Pain after Knee Replacement
Just as you are gearing up to live for yourself, and to embark on those little adventures which you could not take up while you were busy with work and family commitments; comes the warning from your knees “Hold on; we are a little rusted; Slow down!” Thanks to Knee replacement surgery; millions of senior citizens are now being able to carry on with activities which they would not have dreamt of otherwise. Here is what you need to know before embarking on a knee replacement.
Firstly, it is important for you to understand your knee replacement is not going to make you feel like a 20 year old overnight or help you climb Mount Everest. Osteoarthritis is a process in which the cartilage surfaces of knee joint get eroded gradually. With the movement of knee the raw surfaces keep rubbing on each other leading to chronic debilitating pain. Knee replacement involves smoothening of eroded cartilages and insertion of a prosthetic cap on either side to allow smooth and painless movement of the joint. However, surgery inevitably causes some degree of trauma, swelling, stiffness, and pain in the immediate postoperative period. While the severity of the disease, surgical technique, choice of implant and expertise of the surgeon determine how well your new knees function; your understanding of the process, preparation and the will power to get back on your feet, determine how fast you can achieve the goal. You will need a thorough health check to evaluate fitness for surgery, before a surgeon can advise you on what suits you the best. Once you make up your mind about the surgery, it is time to prepare yourself mentally, physically and plan for the course. The fitter you are, the faster you recover. Physiotherapist can teach you exercises which strengthen your upper body and thigh muscles and help you get on your feet fast.
Your Anesthesiologist plays an important role in postoperative pain management. Optimal pain management, which starts in the preoperative period itself, aims at early ambulation and discharge to minimize side effects such as clots in circulation and hospital acquired infection. Anesthesiologists use several strategies to reduce pain after surgery. The common drugs used include Paracetamol (acetaminophen), Non-steroidal drugs such as Diclofenac & Ibuprofen, Tramadol and Opioids (Morphine like drugs). While Non-steroidal drugs can cause acidity and stomach ulcers, Opioids can cause nausea, constipation, itching and drowsiness frequently. To minimize such side effects, some anesthesiologists insert a fine catheter in the back called epidural through which they can give local anesthetic for first couple of days. While this numbs the lower part of the body and keeps the patient pain free, it may cause heaviness in legs, retention of urine and may delay ambulation in some.
The more advanced techniques involve Local anesthetic infiltration in to the joint, or at the site of the nerves in groin (Femoral nerve block) or thigh (Adductor block) that carry pain sensation from knee to the brain. These injections target the area of surgical incision specifically and aid early ambulation.
If you have troublesome pain either in the legs or feet, or a slip disc, do mention it to your anesthesiologist at the time of surgery. You may need a different modality of treatment for pain relief.
While the doctors use different strategies to keep you pain free, here is what you can do to get on your feet fast. Meditation and Pranayama (Breathing exercises) are excellent distraction techniques that will aid your psychological and physical wellbeing during recovery. A set of head phones with your choice of music would be great too while you are in the hospital. Ice packs reduce swelling and speed up healing process and are surely an investment worth. Seek enough information about each of drugs that are prescribed to you at the time of discharge. Knowing potential side effects of each drug is important for you to be able use your discretion in taking pain killers when you go home.
Understanding of the process, knowing what to expect, preparation and good communication with your medical and paramedical teams can make your experience of knee replacement surgery and the hospital stay smooth.