Pain Management for Joint Replacement Cases – Physiotherapy Perspective

Introduction Total joint arthroplasty is considered as one of the most successful surgical procedures to relieve pain and improve physical function for patients with severe osteoarthritis of knees or hips. In Hong Kong, there are about 6,000 total knees or total hip arthroplasty operations performed in public hospitals yearly. Adequate and appropriate post-operative pain management allows faster rehabilitation, reduces risk of complications and hence, associated with shorter length of stay in hospital (Parvizi et al, 2011). However, after hip or knee arthroplasty, a significant proportion of patients experience certain period of pain which may persist for months. Previous studies showed that at least 7%-23% of patients experienced long-term pain after hip arthroplasty and at least 10%-34% of patients had long-term pain after knee arthroplasty (Beswick et al, 2012). In order to improve the quality of the outcomes after total joint arthroplasty, multimodal pain management is used to tackle the pain. This is a multidisciplinary approach with input from surgeons, anesthesiologists, as well as physiotherapists. Surgeons and anesthesiologists work much during the pre-operative period, during operation and post-operative period by using spinal analgesia, epidural analgesia, local analgesia, nerve block, NSAIDs, COX-2 inhibitors, Gabapentin, Tramadol, etc. (Beswick et al, 2012; Fischer et al, 2008).