Pain Management Before and After Knee Replacement

Question

Pain Management With Knee Replacement

Osteoarthritis

Osteoarthritis is a medical condition that affects joints of a body including hips, knees, hands, neck and lower back. It damages cartilage found on the joint and makes the surface rough. The bones lubricate against each other causing pain that is a characteristic of Osteoarthritis. The knee experiences tenderness and stiffness. It becomes hard to move the knee around, and this limits walking or climbing up the stairs. It also causes loss of flexibility; the knee cannot move to its full motion (Diego, 2007).

The causes of Osteoarthritis include sex, age, obesity, sedentary lifestyle, joint injuries and bone deformities. Osteoarthritis often affects women though the reason behind it is still unknown, and it affects older men and women more than the young. Another cause of the disease is obesity, which causes knee arthritis because of the heavy weight of the body it carries. The sedentary lifestyle of people causes arthritis in later life as they eat less nutritious food and do less exercise. Finally, people who are born with deformities are most likely to suffer from Osteoarthritis.

Knee arthritis often causes lots of pain that forces one to undergo knee replacement surgery to ease the pain. Osteoarthritis causes a lot of pain to patients before, during and after surgery, but the pain is minimal after knee replacement. Orthopaedic surgeons try to minimise this pain by performing knee replacement surgery on the ailing patient.

This essay looks at pain management; discussions will be on the type of pain a patient experiences before surgery, the surgery procedure and how a patient recovers after the surgery. I am also going to discuss the multi-disciplinary team that was available during the whole process and the care they give to the patients, the management of pain and the four dimensions of pain. The guidelines, consent and confidentiality of patients are to be put in place, and I will explain how orthopaedic surgeons and therapists put it into consideration.

Pain Management before Surgery

When patients develop arthritis of the knee, they undergo a lot of pain due to the friction between the bones at the joint. Arthritis wears off the cartilage that supports the tibia and femur, which are the lower and upper side of the knee bones respectively. The two bones end up lubricating against each other at the patella, which causes pain to the knees and inhibits movement (Sharma, 2004).

The pain is so intense that a person opts to get a knee replacement to ease the pain. A thorough procedure is undertaken, which includes looking for other means of eliminating the pain without knee replacement. Commencement of a crucial journey begins to help the patient manage pain before and after surgery. Care is given to patients during the whole period before and after surgery, and ways of how to manage the pain are shown. Pathophysiology given to the patient is also a determinant of the quick recovery a patient will get.

An acute pain at the joints that inhibits movement is characteristic of the pain a patient feels before surgery. The knee feels stiff and swollen so that a trip to the bathroom would seem impossible. It makes the knee lose its flexibility and ability to function well. Care offered to the patient at the time influences the process of pain management before and after knee replacement. Before knee replacement, a patient feels too much pain; therefore a therapist determines the cause and type of pain, which involves undertaking different tests. A therapist asks the patient if the type of pain they have causes numbness and stiffness of the knee. They evaluate whether it can be symptoms of another disease (Fishman, Ballantyne, & Rathmell, 2010).

If they determine that the pain is really of osteoarthritis, a necessary step is taken to help reduce the pain. The physicians and therapists look at the methods of how to reduce the pain on a patient. They ask the patient to reduce the amount of work they do or change some of their lifestyle behaviour. They try to look for areas they feel a patient is straining and ask them to change. Nurses are extremely helpful in making sure patients are comfortable and experience the least pain.

After the discovery that the joint of the patient needs a knee replacement, the patient is prepared psychologically and physically for the surgery. The surgery preparation entails short-term and long-term preparations. One-to-two weeks before the surgery, the patient is under a nutritious diet that helps boost the immune system and functionality of the cells of the body. The doctor asks the patient to stop taking some drugs such as ibuprofen and aspirin as these drugs make blood harder to clot (Diego, 2010).

The patient stops drinking and smoking as these two things affect immunity because of chemicals that affect the cells. In case of having conditions such as diabetes and hypertension, the surgeon will ask the patient to see the doctor that treats him/her. This prevents any form of complications that might arise during surgery. The surgeon will also ask the patient to tell him/her of any flu or herpes outbreak during those two weeks before surgery. A patient may also see a physician to know of the type of exercise they may do after and before surgery to increase the chances of a quick recovery. The home of the patient should be in a stately condition that allows therapists to work in there, and the patient is in a position to move around freely.

Pain Management During Knee Replacement

During the knee replacement surgery, a patient is put under anaesthesia either general or spinal anaesthesia, that is, numbness just below the waist. Then the surgeon proceeds by cutting 8-12 inches of flesh at the front part of the knee. The surgeon then removes the damage on the ligaments and shapes the joint to accommodate the metal or plastic replacement (Sherperd, 2006). The placement of the artificial joint (prostheses) should have an attachment at the tibia, femur and patella. The joining is done using a special cement to hold them together. After the fitting, the prostheses now rely on the surrounding ligaments and muscles for support and ability to function.

Pain Management After Surgery

A patient stays in the hospital for an average of three to five days after surgery. They recuperate at the hospital with most things done for them like bathing and using the washrooms. The physical therapists now get more familiar with patients and become their aid when they need help (which they mostly do). After the three-five days, the hospital discharges the patient and they can move back home. Here, physical therapy offers them pathophysiology, which entails reducing the pain as much as possible and at the same time helps them heal faster.

A physical therapist works at home or at a rehabilitation clinic where the patient goes after discharge. He/she makes sure the patient does not work under too much physical stress. They guide them to move around the room with parallel clutches and then help them use single clutches as they keep on improving. After a while, the patient manages to walk alone without the aid of a physician or a cane. A patient after knee replacement is not supposed to do heavy work and lift heavy objects. A physical therapist also guides the recuperating patient on how to manage the knee to avoid infections. Infections can occur through other body organs and spread to the knee (Smith, 2001).

Considering the knee is still weak, patients avoid delicate surfaces. The physical therapist ensures the diet of the patient contains enough calcium and vitamins to make the healing process quick. The pathophysiology given to the patient helps achieve quick recovery.

Tools Used to Determine Osteoarthritis

Before the knee replacement, consideration is put on the evaluation of the pain of the patient. Orthopaedists make sure the pain of the patient is addressed, and there is the use of different tools to address the pain. Diagnosis on a patient who requires a knee replacement is established through different methods such as X-ray, Arthrocentesis, arthroscopy and careful analysis of joint location, symptoms and the appearance of joints. An orthopaedist tests the joint with an X-ray to look at the joint. With an X-ray, an orthopaedist gets to see the loss of joint cartilage, bone spur formation and narrowing of the space between adjacent bones.

With these observations, an orthopaedist concludes the cause of the pain is osteoarthritis. Arthrocentesis is another tool that a doctor uses to test a patient for arthritis. Performance of Arthrocentesis is in the office of a doctor where he takes a sample of joint fluid for analysis. The fluid helps in determining diseases such as gout, infections and another form of inflammatory arthritis (Folkmarson Kaal, 2013).

The removal of the fluid helps reduce pain and inflammation in the patient. Arthroscopy is also another tool used to diagnose knee arthritis. It is a surgical procedure where a doctor inserts a tube (arthroscope) inside the joint space. It easily detects abnormalities and damage on the ligaments and cartilage. The arthroscope can as well correct the problem. A doctor can also detect osteoarthritis by careful analysis of the location, duration and character of joint symptoms. One diagnosis of osteoarthritis is the bony enlargements of the joints from spur formation. These are all some of the tools that may be in use to diagnose knee arthritis and help manage the pain the patient experiences (Fishman, Ballantyne, & Rathmell, 2010).

Holistic Management of Pain and Four Dimensions of Pain

Management of pain in a patient is performed holistically, and one views the pain in four dimensions. The four dimensions include sensory, affective, cognitive and behavioural. The sensory dimension underlies physical harm induced to the patient due to pain, on the other hand, it reflects on the negative emotions evoked by pain and physical harm such as unpleasantness and distress. The cognitive dimension of pain evaluates the problem and looks at the solution in the end. Finally, the behavioural dimension of pain looks at the overall behavioural expression of pain.

A person suffering from knee arthritis undergoes this type of pain. The pain affects the person from one dimension to the other; they are all interrelated. The holistic management of the pain bases it on the degree to which the pain affects the person. The holistic management of this type of condition is ensuring the patient has great nutritional care. A physical therapist ensures that they holistically manage the pain of the patient by considering the four dimensions of pain.

Multidisciplinary Team Helpful in Pain Management

In the whole process of pain management, the completely disciplinary team is responsible for a successful surgery and recovery. The physical therapist looks at the condition of the patient and analyses exercises that are suitable for them. The orthopaedist considers the type of arthritis the patient has and determines the best treatment to offer (Cynthia, 2006). The surgeon operates on the knee while replacing it the nurses surrounding him offer him support and help. Considering having a knee replacement requires an orthopaedist to have a network of other doctors relating to human anatomy.

He/she requires a second and third opinion before proceeding to the next step. The multidisciplinary team is responsible for preparing the patient for knee replacement surgery. They make sure a patient has enough mental and physical preparation for the coming operation. They guide them on what to eat and what to do in advance of the surgery. They are also responsible for putting the patients under anaesthesia, and other drugs to prevent post-surgery stress. Other patients, even though they are under anaesthesia, experience traumatic stress.

In a way, they relate to what is happening to them and in cases, it happens, they receive drugs that help them forget about it. It is done to reduce patients’ chances of suffering from post-traumatic stress later in life. They are also responsible to guide the patient through the recovery steps and in case of another knee replacement surgery; they know how to handle it. Without them, patients would have a hard time adjusting and healing at a reasonable pace of about three to one year. They play a very vital role in managing the pain of the patient before surgery and the minor one after surgery. They do their work extensively even out of their normal jurisdiction.

Management of the Pain of a Patient

A patient having osteoarthritis undergoes a lot of pain and is vulnerable to being hurt. Therefore, they are under a lot of care to avoid the pain and to improve the healing process too, that is, in terms of what and what not to do as well as the physiotherapy. A physical therapist helps the patient manage their pain as well as guide them on the type of work that reduces pain. A person with osteoarthritis is to abstain from work as they are not to put a strain on their joints. They accept advice encouraging them to eat healthy as one of the causes of the ailment is obesity and a sedentary lifestyle. An osteoarthritic patient eats a well-balanced meal containing minerals like calcium, which enhances bone formation (Thorp, Wimmer, & Sumner, 2007).

They are also helpful in quickening the healing process. The exercise is given to the patients also quickens the healing process and puts them in an optimistic position. A physical therapist guides them through the journey and acts as a person to talk to when they feel lonely or depressed. They are unlikely to be under depression, and they will have the motivation to work hard to heal faster. The multi-disciplinary team also gives them hope and a feeling of satisfaction, that no one has left them alone. At the end of the healing journey, their pain will be under control and their spirits intact.

Management of the pain also has its focus on how well they exercise. They are to perform less strenuous activities that put pressure on their joints, which leads to pain in the joints. The care they are given is adequate to help them heal.

Evidence Underpinning the Management of Pain

Lots of evidence show underpinning of the management of pain. Patients with osteoarthritis get advice to choose the type of shoes they wear. Some shoes cause lots of discomfort and cause changes in kinematic and skeletal alignment. Research suggests that the benefit of foot orthotics affects foot muscle activation and gait pattern to reduce the load on the joints (Nigg, 2011). With foot orthotics, there is a reduction of the lower extremity.

When the data are put together, they provide evidence that the foot provides the micro-control of gait and suggests orthotics and specific footwear provide an effective non-surgical and non-pharmacological intervention in osteoarthritis. There is a notable association of foot alignment with osteoarthritis. Patients with osteoarthritis are flat-footed (Daniels, 2004). Effects of shoe wear and osteoarthritis cause a high rate of loading and external abductors. These effects focus on the biomechanical markers associated with walking.

Conclusion

In conclusion, the management of knee pain in patients takes a lot of care and time. To make the whole process successful, different people are required. A patient with osteoarthritis is taken care of and helped to reduce the pain they experience through various methods such as knee replacement. The knee replacement is the final step to help reduce the pain of an arthritic patient. It involves a lot of steps and time. The orthopaedist makes sure the needs of the patient are catered for and they are given the right pros and cons of undergoing surgery.

They also guide the patients on the consequences of undergoing surgery. A physical therapist plays an important role in enabling the patient to recover quickly and in a healthy manner. They watch their diet and the activities they undertake so as not to injure themselves. They also determine how long a patient can do without some form of strenuous activities like swimming and can cure, as well.

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The four dimensions of pain show how a patient suffers from arthritis. It explains how pain affects both the social and physical environment of the patient. Relations between the dimensions are there as if one suffers from sensory pain, he/she will experience affective pain. Sensory causes physical harm whereas affective shows how distressful the patient feels under such pain. It causes them to have mood swings and at other times causes depression.

The different tools to determine if a person has arthritis are also important to evaluate the solution quickly. X-rays offer an instant account of how the bone ligaments have deteriorated and give a quick answer to the problem. Arthrocentesis is a simple way of determining knee arthritis as observation and analysis are on the sample fluid. It gives more than one option of the problem solution to the patient, and the performance of a minor surgery helps reduce the pain of the patient. Arthrocentesis can enable a patient to undergo knee replacement surgery after the performance of the minor surgery. The other forms of determining knee arthritis such as arthroscopy can also be a tool to determine the type of pain a patient is experiencing.

The knee replacement procedure is an easy task, which includes removal of the worn ligaments and replacing them with metal or plastic ones. The prostheses stay in the body for about 20 years before a person decides to seek another replacement. It has a long-term benefit and the pain will be obsolete.

The evidence that underpins the management of pain is majorly associated with the footwear someone chooses to have. The footwear causes strain on the joints hence leading to more pain. With the correct footwear, a patient can experience less pain and lead a more painless journey than the one who chooses the wrong footwear.

Physical therapists help manage the pain of the patients and help them to heal quickly. They not only help them physically, but they also guide them on how to gain motivation to work harder to heal quickly. The whole pain management before and after knee replacement is governed by how well the people involved help the patient heal.