Joint replacement and recovery
Innovative new surgical techniques, collaborative care protocols, and professional recovery programs are improving patient outcomes significantly
The world of orthopedics is vast and dynamic, and joint placement is one of its common hallmarks. At Meriter Medical Group, orthopedic surgeon Jim Bowers has seen a marked increase in the popularity of his anterior hip-replacement procedure, in which the patient lies on his or her side (instead of back) on a special table for this highly specialized, muscle-sparing procedure. While initially successful for quicker recovery with fewer restrictions, time has shown anterior hip replacement is also improving alignment.
“What was typically a big problem with hip replacement surgery was the leg lengths could be different afterward,” says Bowers. “With this procedure I’m finding people are very happy with their overall alignment, specifically leg lengths.”
Also in recent years, Meriter Medical Group has committed to a bundled system, team approach to hip- and knee-replacement surgeries that incorporates anesthesia services, physical therapy, physician surgeons, nursing and administration.
“What we’ve done is come up with a more collaborative protocol, which I think has greatly improved the quality of these surgeries,” says Bowers. “Additionally, we’re able to do nerve blocks and long-acting numbing medicines that improve patients’ pain, especially in the post-op period.”
Patients play a role, too. Although a skilled care team is critical when it comes to successful joint replacement, there is something you, yourself, can do to help ensure a positive outcome. Bowers says a patient’s healthy lifestyle coming into surgery has a significant impact, recommending low-impact cardiovascular activity at least three times per week. If pain is an issue, seek expert evaluation to determine if activity should continue.
“Taking care of yourself ahead of time,” says Bowers, “is preventative medicine.”
Birmingham Hip Resurfacing With conventional total hip replacements, both the ball and socket are removed and replaced with metal and plastic components. While these types of replacement surgeries are certainly effective, high-impact activities are subsequently discouraged for the life of the hip. That’s why Birmingham Hip Resurfacing (BHR) is a game-changer for select patients.
“Birmingham Hip Resurfacing is designed for young, active patients who have worn their hip joint to bone-on-bone but still want to go back to a high level of activity,” says Stoughton Hospital orthopedic surgeon John Rogerson, who originally testified at the Federal Food and Drug Administration to get the BHR approved in the United States. He then became only the second U.S. surgeon to perform it. Since 2006, he has since successfully performed nearly eight hundred of these procedures.
“The Birmingham prosthesis is a bone-conserving procedure where you shave and cap the surface of the femoral head (ball) and not totally cut it off,” says Rogerson. “It is a much larger ball, which is ten times less likely to dislocate, and there is no plastic in the system to wear out.”
In addition to the benefits of hip resurfacing, Rogerson’s innovative HipHab rehabilitation program, which combines both water and land physical therapy in the first week post-op, also has been found to significantly enhance the speed and quality of recovery. This program, and Rogerson’s experience in performing the BHR procedure, have drawn patients from thirty-five states to Stoughton Hospital and the Madison area.
“We’re seeing so many extreme athletes wearing their joints out at a much earlier age, yet they don’t want to give up being this active for the rest of their lives,” says Rogerson. “I just feel very strongly that Birmingham Hip Resurfacing is the best option for them.”
Coordinated recovery Joint Replacement surgery can be a daunting proposition, whether you’re facing various knee or hip procedures or evaluating rehabilitation options. That’s why Dean and St. Mary’s developed Steady Strides, an innovative system of orthopedic care involving a comprehensive, multidisciplinary team approach from pre-surgery through recovery and guided from start to finish by a care coordinator. It’s a regional program that leverages the collective expertise of nurses, doctors, physical therapists, anesthesiologists and other departments, to define and implement best practices, empower patients, and streamline the entire process.
“My role is really being that guide for the patient,” says Katie Blanchar, a registered nurse and orthopedic care coordinator for Steady Strides. “To be that face, that person they can actually contact if they have any questions at all, and guide them from the moment they decide to have surgery and all the way through.”
As part of Steady Strides protocol, Blanchar teaches a two- to three-hour pre-op class to educate patients and prepare them for what’s ahead. She says patients are often skeptical about recovery times and mobility after surgery, as well as apprehensive about pain and other uncertainties; the more she can address their specific concerns ahead of time—which are often different for everyone—the better the real-life outcomes.
“I think a lot of things that we’ve put in place with Steady Strides have made it so people really do feel better,” says Blanchar, whose post-op patients are often up and on their feet the first night of surgery, and walking the halls in their own clothes the next morning. “They’re surprising themselves at how well they’re doing.”
Short-term rehab stays Following joint replacement, many patients face the question of whether to rehab at home or spend a few weeks in a rehab center. While recovering at home is understandably appealing, “There are a few important reasons to consider a short-term stay you may not have considered,” says Keith VanLanduyt, vice president of marketing and community relations at Oakwood Lutheran Senior Ministries.
During a rehab stay at Oakwood, professional staff support is available twenty-four hours a day. Registered nurses are present around the clock to oversee medication and assist in monitoring pain. Multiple physical and occupational therapist appointments are scheduled throughout the day, as the frequency and intensity of rehab can improve your chances of success and shorten recovery time. You don’t have to worry about burdening loved ones or navigating stairs, particularly if you live alone or in a home that wouldn’t easily accommodate using a wheelchair, walker or cane. Staff can also help coordinate services for your return home after your stay, to help ensure a smooth and successful transition home and, after a three-night stay in a hospital, the first twenty days in a rehab center are likely covered by Medicare.
“Investing in a short-term rehab stay can sometimes mean the difference between a successful or an incomplete recovery from surgery,” says VanLanduyt. “If you are making the commitment to have joint replacement surgery, you owe it to yourself to do all you can to make a complete recovery.”