Preoperative Planning and Postoperative Planning

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Preoperative Planning
Day of Surgery
Pain Medication
Accommodations
Contact Information for Other Entities
Pulmonary Hygiene Instructions
Map
Postoperative Planning
LaPrade Team Contact Information
Physical Therapy
Functional Sport Test
Research

Preoperative Planning

  • You may be required to have a preoperative clearance from your primary care provider. Dr. LaPrade and his team will decide, based on your medical history, and a PA will contact you with requirements. Medical Clearance and documentation must be obtained within 30 days of your surgery. Please see below under “Preoperative Clearance by Primary Care Provider” for more detail.
  • Generally, Dr. LaPrade recommends staying in Vail for 5 to 10 days after surgery. This varies depending upon the procedure(s) you undergo. This allows time for our team to monitor your progress, modify medications, and answer all questions. In addition, you will be scheduled for physical therapy daily at Howard Head Sports Medicine (HHSM).
  • You are required to arrange a ride home to your accommodations the same day of surgery
  • Discontinue eating and/or drinking after midnight the night before your surgery. This includes no water, coffee, mints or gum. You may brush your teeth on the morning of surgery.
  • Please discontinue any medications prior to your surgery, unless otherwise indicated by your primary care physician and cleared with Dr. LaPrade.
  • Please avoid all anti-inflammatory NSAIDs (ex. Ibuprofen, naproxen, etc.) and aspirin 7 days prior to your surgery to reduce chance of excessive bleeding that can occur on these medications. Tylenol can be taken.
  • If you are a smoker, it is highly encouraged to discontinue any tobacco use 6 weeks minimum prior to surgery. Smoking not only increases your risk of infection, but also delays bone growth and soft tissue healing.
  • Please discontinue caffeine prior to surgery. For those who have a caffeine addiction, and may have surgery scheduled later in the day we do not want you to suffer from a caffeine headache preoperatively nor postoperatively.

Preoperative Clearance by Primary Care Provider (If Required)

Depending upon your current health and medical history, you may be required to obtain a preoperative clearance by your primary care physician within 30 days of your surgery. This may be required if you have one of the following conditions:

  • Over the age of 65
  • Heart, Lung, Liver or Neurologic Condition
  • Diabetes
  • Personal or Family History of Blot Clots or Blood Clotting Disorders
  • History of Complications under Anesthesia
  • History of MRSA

Do I need to quit smoking prior to surgery?

We encourage all tobacco users to quit 6 weeks prior to surgery. Tobacco use not only increases your risk for infection, but also delays bone growth and soft tissue healing.  It is also highly important to remain tobacco-free for a minimum of 6 months after surgery to increase your chances of success post operatively.

How do I obtain braces, crutches, and other durable medical equipment (DME)?

The Steadman Clinic has a DME department available M-F from 8-5.

Details regarding the duration you are to wear your brace will be discussed during your pre operative visit as well as along your recovery process during postoperative clinical visits. Any required postoperative braces or crutches will be fitted and provided the day of your surgery. If you have any issues with your equipment, the DME will help you with any adjustments you may need upon your next clinical visit with us.

Please contact DME at The Steadman Clinic or call 970-476-1100 and ask for a DME team member.

How soon do I start physical therapy?

Physical therapy is started the day after surgery? In general, our practice recommends twice daily sessions up to the first 10-14 days (including weekends) or as long as you are able to stay in Vail and depending upon the type of surgery you undergo. After this time, your physical therapist will schedule you with 3-5 sessions per week with specific exercises for you to perform daily at home. Your physical therapy protocol will detail what specific activities you can perform at different time frames during your rehab. Follow these instructions carefully and DO NOT ADVANCE or let your Physical Therapist advance your protocol beyond the normal time frames unless directed so by Dr. LaPrade.

How do I get FMLA/ Short-Term Disability paperwork completed?

If you need FMLA (Family & Medical Leave Act) or Short-Term Disability paperwork completed, the two forms (with links on the PreOperative webpage) should be completed and brought in with any required forms to your preoperative visit. Paperwork is completed after your surgery with a fee of $25 and will be directly faxed to your place of work.

Preoperative Visit

Preoperative preparation is important in the overall success of your surgery and recovery. If no formal preoperative clearance is required from your primary care provider, you will undergo a formal preoperative visit in our clinic the day prior to your planned procedure.  During this visit, we will:

  • Meet with Dr. LaPrade to review your planned procedure and get your questions answered.
  • Discuss location and time of surgery.
  • Review your procedure(s) and obtain consent and complete all necessary forms/paperwork for surgical facility admission.
  • Perform a brief physical exam.
  • Obtain the necessary bloodwork.
  • Discuss postoperative medication regimens (including pain management, anticoagulants, anti-nausea, anti-constipation, etc.).
  • Receive a prescription for physical rehabilitation for when you return home.
  • Provide paperwork with postoperative care instructions.

Postoperative Planning

How can I reduce swelling after the surgery?

There are multiple methods to help you reduce swelling after your surgery. They include the following:

  • Elevating your affected limb at or above heart level.
  • Ankle pumps (rotating your ankle, as well as, moving your foot up and down).
  • Continuous use of TED hose stockings.
  • Ice Machine.

How long do I have to wear the TED hose (surgical stockings)?

TED hose stockings are essential for preventing lower extremity swelling and decreasing your risk for a DVT (deep vein thrombosis- also known as a blood clot). These stockings are worn on both legs while on crutches for the first 2 weeks as there is still risk of getting a blood clot in the non-surgical leg. You may remove the TED hose stocking on the non-surgical leg at the two week mark; however, the affected limb is to have a stocking until you are full weight-bearing.  Stockings may be removed daily to wash and dry; however, be advised that they should be placed back on the lower extremities as quickly as possible.  Additional sets of TED hose may be purchased at the pharmacy.

How often do I use the Ice Machine?

Icing is an important part to reducing swelling and pain after your surgery. We recommend using the Game Ready ice machine. When icing, we recommend 30 min -1 hour breaks between icing sessions and wearing a protective layer between your skin and the ice machine. A Game Ready representative will meet with you in recovery postoperatively. The machine settings will be reviewed and set for you at set-up.  If you have questions regarding rental fees, when to return the machine or any other questions, please feel free to contact the company representative at (970) 471-6267.

How often do I do dressing changes at home?

Dressing changes are a vital part of your post-surgical process. You will be supplied with the needed dressing change materials and provided with hands-on instruction.

  • For the first 2 weeks, change the 4×4 gauze pads at least every other day or if they become wet/soiled. Keep them in place with the tubigrip provided.
  • Do not touch, remove or apply ointment to the steri-strips (tape) that are over the arthroscopic portals or skin incisions. Steri-strips are to remain on the incision sites for 2 weeks. If they fall off before the 2 week time period is up, please reapply them with the extras that you have been given.

At each dressing change, evaluate the incision sites for any purulent drainage (pus), excessive redness, increased warmth or pain. These signs may indicate an infection. Contact a team member immediately if these symptoms occur.

When do I have my sutures (stitches) removed?

Our surgical team typically uses dissolvable sutures in scope portals and surgical incisions (unless otherwise specified). These require no special care because the sutures are underneath your skin and will dissolve on their own. If you do have an incision, extra suture material may be on the outside of the skin. These sutures will need to be cut at 2 weeks post-operatively which can be done in our office during your follow up visit or at home by a family member/friend. A suture removal kit will be provided upon request. For clear sutures, clip any extra suture at both ends of the incision. The remaining suture under the skin will dissolve.

When can I bathe/shower or get my incision wet?

In order to reduce the risk of infection, it is crucial that you maintain a dry environment for your incisions for the first 2 weeks. A shower bag has been provided to you in your dressing change kit. If the shower bag’s elastic band does not fit well, you may use another rubber band or tape to secure it. Please use the shower bag for 2 weeks until you have your incisions evaluated by a medical provider.  After two weeks, patients may get the incision site briefly wet in the shower but are still advised to avoid soaking in a pool, hot tub or bath for up to a month after the surgical procedure.

How much weight can I bear on my leg after surgery?

Weight bearing status is dependent on both the type of surgery and anesthesia you will undergo.  If you decide to have a nerve block during surgery, you will be automatically placed in a knee immobilizer with non-weight bearing status until the nerve block is removed.  We will discuss your weight bearing limitations during your pre-operative visit and again after your surgery. The physical therapists will also help instruct you on the proper use of your crutches to ambulate.

Why do I have to take a blood thinner and for how long?

Any orthopaedic surgery is a risk factor for developing a blood clot, also known as a DVT (deep vein thrombosis). Our team is highly attentive to this risk and proactive at preventing blood clots. In order to decrease the chance of a blood clot, patients are placed on one of two blood thinners depending on their weight bearing status post-operatively. The type of medication you will be placed on will be discussed during your pre-operative visit. Please notify our providers if you are on any hormone medications (including birth control) or if you have any personal or family history of blood clots or blood clotting disorders as these also increase your risk for blood clots.

Any orthopedic surgery is a risk factor for developing a blood clot, also known as a DVT (deep vein thrombosis). Our team is highly attentive to this risk and proactive at preventing blood clots. In order to decrease the chance of a blood clot, patients are placed on one of two blood thinners depending on their weight bearing status post-operatively; either aspirin or Lovenox (enoxaparin). The type of medication you will be placed on will be discussed during your pre-operative visit. Our patients who will be able to put weight on their affected leg immediately following surgery are given a script for aspirin, which is to be taken for four weeks following surgery.  Patients that will not be able to put weight on their affected leg and will be on crutches will be given a script for Lovenox, which is to be taken for two weeks after surgery, followed by four weeks of aspirin as well.  Lovenox is an injectable blood thinner which has been shown to be very effective in reducing the risk of blood clots post-operatively.  It is prescribed in pre-loaded syringes, which are administered by the patient once daily via a very small needle.  The injection is performed in the soft tissue on either side of the patient’s belly button.  This medication is typically very well tolerated, however side effects are occasionally noticed by patients including mild fever, nausea, diarrhea, and bruising at the injection site.  Please notify our providers if you are on any hormone medications (including birth control) or if you have any personal or family history of blood clots or blood clotting disorders as these also increase your risk for blood clots and may determine which medication you are prescribed.

How to self-inject with LOVENOX

What are signs of a blood clot and what do I do if I suspect one?

Signs of a blood clot include the following:

  • Severe calf/leg swelling or diffuse redness.
  • Severe calf pain with moving foot up/down or when squeezing the calf.

If these symptoms arise, please contact our office immediately. We will need to order an ultrasound of your leg to rule out a blood clot. Our team is available Monday-Friday 9 am to 4 pm. If you are calling after business hours, please contact our main line at (970) 476-1100 to reach our on-call fellow physician.  NEVER massage calf pain!

*If you develop chest pain or difficulty breathing, call 911 IMMEDIATELY.

What are signs of an infection and what do I do if I suspect one?

While infection is not common, there is always a risk with any type of surgery.  Contact our office immediately if you develop the following signs:

  • Fever of 101.5 degrees F or higher
  • Purulent drainage (pus), excessive redness or swelling around the incision site(s).

When is my first postoperative visit with the team?

Dr. LaPrade along with his team rounds on all patients the day after surgery. The team will meet you at Howard Head Sports Medicine at 7:30 am to monitor your progress, change your dressing and provide instructions, discuss activities of daily living and obtain post-operative x-rays (4th floor, if needed). There will be an opportunity to have any further questions answered, although we will be available throughout your recovery process to address your concerns.

What is the expected timeline for postoperative office visits with Dr. LaPrade?

Dr. LaPrade would ideally like to see each of his patients for post-operative office visits with the following timeline below:

  • 1-2 weeks (At 2 weeks suture removal is performed. If you are not able to make this visit, we recommend you follow up with your primary care provider for post-op wound care.)
  • 6-8 weeks (Depending on procedure type.)
  • 3.5 months
  • 6 months
  • 12 months
  • Annually (for osteotomies, meniscal transplants, fresh allografts, and ligament reconstructions)

Dr. LaPrade’s Scheduler will contact you postoperatively to schedule a postoperative visit. To schedule, call Amie at 970-401-8702 or email afilauet@thesteadmanclinic.com. You can schedule a clinic visit with Dr. LaPrade from 9:00am -3:30 pm on Mondays or Wednesdays.

Pain Medications / Narcotics

Medication Refill

Pain medication prescriptions are provided on the day of discharge for inpatient surgeries or the day of the pre-operative visit for outpatient surgeries. All other medications (anti-nausea, anti-constipation and blood thinners) are prescribed day of surgery. If you require a refill on any of these medications, please contact our office during business hours. Of note, some pain medications require by federal law a written prescription that needs to be picked up from our office and taken to your pharmacy. If you are not within driving distance, we recommend you see your primary care provider or an urgent care clinic for further evaluation.

*While our team takes your pain concerns very seriously, we are devoted to the national effort in decreasing the opioid addiction epidemic. We abide by strict guidelines provided by the CDC and have created a pain medication agreement plan with a link below.

Controlled Substance Agreement

May I take anti-inflammatory medicines after the surgery?

Unless otherwise directed by Dr. LaPrade, all patients are to avoid anti-inflammatory medicines (NSAIDs – such as ibuprofen, naproxen, etc.) after surgery as these delay bone healing and interfere with ligament graft healing. While we provide you pain medication for the first weeks after surgery, we recommend that patients transition to Tylenol for pain relief. Tylenol is not to be taken in conjunction with Norco, Vicodin or Percocet because these medications contain the same ingredient (acetaminophen). The maximum daily dosage for Tylenol should not exceed 4000mg (or 4grams) per day as this can cause permanent liver damage.

Day of Surgery

Surgery Day

  • All surgeries are performed in the Vail Health builiding located at 181 West Meadow Drive Vail, CO 81657. Patient parking is available at Vail Health parking structure when entering from South Frontage Road, or at the West end of Vail Health when entering from West Meadow Drive. Both locations offer valet parking to patients.
  • Vail Valley Surgery Center –  Admissions is on the 3rd floor. Take the elevator (bank of 3 elevators) to “3R”. The surgery center will be located on the right hand side when exiting.
  • Vail Health surgery –Admissions is located on the 1st floor of Vail Health. After check-in is completed you will be directed to Vail Health preoperative area on the 3rd floor.
  • Family/Friends/Caregivers – Food and drinks are available on the basement level at Vail Health’s Remedies Café. Using the bank of 3 elevators, the café can be found on level B.

Day After Surgery

  • At 7:30 am the day after your surgery, our team will meet you at your first physical therapy session at Howard Head Sports Medicine (HHSM) located on the 1st floor of Vail Health. Physical therapy early on in your recovery is crucial to improved outcomes postoperatively.
  • During this visit, you will:
    • Undergo dressing changes.
    • Learn how to do daily living activites (bathing, etc.).

*You may be asked to have postoperative x-rays taken at The Steadman Clinic (4th Floor) after your physical therapy session has been completed.

  • Dr. LaPrade advises patients to rest for the first 24 hours after surgery to minimize swelling and bleeding.

Physical Therapy

How soon do I start physical therapy?

Physical therapy is started the day after surgery! In general, our practice recommends twice daily sessions up to the first 10-14 days (including weekends) or as long as you are able to stay in Vail and depending upon the type of surgery you undergo. After this time, your physical therapist will schedule you with 3-5 sessions per week with specific exercises for you to perform daily at home. Your physical therapy protocol will detail what specific activities you can perform at different time frames during your rehab. Follow these instructions carefully and DO NOT ADVANCE or let your Physical Therapist advance your protocol beyond the normal time frames unless directed so by Dr. LaPrade.

Do I need a prescription for physical therapy at HHSM?

Dr. LaPrade’s team provides orders for all physical therapy sessions that occur at Howard Head Sports Medicine immediately after the surgery.  A prescription will be provided during your pre-operative visit in your packet for a Physical Therapist when you return home. This order prescribes 3-5 sessions weekly for up to a total of 3 months and will be renewed upon your next post-operative visit with our clinic.

What are my physical therapy benefits?

Our office encourages patients to contact their insurance carrier to better understand the benefits they have selected for all services. Often times, your plan may have a limit on benefits you may not be aware of and calling to discuss with your insurance carrier to better understand what will or will not be covered is advised. If you are made aware of any limitations or restrictions on your policy, please notify your treating therapist.

Physical Therapy Overview

Dr. LaPrade’s postoperative patients are all provided with  folder(s) from The Steadman Clinic and Howard Head Sports Medicine (HHSM). The folder received from Dr. LaPrade’s office at The Steadman Clinic will include a prescription/referral/order for physical therapy along with postoperative instruction including dressing change details. Make sure to give the prescription/referral for physical therapy to your local provider. Some providers require that you provide this prior to scheduling. You may need to take to them, in person, to schedule. This order for therapy is what will be used, by your physical therapy provider, to fulfill insurance requirements and authorizations for treatment. When scheduling with your local therapist, we recommend you explain you will bring your prescription and protocol to your first session with them. HHSM will provide a folder which will include a protocol, exercises, and immediate postoperative orders given to them by Dr. LaPrade. Protocols and orders are extremely important for you to adhere to postoperatively. You or your physical therapist need to follow all provided exercises and protocols closely and you should NEVER advance your protocol without permission from Dr. LaPrade.

Physical Therapy Protocol Sample

Physical Therapy Prescription Example

Encourage your treating therapist to update Dr. LaPrade and team with regular progress reports and plans of care. These can be emailed to medicalrecords@thesteadmanclinic.com or faxed to 970.479.5835.

For those therapists who may have questions, please contact Laurie Griffin, Dr. LaPrade’s lead therapist, by email at Laurie.Griffin@vailhealth.org. Laurie will assist with questions regarding protocols, restrictions, and limitations given by Dr. LaPrade for his postoperative patient. 

To request another physical therapy prescription, please email Nick DePhillipo at ndephillipo@thesteadmanclinic.com. Include the following:

Patient Full Name:

Date of Birth:

Fax Number of Your Physical Therapy Provider: 

If your insurance plan has a physical therapy visit limit, Dr. LaPrade can provide you with a letter to request additional visits. Please request through Nick DePhillipo by emailing ndephillipo@thesteadmanclinic.com. Please note:  

Dr. LaPrade is not the provider of services and cannot request additional visits. As the provider of services, your current physical therapy company should submit this letter with their claims along with any other supporting documentation, coding, and plan of care. Historically, with insurance carriers becoming more stringent,  most insurances do not entertain extending this benefits unless you have a plan that does not have a hard limit.

Extension of Physical Therapy Benefits

Accommodations

Please contact Aimee Filiault: afiliault@thesteadmanclinic.com and 970.401.8702

Contact Information for Entities Involved in Your Surgery

Pre-Surgical Planning Nurses

Dr. LaPrade performs surgery at both Vail Valley Surgery Center and Vail Health. A presurgical planning nurse will contact you prior to surgery and to review your medical history, if any. They will review bathing, eating, and drinking regimens and answer any other questions you may have.

The nurse is a liaison between you and the anesthesia team as well and can assist you with questions you may have regarding anesthesia.

Each entity has a medical passport you will be asked to complete prior to undergoing surgery.

Vail Valley Surgery Center – 970.476.8872

Vail Health – 970.476.5144

Pulmonary Hygiene Instructions

Click to Download Pulmonary Hygiene Instructions

Dr. LaPrade Team Contact Information

What is your phone policy?

You will be provided with direct contacts for the providers on Dr. LaPrade’s team to answer any concerns or questions.  Our office hours are Monday – Friday 9 am to 4 pm.  If you require assistance after hours, holidays or weekends, please call (970) 476-1100 to reach our on-call fellow physician.

Amanda Pena – 970.479.5881 or amanda@thesteadmanclinic.com

Nick DePhillipo – 970.479.1584 or ndephillipo@thesteadmanclinic.com

Fred Cook – 970.479.5869 or fcook@thesteadmanclinic.com

Chris Armstrong – 970.479.5801 or carmstrong@thesteadmanclinic.com

To reach all team members: teamlaprade@thesteadmanclinic.com

Aimee Filiault – 970.401.8702 or afiliault@thesteadmanclinic.com

Saghel Reddy – 970.401.8725 or sreddy@thesteadmanclinic.com

Functional Sport Test

  • All patients are required to complete a functional sport test prior to being released to full activities and sports following surgery
  • The functional sport test is conducted with one of the physical therapists at Howard Head Sports Medicine (HHSM)
  • Patients who are approved to take the sport test should schedule an appointment with HHSM to take the test prior to their clinic appointment with Dr. LaPrade. Most patients schedule a midday appointment with HHSM and see Dr. LaPrade following. Please keep in mind, Dr. LaPrade is typically in the office on Mondays and Wednesdays.
  • Please bring the completed sport test report with you to your clinic appointment
  • If you have any questions about what the test entails, please contact Laurie Griffin, DPT, OCS at 970.476.1225 or laurie.griffin@vailhealth.org.

Research

  • The Steadman Clinic and Steadman Philippon Research Institute have one of the largest research programs in the country to advance the care of complex knee problems
  • We request you to complete data on how your knee is doing preoperatively and postoperatively as part of our assessment of many of the surgical procedures which Dr. LaPrade invented
  • In addition, we may ask you to participate in a research study to try and advance the care of all patients. These studies include different methods of surgical reconstruction, postoperative physical therapy, and different biologic therapies.
  • The research that we have performed to date has greatly advanced the care of many sports medicine problems and we appreciate your participation in these research projects if you qualify.