Download - Jared Brummel, DO Orthopedic Surgeon
Objectives
1. Discuss the impact of patient selection for total knee arthroplasty and its impact on outcomes
2. Describe the materials and surgical techniques of partial and total knee arthroplasty
Outline
1. Indications and Eligibility Requirements2. Surgical Technique3. Total vs. Partial Knee Replacement4. Managing Post Surgical Pain5. Outcome Data
Advances in Knee ArthroplastyTraditional Recent Advances5-day hospital stay Typically go home next day3-month recovery time Walking day of surgery~ 12-inch incision ~ 3-4 inch incisionLarge scar Smaller and less noticeable scarsSurgeon can fully see knee joint Surgeon can fully see knee jointSevere disruption of muscles and tissue
Less disruption of muscles and tissue
Bearing materials prone to corrosion and/or squeaking
Advances allow for reliable materials that last longer
Assessing the Patient’s Pain• Does your knee hurt one or more days per week?• Does the pain interfere with your sleep?• Is it painful for you to walk more than a block?• Are pain medications no longer working?• Is knee pain limiting your participation in activities
(e.g. family vacations or other functions)?• Has inactivity from knee pain caused you to gain
weight?
Conservative Treatment Options• Water therapy
– Soaking, ice packs, hot packs• Exercise & physical therapy
– Also good for weight loss• Medications
– Analgesics (NSAIDS)– Corticosteroids
• Injections– Corticosteroids,
hyaluronic acid, biologics• Braces
– Hinged, Offloader
Managing a Patient’s RiskWhen Is Surgery Right for You?
Minimize health factors that increase risk for potential problems after surgery
A multi-disciplinary team convened by orthopedic surgeons, and included; anesthesiologists, pharmacists, Clinical Nurse Specialists, physical therapists, and bedside orthopedic RNs.
Goals:• Decrease post-operative pain,• reduce physician variation,• improve patient compliance with ambulation and exercises, • increase patient satisfaction, and• reduce patient falls.
The Palomar Health Pain Protocol
• Reduced need of Patient Controlled Analgesia
• Time patients spend in severe pain was dramatically reduced
• Commonly heard from our patients:
“I had surgery before and this is a totally different and
better experience!”
The Palomar Health Pain Protocol
Methods
• Preop meds• Intraop methods• Periop methods• Postop protocols
• Preop cocktail• Local anesthesia• Adductor canal block• Postop regimen that
minimizes use of narcotic/opioid meds
Length of Stay2.3
2.1 2.0 1.9 1.8 1.8 1.6 1.5
-
0.5
1.0
1.5
2.0
2.5
PMC Escondido PMC Poway2015 2016 2017 2018
% of Patients Discharged on POD1
11%
31%28% 34%45% 49%
67%76%
0%
20%
40%
60%
80%
100%
PMC Escondido PMC Poway
2015 2016 2017 2018
Patient Falls per 1,000 Bed Days
-
1.68
0.70
1.68
0.94
1.81
3.18
3.94
-
1.00
2.00
3.00
4.00
5.00
PMC Escondido PMC Poway
30-day All-Cause Readmissions
1.1%2.6%
0.9% 1.3%1.6%0.3%
0.0%
2.5%
5.0%
7.5%
PMC Escondido PMC Poway2016 2017 2018
Published Benchmarks3.37% (National Average)2.69% (Top 10%)