Knee Surgery FAQ

Yes, you will be asleep during the procedure. Most knee surgeries are performed using a combination of “light” general anesthetic and regional anesthesia (nerve block). With “light” general anesthesia, medication is administered to allow you to sleep during the procedure, an oral airway with oxygen supplementation is used instead of a breathing tube in your main airway, but you are breathing on your own, and your body is not paralyzed. This is quite similar to the anesthesia you might receive for a colonoscopy. Only more complicated or lengthy procedures might require deeper anesthetic, true intubation with a breathing tube, and muscle relaxation.

Regional anesthesia is a key component of effective anesthesia for knee surgery. This procedure involves the injection of medication around the nerves of the lower extremity as they exit the spine, so that the knee is numb throughout the procedure and afterwards. This procedure provides excellent comfort and pain relief during the perioperative period. Other medications can be added to prolong the effect of the nerve block. Current techniques and medications can provide up to 72 hours of effective pain relief. As the nerve block wears off, the patients will begin to feel tingling of the toes, and improvement in sensation and motor strength, with gradually return to normal. If you notice that the block has not worn off after 72 hours, or that the neurological symptoms are worsening rather than improving, you should notify Dr. Kowalsky and his care team.

Our understanding of post-operative pain, and our strategies for managing this pain have improved significantly over time. In fact, our team at the ONS Foundation for Clinical Research & Education has published research in this area of study that has changed standards of care and best practices for pain control after orthopedic surgery. We use multimodal pain control, which refers to the use of multiple different, safe medications that treat different steps of the pain cascade to more effectively manage pain without reliance on opioid medication. A significant portion of our patients either use none or minimal opioid medication after orthopedic surgery at ONS. You will be given prescriptions for tylenol, prescription-strength anti-inflammatory medication, and a medication for nerve pain. Using these medications together on a schedule will effectively control pain, and minimize the need for opioid medication. We do not recommend taking prescribed opioid medication ahead of time, to anticipate or stay ahead of pain, as this may lead to the use of opioid medication you likely would not have required.

For arthroscopic procedures, the wound should stay dry for 48 hours. For open procedures with a longer incision, the wound should stay dry for 5 days. If you have a waterproof dressing, you can shower before this time, as long as the dressing remains dry and intact. Otherwise, you should wait this amount of time before showering. Avoid a direct stream of water on the dressing if showering earlier, and if the dressing becomes saturated, remove and replace it with dry sterile gauze and an occlusive dressing (i.e. Tegaderm).

Once the dressing is removed and you begin showering normally, avoid spraying/submerging/soaking/scrubbing the wound. Simply leave alone, and allow water to drip over the wound. Pat it dry after showering, and either leave it open to the air or cover it if desired.

Some patients who have had knee surgery, and have a brace with a dressing underneath, may choose to leave the brace and dressing in place without changing it, and instead to bathe with a shower bag over the leg, as we would do for a casted leg. This is perfectly appropriate, and Dr. Kowalsky can remove the dressing and examine the wound with you at your first appointment. This is particularly helpful if you are not comfortable removing the brace and dressing, or if you do not have room for for shower chair for bathing while protecting the operative knee.

For most knee procedures that require bracing, you will wear the brace for 4-6 weeks. You will be encouraged to wear the brace during sleep. The specific details of brace use will depend on the nature of your condition and procedure.

Some patients will choose to rent or purchase a cryotherapy device to assist with icing the operative shoulder. You can speak to Dr. Kowalsky’s coordinator about this during the scheduling process. Otherwise, patients can acquire ice packs and sleeves online if desired, as an alternative to a typical bag of ice. Some patients will require a CPM (continuous passive motion machine), to be used at home to help with gradual gentle motion of the knee during the early post-operative period of time. This will be specified by Dr. Kowalsky, and his coordinator will assist with communication with the team that will provide the device and deliver it to your home. Specific instructions regarding its use will be provided based on the specific details of your condition and procedure.There is other equipment that might be helpful that can be found on the website on the “home equipment” page (insert hyperlink).

For most procedures, it is encouraged to sleep with the brace. To assist with elevation, 1-2 pillows should be placed under the lower leg to keep the knee at or above heart level. Patients are discouraged from placing pillows below the knee, as this can lead to stiffness and difficulty achieving full extension of the knee.

Cryotherapy is most helpful during the early post-operative period of time, but can be helpful throughout your recovery. If using ice or ice-packs, you should only apply ice for maximum 20 minutes, and there should be a towel or fabric between the ice and your skin to avoid skin burns. Dr. Kowalsky’s care team may discuss cryotherapy devices with you. These devices have a cooler of iced water that is pumped into a pad secured to the operative arm for continuous cooling therapy. While they can be used for an extended period of time, you are encouraged to follow the doctor’s and manufacturer’s instructions, avoid excessive compression, always keep a barrier between the device and skin, and check the skin frequently (every 1-2 hours) for redness or other signs of an adverse reaction.

Heat can also be helpful, primarily for the muscles that surround the operative joint. Consult with Dr. Kowalsky regarding the use of heat during the early post-operative period of time, and if using heat, only apply the heating pad to the muscles adjacent to the joint, for maximum 20 minutes.

This will depend on the specific details of your condition and procedure. Most patients who have had a repair or reconstruction will observe protected weight-bearing, and will be allowed to allow the toes touch town for balance, but will use crutches and avoid full weight-bearing on the operative leg.

The timeline to return to work will depend on the nature of your work and of the procedure that was performed. For most knee procedures, desk workers will be able to return to work within 1-2 weeks. Strenuous manual laborers may require up to 3-6 months to return to full duty. There are occupations that involve a hybrid of deskwork and strenuous activities, and return to work for these professionals is handled based on the unique demands of these patients and the details of their conditions and procedures. Typically these patients may require at least 6 weeks to return to work.

There are no universal or specific guidelines for driving after surgery, and there is no specific test or criteria to determine when it is safe to drive. It is best to consult with your local DMV, state and local laws for guidance. If you require opioid medication to control post-operative pain, you should not drive. If you still require brace immobilization on the right leg, you should not drive. For patients who have had left knee surgery, the knee has to be able to bend enough to safely access the pedals. Most patients will wait 4-6 weeks to drive after more significant procedures. When you do begin driving, exercise caution, drive short distances in perfect conditions, and observe defensive driving strategies.

This will be determined based on the details of your condition and of the procedure. Most patients who have undergone knee surgery will start physical therapy within 3-5 days after surgery. The PT protocol will be specified by Dr. Kowalsky, and will outline the weekly plan of exercises you and your therapist can perform, as well as precautions and limitations to protect the repair or reconstruction. You will typically attend therapy twice weekly for several months. The physical therapist will provide home exercises that you can perform on your own between sessions.

Dr. Kowalsky and his care team will usually call you the day after surgery to check in with you. Your first post-operative appointment will usually occur at 10 - 14 days. You will then see Dr. Kowalsky 6 weeks after surgery, 3 months after surgery, and 6 months after surgery. This schedule will be modified if needed based on your progress.

At your first post-operative appointment, Dr. Kowalsky will discuss with you any events over the first two weeks, and evaluate your comfort and pain control. The wound will be examined and sutures will be removed if needed. A thorough examination will be performed, and x-rays will be obtained and reviewed if needed. The details of the procedure will be reviewed, and the post-operative plan, including physical therapy, will be discussed.

Dr. Kowalsky encourages you to contact him and his care team with any concerns during the early post-operative period. Specific concerns that would require immediate contact include fever > 101.5°F, chills/malaise/night sweats, severe pain not controlled with prescribed medications, persistent drainage from the surgical site, persistent or worsening numbness/tingling, shortness of breath or chest pain, persistent nausea or vomiting, or hives/itching/rash.