Total joint replacements, often considered miracles of modern medicine, have changed the lives of millions of patients by decreasing their joint pain and increasing their motion and mobility. Prior to their development over 50 years ago, patients with degenerative and inflammatory joint diseases were forced to live out their lives with pain and debility.
Over the years orthopedic surgeons around the world have advanced the science of joint replacements by improving materials, surgical techniques and rehabilitation protocols. With these advancements, patients receiving joint replacements can now expect new joints to last, in many cases, up to 20 years or more.
The most recent advances in joint replacement have been in perioperative pain management. In the past, surgical pain was considered the chief complaint among those undergoing total hip and total knee replacements and often this pain would be an impediment to them having a second or subsequent joint replacement performed. In the past, the postoperative pain from their joint replacement has contributed to slower recovery and rehabilitation as well as delays in discharge from the hospital.
With our new approaches, however, postoperative pain should rarely be a concern. In our practice, pain management is an integral part of the total joint replacement process. Our goal is to eliminate as much pain as possible so that you as a patient can be free to pursue your physical therapy and work rapidly toward restoration of mobility.
Total joint procedures replace the diseased joints, but it is the surrounding muscles and tendons that make them work. It is easier to prevent pain from occurring than to try to eliminate it once it is established. Thus, our goal is to minimize the pain producers even before the procedures have started. I personally employ multiple methods including anti-inflammatory drugs, nerve blocks, and local infusions, which are used to block the nerves at the site of incision. Our goal is to minimize narcotic use, which is often associated with confusion, poor balance, and lethargy – all of which can impede the healing process. Some other side effects of narcotic use include vomiting and constipation, which can also be major impediments to recovery following a joint replacement. In the postoperative period, patients manage their own pain with the use of a pain pump, which allows them to control the amount of narcotics they require, within the confines of safety.
Using these advances in pain management for joint replacement patients, we have significantly diminished the psychological and physiological effects of pain. We eliminate the fear associated with total joint replacements and allow the patient to pursue an aggressive rehabilitation program. This helps to restore the patient’s function and speeds them on their way to recovery.
Most patients utilizing our protocols are up and active the next day following surgery. They are ambulating on the floor with the aid of a physical therapist in a day or two and are usually ready for discharge by the third day. Physical therapy is continued at home along with additional methods to control any discomfort.
Are total joint replacements totally pain free? Unfortunately, we cannot make that a reality at this time. However, with our pain management protocols, we do everything possible to minimize your discomfort and speed your recovery so that you can enjoy all the benefits of these wonderful procedures.
Dr. Alan E. Hibberd is a board-certified orthopaedic surgeon with The San Antonio Orthopaedic Group. He treats all orthopaedic conditions, with the exception of the spine, for patients aged 16 years and up. His special interests include total hip replacement and total knee replacement. To schedule an appointment with Dr. Hibberd, call 210.281.9595.