Transforming Lives: Total knee replacements available at 48th MDG Published April 17, 2023 By Maj. John J. Carroll, MD 48th Surgical Operations Squadron ROYAL AIR FORCE LAKENHEATH, England -- When I arrived here at Royal Air Force Lakenheath in July of 2020 and began to see patients in the 48th Medical Group, I did not realize the number of retirees and beneficiaries that I would be seeing with knee osteoarthritis. Knee osteoarthritis is the degenerative, wear and tear arthritis that most commonly occurs with age or after prior trauma. It can cause decreased motion, pain with activity and limited activity tolerance. The first treatments for osteoarthritis focus on non-operative management. These measures include physical therapy to try to gain range of motion and strength, brace wear, diet/weight optimization, anti-inflammatories and potential intra-articular injections for pain relief. Once non-operative management fails to provide lasting relief or benefit, and patients are having a continued impact on or decrease in their quality of life, it may be a time to consider a joint replacement. There is no good way to turn back the clock on arthritis or re-grow it. The treatment for end-stage osteoarthritis is to replace it in the form of a total knee replacement. This is ultimately the patient’s decision, and they must weigh whether the risks associated with surgery are outweighed by the potential benefits. From 2020-2022, when patients reached the decision for a total knee replacement, my partners and I would refer them off-base to obtain a knee replacement in the community. With the COVID pandemic and increased NHS wait times, patients were sometimes waiting for up to 24 months for surgery. The surgeons are of very high quality here in the community, but I wanted to secure a better option for our patients in terms of timing and availability. I petitioned hospital leadership and got support right away. My goal was to be able to provide high quality knee replacements with each step of the process backed by current literature and being consistent with standard-of-care in the United States. I worked closely with the operating room, logistics, physical therapy, inpatient services, pharmacy, and internal medicine to obtain the necessary items to create a total knee program identical to one that you would see at a CONUS MTF (Continental United States Medical Treatment Facility). We have standardized the pre-operative clearance, infection prevention steps, operative case, and post-operative care to provide as streamlined a process as possible to optimize patient care. Patients must be appropriate candidates for surgery here at the 48th Medical Group and that is determined as part of the pre-operative clearance process. We have completed our first two total knee replacements on base thus far and patients are doing great. Patients typically stay in the hospital one night and discharge home post-operatively with outpatient physical therapy. We are happy to evaluate anyone with persistent knee pain and help discuss treatment options with them. Please get in touch with your primary care team and have them place a referral to Orthopaedics. While a total knee replacement is such a powerful surgery with a great track-record and superb outcomes, we do recommend working through the non-operative measures first. Many times, non-operative treatment can delay or prevent the need for a replacement. Should patients progress to needing a total knee replacement in the future though, we now offer the full range of treatment options here at RAF Lakenheath, which is incredibly exciting for patients and for us as providers. The ability to complete a total knee replacement at the end of the treatment pathway and see the significant clinical improvement that patients have is rewarding.