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Is Pain-Free Knee Surgery a Possibility?

September 16, 2004 |  By: Sydonya E. Barker for Knee1 Imagine undergoing knee replacement surgery, leaving the hospital within hours, and walking unassisted in less than one week. Each year 300,000 Americans undergo traditional knee replacement surgery, a costly procedure meant to restore normal mechanics to the knee joint. The traditional surgery, lasting between one and a half to two and a half hours, often leaves a 12-inch scar. Fortunately, general anesthesia helps patients feel no pain during surgery, but once its effects wear off, patients writhe in pain as the cut muscles and tendons heal. “There’s just no excuse for painful surgery,” said Dr. Barry Cole of the American Academy of Pain Management. For the past five years, the medical community has increased efforts to lessen postoperative pain, said Cole. “You could get conceivably close to pain-free surgery without necessarily causing the patient any more surgical risk.” Because doctors can perform surgery through a small tube rather than through large incisions, there is less pain, said Dr. Jacques Chelly, director of the new Posner Inpatient Center at the University of Pittsburgh Medical Center. Since 2003, the new center aims to manage pain before, during, and after surgical procedures. The nerve block is a popular procedure used at the center. Tested regional injections used for over 100 years in the medical field, patients benefit from nerve blocks because they can retain consciousness throughout surgical procedures. Nerve blocks, which can be used after surgery, continuously anesthetize patients allowing them to feel less postoperative pain. At the Robert Wood Johnson Medical School (New Brunswick, NJ), doctors use another method to manage postoperative pain. Through a 3-inch incision into the knee, they are able to avoid cutting muscles and tendons. Patients who undergo the less invasive procedure recover three times faster, said Dr. Alfred Tria, Clinical Professor in the Division of Orthopedics at the medical school. In comparison to traditional surgery, “the principles of the operation have to remain exactly the same,” he said. Surgeons practice the minimally invasive procedure by training on cadavers and the surgery can last up to 30 minutes longer, he added. Using specialized instruments manufactured by Zimmer Inc., the new “MINI” technique allows patients to shorten their hospital stays, experience lower blood loss, and quicken their rehabilitation, said Dr. Luke Vaughan, Director of Orthopedic Tumor Service at the Scripps Clinic and Foundation in La Jolla, California. Tria warns that not all patients are eligible for this minimally invasive procedure. The procedure is not suitable for individuals who are obese, 80 and above, bowlegged or very knock-kneed. In addition, patients who have had other nonarthroscopic knee surgeries do not qualify. Costing about 30 percent less than the traditional $22,000 to $39,000 procedure, the “MINI” procedure promises faster recovery than traditional knee replacement surgery because it is less invasive. With a new focus on pain management, patients can look forward to pain-free postoperative periods. Tria expects within the next five years, 40 percent of patients will undergo these less invasive surgeries and more patients will realize that, according to Chelly, “Pain is not a must.”

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