You may need surgery when your knee has structural damage. You may also need it if your knee pain has not responded to other methods of pain relief for structural damage or other conditions, such as osteoarthritis. If you choose surgery, a physician anesthesiologist will prevent you from feeling pain during the operation. As pain management specialists, physician anesthesiologists also play a key role in pain relief and recovery after surgery. This postsurgical pain relief is critical for effective participation in physical therapy and rehabilitation.
The most common knee surgeries involve arthroscopy — a surgical technique used to repair many different types of knee problems — or knee replacement.
Arthroscopy is a type of keyhole surgery used to diagnose and treat a wide range of knee problems. A keyhole surgery is one in which long, thin instruments are inserted into the patient’s body through small incisions.
For arthroscopic knee surgery, the surgeon inserts a probe with a small camera, called an arthroscope, into the knee joint. The scope displays pictures on a video monitor to help guide the surgeon’s work. Surgical instruments are inserted into the joint through a second incision.
The American Academy of Orthopaedic Surgeons describes the following as the most common arthroscopic procedures for the knee:
- Removal or repair of a torn meniscus — a type of cartilage in your knee that cushions and stabilizes the joint
- Reconstruction of a torn anterior cruciate ligament (ACL), which is a ligament that helps stabilize the knee joint
- Removal of inflamed synovial (connective) tissue
- Trimming of damaged articular cartilage
- Removal of loose fragments of bone or cartilage
- Treatment of patella (kneecap) problems
- Treatment of knee sepsis (infection)
In a knee replacement operation, the surgeon removes damaged parts of the knee joint and replaces them with new parts made of materials such as metal, ceramic or plastic. Contrary to the name of the procedure, the surgeon does not replace the entire knee joint.
After knee replacement surgery, you may have some temporary pain in the new joint. Nonetheless, physical therapy can often begin the day after surgery. Physical activity after surgery is considered a key to success. That makes postoperative pain relief particularly important, so you can be active and participate effectively in physical therapy.
Knee replacements can be expected to last at least 15 years; some last 20 years or longer. Because knee replacements do not last forever, age is a factor in deciding between surgery and other pain management alternatives.
Your choice of anesthetic depends on many factors, such as the surgery being performed, your risk factors and your preferences. Your choice may affect the risk of complications, cost, and time spent in the medical facility. It also may affect how quickly you can begin physical therapy.
Always consult with your physician anesthesiologist on the best option for you.
- Regional anesthesia is a common option for arthroscopic surgery. It numbs only the area of the body that requires surgery. You remain awake and aware. Regional anesthesia includes spinal or epidural anesthesia and peripheral nerve blocks. Some research has found that regional anesthesia can provide better pain control and lead to faster rehabilitation and fewer complications than general anesthesia.
- Local anesthesia may be an option for arthroscopic surgery, although it is less commonly used. A one-time injection numbs just a small area around the surgical site. Advantages to local anesthesia include lower risk of complications, lower cost and faster release from the medical facility.
- General anesthesia, which renders you unconscious during surgery, is sometimes used for knee replacement. But regional anesthesia can also be an option for this surgery.
You should consider a number of options for pain relief following knee surgery. These options should be discussed with a pain management specialist, who can explain the pros and cons of each option or combination of options, including effectiveness, potential side effects, potential for addiction and impact on the recovery process. Physician anesthesiologists who specialize in pain management can work with you before and after surgery on a plan tailored to your condition, personal history and preferences.
Some of the options to consider and discuss are:
- Analgesics such as acetaminophen (Tylenol). These act solely to relieve pain.
- Anti-inflammatory medicines like aspirin, ibuprofen and naproxen sodium. These act to relieve pain and reduce inflammation.
- Peripheral nerve blocks. These involve the injection of an anesthetic into specific nerves to block pain signals between the brain and the knee.
- Opioids. These drugs, which block pain signals to the brain, are sometimes necessary to relieve severe or persistent pain, but patients should take them only as needed and use as low a dose as possible. Monitoring by a pain management specialist is important because opioids can be addictive.
- Multimodal therapy. This is commonly used for pain management after knee replacement surgery and typically involves opioids and one or more additional pain relief methods. Multimodal therapy can improve pain control while limiting opioid use.
It is important to consider all options in consultation with a pain management specialist. For example, a recent study found that patients undergoing minimally invasive knee replacement left the hospital sooner and with less pain when given a combination of medications that act by different mechanisms to control pain, rather than relying on one type of pain medication.
Physician anesthesiologists work with your physician team to evaluate, monitor and supervise your care before, during and after surgery, delivering anesthesia, leading the Anesthesia Care Team and ensuring your optimal safety.