous injection a day  for 2 weeks after surgery.  It is to reduce the incidence of blood clots following surgery.  This is particularly important in high risk patients: over the age 40 or females taking oral contraceptives.
  2. Other medications:_After the Fragmin is finished, please take Aspirin (325mg) one tab by mouth q day for 30 days after the surgery___________________________________________________________________.


  1. Crutches and weight bearing:
    1. You are to be     weightbearing as tolerated on your surgical leg .


  1. Brace:
    1. In most cases, a cryocuff device which supplies ice compression to your knee has been applied under your brace.  You will be instructed in its use before discharge.  It should be used regularly for the first three days after surgery (then as needed).  Before walking, it should be drained and the brace straps tightened.  After three days, you should still use the cryocuff for icing the knee; though, you do not have to wear it all the time.
    2. You need to keep an ACE bandage on top of your dressing for the first 2 weeks after surgery. 


  1. Swelling in your lower leg below the knee and/or the foot can occur from being on your feet for longer periods of time in the immediate post-operative period or from the brace straps and / or cryocuff being too tight and constricting.  You can lie down on your back, elevate you leg on some pillows above the level of your heart and remove/reposition the brace and cryocuff.  If you continue to have swelling, while lying on your back, remove the brace and bandages and do ankle pumps.
  2.        Dressing Instructions:
    1. Expect some bloody staining through your dressing, especially in the first couple of days.  If mild, just leave the dressing intact for the first 5 days after surgery. If moderate, the dressing can be changed sooner.  If excessive, contact the office immediately at 617-638-5633617-638-5633.
    2. In routine cases, the dressing can be changed five days after surgery.  Pull the stocking down and remove the wrap and bandage around you knee.  The incision site will be covered with steri-strips (white strips) and/or sutures.  Do not remove the steri-strips.  This will be done at your follow-up visit.  There will be approximately 2 tiny “nick” portal site incisions with 1 to 2 stitches.  You can clean these sites with alcohol or peroxide and apply a Band-Aid. Apply sterile gauze pads to the incision site and wrap the knee loosely with kerlex or kling bandage.  Only change the bandage as necessary after this until your follow-up appointment. 
    3. You must cover the incision with a bag to shower or bathe.  Keep the incision dry.
    4. Report any pus or unusual drainage immediately, especially if it is associated with increased pain, redness, warmth, and a temperature > 101°F.  However, it is normal to have a low grade temperature the first few days following surgery.
  3. CPM (Continuous passive motion):
    1. The CPM machine is to be used at home starting 1 day after surgery.  The initial setting should be from 0° (knee straight) to 40°.  The machine should be used in two hour sessions, three times a day.  Set the machine at a slow speed.  Try to increase 10 degrees per day, up to 125 degrees.  The machine has been prescribed for two weeks at which time the CPM representative should be called to pick it up.  If you pause the machine for a period of time, stop it at 0 degrees (with the knee straight) so your knee does not get stiff in a bent position.
    2. Company used for CPM:  SurgiCare 1-800-797-87441-800-797-8744 FREE
  4. Physical Therapy
    1. Formal physical therapy should start soon after surgery, with sessions initially three times per week.
    2. You will be given home exercises by the physical therapist and you should do these along with the following exercise flow sheets provided for you to get started.  These are very important in addition to the CPM.  In particular, the exercises to straighten you knee completely (towel extension) are critical during the first couple of weeks. 
    3. A written physical therapy protocol has been supplied to you and your therapist.  This is a “rough guideline” and there will be a lot of individual variations. 


  1. Driving Instructions:
    1. Right knee- no driving in the first six weeks. You will be able to get back to automatic driving sooner than standard.
    2. Left knee- automatic driving is acceptable once you are comfortable.
    3. We advise no driving while taking narcotic medication.
  2. Follow-up appointment:

a.    Call 978-927-3040978-927-3040 schedule you follow-up appointment, preferably 10-14 days after surgery.


  1. Other Instructions: _______________________________________________________________.


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