Joint Replacement: Getting It Right

While no operation has a 100 percent success rate, it’s worth asking some key questions in advance of orthopedic surgery to help ensure a good outcome. Between 3 and 4 percent of hip and knee surgeries are revisions—surgeries performed to compensate for problems with the original operation—according to the American Academy of Orthopaedic Surgeons.

A major part of planning is deciding where you’ll have your procedure done. “Whether you are contemplating having a surgery for the first time, or whether things haven’t worked out correctly from the original surgery, you want a medical center that has the ability and personnel to fix whatever issues you have,” says Frank Liporace, MD, the new Chair of the Department of Orthopedics at Saint Barnabas Medical Center.

Here, Dr. Liporace offers his advice for people considering joint surgery.

What misunderstandings do people have about orthopedic surgery?

Some people think the surgery is debilitating, that the patient is in great pain afterward and prohibited from living his or her regular life for a long time. None of that is true.

Now, enhanced pain management protocols enable us to keep people’s discomfort under control without the use of narcotics. Advancement in surgical techniques means the pool of people we can treat has greatly expanded, and the materials used to make joints have much more longevity than they did even a decade ago.

Depending on what you do for a living, you could be back to work within a week. I’ve even had some very Type A people go back to the office in two days.

What can cause an orthopedic surgery to go wrong?

A host of factors can contribute to problems with a surgery—infection, technical issues or something related to the patient’s condition, such as osteoporosis or malnutrition.

However, the biggest factor in preventing complications is the orthopedist’s attention to detail. Big problems can be avoided if signs are caught early on. These can include unfounded pain, redness, discoloration or a feeling of instability in the extremity during rehabilitation.

What should a patient look for in an orthopedic surgeon?

Do some research to check out the surgeon’s training and years of experience, and to see whether the surgeon has been published in evidence-based national literature and has taught medical students and residents. You want somebody who’s board-certified and well-respected in the field.

Word of mouth is also a highly reliable referral source. If the surgeon has a long waiting list for elective surgery, that’s a sign that he or she must have had a lot of happy patients.

Because communication is so important, you should feel that you have timely access to evaluation and care from your orthopedic surgeon.

How about the institution where the surgery will take place?

Medical centers are ranked by many organizations for safety and quality. For example, Saint Barnabas Medical Center is one of only 29 U.S. hospitals to have received an “A” grade for safety in every assessment done by The Leapfrog Group, among many other awards and accreditations.

At Saint Barnabas Medical Center, we have some of the shortest lengths of stay for joint surgery patients in the tri-state area. We also have some of the lowest readmission rates and the highest rates of patients who go straight home after surgery, rather than having to go to a skilled nursing facility or inpatient rehab first.

Orthopedic patients should look for comprehensive care in a facility. They may need many musculoskeletal services, including rehabilitation, physical therapy, neurology, advanced imaging studies and infectious disease expertise. Here, we can offer all those services under one roof, at the Barnabas Health Ambulatory Care Center (ACC) at 200 South Orange Avenue in Livingston.

What’s a typical journey of care for a joint replacement patient?

Let’s say you come in to see us because your knee hurts. You’ll get an exam and radiographic studies, and receive a diagnosis. Then you’ll be given options for care that are tailored to the specifics of your case.

The first step is to go through the nonoperative gamut of care—medication, injections, physical therapies and so on. It’s important to know that many orthopedic issues can be treated nonsurgically. Because every surgery has the potential for complication, patients should not have an invasive procedure unless it is truly necessary.

Many patients come to a stopping point in their journey with nonoperative therapies because those treatments are enough to take care of their pain. For other people, the treatments work for a while, but the condition progresses and surgical options are considered.

If surgery is indicated, what’s next?

If your options involve joint replacement, you could be cared for at the ACC or the main hospital. We can offer the latest treatments and techniques, such as robotic arm-assisted joint replacement for advanced accuracy.

In addition, we can convert a patient’s CT scan into a 3D model of their knee and from there design an implant that precisely matches the size and shape of the patient’s joint.

We are proud that we have a total joint program navigator to coordinate care for each patient. In addition, we invite all total joint patients to join education classes along with a friend or family member, so they’ll know what to expect and have the best possible outcomes.

To learn more about orthopedic services at Saint Barnabas Medical Center, call 888.724.7123 or visit www.rwjbh.org/ortho.