Knee Replacement with Less Pain, More Gain

A new approach to anesthesia is transforming the experience of total knee replacement. Most Sibley knee replacement patients are given nerve blocks to help manage pain. Orthopedic surgeon Randall Lewis, M.D., is particularly interested in the extended peripheral nerve block technique, working jointly with anesthesiologists for successful results.

Contact Dr. Lewis’s Medical Assistant: Alex F. x 653

One revolutionary technique. Four points of view:

Andrei Cernea, M.D., chairman of anesthesiology
“This anesthetic approach is a true advance, bringing more comfort and fewer complications to patients.” 

Our goals are to minimize complications and promote rapid recovery. Previously, total joint replacement required either a deep general or local anesthetic. Now, for patients who are candidates, we can use peripheral nerve block techniques to selectively numb only the surgical limb, significantly reducing the need for additional anesthetics.

Before surgery, we use an ultrasound probe to precisely locate the nerves that will carry pain impulses. We then interrupt those impulses by administering a long-lasting block near the nerves that carry pain sensation from the surgical site. Sometimes we place a catheter that can continue to deliver local anesthetic to those nerves. In total knee replacements with Dr. Lewis, we leave the catheter in place for up to three days, allowing patients to push a button and give themselves additional doses as needed for immediate relief.

Since patients have almost no pain after surgery, we can limit narcotic pain relievers. Those drugs, especially in older adults, can cause confusion, respiratory problems, nausea, severe constipation and inability to get out of bed. This impedes rehabilitation of the new joint and can lead to complications such as pneumonia. In contrast, the peripheral nerve block approach enhances the quality of the entire patient experience.

Orthopedic surgeon
Randall Lewis, M.D.
“I now use this technique 100% of the time. I see dramatically less pain, far fewer side effects, less need for narcotics and faster recoveries.” 

For years knee replacement has been tremendous for restoring mobility, but it’s also been very painful with prolonged rehabilitation. Past approaches to pain relief weren’t effective and had many side effects. Now that’s changed. The anesthetic approach of extended peripheral nerve blocks has revolutionized knee replacement. It allows us to perform the same incredibly reliable operation, without the same pain.

My patients wake up after surgery with little or no pain. They’re out of bed the same day and start formal physical therapy the next morning. Since it doesn’t hurt, they make progress much faster. After three days, when we take the nerve block out, they’ve already had four therapy sessions, regained most of their mobility and can control discomfort with small doses of non-narcotic pain medicine.

A recent study in Australia compared this technique to others and showed that patients had less pain, made better progress, used far less narcotics, had fewer side effects and were happier. It almost sounds too good to be true, but it’s not.

Michael Thompson, age 67
“Pain doesn’t help you heal, it saps you. Having this kind of relief was crucial to my recovery.” 

Before my double knee replacement I was in constant, excruciating pain. I had to drag myself up stairs with the hand rail. Even walking up or down slight hills or stepping off a curb was hard. Pain medication didn’t help. We finally met with Dr. Lewis and the X-rays showed there was no cartilage left on at least half of each knee. I knew I needed to get both replaced, but I’d heard so many horror stories about pain after surgery. So when Dr. Lewis said he didn’t believe in pain, it took me three seconds to say, ‘I’m using you!’ The day after surgery, I was up and walking. The grinding pain I’d had for so many years just wasn’t there. I used my catheter medication pump and it wasn’t bad at all—nothing like what I expected and feared. I actually looked forward to having the second knee operation a week later. Now, six months after surgery, I’m climbing stairs, going up and down hills, getting in and out of cars and working full time without pain.

Patient’s wife
Katherine Thompson
“Seeing Michael reach out and grab life again almost immediately was phenomenal.” 

Before surgery, Michael’s knees hurt so badly he walked like a duck, swaying. We live in a three-story townhouse and if he forgot something upstairs, I was the one who went to get it. I knew surgery would be worth it, but I thought recovery would be agonizing for him. Instead, he woke up ecstatic and kept saying, ‘this is so easy, I really have no pain.’ He stayed that way start to finish and it was fundamental to his success. He could focus all his energy on moving his knees and healing. His body was able to kick in and do what it needed to do in rehab. He was walking normally again right away, and within a few weeks he’d even talked a friend into having his knees done. Today he’s the busiest person I know, right back in the thick of it at the level he was when he was healthy—doing things he hasn’t been able to do forever. Dr. Lewis was completely true to his word about keeping pain at bay. It made all the difference.

Bionics pool class helps people with joint replacements. 

Remember the old TV show The Bionic Man? Just like that hero, joint replacement patients are using their new metal parts to reclaim active lifestyles. Our Bionics pool class can be an important part of the process, since

aquatic exercise in a warm water pool has been shown to improve outcomes in people with knee or hip arthritis. Sibley physical therapists lead classes to help patients gain flexibility, strength and balance while minimizing pain and the risk of a fall.

Before your surgery
Our Bionics pool class uses gentle low-weight bearing exercises and stretches to prepare you for a good outcome—loosening stiff joints and strengthening weakened muscles.

After your surgery
Bionics pool classes, in conjunction with land based therapy, help restore range of motion and improve strength and balance.

Getting started
With a prescription from your doctor, we’ll schedule a physical therapy evaluation and your physical therapist will get you started in a class. Your insurance will be used for coverage. Our Bionics class meets on Tuesdays and Thursdays from 4:00 p.m. to 4:30 p.m.

Schedule an evaluation and a spot in our Bionics class by calling 202-364-7665. 

“Sibley’s great safety record results from spectacularly good nursing and physical therapy. Our orthopedic care team is well-informed, motivated and enthusiastic about paying close attention to communication and safety.” ~Dr. Randall Lewis, orthopedic surgeon

For more information on Sibley’s Joint Replacement Program:
Contact Suzanne Honchalk, R.N., M.S.N., Nurse Navigator at 202-537-4144