HomeKneeTotal Knee Replacement Pain Management Protocol 2021

Total Knee Replacement Pain Management Protocol 2021

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Immediately After Knee Replacement Surgery

How painful is a total knee replacement

After your knee surgery, your orthopedic surgeon will most likely have you on narcotic pain medication. Pain management after a knee replacement is an absolutely necessary part of recovery. You can expect to take your medications for a few weeks. As with all narcotics, there are side effects, therefore one should follow the instructions exactly as they are written. The importance of medication is important for one simple reason. Pain causes swelling, which can interfere with your physical therapy, your healing, and your progress. At lower pain levels, the medication your doctor gives you will work more quickly. However, the more the pain is permitted to build up, the longer the drug takes to become effective.

Protecting Your Knee Replacement

After surgery, make sure you also do the following:

  • Participate in regular light exercise programs to maintain proper strength and mobility of your new knee.
  • Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery.
  • Let your dentist know that you have a knee replacement. Talk with your orthopaedic surgeon about whether you need to take antibiotics prior to dental procedures.
  • See your orthopaedic surgeon periodically for routine follow-up examinations and X-rays. Your surgeon will talk with you about the frequency and timing of these visits.

Weeks After Knee Replacement Surgery

Weeks after the surgery, you may still need pain pills even though you are getting back to normal activities. This is true especially at night when pain tends to become more obvious. Ice is also essential for pain management in knee replacement surgery recovery. Ice can reduce pain in combination with medication, and with less severe pain, it can be used on its own. Lastly, elevate your legs and rest while you are icing.

Knee Pain can Last for Weeks Post Knee Surgery

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How Can I Manage Pain After My Total Knee Replacement Surgery

Pain is a major concern for patients who are about to have total knee surgery. Post-operative knee replacement patients want to know what their life will be like after their surgery, how much discomfort they will have, and how many narcotics or other medications they will have to take. Educating yourself about pain before you are in pain can significantly reduce fears and help you manage your expectations. We recommend patients follow a simple mantra when practicing pain management for total knee surgery: Rest, Ice, Medicate, Elevate.

We Will Give You The Most Important Information About

Physical Therapy Clinical Practice Guidelines For Total Knee ...

This analgesic medication numbs the patients knee area by blocking pain signals to the brain. In conjunction with medications, ice can minimize discomfort, and it can be used. A total knee replacement, also known as total knee arthroplasty, involves removing the arthritic parts of the bones at the knee joint and replacing them with artificial parts.

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Characteristics Of The Included Studies

Initially, 170 potentially relevant studies were identified, of which 91 duplicates were removed. Of the 79 records left, 67 were excluded after screening the titles and abstracts, leaving 12 potentially relevant studies for full-text review. Finally, five RCTs involving 593 patients were included in the meta-analysis .

The characteristics of the included RCTs are listed in Table 1. The flow diagram of the study selection process is shown in Figure 1. The risk of bias of the included studies is shown in Figure 2.

Table 1. Characteristics of the included trials.

Figure 1. Flow diagram of study selection.

Figure 2. Risk of bias of included studies.

The included studies, which were performed in China, Japan and Indonesia, were published between 2008 and 2021. Among the five included studies, three reported VAS scores at 24 h after TKA , three reported VAS scores at 48 h after TKA , three reported VAS scores at 72 h after TKA , three reported morphine consumption over 72 h postoperatively, , two reported active ROM at 24 h after TKA , three reported active ROM at 48 h after TKA , three reported active ROM at postoperative 72 h, two reported active ROM at 7 days after TKA , two reported the incidence of PONV, and one reported total blood loss after TKA. The main outcomes of the included studies are summarized Table 2.

Table 2. Main outcomes of each included studies.

Study Design And Enrollment Of Patients

This study was a single-center, prospective, double-blind randomized controlled trial conducted in a tertiary care hospital. The study started after obtaining approval at the Bioethics Committee Jagiellonian University meeting on the research plan presented. The Bioethics Committee of the Jagiellonian University, Kraków, Poland, confirmed its consent by letter no. 1072.6120.11.2020, 23/01/2020. The research was registered with ClinicalTrials.gov . All research was performed in accordance with relevant guidelines and the Declaration of Helsinki. After obtaining oral and written informed consent to participate in the study, consecutive patients above 65 years of age, were operated on with unilateral TKA in the period of June 1st to December 31st, 2019, and the ERAS protocols were recruited following the procedures. We excluded patients due to clinical circumstances that restricted glucocorticoid administration, such as: diabetes type 1 and 2, CRP levels above normal values , current chronic steroid treatment, peptic ulcers treated within the past 30 days, and chronic pain such as: in the course of gonarthrosis, patients being treated in Pain Clinics, high intensity pain above 6 points on the NRS scale, inability to perform activities of daily living, and night pain at rest despite multimodal pharmacotherapy already requiring the use of additional transdermal and less often oral opioids.

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Immediately After The Operation

Doctors have made big advances in pain management after total knee replacement over the last 10 to 15 years due to advancements in using regional nerve blocks, spinal blocks, and other methods of pain control.

During knee surgery, your healthcare team might either use a general anesthetic, where you will be fully asleep, or a localized anesthetic, where youre numb from the waist down but still awake.

After the surgery anesthesia wears off, your healthcare team can provide pain medication either orally or through an intravenous tube.

These medications may include a strong opiate or opioid such as morphine, fentanyl, or oxycodone, and are intended only for short-term use. Its important to note that larger doses over time can lead to physical dependence and addiction. Follow your doctors instructions to avoid adverse effects.

Post Joint Replacement Surgery: Alternatives To Narcotics For Pain Relief

One Month Post-Op Total Knee Replacement – Expectations, common findings and physical therapy

Pain relief forknee replacement surgery and other joint surgeries has been a hot-button topicover the past decade. With an epidemic of nearly 450,000 opioidoverdoses in America since 1999, physicians have been more mindful of therisks of narcotic prescription drugs and more dedicated to educating patientson alternative methods of pain relief.

Orthopedicsurgeons perform these procedures to help people who are in end-stagearthritis and living in chronic pain. As with any surgery, some discomfort andpain can be expected after a hip or knee replacement.

There is arange of pain management resources available for patients who have had surgery.From prescriptions to over-the-counter medications to drug-free alternatives,there are safe and effective options for all patients. Let’s explain thedifferent kinds of post-surgery pain relief in the following list.

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Variables In Pain Level

There arefactors that can increase or decrease your level of pain after surgery.

  • Activity Level: Movement of the joint and physical activity is encouraged after surgery and should be guided by your doctor and physical therapist. Activity level can increase swelling and lead to more pain. This is normal and can be managed through medications or hot/cold therapy.
  • Time of Day: Believe it or not, the time of day can play a factor in your pain level after hip or knee replacement. Pain at night is more common. There are several reasons for this, including being active during the day and increased swelling, as well as not having any distractions at night and focusing on your pain or discomfort.
  • Stress: Heightened stress levels can worsen both physical and perceived pain. If you are feeling stressed or anxious, tell your doctor and set aside dedicated time each day to meditate or relax. Journaling, talking with a friend or listening to calming music are ways to relax while recovering from surgery.

Guidelines For The Management Of Postoperative Pain After

It is based on a systematic review of published studies on the management of postoperative pain after total knee arthroplasty and was

You may feel some discomfort in your new joint. Raise your leg above the level of your heart by placing a pillow under your calf or ankle, not your

in this protocol. The overall goals of the operation and rehabilitation are to: -. Control joint pain, swelling, hemarthrosis .

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How To Take Opioid Medicine

  • Take the medicine as directed by your health care provider.
  • Eat before you take the medicine.
  • Drink plenty of water with the medicine.
  • Write down when you take the medicine and how many pills you take.
  • Do not drive when you are taking the medicine. The medicine will affect your ability to make decisions or react quickly.
  • Do not drink alcohol when you are taking the medicine.
  • Use it only for the first few days or weeks when the pain is most intense. Talk with your health care provider for a taper plan.
  • Put your opioid medicine in a secure place to prevent others from using it.

A Guide To Regional Analgesia For Total Knee Arthroplasty In

Physical Therapy Goals After Total Knee Replacement

by FA Rodriguez-Patarroyo · 2021 Regional analgesia has been introduced successfully into the postoperative pain management after total knee arthroplasty, reducing pain

by J Heimroth · 2021 Treatment options for chronic pain management after total joint arthroplasty include genicular nerve radiofrequency ablation, transcutaneous

SAN DIEGO Patients who have acupuncture during total knee replacement surgery report less pain and need far fewer opioids to manage their

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Managing Postoperative Pain Swelling And Bruising After

Doctors have made big advances in pain management after total knee replacement over the last 10 to 15 years due to advancements in using regional nerve blocks,

Pain relief for knee replacement surgery and other joint surgeries has been a your total hip or total knee replacement pain management protocol,

Multimodal pain management using acetaminophen, gabapentinoids, and celecoxib are effective at reducing length of stay and postoperative narcotic requirements

Vas Scores At Rest At Postoperative 24 H

Three studies reported VAS scores at rest at postoperative 24 h. Pooled results showed a significant reduction in VAS scores at rest at 24 h in the celecoxib group compared with the placebo group .

Figure 3. Forest plot for the meta-analysis of VAS scores at rest at postoperative 24 h, 48 h, and 72 h.

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Total Knee Arthroplasty Protocol:

Adequate pain control after TKA is important in expediting patient progress with mobility and range of motion after surgery. This in turn may result in a

Results 115 120 Multimodal analgesia has become the standard of care for total joint arthroplasty as it provides superior analgesia with fewer side effects

There is good evidence to show that patients who have a spinal or epidural instead of general anesthesia for knee replacement will have fewer complications

Comparison With Other Studies

3 Month Post-Op Total Knee Replacement -Expectations and Answers to what is normal following surgery

A recent review of total hip and knee arthroplasties included no low risk of bias trials, but suggested beneficial effects of glucocorticoids, which needed confirmation from further trials. Our results concur with most previous, but smaller, trials for the effect of high dose glucocorticoid on morphine consumption and pain scores. This DEX-2-TKA low risk of bias trial shows a statistically and patient important adjuvant analgesic effect of two doses of high dose dexamethasone, and with follow-up at 90 days.

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How To Get Rid Of Unused Opioids

Do not keep unused medicine “in case” you think you may need it. Having it in the house where other adults, children or pets could reach it is unsafe.

  • To get rid of unused opioids, bring them to a drop-off location or to an Allina Health Pharmacy. To find a location near you:
  • Minnesota: Go to pca.state.mn.us and type “household hazardous waste” in the search box.
  • Wisconsin: Go to dnr.wi.gov and type “health care waste” in the search box.
  • If you can’t get to a disposal site:
  • Scratch off your name, your provider’s name and the prescription number on the medicine label. Or, scribble the information out with a black marker.
  • Add a small amount of vinegar to dissolve most of the pills.
  • Take the cap of your medicine container shut with a strong tape.
  • Put the taped medicine container in a paper bag or other container you cannot see through .
  • Throw the contents in the garbage, not the recycling bin.
  • Knee Replacement Surgery In Merriam Ks

    At Midwest Orthopaedics, our team includes highly skilled orthopedic surgeons who have performed numerous successful joint replacement surgeries over the course of their careers.

    If youre experiencing chronic knee pain that doesnt respond to conservative interventions, we will evaluate your condition to assess your eligibility for a knee replacement. If we find that youre a perfect candidate, we will work closely with you to get you adequately prepared for your procedure. You can trust us to take all possible measures to ensure your comfort and safety not only during your surgery but throughout the recovery process.

    We have on-site physical therapy services, as part of our commitment to deliver high-quality, comprehensive care.

    If you want to make an appointment with one of our surgeons, call us at 362-8317 or use our appointment request form.

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    Simple Digital Interventions Could Pay Off Big For Patients Providers And Facilities

    A recent study from Penn Medicine in Philadelphia shows that monitoring patients remotely could lead to a significant decline in rehospitalization after joint replacements.

    The study, published in JAMA Network Open, enrolled 242 total hip and total knee replacement patients over a period of 14 months. The patients were randomly placed into two groups: one receiving the standard of care at their hospitals, and the other enrolled in a hovering program powered by a Penn-developed software platform called Way to Health. Penn Medicine describes the hovering program as keeping tabs on patients recovery through wearable activity trackers, text messages detailing postoperative goals and milestones, pain score tracking and easily accessible remote connections with clinicians.

    Researchers sought to determine whether this automated hovering over patients would lead to a drop in readmissions, and an increased ability for providers to address postoperative issues remotely before they require hospitalization. The intervention involved monitoring the patient postoperatively for 45 days. Penn Medicine says hovering brought about a “fourfold decline” in readmission rates. Just 3% of “hovered” patients required readmission, while 12% of the non-hovering group did.

    Rapid Recovery Protocol Improves Knee Replacement Outcomes

    Types Of Arthritis That Affect The Knee

    Is Outpatient Knee Replacement Right for You? Six Common Indicators ...

    Inflammatory arthritis

    This broad category includes a wide variety of diagnoses including rheumatoid arthritis, lupus, gout and many others. It is important that patients with these conditions be followed by a qualified rheumatologist as there are a number of exciting new treatments that may decrease the symptoms and perhaps even slow the progression of knee joint damage.

    Patients with inflammatory arthritis of the knee usually have joint damage in all three compartments and therefore are not good candidates for partial knee replacement. However, inflammatory arthritis patients who decide to have total knee replacement have an extremely high likelihood of success. These patients often experience total, or near-total, pain relief following a well-performed joint replacement.


    Osteoarthritis is also called OA or degenerative joint disease. OA patients represent the large majority of arthritis sufferers. OA may affect multiple joints or it may be localized to the involved knee. Activity limitations due to pain are the hallmarks of this disease.

    OA patients who have symptoms limited to one compartment of the knee sometimes are good candidates for minimally-invasive partial knee replacement .

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    Technical Details Of Total Knee Replacement

    Total knee replacement surgery begins by performing a sterile preparation of the skin over the knee to prevent infection. This is followed by inflation of a tourniquet to prevent blood loss during the operation.

    Next, a well-positioned skin incision–typically 6-7 in length though this varies with the patients size and the complexity of the knee problem–is made down the front of the knee and the knee joint is inspected.

    Next, specialized alignment rods and cutting jigs are used to remove enough bone from the end of the femur , the top of the tibia , and the underside of the patella to allow placement of the joint replacement implants. Proper sizing and alignment of the implants, as well as balancing of the knee ligaments, all are critical for normal post-operative function and good pain relief. Again, these steps are complex and considerable experience in total knee replacement is required in order to make sure they are done reliably, case after case. Provisional implant components are placed without bone cement to make sure they fit well against the bones and are well aligned. At this time, good function–including full flexion , extension , and ligament balance–is verified.

    Finally, the bone is cleaned using saline solution and the joint replacement components are cemented into place using polymethylmethacrylate bone cement. The surgical incision is closed using stitches and staples.


    Length of total knee replacement surgery

    Pain and pain management

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