Pain management after surgery is being approached differently than it has been in the past. Your body will interpret surgery as a new trauma and will respond with swelling and inflammation. In fact, swelling and pain will worsen for about the first 7 days and then will typically decrease as you continue to recover. To manage this, we initially focus on reducing swelling and restoring basic function, this is very important for knee replacements. We will use a wide range of medications, ice packs or cold therapy machines, elevation of the leg, and exercises. Our goal, especially in the first 2 weeks, is to reduce inflammation and improve range of motion and walking. It is possible to overwork your healing muscles and tendons and cause more inflammation and bleeding and therefore Dr. Montgomery requests that you focus more on making small consistent improvements throughout your recovery rather than hope for big improvements to be made in physical therapy sessions. In addition, Dr. Montgomery encourages you to minimize use of addictive pain medicines (opioids / narcotics) as much as possible and strongly advises that you DO NOT take before therapy sessions. If you require narcotics to get through therapy the joint is being pushed too hard and you need to find alternative exercises, having short term pain afterwards that can be treated effectively with pain medicine is acceptable and normal.
For pain that is not controlled (8/10 or greater):
Step 1: Ensure you have taken your acetaminophen (Tylenol) and anti-inflammatory medicines, do not skip these believing that they are “not strong enough”. Our goal is to utilize all available pain control pathways and we should ensure we use the safest ones first.
Step 2: Ensure the operative leg is elevated with your ankle higher than your knee and your knee higher than your heart. We want the fluid from the swelling in your leg to drain to your heart where it can be pumped throughout the body and eliminated. Use cold therapy machines and ice packs as instructed. Avoid activities that make your joint feel worse.
Step 3: If you still have pain, take another 100mg celecoxib (celebrex) tablet, wait 30 minutes.
Step 4: If you still have pain, take 1 oxycodone 5mg tablet wait 1 hour
Step 5: If you still have pain, you may take a second Oxycodone but you will need to wait for 5 hours before taking any further doses.
For a comprehensive guide to total joint replacement, including information on preparation and daily recovery expectations, please see Dr Andrew Wickline’s total hip or knee replacement guides found here:
Hip Booklet:
Dr. Andrew Wickline’s Total Hip Replacement Guide
Knee Booklet:
Dr. Andrew Wickline’s Total Knee Replacement Guide
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