Panel Discussion Dr Antony Kodsi, Prof Sam Adie, Dr Razvan Stoita

The podcast opens with a discussion around the decision-making process regarding prosthesis options in surgical orthopedics. One participant clarifies that while the fund doesn't dictate the type of implants used by surgeons, it does influence rehabilitation protocols, emphasizing a model where patients are encouraged to return home shortly after surgery. The conversation highlights that surgeons retain the autonomy to select implants based on individual patient needs, with one panelist explaining their personal disinterest in managed care because it challenges the equitable provision of patient care.

As the discussion transitions, a specific case is presented, who is described as a patient suffering from chronic pain post-repeated hip replacements. The experts address the complexities associated with distinguishing pain sources in patients who have undergone multiple revisions. They stress the importance of understanding multifactorial pain—where surgery is not necessarily a panacea for all patient issues. The panel agrees on the necessity for thorough diagnostic assessments and emphasizes the importance of patient involvement in their recovery. Treatment strategies discussed include targeted medication regimens, potential use of procedures like fascia iliaca blocks, and considering non-surgical contributions to pain, such as sensitization or issues related to surrounding joints.

The conversation evolves to include specific inquiries about lidocaine use in post-operative settings, where it is noted that its utility is often limited to intraoperative scenarios, particularly involving nerve structures. Michael, another participant, stresses the need for accurate diagnosis before considering further surgical interventions for painful joint replacements, reiterating that understanding the root cause of pain is critical.

Questions arise about the appropriateness of second opinions. The surgeons generally favor patients returning to their original surgeon unless there's a clear mechanical issue needing reevaluation. They advocate for continued patient support, focusing on reassurance and recovery guidance, indicating that unnecessary second opinions could lead to further anxiety rather than providing solutions.

The discussion then touches on the challenges of managing postoperative opioid prescriptions. The panel acknowledges common practices whereby patients leave hospitals on opioids, leading to a concerted effort in primary care to manage tapering and long-term use. They suggest that an effective pathway would involve early screening and referrals to pain specialists when red flags are present.

Next, the complex issue of medicinal cannabis is broached. Participants outline the current lack of robust evidence supporting its use in pain management, particularly emphasizing the need for more definitive research in the orthopedic space. While acknowledging its potential, they express skepticism about its efficacy and the risks involved.

A case study of a patient with bilateral knee replacements facing postoperative pain issues brings forth a discussion on chronic pain after surgery, where the challenges of knee interventions contrast with other joint surgeries. Noting a significant percentage of unhappy knee replacement patients, the participants stress that chronic pain management requires a multidisciplinary approach, incorporating psychological support and the continuous reassessment of the surgical intervention's outcomes.

Towards the end of the interview, they discuss initiatives aimed at establishing a more structured model of care to address the needs of patients suffering from chronic postoperative pain. This highlights the necessity for collaborative efforts among surgeons, primary care physicians, and allied health professionals in creating comprehensive care plans.

The...