New knee replacement protocol a first in Western Canada

Patients spend less time in hospital, feel minimal discomfort following surgery

CALGARY – Patients undergoing knee replacement surgery are recovering faster and going home sooner as a result of a new approach to this surgical procedure.

Earlier this year, Dr. Rajrishi Sharma became the first orthopedic surgeon in Western Canada to adopt a new protocol for knee replacement surgery in patients with osteoarthritis. Since then, he has used it on 20 patients at the Peter Lougheed Centre; 17 returned home same-day and the other three within 24 hours. None required hospital readmission. Before this approach, patients undergoing this surgery would typically remain in hospital for three to five days.

“Knee replacement surgery can be extremely painful and have a lengthy recovery time for patients,” says Dr. Sharma. “This new protocol helps the patient experience less post-operative pain and have less functional restrictions, which reduces the time it takes them to walk from a few days to just several hours. This significantly impacts a patient’s post-surgical experience, ultimately helping them recover more quickly. These are still early days – we’ve used this protocol for only nine months – but I’m pleased the results we’ve had to date are promising.”

The new protocol involves alternative pain management and pain medications before, during and after surgery, and new surgical techniques to mitigate soft tissue pain. Together, these changes provide pain relief for up to 48 hours, enabling patients to move their legs immediately after surgery with minimal discomfort.

“Congratulations to Dr. Sharma and AHS,” says Tyler Shandro, Minister of Health. “This is a great example of innovation that makes care better for patients and more efficient for the health system, building on a long record of leadership in orthopedics. Our government is committed to strengthening our publicly funded health system and reducing surgical wait times, and we need new approaches like this to help deliver on that promise.”

Kenn Thompson, 59, had knee replacement surgery using the new protocol in March. Prior to the procedure, the Calgary man was having difficulty with everyday tasks such as walking, doing stairs, and tying his shoes following a bike accident. On bad days, the pain was so severe that even dressing for work became a challenge.

“I found I even started having pain in my back and other leg because I was compensating so much for the pain in my knee,” Thompson recalls.

Following surgery, Thompson says he got his life back. He was walking without supports within three weeks and was back to work within 10 weeks to a job that requires him to walk up to 10 km a day.

“Getting back on track after surgery was indescribable and the actual procedure and recovery was nothing compared to the pain I went through before the operation,” Thompson says. “I don’t have the words to thank Dr. Sharma and his team for the wonderful job they did.”

About 6,000 knee replacement surgeries are performed each year in Alberta.

The AHS Bone & Joint Health Strategic Clinical Network (SCN) monitors joint replacement quality indicators, such as hospital length of stay, at the 12 centres that perform this surgery in the province. Over the past 10 years, through care path development, measurement, and ongoing quality improvement initiatives involving acute care surgical teams, the median length of stay for knee replacement in the Calgary Zone has been reduced from 4.2 days to 2.3 days.

“Dr. Sharma’s project builds on this success even further,” says Dr. Jason Werle, Medical Director of the Bone and Joint Health SCN. “Having your knee replaced and going home the same day would have been unheard of even a few years ago.”

Dr. Sharma is currently working on teaching the new protocol to other orthopedic surgeons here in Alberta and across Canada. This new approach to knee replacement surgery was developed in the U.S. and is currently performed in several U.S. centres, as well as Toronto, Montreal and Halifax. Dr. Sharma adopted the protocol into his practice after training last year with a U.S.-based orthopedic surgeon.

Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than four million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.