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

A View Down the Line

September 22, 2016

I am now at 4 weeks post-surgery. The journey of healing is really amazing. It's not a linear experience. There are quite a few ups and downs; during the ups, everything feels great; during the downs, even I, as a surgeon, was getting worried. These vacillations primarily relate to function, motion, general vitality, and pain.

Let me start with how I am at 4 weeks:

  • I am walking well with no pain.

  • I can walk up steps in a normal manner, barely needing to use the railing.

  • Walking down steps is still difficult; I use the railing and place my hand on a wall on the other side for support. Sometimes I walk down with two feet on one step at a time.

  • I can walk for about a quarter-mile around my neighborhood. I have not needed a cane since the end of week 1.

  • My leg is fully straight and I can bend my knee to a 121-degree angle. I started driving this week without problems.

I've been going to physical therapy three times a week for 90-minute sessions, which include moist heat, manual massage, quad sets (a number of different exercises), extension and flexion stretches, stationary bicycle, hamstring stretches, and a compressive cooling device.

When I am home, I use my stationary bicycle and continue the exercises I learned in preop and postop physical therapy. I heat up my knee a couple of times a day and ice it down about three times a day.

I start my day with 325 mg of aspirin, 660 mg of Aleve, and 650 mg of Tylenol. I take no more Tylenol or Aleve for the rest of the day. The aspirin is for anticoagulation, so I take another tablet at night.

I have not felt the need for any further opioid medication.

I think the keys to opioid reduction are:

  • Preoperative patient education—really getting the patient to know what to expect regarding pain is critical.

  • Preoperative caregiver education—almost as important as the first point.

  • The use of multimodal pain techniques: IV acetaminophen (Ofirmev®); injections during surgery that include liposomal bupivacaine (Exparel®), which extend the pain relief for 2-3 days; NSAIDs (I used Aleve but some people use Celebrex®; it depends on what your stomach can tolerate); Tylenol 650 mg every 4 hours; surgical techniques that protect from excess tissue damage; early activity, including range-of-motion exercises; and frequent ice packs/cooling of the knee.

I will be returning to work the first week of October. Since I am the chairman of orthopedics at my hospital, my entire staff is going to be pleased, mainly because the ceaseless flow of emails I am sending them from home will stop—or at least abate.

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