According to one estimate, more than half of the adults in the U.S. who are diagnosed with knee osteoarthritis will go on to have knee replacement surgery. Pain control after the surgery remains a persistent side effect for patients.
Study Advocates Better Post-Op Pain Control
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A Henry Ford Hospital study found that injecting a long-acting numbing medicine—called liposomal bupivacaine—into the tissue surrounding the knee during surgery may provide faster recovery and higher patient satisfaction.
In the Henry Ford study, doctors evaluated 216 patients for pain control the first two days after surgery from October 2012 to September 2013. Half of the patients received the traditional pain control method with continuous femoral nerve blockade, in which common numbing medicine is injected into the groin area, blunting the main nerve down the front of the knee. This method uses a pain pump to extend pain control for two days but causes some leg weakness. “Pain control came at the price of weakness and made patients somewhat tentative when walking during their hospital stay, ” according to Jason Davis, M.D., a Henry Ford West Bloomfield Hospital joint replacement surgeon and the study’s senior author, in the December 2015 press release.
The other half of patients received the liposomal bupivacaine injection at the site of the surgery. Many of these patients were able to walk comfortably within hours after surgery.
Davis said that the injection around the knee itself “optimizes pain control early on” without the side effects of the traditional technique. “Function-wise, it was a lot easier for patients to move around more confidently. In the past decade, we’ve made major advancements in pain control for knee replacement surgery. This option is a promising, viable one for our patients.”
He added, “The pain scores for this injection technique averaged about 3/10, which is similar to the pain scores seen with our traditional method. “Patients had pain relief for up to two days after surgery and better knee function compared with the traditional method.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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