In September 2010, Bob Faught's mother had a right total knee replacement. The same day, Bob's aunt had her second total knee replacement on the other side of Kansas. Two weeks later in Tennessee, Bob's sister had her second total knee replacement. In this short time span between three different hospitals, let's take a look at the inconsistencies that were experienced:

Femoral Block:

The femoral block is lidocaine given in your groin to provide longer pain relief on the top of the knee. Here is a summary of the three surgeries:

Bob's Mother: Yes

Bob's Aunt: No

Bob's Sister: No

Cumadin or Warfarin:

Cumadid, or Warfarin, is a blood thinner used to prevent blood clots & insure smooth blood flow. This can be taken by pill or a series of ten shots in your stomach, one per day. Again, here are the results:

Bob's Mother: Warfarin pills

Bob's Aunt: Warfarin shots

Bob's Sister: Didn't get pills or shots

CPM (Continuous Passive Motion) Machine

The CPM machine is used after total knee replacement in hospital to mechanically move your leg from full extension to reflex based on the settings used. Using the CPM after surgery helps get movement in the joint, circulation, etc. Today, some hospitals have stopped using the CPM machines because they feel they get the patient up right away & want them to use walking for joint movement. Also, some hospitals have stated that there have been workers' compensation claims from nurses due to the extent of physical strength necessary to set the CPM up each time for patients. When the CPM machines are used, doctors each have their own insight on the amount of time & number of times to use per day. They will vary from once a day, to using most of the time the patient is in bed. Here are the results:

Bob's Mother: NO CPM

Bob's Aunt: YES, twice per day

Bob's Sister: YES, three times per day

Time Before Taking Shower:

This simply means when does the doctor allow the patient to take a shower with water directly on the healing incision. To prevent infection, most doctors wait until after the sutures are taken out, which is between 10~14 days. When a patient takes a shower before then, they need to cover it up. For example, doctors use bags around the knee to saran wrap with tape. On Bob Faught's second knee replacement in 2003, he had a special clear tape over the entire incision that protected it from water. Bob asked why they are not using that today on his mother's surgery. Cost was given as the reason. Here are the results:

Bob's Mother: After staples out, saran wrap/tape

Bob's Aunt: After staples out, plastic bag

Bob's Sister: Shower third day after surgery, no covering

These are just a few of the many orthopedic inconsistencies that exist today. Hopefully you can see why a patient making the best "Joint Decision" can become confused after talking with their doctor & comparing it to family & friends. All three patients ended up with pain-free mobility & a higher quality of life. The path to get there varied depending on the processes & procedures preferred by the doctor & hospital.

Orthopedic inconsistencies simply means inconsistent processes & procedures that vary by doctor, hospital, region of the country, etc. Patients become very confused when they are making an important "Joint Decision" only to find that their family or friends had different experiences or procedures. Our Joint Decisions wants to dedicate this web page to mention just a few of these inconsistencies. Many doctors discuss the fact that the orthopedic community does not have fixed standards for surgical procedures. Yes, there can be confusion, but the patient needs to understand most of these are based on different schools of thought that still strive for the same result: best care for the patient.

As you see from the picture above, Our Joint Decisions feels it is the lifebouy for support, education & motivation for patients, especially on orthopedic inconsistencies. We will strive to always update & publish those inconsistencies that patients send to us. We want to insure you are able to make the best "Joint Decisions" for a higher quality of life.

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