Patient Stories: Rick, Knee Replacement Surgery

I was completely floored. The first night after my surgery I was standing, the next day I was using a walker without pain, and I was home the day after that.

With three torn ligaments and no cartilage left in his right knee, 49-year-old Rick Litavis of Hopkinton, MA, had two options – continue to live in pain and suffer through sleepless nights, or get a knee replacement.

Rick was ready for relief.

And thanks to the expertise of one of the country’s leading orthopedic programs and an innovative approach to improving knee replacements, Rick was not only pain-free within days after his January 2013 operation, but also walking and biking within weeks.

“I was completely floored,” says Rick. “The first night after my surgery I was standing, the next day I was using a walker without pain, and I was home the day after that.”

Finding Help in a Familiar Place

After playing football at Northeastern University, Rick continued to play competitive, high-impact sports throughout his 20s and 30s. But such a lifestyle also comes with risks, as Rick has severely injured his right knee several times.

Those mounting knee injuries led to increasing pain, decreasing physical activity, and sleeplessness. The lack of sleep, in turn, sapped his motivation and energy.

When he was ready for help, Rick turned to orthopedic surgeon Thomas Thornhill, MD, the same physician who had replaced both of his father’s knees during a single operation several years before. But what Rick didn’t fully realize at the time was that he wasn’t only going to benefit from the expertise of Dr. Thornhill and his team, but also from a new approach to improving knee replacement outcomes.

A New Approach

The Department of Orthopaedic Surgery developed a Care Improvement Team to define and establish new and improved knee replacement processes. The team has not only conducted extensive research to determine which practices improve outcomes, but also has worked hard to ensure that these best practices are adopted and applied consistently by every member of the care team – and that includes Rick.

The care team starts by emphasizing patient education – helping patients prepare mentally and physically for the procedure – and making sure that patients know that they are an important part of the team. By adhering to best practices on their end (e.g., proper nutrition and exercise), patients can contribute significantly to improving their recovery.

On the day of the surgery, one of the most significant procedural changes could be observed right before Rick’s surgery began. According to the new protocol, Rick was given long-acting pain medication immediately before surgery instead of short-acting pain medications immediately after surgery. Long-acting medications, which can work for up to 12 hours, produce fewer side effects than short-acting medications and provide steady, continuous pain relief for a patient after surgery. Short-acting medications, on the other hand, only provide intermittent relief. Thus, Rick was in minimal pain immediately after surgery – step one to a quicker recovery.

But recovery doesn’t mean relaxation.

The former stan­dard of care was to have a patient’s knee moved for them by a continuous passive motion machine shortly following surgery. Research by the Care Improvement Team, however, has demonstrated that this tech­nique actually increases the amount of pain and slows recovery. The orthopedic surgery team now uses a rehabilitation protocol that literally gets patients back on their feet within hours after surgery.

Rick stood up on the first night after his surgery. Only days after that, he was participating in active physical therapy, such as flexing his knee, picking his leg up off the floor and onto his bed, and walking.

Rick quickly recognized that getting him moving right away was a priority for the entire medical team – his surgeon, nurses, and physical therapists. They were, according to Rick, persistent, but also supportive.

“Everybody was consistent. Everybody was super friendly. Everybody was a cheerleader,” recalls Rick. “And that positive reinforcement makes you want to get to the next level.”

Active and Pain-free

On the first night after surgery, Rick stood up. Within two days, he was navigating the hospital hallways with the aid of a walker. Now, only months later, Rick, who turned 50 in March, enjoys frequent walks around a local lake with his son and wife and is looking forward to visiting, and trying to keep up with, his daughter at school in New York City. He’s already picked up his golf clubs and hopes to be able to walk 18 holes by the end of the year.

This type of rapid recovery is becoming more important as knee replacement patients are getting to be more like Rick – younger and often still leading active lifestyles. With our new approach, patients can not only look forward to getting out of the hospital quicker with less pain, but they also can expect to get back to their daily activities and jobs quicker. Based on his experience, Rick wonders why a qualified candidate for knee replacement surgery would wait.

“Why torture yourself for 10 more years?” explains Rick. “Why put yourself through pain and aggravation when you can live happily with no pain and do the things that you want to do?”

Learn more about Brigham and Women's Hospital

For over a century, a leader in patient care, medical education and research, with expertise in virtually every specialty of medicine and surgery.

About BWH