Managing pain after a total knee replacement

 

Don’t let pain hold you back!


 

We caught up with Mr Simon Mellor (Consultant Orthopaedic Surgeon) who discusses how to manage knee pain after surgery. 

 

Pain relief after any operation is a major factor for patients. Unsurprisingly it’s a great concern and patients worry that they will suffer pain which will obviously impact on their recovery. Thankfully the practice of knee replacement surgery has changed significantly during my career, and I think for the better. One facet of this has been techniques to help improve pain control. This is particularly important after knee replacement since knee replacement surgery has traditionally been considered to be one of the more painful operations to recover from. In recent times knee replacement surgery has developed significantly and there are anaesthetic, surgical and post-operative changes which can hopefully improve patient outcomes and in particular, help with post-operative pain control.

 

In my practice nowadays it’s quite common for patients to have both hip and knee replacement surgery and rather than having a standard traditional general anaesthetic they will have a spinal injection which numbs the patient from the waist down and this last for several hours, certainly long enough for the duration of the operation. My expert anaesthetist will sometimes add nerve blocks to the anaesthetic. These are pain-killing injections performed before the operation and placed in the vicinity of nerves that supply sensation around the knee. These have proved to help significantly with post-operative pain control. If patients choose to have a spinal injection then during the operation they will also be given intravenous sedation and this cocktail of drugs will help patients to doze off and snooze during the surgery so that they’re not aware of any of the actual operation. This differs from a traditional general anaesthetic as the patient breathes spontaneously and doesn’t need to be connected to a ventilator machine. 

 

Traditionally knee replacement surgery was performed with the benefit of something called a tourniquet. This is an inflatable cuff which is placed temporarily around the upper thigh and during the operation, this is inflated to stop blood flow to the leg. Whilst the use of a tourniquet can help the surgeon to perform the operation without any visible blood flow, the tourniquet itself can result in a degree of pain around the thigh after the operation. In recent times there’s been evidence that it’s not necessary to use a tourniquet during knee replacement surgery. In fact, nowadays I only use a tourniquet for about 10 or 11 minutes of the operation just while I’m actually implanting the new knee joint.

 

One important factor with regards to postoperative pain after knee replacement surgery is the technique of the operation itself. Some patients may be suitable for different types of knee replacement, which can reduce postoperative pain. For example, there is evidence that partial knee replacement (as opposed to full knee replacement) can be done with a smaller incision and less soft tissue damage. This is important, since being as considerate to the soft tissues during the actual operation is an important point and it will help to reduce the levels of pain after surgery. This is something that I offer to suitable patients, as well as patient-specific knee replacements which minimise the amount of bone removed and maximises the exact fit of the implant to the bones. 

 

During the operation, I will routinely inject local anaesthetic in and around the knee joint and this is a longer-acting anaesthetic which helps with pain relief certainly for the first 6 to 12 hours. This is useful because by this stage the spinal injection would have worn off. My anaesthetist will also routinely write up my patients for a cocktail of painkilling medicines that can be taken very shortly after the operation is completed. All these techniques are used to try and avoid any breakthrough pain, which is a period of pain that can happen once the spinal injection wears off, but before painkilling tablets have started to kick in. 

 

In recent times I’ve started recommending to my patients that they consider hiring a special post-operative ice application machine called Game Ready. This is a device that’s hired by the patient, usually for four weeks after surgery and used at the patient’s home (www.gameready.co.uk). I have found it to be really helpful for both reducing swelling after surgery and also helping with pain control. Basically, this is a cuff which gets placed around the leg and then ice cold water is pumped through the cuff resulting in compression of the leg but also icing of the leg. I’ve seen really good results in my patients when they choose to hire this machine.

 

In summary pain control after knee replacement surgery has come on leaps and bounds even during my career as a consultant. I think we’ve got to the stage now we can reassure our patients and hopefully make the early recovery after knee replacement surgery as comfortable as possible.

To find out more about Mr Simon Mellor’s practice click here