Q:
What's the best way to
manage pain for these patients?
A:
Top-notch anesthesia care is one of the main factors leading to
the ultimate success of performing partial knee replacements,
especially in the outpatient setting. Post-op pain is best controlled with
a multimodal analgesia regimen, including the use of regional blocks,
intraarticular injections around the joint at the end of the procedure and
treating patients with a cocktail of medications from several different
drug classes — both oral and injectable. Placing a catheter and sending
patients home with a pain pump extends analgesic effects and provides
patients with relief during the initial painful days of recovery.
Q:
How do surgeons ultimately decide when partial
replacements are appropriate?
A:
There are several factors in play here. Surgeons must first
decide whether to offer a partial knee replacement as an option.
As mentioned, the procedure doesn't make good clinical sense for
patients who have arthritis in all three knee compartments. The
majority of patients have arthritis in more than one compartment, so
partial replacements often aren't an option.
If arthritis is limited to one compartment of the knee and the patient
is otherwise a good candidate for replacement surgery, the surgeon
must discuss the option with the patient and come to a mutual deci-
sion on how to proceed. One of the main factors to consider is whether
the patient prefers a more natural-feeling partial knee replacement or
prioritizes the greater durability of a total replacement.
It's our job as surgeons to engage with patients in decisions that
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UNI-KNEE DISTRACTOR
ORTHOPEDIC INSTRUMENTS
TARGETED APPROACH Total knee replacement involves replacing the entire joint (left) while unicompartmental arthro-
plasty (right) resurfaces only the portion impacted by degenerative disease.
Seth
S.
Leopold,
MD
