June 16, 2010

Dick Pierce was out of joint. A lifetime of injuries, running, basketball, and the wear and tear of weight bearing had eroded the satin-like cartilage that was supposed to cushion the space between his tibia and femur and allow his knees to rotate comfortably.

After several surgeries to remove damaged cartilage, his doctors told him in 2000 that he no longer had anything left to repair.

“The only option left is total knee replacement,” they said.

“You tell us when you're ready.”

For six years, Pierce, who was otherwise in good health, wondered how do you decide when you are ready to undergo surgery for a creeping condition that kept getting just a little bit worse.

“The hardest medical decisions to make are the ones you have to make for yourself,” said the 63 year-old estimator for Resenhouse Electric Supply.

His pain sharpened from soreness, to aching, to stabbing. The intervals of comfort grew shorter and less frequent. One by one, the activities he enjoyed so much—golfing, hunting, and fishing—became harder to bear. He could no longer do the cardio exercises so important to maintain his heart health after undergoing bypass surgery in 1996 to clear clogged arteries.

By 2007, he couldn't walk farther than a block, and his legs bowed like parentheses, shortening his height by 2 1⁄2 inches. During a walk in the park with his wife last April, his moment of certainty arrived. After a few hundred feet, Pierce turned to her and said, “I don't know if I can get back to the car. I am tired of fighting through the pain. I'm getting this fixed.”

Good things come to those who wait

Pierce managed to hobble back, and the next day called orthopedic surgeon Robert Gardiner, M.D.

Pierce's timing turned out to be advantageous. Dr. Gardiner told him that Saint Luke's South was piloting a new program for hip and knee replacement patients. He would be one of the first to be segregated from other hospital patients and benefit from a dedicated nursing and physical therapy staff.

Because mobility was so important to him, Pierce asked to have both knees replaced at the same time. He didn't want to prolong down time and risk putting further stress on his back by favoring one knee.

“Plus, I had heard it was painful,” Pierce said. “I was afraid that if I had only one done, I would never go back for the other.”

He was comforted by a pre-op course taught by Betty Crome, R.N., B.S.N., Certified Orthopedic Nurse and Coordinator for the Hip and Knee Center. She showed him a model knee and told him what to expect during his hospital stay and after he returned home. She talked about new processes that would speed his recovery and new pain management techniques that would make him more comfortable.

Knees today, walking tomorrow

On the day of surgery he told his wife he hoped all this would prove true. She measured his height before surgery. He was 6'1".

Here's what he experienced:

Less pain. Pierce awoke from the two-hour surgery without any surgical or incision pain. He waited for the pain to start, but the anesthesiologists at Saint Luke's South used multiple approaches to keep him comfortable. They injected medications into the site and used nerve blocks, pain pumps, oral medications, and a platelet gel that assists in healing and pain control. “Every day, the nurses asked me to rate my pain,” Pierce said. “I had sore muscles and tendons, but if I said anything close to a five, I would have been exaggerating.”

Quicker recovery. The morning after surgery, nurses removed his bandages and put on support hose. A physical therapist started him on stretching exercises. In the afternoon, he went to physical therapy classes. The day after surgery, he was up and walking.

Better joints. Although the actual surgery to replace joints hasn't changed much in the six years Pierce waited, the replacement joints have improved. Dr. Gardiner chose a model that was narrower than most, giving it a more natural feel and a higher degree of flex. His new knee had a life expectancy of 20 to 25 years, up from 10 to 15.

More amenities. The new center lets patients order meals from a menu—whenever they want. He got to maintain his own schedule for sleeping and waking, while wearing his own clothes. “It felt more like a hotel than a hospital,” Pierce says. Three days after his surgery, he went home. His wife measured his height again. He was 6'3".

Walking tall

“Dick's story is just one example of the wonderful patient successes that make orthopedic surgery such a gratifying field,” Dr. Gardiner said. “You see huge improvements in people's function almost overnight. It's an honor to work with the dedicated team at Saint Luke's South in offering such a unique program to our patients.”

Pierce left the hospital on a Friday, using a walker. By Sunday, he was on a cane. A week later, he could walk on his own. Each day, he went a little farther—to the end of his driveway, halfway down his block, around his block. Soon, his range of motion reached 135 degrees, just 15 percent less than the average person with their own healthy knees.

He played golf in August and took his first hunting trip in September. Five days a week, he walks about three miles an hour—pain free.

“I'm back to enjoying physical activities,” Pierce said, “instead of bearing them.”

Camp Wounded Knee

Saint Luke's South's new Hip and Knee Center sends teams of “campers” for new hips or knees so they can share the experience and recover more quickly

“I walked 100 feet today,” said one patient who got a new knee yesterday. “Wow, not bad,” said another knee patient.

“I only did 70, but I'm going to shoot for 100 this afternoon.”

“Are your thigh muscles sore?”

“Yeah, a little.”

“Guess that's normal then.”

These kinds of conversations can be heard around the new Hip and Knee Center at Saint Luke's South. The center groups people undergoing knee or hip replacement surgery into weekly camps. Each team undergoes surgery on the same day, starts therapy together, and recovers together. They see the same nursing staff and physical therapists during their stay.

A collegial, camp-like atmosphere prevails. Team members encourage each other, as well as compete, and their common experience tends to motivate them to recover faster.

Studies have shown that people who get new knees or hips this way heal more quickly and are more satisfied with their new joints.

“What better way to go through something like this than with someone who understands just what you are going through, the pain you feel, and challenges you face,” said Betty Crome, R.N., B.S.N., Certified Orthopedic Nurse and Coordinator for the Center. Before the center's opening, the hospital had dedicated a section to joint patients and put the group process in place in early 2007.

Since then:

  • The average length of stay for joint replacement surgery has been two-and-a-half days, compared with a national average of four.
  • The infection rate has been 0. Nationwide, it ranges between .5 percent and 10 percent.
  • More of the group knee patients reach the 135 degrees range of motion considered ideal. Jeffrey W. Salin, D.O., is one of the orthopedic surgeons performing total joint replacements at Saint Luke's South.
  • “Consistency in procedures and in people delivering care have enhanced outcomes and kept complications to a minimum,” Dr. Salin said.
  • The process has led to friendships as well. The hospital has been hosting quarterly luncheons for joint alumni to catch up and compare notes on their new mobility—think camp reunion.