Mohan Makkar, 73, struggled with severe knee pain that affected his daily life and social interactions. After trying several treatments without success, he underwent conventional knee replacement surgery on his right knee in 2023. While the operation eventually relieved his pain and restored mobility, the recovery process was lengthy and challenging. He relied on a walker for weeks, needed prescription pain medication, and avoided social activities during this period.
For his left knee replacement, Makkar experienced a different approach at Cedars-Sinai Medical Center. This time, he used a walker for only two days, resumed meeting friends within days of surgery, and managed pain with Tylenol instead of stronger medications.
“This recovery felt so much easier,” Makkar said.
Sean Rajaee, MD, chief of Arthroplasty at Cedars-Sinai Orthopaedics and Makkar’s surgeon for both procedures, noted that many patients avoid necessary surgeries due to concerns about difficult recoveries. To address this issue and help patients walk sooner after surgery—which can lower risks such as blood clots or infections—Cedars-Sinai implemented an enhanced joint replacement recovery program. According to Rajaee, “Now that patients are hearing about improved techniques and smoother recoveries, there is a growing demand for faster care—and Cedars-Sinai is committed to meeting that need.” The initiative has led to nearly 80% of total joint replacement patients walking and returning home within 24 hours after surgery, compared to 68% in 2022.
The program involves identifying suitable candidates based on health status and age while assessing their home environment and support systems post-surgery. Collaboration among surgeons, anesthesiologists like Michael Kissen, MD, nurses, and physical therapists is central to the approach. Teams regularly discuss treatment plans—including medication choices—to ensure patients begin moving soon after surgery.
“Every part of this pathway has existed for a while on its own,” Kissen said. “But coordinating all these processes and fine-tuning what we do through constant feedback and regular meetings is the novel concept behind creating this pathway.”
Patient education also plays a role; presurgical appointments help set expectations about recovery plans.
Advancements in anesthesia contribute significantly to quicker recoveries. Instead of relying solely on general anesthesia—which can cause more side effects—spinal anesthesia is now commonly used. This method numbs the lower body but allows earlier mobilization after surgery by wearing off quickly. “Spinal anesthesia has been used safely for years,” Kissen said. “What’s changed is our shift to shorter-acting medications that last through surgery but wear off quickly so patients can move and start therapy much sooner.”
Other regional anesthesia techniques include peripheral nerve blocks such as the adductor canal block for knee surgeries; these target sensory nerves around the knee while preserving motor function so patients can walk immediately after their operation.
Robotic-assisted surgical methods further reduce tissue trauma during procedures like knee replacements.
During Makkar’s second procedure on his left knee—unlike his first—Rajaee chose not to use a tourniquet (a device typically used to control blood flow), which recent studies suggest may reduce postoperative pain. A quadriceps-sparing midvastus approach was also employed to preserve muscle tissue in the thigh area. Anesthesiologists added low-dose ketamine during surgery to manage pain pathways not addressed by narcotics.
“At my age I am super happy I’m walking,” Makkar said.
Plans are underway at Cedars-Sinai Medical Center—a Los Angeles hospital founded in 1902 with Thomas M. Priselac as its current president—to expand these enhanced recovery protocols beyond joint replacements into other surgical areas such as robotic prostate procedures (https://www.cedars-sinai.org/).
Read more on the Cedars-Sinai Newsroom: Cedars-Sinai Slashes Anesthesia Emissions, Reducing Carbon Footprint
