Transcription:
Is Joint Replacement Right for Me?

Deborah Howell (Host): Hello, and welcome to the show. You're listening to the Weekly Dose of Wellness. It's brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Debby Fenton, who is the Joint Care Coordinator of the MemorialCare Joint Replacement Center at Long Beach Memorial. She hosts the weekly interactive preoperative education class, where patients learn the basics of joint replacement surgery and lets them know how therapy will help them return to their active lifestyles. Welcome, Debbie.

Debbie Fenton (Guest): Thank you so much for having me.

Deborah: Our pleasure. Today we're going to be talking about joint replacement and who would be a good candidate for it. Every year, believe it or not, 700,000 people make the decision to undergo joint replacement surgery, so let's start with a working definition. What is joint replacement surgery?

Fenton: Well, joint replacement is the surgical procedure where the worn-out surfaces of the bones that make up joints -- could be the knee, could be the hip, could be the shoulder. They're actually having joint replacement of elbows and ankles.

Deborah: Wow, I didn't know that.

Fenton: But the ends of these bones are resurfaced, and metal and plastic components are placed on the ends of these bones.

Deborah: I can't imagine ankle joint replacement. Is that relatively new?

Fenton: It's relatively new. Here at the Joint Replacement Center at Long Beach Memorial, we care for patients having had hip and knee replacement. The ankle replacement is not typically in our program.

Deborah: Right. What is the typical candidate for joint replacement surgery? Or who is, actually?

Fenton: Well, it could be male or female, obviously, and typically, it's anyone that's suffering from typically arthritic pain of the joint, which is severely limiting the activities of their daily living. These people often have to have failed, if you will, conservative treatment, which might be exercise, physical therapy, anti-inflammatory medication. Typically, joint replacement is the end of the road for treatment of painful joints.

Deborah: Okay. Can you tell me a little bit about the joint replacement program at Long Beach Memorial?

Fenton: Oh, I would love to.

Deborah: I'm glad you would.

Fenton: The joint replacement program at Long Beach Memorial is really a model of patient-and-family-centered care that is highly focused on wellness and mobility. It's comprehensive in that it begins preoperatively—actually, at the time that the patient is meeting with the surgeon with complaints of knee or hip pain. Maybe they've been treating all along and now they are at the end of the road. So, at the time of scheduling, they hear from the surgeon about the program and about their option. Comprehensiveness continues on through the hospital stay, through discharge into outpatient physical therapy. It's inter-disciplinary in that we do work with our doctors' offices, obviously. They are the first line of approach. Once patients are scheduled for joint replacement, they would get one of our guidebooks. This continues through all the touch points—through the hospitalization and again on into formal outpatient physical therapy.

Deborah: Okay. If joint replacement is right for me, what should I do next to see a joint specialist at the Long Beach Memorial Joint Replacement Center?

Fenton: Well, you would need to be treating with a physician who is participating in our program. We have 10 of them currently. You can find out about them by dialing the physician referral line here at the hospital. Also, we have a listing on our web.

Deborah: Okay. Very good. Now, after the surgery, what is the benefit of having patients stand up and start activity the very day of the surgery?

Fenton: The very same day. Probably, the most beneficial reason to get people up and have them begin activity as soon as possible, most of the time the day of operation, is to avoid complications that are associated with prolonged bed rest—for instance, blood clot, possibility of post-operative pneumonia. And it also promotes that wellness attitude for patients that it actually can be done and promotes them getting up and moving faster.

Deborah: I remember back in the day you would have those machines in the bed where they would work the joint. Is that still something that you do?

Fenton: It is available. We do not incorporate that in our program. We are incorporating patients with the mental drive to actually move and strengthen their own muscles versus depending upon a machine to do that for them.

Deborah: Okay. Of course, people are wondering, "Won't that hurt the day of the surgery?" How would you answer that?

Fenton: There is pain involved. We won't fib about that, if you will, but we do have a comprehensive, multi-model pain management approach that we take. Patients are most often having their procedures done under a spinal anesthetic, which does provide some prolonged pain management for the first 24 hours. We're also incorporating medications, IV, that would work on different pain pathways in the body, attacking the inflammatory response, which is initiated both from the disease process as well as the operation itself. And then, obviously, pain medication. That's available for patients. Usually, they need it every three to four hours, and icing and moving. We like to say around here that "motion is lotion for joints." Oftentimes, patients, when we've tried to step up everything that we can to get their pain managed, we always do make sure that we tell people we're attempting to manage their pain. We're not promising to make you pain-free, especially in the beginning. Often, if we have done every other the modality that we can think of, we would suggest, "Well, let's get up and take a walk," and almost all the time, patients do give feedback that the movement has helped.

Deborah: Oh, good. Well, that's all the medical team. But how important is it to have a family member or just a friend to act as your coach throughout the whole joint replacement journey?

Fenton: Well, there is support that's needed for patients. We have all age range that our candidates [anymore] for joint placement. Many times, we're seeing people mid to late 50s, all the way up to mid, to sometimes, late 80s. So, depending upon the patient's preliminary status, they might need more support than others. But again, it is a patient and family/friend model of care, and so, having the coach -- we call them coaches. That's the person or persons that the patient has solicited to be that number one support person for them in their journey. We invite them and encourage them to be part of the process from preoperative education class through the hospital stay on out to that transition home, then possibly being the driver for the patient to outpatient physical therapy.

Deborah: Right, because you're certainly not going to drive yourself home after a joint replacement surgery.

Fenton: Exactly. If they're here, then that's their opportunity to learn from both nursing and therapy on how to help the patient once that transition from the hospitalization happens to home. We hope that it's just that much more of a positive experience, both for the patient and for that coach. Our coaches are not visitors. They're just coming to see patients. They are actually a little bit of an extension of us, the healthcare team, and we encourage them to be here during the hospital stay as much as possible.

Deborah: And they help on the emotional part of the recovery, as well, I would imagine.

Fenton: Exactly.

Deborah: Where can I learn more about the Joint Replacement Center at Long Beach Memorial?

Fenton: Well, you're always welcome to call me here. The phone number is 562 933 4014, and you can find us on the web at memorialcare.org/jointreplacement.

Deborah: Fabulous. What else should we know about joint replacement therapy and surgery?

Fenton: Probably the latest and greatest is that some people, candidates for joint replacement, might actually be candidates to go home the same day as their operation. We are seeing that more and more. It does require a patient to be a certain status, if you will. Often, it's age. It's preexisting or non-preexisting conditions, the type of support you might have in the home, and just in general, your attitude, as well as any other medical conditions that you might have going on, as well as whatever has destroyed your joint. Outpatient joint replacement is not always for everybody, but for a select patient population, it is possible and happening.

Deborah: Wow! It's a great day and age to live in, is it not?

Fenton: Yes, it is.

Deborah: Last question. What is the average—and I know everybody there varies—recovery time for, say, hip replacement?

Fenton: Well, everybody defines recovery differently. We've had patients that are back to work in a couple of weeks. But I would say on average, what a person would describe as recovery would be about a month.

Deborah: Okay. Good to know.

Fenton: They're often walking and returning to their activities of daily living as soon as they can. And again, that's variable from patient to patient.

Deborah: Well, worth it for the ability to walk again, huh?

Fenton: Exactly, and be pain-free. Exactly.

Deborah: Well, thank you so much, Nurse Fenton, Miss Debbie. It's been so informative to have you in the program today and help get the word out about joint replacement therapy. We appreciate it. To listen to the podcast or for more info, please visit memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another weekly dose of wellness brought to you by MemorialCare Health System. Have a fantastic day.