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What's going on in this joint

March 18, 2002|BY KEVIN CLAPP

The Washington County Hospital Center for Total Joint Replacement has changed the way joint surgery is done

When she retired, Frances Bayer, her husband and another couple would walk together in the morning, two or two and a half miles up and down the hills of Ringgold.

At first, the dull pain in her knees was uncomfortable, but certainly not debilitating. But as the pain progressed, movement became more difficult.

First to go were the walks. Then she needed a cane to move around. Eventually, the most walking she could stomach involved grocery shopping.

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Even navigating the few hundred feet from her front porch to Ringgold Church of Christ became excruciating.

In February 1997, on a Monday morning, she entered Washington County Hospital to revolutionize her life.

Bayer was among the inaugural patients at the hospital's Center for Total Joint Replacement, which celebrated its fifth anniversary last month. More than a lube job to grease up aching joints, the center creates a wellness program to maneuver the patient through joint replacement, from pre-operative education to post-op therapy.

"It was a dull pain in through here," she says, rubbing her kneecap. "And then got to be a sharper pain.

"I was anxious to get it done. I figured it couldn't hurt any more than it already did."

Joint replacements have taken place since 1973, with the average hospital stay lasting seven to 10 days. Patients with hip replacements would be transported home by ambulance, largely to prevent dislocations of the new joints by such movements as getting into a car.

Ralph Salvagno, MD, co-founded the center with Tom Altizer, now deceased. Made of metal and plastic, replacement joints are usually the last resort for men and women with degenerative arthritic conditions. In a knee, this means the spongy cartilage in the joint has worn away and lower and upper leg bones are rubbing painfully against one another.

Hips and knees are most commonly replaced, but ankles, shoulders, elbows and even finger joints are fair game.

Salvagno says patients need to keep in mind that this is an elective procedure, something many patients are having to improve their lives.

"People have a greater expectation of a quality of life as they get older," he says. "They want to stay active, they want to stay independent, they want to stay mobile."

Doing it more than once

Bayer felt so good after having her left knee fixed in February 1997 that she returned that July to have the right knee done. Salvagno says it's not uncommon to see patients who have had both knees, both hips and a shoulder replaced, though the cause can often be attributed to a degenerative condition.

More than 300 people will have joints replaced at the hospital this year, an average of eight to 11 people per week. When the center opened, three to five operations were performed each week, with surgery taking place Mondays and Tuesdays to have patients home by the weekend.

The median age of patients, according to the center's case manager, Pat Ford, ranges from 72 to 75, though replacements have been performed on people in their 30s and as old as 92. Bayer was 72 at the time of her first replacement.

Time in surgery varies depending on the surgeon and joint, but a typical knee or hip operation will last between one and two hours. By the end of the day, nurses are rousing patients from their beds to begin what will be an intense rehabilitation, including work on stairs and increasing their range of motion.

Patients are also tested in a mock apartment before they leave to ensure they can get in and out of a regular bed without difficulty, as well as navigate a kitchen. Bayer remembers rehab being a difficult process, but worth it.

"Our goal is for them to go home as safe as possible but as independent as possible," Ford says. "We don't want them dependent on a spouse or a friend."

With few exceptions, patients are in and out of the hospital within three days, with up to four weeks of out-patient therapy ahead of them.

But the joint replacement process begins long before anyone goes under the knife. Four weeks before surgery, a team of nurses and therapists begins meeting with patients to prepare them for what lies ahead.

Ford, a certified orthopedic nurse for 28 years, says readying patients ahead of time increases the likelihood of a quick recovery. And each patient has a coach - a spouse, family member or friend - who assists them throughout the process.

Painful joints create sedentary people whose joints and muscles are unaccustomed to physical exertion. Among the first tasks Ford assigns patients are a series of exercises to strengthen the body in advance.

A family affair

Ford says the trick at the center is that the work encompasses more than rehabbing joints. It breeds a familiarity between staff and patients that makes the entire process more palatable.

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