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Helping Total Knee Replacement Patients Walk the Day of Surg

In April 2016, a woman who had just received a total knee replacement did something that no patient at Tanner had done before: within hours of her procedure — and with the help of her patient care team — she stood up and walked about 25 feet to the door of her room.

Then she kept going.

All told, that patient walked more than 250 feet and climbed five stairs the same day as her total knee replacement. She was the first of many.

Walking on the same day as a total knee replacement used to be unheard of in orthopedic surgery. In fact, the way we historically controlled pain for total knee replacement patients — an indwelling nerve block catheter releasing a continuous administration of medication — kept the leg numb for two days, making it virtually impossible for a patient to stand and walk.

Now, at Tanner, a new multimodal pain protocol developed by our anesthesiologists, pharmacy staff and orthopedic surgeons enables us to change the type of nerve blocks that total knee replacement patients receive.

Now, we are performing periarticular injections during the knee replacement procedure, making it possible for the anesthesia team to use adductor canal blocks that take away the leg’s sensory capabilities without taking away its motor functions.

Over the last year, we’ve also reevaluated the many other encumbrances to walking after surgery, including the surgical drains, urinary catheters and other tubing, such as IV fluids, that follow patients around the hospital, ensuring that none of them stayed in longer than was necessary — if they must be used at all.

Walking — or “ambulating,” as medical providers call it — on the day of surgery for total knee replacements is considered a best practice for orthopedic care. It’s been shown to reduce complications, improve outcomes and reduce length of stay.

Prior to April, exactly 0 percent of Tanner’s total knee replacement patients ambulated the day of surgery. Last month, more than 81 percent ambulated the day of surgery. And though the goal for each patient is to at least walk to the door of their room, about 60 percent of those patients go beyond that to ambulate at least 100 feet — and many, like the first patient who ambulated the day of surgery, go farther.

Because of these advances, most patients only stay in the hospital one or two nights after surgery.

Accomplishing this took a tremendous amount of teamwork, with orthopedic surgeons, anesthesiologists, nurses, physical therapists and others putting together plans to make this successful.

Now, we’re talking up the value of walking on the day of surgery throughout our practice, from the patient care team at Carrollton Orthopaedic Clinic to the Tanner Joint Academy and in the patients’ interaction with Tanner Ortho and Spine Center staff.

We’re showing our orthopedic patients that they’re not sick; they’re here for a repair. That message is hard to accept when you’re confined to a bed and in a hospital gown.

Now, at Tanner, we’re able to help you get up, get dressed in your own clothes and walk around with the help of our staff. And that’s leading to an even better level of care for our total knee replacement patients than ever before.

To learn more about knee replacement at Tanner Ortho and Spine Center, visit TannerOrtho.org.

Carrollton Orthopaedic Clinic has locations in Bremen, Carrollton and Villa Rica. For more information, visit carrolltonortho.com or call 770-834-0873.

Orthopedic and Spine Care

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