Sunday, July 15, 2012

Painless Total Knee Arthroplasty

As a young boy, I can still remember my father's office having a sign that said, “painless dentist”.  I do not know of anyone who particularly enjoys dental work and I suppose the same is true for most any operation.  After all, none of us want to have pain.  In fact, most people that desire knee replacements in deed want less pain in their day to day lives.  For many years, orthopedic surgeons, including myself, have desired to provide a less invasive means of total knee arthroplasty.  While it is possible to do knee replacements now with a smaller incision, the fact remains that the surgery is invasive requiring, at times, extensive dissection, bone cuts, and implanting large parts.  In order to achieve a more rapid and consistent recovery with good range of motion, adequate pain relief is essential.  I have been working with my partners to standardize pain management and provide a means of consistent, adequate pain relief.  I do occasionally have patients that are surprised by how little discomfort they have following knee replacement surgery.  Unfortunately, not everyone has that experience.  In order to decrease pain, we utilize multimodal pain management.  Basically that involves using many different methods to decrease pain following surgery, including use of oral narcotics, anti-inflammatory medications, local anesthetics both in the tissue as well as nerve blocks for postoperative pain control.  I have been minimizing or eliminating use of a tourniquet during surgeryThe idea is that the tissue continues to have its blood supply throughout the operation, which may lead to less swelling and pain in the early postoperative period.  For most patients, we still have not achieved a truly painless total knee arthroplasty.  However, my hope is that my patients not dread having a second knee replacement if necessary

Early postoperative pain control is helpful.  The patients are able to regain range of motion within the first few weeks; they typically have a relatively straightforward recovery.  Obviously, avoiding complications such as infection, stiffness, and blood clots is critical to having a relatively painless total knee replacement.  Unfortunately, we cannot provide general anesthesia for our patients for 3 months to ensure that they have no pain following knee replacement surgery.  However, new approaches to better pain management immediately following surgery has been very helpful and well received.  

Written by John McAllister, MD