knee replacement process improvement

New knee replacement practices – before, during, and after surgery – are improving patient outcomes.

Brigham and Women’s Hospital (BWH) orthopedic surgeon Dr. John Wright specializes in both performing knee replacement surgery and improving knee replacement surgery.

Dr. Wright performs roughly 300 knee replacement procedures each year – well above the regional average – and this significant experience leads to exceptional results. But Dr. Wright and his team have discovered that experience is not the only way to improve outcomes.

When Dr. Wright isn’t treating patients, he’s working on research dedicated to improving the entire knee replacement process – before, during, and after surgery. He leads a Care Improvement Team at BWH that has applied his research findings to change conventional knee replacement practices. This has resulted in improved patient outcomes, including less post-operative pain, shorter hospital stays, and a quicker return to daily activity.

Dr. Wright’s team starts by emphasizing patient education. Every patient attends a class that helps them prepare mentally and physically for the procedure and stresses the importance of adhering to practices (e.g., proper nutrition and exercise) that will improve their recovery.

“Setting expectations is very important,” says Dr. Wright. “Eliminating the fear of the procedure and setting appropriate goals beforehand has a significant impact on a patient’s commitment to recovery.”

Dr. Wright also stresses the importance of pre-operative health. “I don’t require people to lose weight, but their general health and nutrition is very important,” explains Dr. Wright. “And if they’re diabetic, management of their condition is optimized for the surgery.”

Dr. Wright’s research also has led to a shift in the type of medications and anesthesia used. His patients are now given long-acting pain medications immediately before surgery instead of short-acting pain medications immediately after surgery. Long-acting meds, which can work for up to 12 hours, produce fewer side effects than short-acting meds and provide steady, continuous relief for a patient after surgery. Short-acting meds administered after surgery, on the other hand, provide only intermittent relief.

Dr. Wright enhances this new pain-relief approach by performing surgery, in most cases, with regional anesthesia and sedation rather than general anesthesia. Thus, patients are awake, and in less pain, immediately after surgery. This, in turn, leads to a quicker recovery.

Recovery includes a new rehabilitation protocol. The former post-operative standard of care was to use a continuous passive motion machine, during which a patient’s knee would be moved for them by a machine. Dr. Wright’s research team, however, demonstrated that this technique actually increased the amount of pain and slowed recovery. Patients now participate in active physical therapy as soon as possible.

“We’ve found that when we get patients up and about more quickly, their pain scores have been lower than before,” says Dr. Wright. “And they also gain their range of motion and mobility much quicker.”

Rapid recovery is becoming more important as knee replacement patients are getting younger, and, thus, are often still leading active lifestyles. With Dr. Wright’s new guidelines, patients can not only look forward to getting out of the hospital quicker, but can expect to get back to their daily activities and jobs quicker – in many cases, in as little as two weeks.

– Chris P

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