Thursday, January 28, 2016

American Academy of Orthopaedic Surgeons releases guidelines for surgical treatment of osteoarthritis of the knee

By: Michael F. Blum, MD
Orthopaedic Surgeon Southlake Orthopaedics and Sports Medicine & Spine Center, PC

Recently the American Academy of Orthopaedic Surgeons (AAOS) introduced new clinical practice guidelines for adults undergoing surgery to recover motion and relieve pain caused by osteoarthritis of the knee. The guidelines focus on the surgical procedure most commonly performed for this condition, total knee replacement.

In cases where surgery is warranted, the clinical based guideline is the first evidence-based guideline for diagnosis, treatment, rehabilitation and safety for patients. The guidelines are timely because total knee replacement is the No. 1 procedure, in terms of costs, reimbursed by the Centers for Medicare and Medicaid Services (CMS). Effective April 2016, CMS will issue bundled payment for total knee replacement in designated geographic markets—one fixed cost reimbursement for everything from initial consult through recovery.

The clinical based guideline, “Surgical Management of Osteoarthritis of the Knee,” provides guidelines for physicians and patients to consider when making decisions about knee replacement.

Among the key clinical practice guidelines receiving “strong” rating are:

• Reduction of risk factors such as weight reduction and stop smoking

• Administration of multi-modal anesthesia, including local anesthetic and nerve blockade around the knee joint to decrease pain and opioid use following total knee replacement

• Starting rehabilitation the same day total knee replacement is performed to reduce length of hospital stay.

For patients who I am seeing and discussing total knee replacement, I encourage them to focus on pre-operative strengthening of the quadriceps. The stronger a patient’s quadriceps, the faster the recovery postoperatively is the message I share. The more pre-operative education the patient understands and receives regarding “replacing” a joint attributes to the outcome of the procedure. The success of joint replacement relies heavily on the patient knowing what to expect and their role in the recovery phase.

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