At the Knee, Hip and Shoulder Center we are committed to our patients’ outcomes, particularly early restoration of comfort and function. Most studies in the literature focus on one- and two-year results and cite that there are minimal long-term differences in approaches to joint replacement. However, today’s patient does not want to wait a year to return to daily activities, work or leisure time physical activities. With this in mind, we have engineered the ultimate recipe for an accelerated outcome after total knee replacement, an operation that is now performed on over 500,000 people in the US annually.
Here are the central tenets of this concept.
- Do an operation that doesn’t hurt that much: Attention to surgical technique, gentle tissue retraction, minimally invasive techniques, muscle sparing approaches and minimization of limb manipulation during surgery can all limit tissue trauma and cause less pain. For total knee replacement, this includes not using a tourniquet on the thigh. Tourniquets have been routine in knee replacement since their outset but require high pressures to limit blood loss during surgery and this can cause damage to the quad muscle.
- Cut less muscle: modern surgical approaches allow muscle-sparing access to joints. Not every surgeon is capable to the technical skills necessary to do this but it can be game-changing in terms of early return of function, limiting muscle inhibition, reducing scar tissue and reducing the surgical stress of healing.
- Limit surgical stress: in addition to the above-mentioned technical aspects, bodily preparation in advance of surgery including adequate preoperative hydration and nutrition can enhance the body’s ability to fight surgical stress. Other perioperative processes can also be designed to help the body cope with the energy required for healing. This includes preoperative steroid administration, early mobilization and early, adequate calorie intake.
- Train like a champion: you wouldn’t run a race without preparation and you shouldn’t undergo joint replacement without preparing either. Increasing vitamins, minerals and protein prior to surgery in addition to muscle strengthening, weight optimization and health optimization can make a huge difference in the speed of recovery. Limiting alcohol and smoking cessation also make a difference.
- Pain Management: surgery hurts. This should not be a surprise. However, modern pain management techniques using a combination of non-opiate medications along with local anesthetics can make joint replacement entirely manageable immediately after surgery. Gone are the days of agony and sleepless nights. A properly structured pain management program can allow patients to progress with motion and activity readily.
- Immediate mobilization: studies have shown the immediate joint and limb mobilization make a big difference in limiting pain and stiffness, promoting healing and reducing swelling. Our use of continuous passive motion machines and our emphasis on same-day physical therapy help patients realize early that they can rely on their new joint and trust it.
Our AVATAR Protocol for Continuous Passive Motion compiles each of these tenets of accelerated recovery and offers a care process that is unrivaled in terms of concierge attention to detail.