Part 2: When a Knee Replacement Specialist Needs His Own New Knee

A Noted Surgeon Gains Insight Into Managing Postop Pain—His Own

Ira H. Kirschenbaum, MD

Disclosures

October 05, 2016

In This Article

No Place Like Home

August 31, 2016

Today is Wednesday, a 9 days after my surgery. Two days ago, I traveled from Seattle, where the surgery was performed, back to New York, where I live. I chose to have my knee done, as an outpatient, by a close friend and colleague in Seattle. Aside from the inherent trust I had in my surgeon, I also am a firm believer in his enhanced recovery protocols. I use these protocols in my own practice.

But no matter how modern these techniques are, total knee replacement is still a major operation. Regaining the ability to be safely mobile is a gradual process. I was still quite concerned about navigating through the airport, spending hours on a plane, and then getting back to my house.

In joint replacement surgery, surgeons are concerned about the development of blood clots in the legs in the first few weeks postop. These clots can travel from the legs to a lung, causing serious health problems. Spending 5-6 hours in the air while possibly immobile needs to be mitigated. I had early mobility the first day after my surgery, sequential compression devices for over 12 hours a day on my legs, and chemical prophylaxis with warfarin (Coumadin®) for 3 days, followed by enoxaparin (Lovenox®) injections (self-injected) each day.

These therapies were continued in flight. Enoxaparin aggressively thins the blood. Sitting in my seat on the plane, fully anticoagulated and with my leg pumps, and getting up every half-hour to stay mobile, gave me peace of mind.

The Caregiver's Essential Role

September 5, 2016

I don't believe that anyone can go through a knee replacement operation alone. You either need a mobile and dedicated caregiver 24 hours a day for a solid 2 weeks or you need to go to some type of rehab hospital.

In recent years, there has been talk about joint replacement patients not needing to go to rehab facilities and instead recuperating at home. I suspect that this chatter has been perpetrated by government and insurance company administrators, and not by anyone who cares about the safety and satisfaction of patients, because patients who live alone or have limited caregivers at home cannot go home immediately after surgery.

Here is a partial list of what a caregiver does:

  • Makes sure that all of the prescriptions are available and within the patient's reach;

  • Ensures that the patient has access to food;

  • Helps position the patient on a chair or bed at times when the patient feels tired or dizzy;

  • Observes the patient to ensure that he or she is walking safely;

  • Helps the patient in the bathroom negotiate from the toilet to the shower;

  • Helps the patient change ice packs;

  • Fetches pain medications for the patient in the middle of the night as needed;

  • Assists in transferring the patient from bed to chair to other rooms; and

  • Helps in the communication with the patient's doctor in times of need.

You need a person in the house full-time. A home health aide who is there for 4 hours a day, while helpful, is not enough. You need basic, nonmedical help around the clock. If you don't have that, then while you may not need to go to the most intense rehab facility in the world, you will require a 5- to 10-day stay at a basic skilled nursing facility that understands the joint replacement healing process. They will need to get you up and mobile 6-8 times a day; apply cooling therapy for your comfort, as needed; provide pain medications (if needed); and conduct formal physical therapy at least twice a day.

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