Rajesh Bhalla

Post-Operative Instructions and guide

1. Joint Preservation Procedure

Arthroscopic joint preservation surgery has been found to be very effective at The Dr Bhalla’ s Clinic when it is combined with an aggressive post-operative rehabilitation program with focus on daily physical therapy for 1-2 weeks after surgery to make sure the patient has maintenance of their range of motion, has reactivation of their muscles and has attempts to decrease swelling post-operatively. It is especially important to try to control knee swelling because this will cause quadriceps shutdown and atrophy, increased pain, and can limit motion.

In general, the results of joint preservation surgery are very dependent upon the patient working with a physical therapist following surgery. A properly guided rehabilitation program is essential to achieve one’s maximal outcomes after this type of surgery. In fact, if a patient cannot participate in this type of therapy program, we will generally discourage an arthroscopic joint preservation surgery because we have found that in patients who do not participate in physical therapy commonly has a recurrence of stiffness, scarring, and muscle atrophy.

2. Knee Replacement procedure

Knee replacement surgery will require physical therapy and rehabilitation so that the knee joint can regain strength, motion, and overall mobility. It is important to follow the prescribed protocol and follow the instructions provided by your therapist closely. Initial therapy focuses on safe motion with certain restrictions for 6 weeks. After a recovery period of 2-3 months, patients typically are painless and performing well with their normal activities.

3.Osteochondral Autograft Transfers (OATS)/ Allograft Procedure

Patients is observed for 4-6 weeks of surgery and usually allowed to bear weight thereafter. This is followed by gradual increase in the active exercise. The return to the sports activity is allowed after 6 -9 moths.
Patients often recover from both of these procedures. Basic idea of both of this surgical technique is to replace damaged healthy tissues.

4. Microfracture Procedure Post operative protocol-

A. Patients treated with Defects on either the Femur or the Tibia cartilage

Immediately after the surgery the passive range of motion is started as soon as 6 to 8 hours the moment the anaesthesia recovery is observed. This can be either manual, 400 to 500 cycles 3 to 4 times a day or via a CPM (continuous Passive Machine) 4-5 hours a day.
Toe touch crutch walking is though allowed earlier in small lesion up to 1 cm i.e. 4 – 6 weeks and 6-8 weeks for larger lesion up to 4 cm.

• Non weight bearing and standing on the uninjured leg is allowed to start the next day after surgery.
• Stationary cycling with zero resistance and hydro exercise program begin 1 to 2 weeks after surgery.
• Full weight bearing on both legs is allowed after 8 weeks followed by gradual static and resistance exercise.
• Sports activity is started after 4 to 6 months once after fully examined and allowed by the treating orthopaedic surgeon.

B.Patients treated with Patellofemoral Chondral Defects.

 Postoperatively the patient is started with early CPM to full range of motion without brace to prevent knee stiffness once anaesthesia clearance is given.
These patients are managed with 20degree brace until 8 weeks. They are not allowed to bear weight beyond 20 degree. This prevents this kissing lesion to touch each other. This assures that the super clot mature into fibrous cartilage in due time. This is done to prevent premature traumatic detachment of super clot.
Patient is allowed full weight bearing with 20 degree brace as per tolerated. After 8 weeks, Braces may be discontinued. Muscle strengthening, static cycle and hydro exercise allowed.
Sports activity be allowed after 8 weeks after due permission from the treating orthopaedic doctor.

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