Updated 08 November 2016

Better pain relief after knee replacement surgery

An injected drug might ease knee pain while maintaining mobility, but more research is needed - study suggests.


Postoperative knee pain is always a concern after knee replacement surgery, but a new study suggests a strategy that might give patients another way to ease discomfort.

Read: What is knee pain?

Researchers at Henry Ford Hospital in Detroit note that the painful recovery process following knee replacement surgery is a persistent problem.

Liposomal bupivacaine

However, the research team found that injecting a newer, long-acting numbing medicine, known as liposomal bupivacaine, into the area surrounding the knee helps patients recover more quickly and boosts their satisfaction with the procedure.

"Patients had pain relief for up to two days after surgery and better knee function compared with the traditional method," said the study's senior author, Dr. Jason Davis, a joint replacement surgeon at Henry Ford West Bloomfield Hospital, in a hospital news release.

The study involved more than 200 patients who underwent knee replacement surgery and were then tracked for pain control during the first two days after their procedure.

Read: Treating knee pain

Half of the patients received traditional knee pain  control, in which a common numbing medicine is injected via a pump into the groin area. Although this method can cause leg weakness, it prolongs pain control for two days after surgery, the researchers said.

"Pain control [using this method] came at the price of weakness and made patients somewhat tentative when walking during their hospital stay," Davis noted.

Patients start walking hours after surgery

The rest of the patients received the liposomal bupivacaine injection, targeted to the site of their surgery. Unlike the traditional pain control method, the newer, long-acting numbing medicine enabled patients to begin walking comfortably just hours after surgery, the study showed.

This technique "optimizes pain control early on," said Davis. "Function-wise, it was a lot easier for patients to move around more confidently. In the past decade, we've made major advancements in pain control for knee replacement surgery. This option is a promising, viable one for our patients."

Two experts not connected to the study had mixed opinions about the results.

"Innovative approaches to pain control have markedly improved the early recovery after knee replacement," said Dr. Matthew Hepinstall, an orthopaedic surgeon at Lenox Hill Hospital in New York City.

"This study confirms prior studies showing that local anaesthetic injections can provide analgesia similar to nerve blocks after knee replacement, without the delayed rehabilitation that some patients experience with femoral [leg] nerve blocks," he said.

But Hepinstall stressed that only further research will let doctors know for sure that the more expensive liposomal drug is better than conventional methods at reducing postoperative pain.

Rebound pain

Dr. Jan Koenig is chief of joint replacement surgery at Winthrop-University Hospital in Mineola, N.Y. He said that one "underreported problem with the liposomal bupivacaine time-release analgesia is that we see a lot of rebound pain about day three when it wears off."

Read: Causes of knee pain

The study was presented recently at the American Association of Hip and Knee Surgeons annual meeting in Dallas. Findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

Read More:

Knee Pain Stretches & Exercises
Knee pain may run in the family


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Professor Asgar Ali Kalla completed his MBChB (Bachelor of Medicine and Bachelor of Surgery) degree in 1975 at the University of Cape Town and his FRCP in 2003 in London. Professor Ali Kalla is the Isaac Albow Chair of Rheumatology at the University of Cape Town and also the Head of Division of Rheumatology at Groote Schuur Hospital. He has participated in a number of clinical trials for rheumatology and is active in community outreach. Prof Ali Kalla is an expert in Arthritis for Health24.

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