PRACTICE PEARLS: Return to Function after TKA

    “When you get right down to it, we are in the people-pleasing business,” said Donald M. Kastenbaum, MD, in a presentation on perioperative protocols for total knee arthroplasty (TKA) at ICJR’s Pan Pacific Orthopaedic Congress.

    Dr. Kastenbaum, from Mount Sinai Healthcare System in New York, noted that how the surgeon and the hospital team treat the patient – the customer – is more important than any new instrument or prosthesis or technique. The surgeon may consider a good result to be a technically successful operation, but for the patient, a good result is a return to function.

    The recovery process following TKA has come a long way since Dr. Kastenbaum started practicing, from the 7- to 10-day hospital stay in the early 1990s to hospitals stays that last a couple of days or less in 2017.

    The trend toward reduced length of stay has been fueled by advances in all areas of TKA, including anesthesia, blood management, pain management, infection control, DVT prophylaxis, implants, instruments, and techniques, and this has resulted in perioperative protocols marketed as “fast track,” “enhanced recovery,” and “rapid recovery,” among others.

    Dr. Kastebaum said that regardless of the name, these programs are not really “fancy marketing tools.” Instead, they’re a blueprint for better patient care leading to better patient satisfaction, and they should be the standard of care for all total joint replacement patients.

    At Mount Sinai, Dr. Kastenbaum said, every person from the team who comes into contact with a TKA patient shares the same message: You are having this operation to improve your life and return to function.

    This starts at the first visit, when the patient decides to have surgery. The entire process is mapped out, from diagnosis to preoperative optimization, from preoperative education to the actual procedure, from physical therapy to discharge. When the patient leaves the surgeon’s office, he or she knows what to expect.

    Click the image above to watch Dr. Kastenbaum’s presentation and learn the details of the perioperative protocol he and his colleagues at Mount Sinai follow when managing TKA patients.


    Dr. Kastenbaum has no disclosures relevant to this article.