A recent joint-replacement patient had both knees replaced at the same time — very unusual. In most cases, the physician will replace one knee and then, if needed, the other. Replacing two knees at once doubles the risk, doubles the surgery time and doubles the hard work of recovery — the patient doesn’t have a good leg to stand on.
But Cathy Weaver had no good leg to stand on, after years of painful congenital problems, injuries and rheumatoid arthritis. She was determined to take on whatever the risks and the rehabilitation difficulties to have both knees replaced at once.
Weaver’s journey through the Joint Replacement Program of Wake Forest University Baptist Medical Center was a unique one and very satisfying, beginning with presurgery education and a thorough consultation,
recovery in the Joint Replacement Unit and then ending with therapy that she continues months later at her home in High Point.
Her case is an example of the physician/patient partnership at work at the Joint Replacement Program, which is directed by orthopaedic surgeon Riyaz Jinnah, M.D. “The program has grown exponentially in the last year,” Dr. Jinnah said. “The six surgeons who work in the Joint Replacement Program all have different specialties and overlap. We have really beefed up our staff.
“We now have the most experienced hip-resurfacing team in the entire state. We have specialty-trained nurses and support staff, state-of-the-art equipment, excellent preoperative education and evaluation, a superb regional anesthesia
team and great postoperative care. In addition, our Joint Replacement Unit, which is in the Sticht Center, is fully operational.”
William G. Ward, M.D., an orthopaedic surgeon and Director of Orthopaedic Oncology and Adult Reconstruction, emphasized the breadth of the program. “It’s anything anybody wants. We have the latest developments
for the uni-compartmental knee, for resurfacing for hips, for computer navigation. We have a specialized unit that can handle patients of all ages and joint problems.”
The patients who come through the Joint Replacement Unit are those for whom joint pain is no small nuisance — the pain keeps them from sleeping, interferes with work and stands in the way of enjoying life, friends and grandchildren.
These patients long ago graduated beyond the nonsurgical options, such as anti-inflammatory medications, injections, physical therapy, bracing and/or weight loss. In some cases, less invasive or arthroscopic surgery aimed at relieving pain has helped or delayed the need for major surgery. Now these patients are ready to trade off the time and effort needed for a joint replacement so they can live the rest of their lives, in 95% of the cases, totally pain free. They are ready for joint replacement or resurfacing surgery.
After reaching the decision with their physician to have the surgery, patients need education, always an important part of the program. Patients (and their caregivers) attend a class where they are told what to expect before, during and after surgery. Illustrations of the new joints are very helpful, in addition to suggestions for equipment that will make the transition easier in the home, such as rearranging existing furnituretemporarily, higher toilet seats, alternative bathing methods, etc.
The patient education classes also include a talk by the physical and occupational therapists, as well as a tour of the Joint Replacement Unit on the second floor of the Sticht Center, where joint-replacement patients recover. The presurgery interviews with an internist and with an anesthesiologist are completely thorough.
“The dedication of the Joint Replacement Unit under the management of Cece Buckley, R.N., who is an extremely experienced acute care nurse, has allowed us to develop the unit even for some of the sicker patients who previously would have had to be cared for in another
area of the hospital,” Dr. Jinnah said. “We are now able to have them recover in the unit, where we have four monitored beds. These patients can have the benefit of specialized nursing, physical therapy, occupational therapy and discharge planning right there in the unit.
“Previously, anyone who needed special monitoring, such as an atrial fib or monitoring of their heart for 24 hours, would be in another area of the hospital and they would lose out on a day of rehab. Cece had really been pushing for that.”
Most joint-replacement patients recover in the hospital for about three days. That first day, they walk a little. Before leaving, they bend the joint as much as possible, even walking up and down steps.
Wake Forest University Baptist Medical Center is not just in the joint replacement business, Dr. Jinnah said. “Our philosophy is to avoid replacement if possible, to preserve as much of your own joints as possible and to give you the best life you can possibly lead.” Joint replacement is just one of those options.
“We have a weekly conference to go over any potentially challenging cases,” Dr. Jinnah said. “It’s a veritable free second opinion. Through collaboration, we get better outcomes.
“The average age of the Medical Center’s joint replacement patients is low — 61 years of age — because we are experts in the fi eld of joint preservation,” Dr. Jinnah said. “People come here because they have heard we are the best at resurfacing, preservation and handling some of them more complex cases around the state.”
In addition, this is a leading research institution that has put the word “collaboration” into action with its research. Physicians and scientists are working together to create new meniscus and cartilage. Work is underway to understand not only the deterioration of the meniscus over time, but also the progression of osteoarthritis. Studies like these are being done in conjunction with orthopaedic researchers, the Wake Forest Institute of Regenerative Medicine, School of Biomedical Engineering and others. All of this combined makes the Joint Replacement Program a complete and comprehensive program of care.