Dr. Anthony A. Schepsis

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

Connect With Dr. Schepsis

schepsis@comcast.net

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Patellar realignment



Patient:

DOS:                                                                           Anthony A. Schepsis, M.D.

Coastal Orthopedics

Beverly-Lahey Health

978-927-3040978-927-3040

REHABILITATION PROTOCOL:  PATELLA REALIGNMENT SURGERY

Immediate Post-op (phase one) 0- 4 weeks

    AMZ:   non-weight bearing for six weeks

    Medial tibial tubercle transfer: PWB (50%) _____ weeks 

    Patella soft tissue reconstruction- WB STATUS______ for _____ weeks

                                               

  1. Bledsoe brace locked at 0 ° for ambulating and sleeping for _______ weeks
  2. Cryocuff
  3. TED stocking
  4. Ankle pumps
  5. SLR
  6. Quad isometrics
  7. PROM (at two weeks start gentle AAROM)
  8. NO active knee extension:  Active knee extension to start at ____ week
  9. E Stim quad
  10. CPM:  starting at day ______ (2 hour sessions 3 x per day)

Slow speed starting at 30 – 40 degrees to increase 10 degrees daily for a maximum of ____________________________________________________________________________________________________________________________________________________________________________________________________________________

                    

          

  1. Phase two (4-10 weeks)
    1. Quad sets/ isometrics to start at ____ week
    2. E Stim Quad
    3. SLR
    4. ROM A/AA/PROM
    5. Hip adduction/abduction
    6. Hip extension
    7. Gait training

h.      stationary bike

  1. Phase three (10 weeks):  improve muscular strength & endurance
    1. Knee extension
    2. Stationary bicycle
    3. Water conditioning (after complete wound healing)
    4. Treadmill conditioning (when indicated per MD)
  1. Phase four (approx 12-16 weeks):  muscular strength & functional activities
    1. Light leg press
    2. Vertical squats/ wall squats ¼
    3. Forward lunges
    4. Lateral lunges
    5. Lateral step- ups
    6. Knee extension 60- 0
    7. Hip abd & add
    8. Bicycle
    9. Stairmaster
    10. Pool program
  1. Phase five (approx 16 weeks):  functional drills strengthening exercises and flexibility exercise    



AFTER YOUR PATELLA ALIGNMENT SURGERY

                                                          Anthony A. Schepsis, M.D.

Coastal Orthopedics

Beverly-Lahey Health

978-927-3040978-927-3040

You have just undergone surgery to correct the alignment of your kneecap (patella).  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).

Prescribed Medication:
  1. For pain:

1.  Percocet 5/325mg one to two tablets by mouth 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 stopped (or for mild pain)

3.  Tylenol (2 extra strength tablets every 3-4 hours) or

  1. Advil (Ibuprofen) two every 4 hours with food
  2. Antibiotics:

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

  1. Enteric coated or Baby Aspirin starting the next day (tomorrow) unless there is an allergy or medical contraindication (e.g. GI ulcer disease).  We recommend for you to take aspirin for __2__ weeks.  Aspirin 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:

 

  1. Crutches and weight bearing:
    1. You are not to bear weight on your surgical leg for _______ weeks.
    2.  You will be partial weight bearing with 2 crutches for ______ weeks

 

  1. Brace:
    1. The brace is initially locked in extension (your leg straight).  It is to be worn this way for walking and sleeping.  It is taken off for your exercises as well as for the CPM (continuous passive motion) use.  Do not unlocked for sitting.  The length of time it is to be worn locked with walking depends on the individual case.    Further instructions will be given at your first follow-up appointment. 
    2. 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 at all times.
    3. The snug white stocking on your leg is called a TED stocking and keeps the swelling down in your leg.  It helps prevent blood clots.  It is to be worn for the first 2 weeks after surgery.  After this, an ace bandage just around the knee under the brace is sufficient.
    4. Swelling in your lower leg below the knee and/or the foot.  This 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 lay 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.

 

 

  1. 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 at 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 any white sticky strips (steri-strips).  This will be done at your follow-up visit.  There will be approximately 3 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.
  2. CPM (Continuous passive motion):
    1. The CPM machine is to be used at home starting ______ days after surgery.  The brace should be removed for its use.  The initial setting should be from 0° (knee straight) to 40°.  I recommend using the machine in two hour sessions, three time a day.  Set the machine at a slow speed.  Try to increase _______ degrees per day, up to _____ 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 degress (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
  3. Physical Therapy
    1. Formal physical therapy should start __________  days / weeks after surgery, with sessions initially three times per week.
    2. You will be given home exercises by the physical therapist.  As well as, 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) is 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 to schedule you follow-up appointment, preferably 10-14 days after surgery.

 

  1. Other Instructions:

 

 


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