After the wounds are closed, the author applies a Tegaderm (Sklar Instruments, West Chester, PA) dressing, a compressive stocking and the Cryo-Cuff (Aircast, Summit, NJ) (Fig. 6.71). This is a sleeve that contains cool water and lowers the temperature of the knee, thereby reducing the pain. The patient is transferred to a continuous passive motion (CPM) machine and to the recovery room (Fig. 6.72). When the patient gets up, he/she use the extension splint and crutches (Fig. 6.73).
The patient goes home several hours postoperatively with the CPM, the Cryo-Cuff, the extension splint, and crutches. Oral pain medication is 25mg of Vioxx od, and Tylenol # 3 at 1 or 2 q.4.h. prn. The patient also receives 1 more intravenous dose of antibiotic. The patient returns for a checkup in four to five days. The Tegaderm dressing is removed, and the Cryo-Cuff applied directly to the skin. The wounds are cleansed for the next few days with 3% hydrogen peroxide.
Physiotherapy starts within four to five days. The author has a protocol that can be mailed to remote physiotherapy locations to ensure that the early extension routine is started. Routine checkups are monthly until the patient has fully recovered. The physician should try to get KT-1000 measurements at 6 weeks and at 3, 6, and 12 months. If there is any loss of extension, this is addressed early by vigorous aggressive rehabilitation. If there is still loss at three months, surgical debridement is suggested.
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