2 0 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E A U G U S T 2 0 1 7
the procedures are
performed — but
acknowledges sev-
eral developments
have made same-
day total joints
much more feasible
than in years past.
Multimodal pain
management tops
his list.
Dr. Ball says the amount of post-op pain that patients experience is almost
always the determining factor between overnight stays and same-day dis-
charges, and improvements in anesthetic techniques and pain management pro-
tocols have been the biggest game-changers for knee replacement patients over
the last 15 years.
Stephen Kayiaros, MD, an orthopedic surgeon at University Orthopaedic
Associates in Somerset, N.J., operates through a mini-incision on the knee and
doesn't violate the quadriceps tendon to lessen the post-op pain of his knee
replacement patients. He also uses the muscle-sparing anterior approach to the
hip, so there are no post-op concerns about range-of-motion restrictions. "That's
made it a bit easier to transition hips to the outpatient setting when it comes to
controlling post-op pain," he says.
Dr. Kayiaros's knee replacement patients receive adductor canal nerve blocks.
The block affects sensation, not motor function, at the joint so patients can par-
ticipate in physical therapy soon after surgery. They also receive a tibial nerve
sensory block, which helps control pain in the knee's posterior capsule and pre-
vents patients from experiencing post-op drop foot, which could limit their abili-
ties to complete prescribed physician therapy. Dr. Kayiaros also sends patients
home with a pain pump that delivers analgesics to the operative site for 3 to 4
• TO BE EXACT Robotics is the perfect tool for partial knee replacements, according to
Steven Harwin, MD, FACS.
Northern
Westchester
(N.Y.)
Hospital
