Tag Archives: total knee arthroplasty

Less Pain, Less Opioid Use After Total Knee Arthroplasty

Senior man on his mountain bike outdoorsDr. Stickney, a Kirkland orthopedic surgeon, is a knee expert specializing in new knee surgery procedures, total knee replacementsports medicine, and more.

Managing postsurgical pain after total knee arthroplasty (TKA) is critical to successful surgical outcomes including patient recovery, rehabilitation and overall satisfaction. Local infiltration analgesia (LIA) with anesthetic agents is shown to improve pain and reduce morphine consumption. It also shortens the length of hospital stays compared with using peripheral nerve blocks, which can hinder mobility. A randomized control PILLAR study conducted by Michael A. Mont, M.D., Walter B. Beaver, M.D., Stanley H. Dysart, M.D., John W. Barrington, M.D., and Daniel J. Gaizo, M.D. took a closer look at the efficacy of LIA with Liposomal Bupivacaine (LB) in improving patient pain scores and reducing opioid use after TKA.

Here, the study team compared the effects of LIA with or without LB on pain scores, opioid consumption including opioid-free patients, time to first opioid rescue, and safety after primary unilateral total knee arthroplasty.

The study involved 140 TKA patients randomized to LIA with LB to 266mg/20mL (admixed with bupivacaine HCI %0.5, 20mL) or LIA with Bupivacaine HCI %0.5, 20mL. Standardized infiltration techniques and standardized multimodal pain protocol were used. Co-primary efficacy endpoints were the area under the curve (AUC) visual analog scale pain intensity scores 12-48 hours post-surgery, and total opioid consumption 0-48 hours post-surgery.

Findings were notable. AUC 12-48 post-surgical visual analog pain intensity scores were 180.8 with LB, and 209.3 without the use of LB. Total opioid consumption 0-48 hours post-surgery was 18.7mg with and 84.9 without LB. Significant differences favoring LB were observed for the percentage of opioid-free patients (p<.01) and time to first opioid rescue (P=.0230).  In the TKA setting, LIA with LB administered with optimal techniques significantly improved post-surgical pain, opioid use and time to first opioid rescue, with more opioid free patients and no unexpected safety concerns.

My past TKA patients will tell you the SwiftPath protocols I utilize are well aligned to this study. With a reduction in (or no) opioids after TKA, less post-operative pain and overall patient satisfaction, the use of LIA with LB is well-supported.

If you are a total knee arthroplasty candidate and want to learn more about treatments such as LIA with LB, please contact our office. We’ll help you return to your healthy, pain-free lifestyle.

A New Chapter in Knee Implants

kneeappointmentDr. Stickney, a Kirkland orthopedic surgeon, is a knee expert specializing in new knee surgery procedures, knee reconstruction surgery, sports medicine, and more.

New developments in biomedical engineering and robotics have recently opened a new chapter in high-performance knee implants with the creation of the JOURNEY II XR Active Knee System, which combines an implant designed to restore the stability and natural motion of the human knee with low-friction materials that may help extend the longevity of the implant itself. We are proud to be offering this new product to our patients.

Conventional Knee Implants
All knee implants are faced with the challenge of mimicking the normal swing-and-rotate motion of the knee while making sure the joint remains stable and has durability after surgery. Conventional knee implants have attempted to recreate this natural, fluid motion of the knee with a rotating platform or plastic insert design that allows flex and rotation. Unfortunately, both of these options force the muscles around the patient’s joint to work harder as they adjust to the joint’s new pattern of movement. The anterior cruciate ligament and sometimes the posterior cruciate ligaments are removed with conventional knee designs. These ligaments aid in position sense or proprioception. There have been many different designs of the plastic insert to replicate the function of these ligaments. The JOURNEY II XR is designed to keep the ligaments and build the knee around them. This does make the technical aspect of inserting the knee more complicated. It will also provide a much more natural feeling knee with activity.

The JOURNEY II XR Knee Implant pays attention to anatomical detail, more accurately replicating the true anatomy of the knee. With an anatomically molded femoral component (bottom of the thigh bone) and two plastic inserts, the JOURNEY II XR active knee system recreates the knee’s original shape and range of motion, preventing surrounding muscles and other tissue from straining to compensate for unfamiliar stress. A U-shaped tibial base plate (top of the shin bone in the lower leg) fits around the healthy ACL and PCL, allowing them to function as they normally would rather than being removed.

Knee surgery patients with the JOURNEY II XR total knee system will likely feel less of a difference from a normal healthy knee, and greater stability. The end result may be a quicker recovery, better function, and greater satisfaction. While some may benefit, not all patients qualify for the JOURNEY II XR Knee implant. For instance, many people have ruptured their anterior cruciate ligament in their lifetime, or have developed significant angular contraction of ligaments around the knee and the JOURNEY II XR would not be appropriate in these patients. Please consult with orthopedic expert Dr. Stickney to evaluate your condition and implant options.