The Emerging Focus of Joint Surgery

More active adults are seeking joint replacement surgeries when their joints have worn out. Learn how new advancements are helping patients to recover faster and regain their lifestyles after this elective operation.

The field of orthopedic surgery focuses on the prevention, diagnosis and treatment of disorders in the musculoskeletal system, which is made up of bones, joints, ligaments, tendons, muscles and nerves. Elective surgeries involve full or partial replacement of hip, knee and shoulder joints as well as repair of hand, foot and ankle injuries.
Orthopedic surgeons also repair traumatic injuries resulting from accidents, falls and athletic mishaps. Disorders that result from aging, such as bone density loss, erosion, cracks, fractures and arthritis may be relieved by orthopedic surgeons. Patients may also require orthopedic surgeries to treat spinal injuries and various diseases, such as bone cancers.
According to the American Academy of Orthopedic Surgeons, nearly 2 million elective, full-joint and spinal fusion surgeries are performed annually. And this statistic doesn’t include the vast number of trauma and disease repair procedures performed in orthopedic operating suites across the nation.
While the majority of these surgeries are not in response to life-threatening diseases such as cancer or heart disease, the sheer volume of orthopedic patients is prompting a change in the way patients are supported, from intake to recovery. These changes are not simply physical, as in advanced technology and medication. They encompass a fresh, insightful approach to each patient’s mental and spiritual wellness. Even so, the physical aspect of orthopedic surgery has inspired medical centers to adapt their basic operations to meet changing needs.
Interestingly, the smaller surgical incisions become, the larger the equipment needed to perform them. At Rockford Memorial Hospital (RMH), two custom-designed suites have been created to provide the space needed for not only larger pieces of equipment but also additional staff needed to ensure that each operation goes smoothly and with predictably excellent results.
Donna McDaniel, director of surgical services at RMH, says the concept for these specialized orthopedic suites was first developed in 1999. After considerable research, the new operating rooms opened in 2001.
“Unfortunately, our surgical suites were far too old, nearly 60 years old in fact,” McDaniel explains. “As cases became more complicated and technology involved larger pieces of equipment, it became necessary not only to expand the operating rooms but also to provide storage space in order to have everything a surgeon needed close at hand.”
Rockford Memorial routinely performs arthroscopic and minimally invasive surgery, elective joint replacement and orthopedic trauma surgery. McDaniel says that once a procedure is started, surprises can occur.
“During an operation, there is no time to waste,” McDaniel explains. “We keep X-ray aprons, instruments, equipment and other vital necessities close at hand so we can respond quickly to any unexpected need.”
Along with larger suites and adequate supply storage, many other enhancements have improved both the quality of care and the safety of the patients and staff.
“Our operating teams wear space-like suits to protect them from the airborne bone particles that are created during surgery,” she explains. “We now use high-torque, battery-powered saws and drills instead of the older and less-powerful air-powered equipment. These suits also protect the patients from inadvertent staff contamination during a procedure.”
The environment within the surgical suite is sterile, McDaniel adds. Specialized suction devices eliminate potential toxic elements from the surgical field. These may include smoke from cauterization and any irrigation used during the procedure. Traffic is controlled in and out of the operating room to assist with preventing infection. Staff members enter the operating room suite from a sub-sterile room to control air movement and possible contamination.
“For minimally invasive surgical procedures, we have towers equipped with cameras that allow us to operate through small incisions,” McDaniel says. “The surgical team consists of the surgeon, a surgical assistant, a scrub nurse or two, two circulating nurses and the anesthesiologist. You can understand why we need much more space and considerably more protection for the patient against any kind of contamination.”
The air within the operating suite is continually refreshed. McDaniel says air is exchanged at least 15 times per hour. However, in RMH’s orthopedic suites, total air exchange can be as often as 30 times per hour. The sub-sterile space between operating suites contains an autoclave to sterilize surgical equipment.
“We have excellent infection control and patient outcomes,” McDaniel adds.
The patient’s needs are equally valued, she says.
“Operating rooms must be kept at between 68 and 73 degrees, cool enough to help control the spread of bacteria for infection control purposes,” McDaniel says. “But conversely, the patient must be kept warm for exactly the same reason. We use what we call a ‘Bair Hugger’ that wraps the patient in warmth through patient gowns and special blankets. These can also be used for patient comfort to cool a patient who is feeling too warm.”
Even with the relatively new suites, RMH continually studies emerging technology and innovations by attending conferences to discover what can be applied to its already advanced system.
“We’re looking at suspending camera and video equipment from the ceiling, instead of using the bulky towers in place now,” McDaniel says. “Our suites are also universal, meaning that when they’re not being used for orthopedic surgeries, other types of surgeries are scheduled into them.”
In addition to renovating surgical suites to meet the ever-changing field of orthopedics, regional medical centers are beginning to focus on patients and their families in other, less tangible ways. While doctors, nurses, therapists and supportive medical staff have always been responsive to patient needs, this understanding has led to the creation of formal programs that aid patients in coping with all of the anxiety, fear and frustration that may accompany orthopedic surgeries.
While the field of orthopedics moves steadily and confidently into the future, often the changes are subtle. Small as some refinements may appear to be, the cumulative effect benefits patients and enables surgeons to better treat them.
A general orthopedic surgeon with FHN, Dr. Kevin Draxinger has handled a wide range of orthopedic procedures since joining the FHN Memorial Hospital surgical staff in 2006. Many of the advances in instrumentation have been more like upgrades than major breakthroughs, says Draxinger.
“Prostheses have improved and so have techniques for making smaller incisions,” he says.
“I also do a variety of procedures including shoulder injuries, carpal tunnel syndrome and fractures,” he adds. “Some are the result of arthritis and aging, while others have occurred because of injuries from falls, accidents or sports-related conditions. On average, I handle about 500 surgical procedures each year.”
What has really changed in the last 10 years, though, is the length of stay in the hospital.
“Along with improved surgical techniques and medical treatments, insurance has played a role in how long patients stay,” Draxinger explains. “On average, patients who have had hip or knee repair surgeries stay two days. Most insurance companies allow a stay of three midnights, after which patients either go home or are sent to rehabilitation facilities.”
Physical therapy (PT) is vitally important to help ensure that patients don’t just recover but enjoy a strong, healthy return to the lifestyle they had before pain, dysfunction and loss of flexibility curtailed their activities. Beyond the actual process of treatment and healing, Draxinger says mental and spiritual support is equally assessed.
“Patients need to realize that they can share their concerns not only with their doctors, but also with PT staff and nurses,” Draxinger says. “With elective surgery, patients know in advance that they’ll be away from their jobs for weeks, and they’ve had time to put in place everything necessary to get through the healing process. But trauma patients don’t just suffer pain and disablement. They face tough questions such as what happens to my income? Who is going to pick the children up from school, or buy groceries, or pay the bills? Worse, they fear what medical bills will mean for their future and their families’ welfare.”
They need much more than physical support, Draxinger says. The sensitivity and compassion of FHN’s professional staff is equally as important as its medical support.
“This isn’t a formal program,” Draxinger says. “It’s more of a natural outpouring of understanding. At FHN, it feels very much like community. Patients can turn to us for that level of support at any time.”
Two years ago, KSB Hospital in Dixon established its Joint Academy as an integrated team approach to support and guide patients who are about to undergo knee and hip replacement surgery. The academy brings together members of KSB’s orthopedics, surgery, rehabilitation services and home health care departments, supported by other KSB departments. Managed by Martha Dailey, the orthopedic surgical coordinator, the academy provides patients with educational information, assistance in navigating the health care system and answers to their questions throughout the entire surgical and rehabilitation process.
“Basically, I help patients navigate through the joint surgery process, from when they first elect to have the surgery, to discharge,” Dailey says. “We provide a comprehensive, cooperative approach that fully supports the patient.”
Dailey explains that this step-by-step method is designed to guide patients safely and confidently. At intake, she works with patients to fill out forms detailing vital information like dental and cardiac health, family and personal histories, up-to-date physical examinations, blood work and any chronic conditions they might have.
Dailey also gathers facts on patient medications and previous surgeries – anything that might impact the proposed surgery and recovery.
“We also talk about discharge plans,” Dailey adds. “It’s important to know if they plan to go home or into a short-term rehabilitation center. We talk about their living conditions, if someone will be there to help them, as well as where their bedrooms and bathrooms are located, and stairways.”
This helps to determine what kind of equipment the patient will need after discharge. Walkers, canes, elevated toilet seats, shower chairs and other supportive equipment will need to be found, borrowed or ordered to ensure that the patient has as little difficulty as possible once he or she is discharged.
“It’s not always necessary for patients to purchase equipment,” Dailey says. “Often, family, friends or Goodwill organizations will have equipment from others who have recovered fully.”
Before surgery, KSB patients attend a one-hour class conducted by Dailey in conjunction with occupational and physical therapists that educates patients on the recovery process. Patients can ask questions then, or may call her or the therapists at any time.
“KSB gives patients a guidebook that includes a list of equipment and resources at the back,” Dailey explains. “We also give our patients T-shirts and shorts that most of the men and many of the women wear to their therapy sessions.”
Dailey adds that, depending on where the patient lives, they do their rehab at KSB or in its clinics at Amboy, Oregon or Polo. If they live in the Rock Falls or Sterling communities, there are a number of recommended rehab facilities nearby, or the patient may opt to go to a nursing home for short-term rehab.
“This is especially helpful for patients who don’t have someone who can be there for them at home, or those whose homes are not easily navigated,” Dailey says.
Finally, Dailey says that she is always available and willing to help patients hook up with other resources that are not directly related to the surgery and recovery process.
Even when a formal program is not in place, orthopedic specialists and their staff members are ready and willing to help patients with any problems they encounter as part of the surgical and healing process. It’s not simply a matter of professional courtesy but rather a personal commitment to treat patients as if they were friends and neighbors, members of a unique community.
Within the next 10 years, it’s conceivable that major medical centers will develop orthopedic treatment centers similar to those now being created for cancer and cardiac patients.
Along with the continually growing patient base for all categories of joint and orthopedic issues, an emphasis is being placed on the fact that orthopedic patients are primarily “well” patients.
This means that, in contrast to patients who are admitted to hospitals with potentially communicable diseases or who acquire MRSA and other catastrophic contagious infections while in the hospital, orthopedic patients are not “sick.” By creating isolated treatment centers, medical professionals can more effectively control the environment and significantly reduce transference of illness-related infections.
Dedicated staff including doctors, nurses, therapists – even food service and housekeeping staff – further protect patients. This evolving concept is already being developed in hospitals and medical centers regionally and nationwide in response to the increasing number of patients undergoing orthopedic treatments.
The future of orthopedic surgeries and treatments holds vast improvement for patients on all levels, from diagnosis and intake through the entire healing process. Orthopedics is no longer simply a surgery; it encompasses the patient’s physical, mental and emotional health.