Minimally-Invasive Surgery (MIS) Quadriceps-Sparing Total Knee Replacement: New Quad Sparing Technique May Provide Faster Recovery for Patients with Arthritis of the Knee.
Edited By: Seth S. Leopold, M.D.
Last updated Tuesday, April 15, 2008
Recovering from surgeryPain and pain management Whenever possible, we use a spinal anesthetic, with a long-acting
morphine product to provide pain relief for up to 24 hours after
surgery. Beyond that, pain medications by vein or in pill form are used
to permit early, rapid rehabilitation.
Alternatively, an epidural catheter (a very thin, flexible tube
placed into the lower back at the time of surgery) to manage
post-operative discomfort. This device is similar to the one that is
used to help women deliver babies more comfortably. As long as the
epidural is providing good pain control, we leave it in place for two
days after surgery. After the epidural is removed, pain pills usually
provide satisfactory pain control. Patients who have epidural or spinal
anesthesia can expect to walk with crutches or a walker, and to take
the knee through a near-full range of motion starting on the day after
surgery. In the days that follow, the patient is transitioned on to
pain pills to allow rehabilitation and rapid recovery following
minimally-invasive quadriceps-sparing total knee replacement.
Some patients are not candidates for spinal or epidural anesthetics,
or choose not to have them. These patients receive pain medications by
vein for the first day or two, and then can go home on pain pills
following minimally-invasive quadriceps-sparing total knee replacement. Use of medications Following discharge from the hospital, most patients will take oral
pain medications--usually Percocet, Vicoden, or Tylenol #3--for one to
three weeks after the procedure, mainly to help with physical therapy
and home exercises for the knee.
Aggressive rehabilitation is desirable following this procedure, and
a high level of patient motivation is important in order to get the
best possible result. “Minimally-invasive” does not mean “non-invasive”
or “minor”; it is important to realize that even with the newer
technique, the biggest key to recovery is a motivated patient who is
diligent about his/her rehabilitation and home exercises. Pushing
through a certain amount of discomfort or pain is part of recovery from
any knee replacement.
Oral pain medications help this process in the weeks following the surgery.
Most patients take some narcotic pain medication for between 2 and 6
weeks after surgery. Patients should not drive while taking these kinds
of medications. Effectiveness of medications While any surgical procedure is associated with post-operative
discomfort, most patients who have had the total knee replacements say
that the pain is very manageable with the pain medications, and the
large majority look back on the experience and find that the pain
relief given by knee replacement is well worth the discomfort that
follows this kind of surgery.
Minimally-invasive quadriceps-sparing total knee replacement seems
to be associated with less pain than traditional total knee
replacement. However, it is important to realize that it is a real
surgical procedure, and a good outcome depends on a motivated patients
who is willing to push through a certain amount of discomfort to get
the best possible knee motion and outcome after surgery. Important side effects Pain medications can cause drowsiness, slowness of breathing,
difficulties in emptying the bladder and bowel, nausea, vomiting and
allergic reactions. Patients who have taken substantial narcotic
medications in the recent past may find that usual doses of pain
medication are less effective. For some patients, balancing the benefit
and the side effects of pain medication is challenging. Patients should
notify their surgeon if they have had previous difficulties with pain
medication or pain control.Hospital stay The average hospital stay after traditional total knee replacement
is three days, and most patients spend several more days in an
inpatient rehabilitation facility. Patients who prefer not to have
inpatient rehabilitation may spend an extra day or two in the hospital
before discharge to home.
The overall duration of hospitalization after minimally-invasive
quadriceps-sparing total knee replacement typically is 48 hours; some
patients need to stay for a third day, but many do not. Patients
generally are discharged directly home from the hospital after
minimally-invasive quadriceps-sparing total knee replacement, and don't
require any inpatient rehabilitation. Ultimately, the length of
hospital stay is individualized to meet each patient’s needs, and
discharge occurs when the patient can perform the necessary range of
motion exercises, and when home support systems for the patient are in
place. Recovery and rehabilitation in the hospital Patients begin range-of-motion exercises on the day following
surgery. Patients are encouraged to sit, stand, and walk as much as
possible in the days following the procedure. Patients who regain good
range-of-motion early (defined as near-full extension and bend beyond
90 degrees in the first day or two after surgery) typically do very
well, so this is emphasized in physical therapy sessions that take
place twice daily after surgery. Most patients begin with a walker or
crutches, and transition to a cane is encouraged, and permitted as soon
as patients tolerate it, provided their balance is good. Therapists
instruct all patients in how to perform a home exercise program to
allow recovery to continue after discharge.
DownloadsHospital discharge The average hospital stay after minimally-invasive total knee
replacement is two days, with some patients staying three. Patients
generally are discharged to their homes directly from the hospital
(again, usually after a 48-hour stay), and generally do not require
inpatient rehabilitation. Sometimes the stay is even shorter.
At the time of discharge, the patient should be relatively
comfortable on oral medications, should have a dry incision, should
understand their exercises and should feel comfortable with the plans
for managing the knee.
Management of these limitations requires advance planning to accomplish
the activities of daily living during the period of recovery. Convalescent assistance Most patients will go home following their hospital stay. Home
physical therapy, typically 3 times per week, is initiated as soon as
possible following hospital discharge.
Patients are encouraged to walk as normally as possible immediately
following minimally-invasive quadriceps-sparing total knee
replacements. Most people use crutches or a walker for a week, and then
a cane for another week or so beyond that. Most people are walking
nicely by about two weeks after surgery (see video, above).
Patients are allowed to shower as soon as the surgical incision has been dry for a day or so.
Patients should not resume driving until they feel their reflexes
are completely normal, and until they feel they can manipulate the
control pedals of the vehicle without guarding from knee discomfort.
Certainly, patients should not drive while taking narcotic-based pain
medications. On average, patients are able to drive between three and
six weeks after the surgery. Surgery for knee arthritis at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call the Bone & Joint Surgery Center at 206-598-3354 or Eastside Specialty Clinic at 425-646-7777 to make an appointment.
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