Dr Rob Elliott, Orthopaedic Surgeon
Shoulder, Hip, Knee & Elbow Specialist

Post Surgery

Maximising success

 

What you can do and what can happen after the surgery

Day Stay Surgery

Many operations, including most arthroscopic (keyhole) surgery are day stay. We will ensure that you are comfortable and safe to go home. 

You will need to be driven home. You can not drive after an operation. You will also need to have someone with you for the first 24hrs hours after surgery. 

Pain and painkillers

Through a combination of general anaesthethesia, regional anaesthesia (spinal anaesthetic or nerve blocks) and local anaesthetic we aim to ensure you wake up as comfortable as possible.  Occasionally the pain may be more severe than we anticipated as everyone responds to anaesthesia in a different way. We will endeavour to get you comfortable and pain free as quickly as possible. 

You will need to take pain killers after surgery. We recommend an analgesia ladder.

Step 1: Paracetemol is the safest, and surprisingly effective if taken regularly. Continue taking this if you have any pain. This is the first step of the ladder and you should be taking this regularly before taking stronger painkillers.

Step 2: Anti-inflammatories (Ibuprofen, Diclofenac, Celecoxib)- good for musculoskeletal pain and are non sedating. These can be hard on the kidneys and create stomach ulcers so are not for everyone. Discontinue these when pain is well controlled on paracetemol alone. 

Step 3: Opiate analgesia - strong pain killers that are recommended for acute pain only. Can have sedating effects and cause severe constipation. These medications are also addictive and should be discontinued as soon as the acute surgical pain has subsided.

These medications are safe to take together. 

Rest, Ice, Compression and  Elevation are important adjuncts to pain management

Consider Game Ready system  https://nzsportshealth.co.nz/game-ready-system

 

Physiotherapy

For a joint to have satisfactory function it must regain full motion, be strong and stable.

Physiotherapy is an integral part of the treatment pathway in achieving these goals. Injuries and degenerative conditions can cause muscle inhibitation and rapid wasting. Regaining strength and neuromuscular control of a joint requires focused exercises which generally must be performed by the patient.

These exercises are instructed and supervised by physiotherapists, who are experts at isolating muscles groups, and supervising gradually increasing load.

The patient should perform these exercises regularly at home with intermittent supervision by their physiotherapist.

The goals of physiotherapy are to

1.     Restore movement

2.     Gradually regain strength

3.     Restore co-ordination

4.     Restore proprioception (joint position sense)

You will be provided with post-operative instructions which will guide you and your physio through the stages of recovery. Your physio will tailor the exercises according to your progress.

Wound management

Your wound will be generally closed with absorbable sutures unless you request otherwise (eg allergy). Knee replacements will often be closed with clips. Your dressings are water resistant and should tolerate showering. If they become soaked you should replace them. It is preferable to have no dressings, than to have soaked, wet dressings. 

You should not soak in baths, spas, pools or sea water until your wound is totally healed and there is no scabbing along the wound. 

You will either return to see Dr Elliott or see your GP for a wound check at 10-14 days post-surgery depending on where you live and what is convenient. 

If your wound becomes red, swollen, increased pain or becomes increasingly oozey, then you make have an infection. You should contact our clinic and ideally send a photo clinic@robelliott.co.nz. If the clinic is not accessible to you, you should see your GP. You will likely need oral antibiotics. Should this happen you should rest and elevate the limb to reduce the swelling in addition to taking antibiotics. 

Constipation

Constipation after orthopaedic surgery can be severe. This is due to:

  • Strong opiod pain killers such as morphine and codeine
  • Immobility
  • Dehydration

Dr Elliott strongly advises taking regular laxatives from the first evening post surgery. It is preferable to be on the looser side, rather than trying to move concrete. 

These strategies help prevent post-operative constipation:

  • Laxatives (generally Coloxyl and senna, two tabs morning and night)
  • Early mobilisation – your bowels like movement
  • Fruit and vegetables esp kiwi fruit and prunes
  • Plenty of oral fluids

If you have not passed a bowel motion for more than 3 days, you should try a microlax enema. If this does not work please consult your GP. 

Blood clots

These can occur in the deep vessels of your arm or leg (DVT) after surgery or immobilisation. They can cause pain and swelling in that limb. If they dislodge, they can migrate to the vessels in the lungs and cause a PE (Pulmonary Embolism). This can cause shortness of breath, chest pain and can be life threatening. Blood thinners can help to prevent clots occurring. Unfortunately, they can also cause a wound to bleed which can result in active bleeding, haematoma formation, pain, and increase the risk of infection. This can ruin the results of the operation. The use of blood thinners is therefore a trade-off against two serious problems. Dr Elliott generally recommends Aspirin for a period of 2-6 weeks following lower limb surgery. He generally does not use any blood thinners for upper limb surgery unless the patient is bedbound after the surgery.

Please let Dr Elliott know if you have had previous:

  • Blood clots
  • Family history of thrombo-embolism (DVT/PE)
  • Active cancer
  • On oral contraceptive and smoke cigarettes

Off work / Illness certificate

Dr Elliott may restrict the activities you are able to do following the surgery to allow your condition to heal. If you need a work certificate for ACC and your employer please ask for it.

You can drive:

  • Once you are no longer taking strong pain killers such as Codiene, Tramadol or morphine related medication.
  • After Dr Elliott has cleared you to take full weight on your legs, and you are able to do so without significant pain. You need to be able to apply force to a brake rapidly to avoid collision. 
  • If you have an automatic car and your left leg was operated on you will likely be able to drive sooner. 
  • Once your upper limb is no longer required to be in a sling, and you are confident you can control a steering wheel with out significant pain. You need to be able to confidently, and swiftly, swerve to avoid collision.