Teaming Up on Total Knee Replacement Pain

Team-based approach and newer pain management strategies help relieve patient’s pain after total knee replacement


Getting the team to work together is a well-known sports strategy. It may also work in the health care arena.

A major literature review from Mount Sinai Hospital in New York City analyzed the best ways to help manage a patient's pain after total knee replacement. Researchers found that a team-based approach including the patient, family and health care professionals was most effective. Newer pain management strategies were also helpful.

Total knee replacement (TKR) is used in patients who have severe arthritis of the knee. The diseased joint is surgically removed and replaced with a metal or metal and plastic prosthetic knee joint.

Traditional pain management for TKR consists of intravenous pain medications and anesthetic medication injected into the area of the spinal cord (an epidural). These treatments have side effects like nausea, vomiting, low blood pressure and itching.

Lead study author Calin S. Moucha, MD, said in a press release, "Managing post-surgical pain is key to promoting early postoperative mobility, reducing medication side effects, and increasing patient satisfaction.”

Dr. Moucha is an orthopaedic surgeon and chief of adult reconstruction and joint replacement surgery at Mount Sinai Hospital.

Newer pain management methods include oral medications and nerve blocks before and after surgery. A nerve block is an injection of an anesthetic directly into the nerve.

The surgeon may also inject pain medications into the surgical area during the operation. The combination of these therapies is called multi-modal pain management.

According to the review of more than 40 studies performed by Dr. Moucha and colleagues, multi-modal therapy decreases patients' reports of pain immediately after surgery. Multi-modal therapy also decreases the risk of side effects and the total amount of pain medication used.

When a patients' pain is under control, they are better able to participate in post-operative physical therapy, which helps them recover faster. Dr. Moucha and colleagues reported that a strong support system of family and friends can also help patients recover more quickly.

The study was published in the February issue of Journal of the American Academy of Orthopaedic Surgeons.

No outside funding was provided for the review.

Dr. Moucha and co-author Mitchell C. Weiser, MD have professional relationships with the American Academy of Orthopaedic Surgeons.