Opioid-free Accelerated Recovery Total Knee Arthroplasty

Opioid-Free Accelerated Recovery Total Knee Arthroplasty

To prove that total knee arthroplasty can be performed with little, if any need for opioids by using a combination of patient education, optimized pre-op and post-op pain and recovery protocols. The goal being opioid-free total knee arthroplasty.

All study patients will receive a standardized protocol

• All surgical procedures performed by single surgeon using same implants, approach, pre-op and post-op optimization, and simplified pain protocol at a single hospital or surgery center
• Will attempt to minimize the number of anesthesiologists to further control variability in care

Methods:

1. Pre-op Optimization

   • All patients enroll in education program
   • All patients have optimized BMI, hemoglobin, albumin, glucose control-A1C, and blood pressure

2. Total Joint Procedure

   • Tourniquet-free cemented total knee arthroplasty is performed with intra-articular block

3. Data Collection

   • Electronic medical record chart review
   • Pre-op assessment and Post-op assessment (post anesthesia care unit (PACU), Phase II-prior to discharge
   • Phone calls after discharge
   • Follow-up assessment in surgeon's office
   • Swift path / KOOS JR surveys

4. Pain Management Regimen

   • pre-op physical therapy teaching
   • post-op multimodal pain regimen

Inclusion Criteria:

• Surgeries to be performed at hospital
• Surgeries to be performed at surgery center
• Ability to read and understand English
• Primary care clearance for patients diagnosed with high blood pressure

Exclusion Criteria:

• Disease states, patient conditions to exclude:

Schizophrenia Bipolar Disease Dementia

• Known allergies to local anesthetics
• Previous burn to affected extremity
• BMI > 40
• Nonoptimized anemia
• Albumin less than 3.5
• A1C > 8.0