When Dr. Thomas Dominick ran into Melinda Barrett at a gas station in early August, he was a little surprised to see her hopping out of a white Jeep. That’s because just a few short weeks earlier, Dominick had performed hip replacement surgery on her.
“I think he was a little shocked to see just how fast I had recovered,” said Barrett.
“It was a pleasant surprise,” said Dominick, who admitted he thought more time had passed since he’d last seen Barrett.
“I asked her ‘What has it been about three months?’” he said jokingly.
Barrett’s surgery was performed on July 29, just three days after her 50th birthday. She required a new right hip due to osteoarthritis.
Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage that cushions the ends of your bones wears down over time. Although osteoarthritis can damage any joint, the disorder most commonly affects joints in your hands, knees, hips and spine.
“Over the past two years, things really started to get worse,” she said. “It’s really almost insidious the way the pain starts to creep up on you and limits your mobility.”
For awhile Barrett, who lives in Mifflinburg and teaches nursing at Bloomsburg University, worked with her family doctor to manage the pain and control it in other ways.
“I tried to keep moving to avoid losing more of my mobility,” she explained. “But eventually, I was taking medications like anti-inflammatories on a daily basis. Eventually I had no choice.”
Tired of not being able to do the things she once took for granted like riding a bike, going for walks or performing simple chores like sweeping, Barrett decided it was time to make an appointment with an orthopedic doctor.
Arthritis and pain
Barrett’s situation is like many others Dominick sees every day.
“The No. 1 reason I see patients is due to arthritis,” he said. “And what usually brings them to me is pain.”
Dominick is the first to note that no one “needs” a joint replacement.
“It is an elective procedure,” he said. “But when someone chooses to have one, it’s because they’re experiencing limitations on their functional activities.”
Prior to joint replacement surgery, Dominick said patients have typically already undergone some conservative pain management with their family doctor, like Barrett.
“For knees there are things like injections, braces, physical therapy, medications,” he said.
Those methods have changed somewhat over the years.
“Early in my career we used to give a lot of anti-inflammatories, before we knew so much about both short term and long term side effects,” he said. “I prefer to do injections. We can do cortisone and supplementation (lubricant) injections for knees right in the office. There are a lot of conservative management strategies for knees.”
Hips, on the other hand, present a bit more of a challenge. While exercise and anti-inflammatories can be prescribed, tactics like injections can be more difficult.
“The hip is a very deep joint and is not as accessible in the office, so we do it under image intensification and at the hospital to make sure the needle is in the right spot,” he explained.
A lot of patients will go years under these types of treatments before electing for a joint replacement surgery, said Dominick, but once they can no longer modify their lifestyles or the pain becomes too much, preventing them from sleeping at night or performing daily tasks, “that’s what typically brings them in.”
Primary candidates for joint replacement tend to be around 61 years old, which Dominick said is interesting.
“You would think we would be looking at people who are in their 70s and 80s but patients are electing to do this earlier and earlier,” he said.
“The Baby Boomer generation that is coming up — they are a very, very active group and have been coming in earlier to have joint replacements,” said Dominick. “They want to be active and keep doing the things they want to do - whether that’s travel or athletics or something else.”
Just because someone wants joint replacement surgery doesn’t mean he or she is a good candidate, though.
“When it comes time to deciding if they need and want the surgery, we will first do X-rays and obtain an imaging series,” said Dominick. “They will also need to go to their regular doctor, who will prepare them by asking them to do things like stop smoking and optimize their situation by losing some weight if they are ‘generously proportioned.’”
Of course, he pointed out, doctors are “very sympathetic to the argument of not being able to exercise because of the pain from joints.”
Pre- and post-op
Still, it’s important to be in the best shape possible prior to the procedure in order to get the best results after, explained Aaron Barner, physical therapist and rehab coordinator at Evangelical Community Hospital.
“What ends up happening for us is that once the doctor determines an individual is eligible for a joint replacement, he or she is sent for one pre-op session with a therapist,” said Barner. “Our goals are to educate patients on what to expect during the hospital stay — things like how to use a walker, how to do steps, how to make the transition back home easier.”
Secondly, Barner said patients can get the answers to questions they might have about the surgery.
“We want to decrease their hesitancy,” he explained. “Our whole philosophy is the more they know what to expect, the calmer they will be while in the hospital.”
At pre-op appointments, the therapist will also do an evaluation to address motion loss and weakness issues prior to surgery.
“The stronger you are before surgery, the better it is for post-op rehab,” said Barner. “If you go in with good motion and strength, your recovery is much quicker afterwards.”
Patients will also get briefed on other expectations and will be given exercises similar to those that they’ll be doing in the hospital and after they’ve been discharged.
“If their bodies are already used to those motions, that will help,” he said.
These steps are important, said Dominick, because while the doctors, program and staffer all wonderful, at the end of the day, the patient specific factors are “way more important that what I do or how I do it, what approach I use.”
“The patient predicts more of the outcome (of surgery) then what I do as a surgeon,” he said. “If a patient has gotten themselves optimized medically and physically, that pays dividends.”
The actual surgical procedure takes approximately an hour, give or take, and most patients are home recovering within a day.
“Eighty-percent are leaving within 24 hours and the expectation is that most of our patients will leave the next day,” said Dominick. “The next day get up and have a session of physical therapy, and as long as all looks good, they can be discharged and get back to their own environment.”
Post-operative care is just as important as preparation prior to surgery, according to Deb Yoder, physical therapist.
“As soon as surgery is over, we focus on teaching the skills needed to go home,” said Yoder. “They learn how to get out of bed, get dressed and take care of themselves. They receive special equipment instruction, we review how to get up and down stairs, and teach them some exercises to begin with so that their muscles are functioning and moving right from the start.”
Patients will have an individual therapy session in the morning, and in the afternoon, may bring a “coach” along to another session. Coaches are friends or family members of patients who aid in the patient’s recovery.
“Our patients get a lot of therapy and individualized time so we can address what they need to do so they feel comfortable going home,” said Yoder.
Nurse navigators also teach a joint replacement class that is really helpful in preparing patient and their families.
“It makes a huge difference when people come in knowing ahead of time what to expect,” said Yoder.
Barring any unforeseen complications, which happen rarely, Dominick said most patients are released from his care within a six-week time frame. And the patients, he said, are typically thrilled.
“Our satisfaction ratings are well over 90 percent,” he said. “After joint replacement, patients can be more functional and active. We see patients doing so much more -sometimes more than what we want them to do.”
Barrett is definitely one of Dominick’s satisfied customers.
“I did not expect my recovery was going to happen that quickly,” she said. “The recovery was definitely one of my biggest concerns prior to surgery — I wanted to know how soon can I drive, how soon until I can get back to work, etc. I was expecting it would be longer than than it was and I was really get back into life normally pretty quickly.
If you’re on the fence about whether or not joint replacement surgery is for you, Barrett recommends giving it a go.
“I would absolutely would recommend to people.” she said. “Once I started to talk to people when considering it, so many people said they wished they had done it sooner.”