Editor’s note: This is the first in a series of three stories examining the growth of the orthopedic medical field. Monday’s story will introduce all the players involved in a patient’s recovery. Tuesday’s story will take readers down the road to recovery.
GLENS FALLS — After an October visit with an orthopedic surgeon, Cyd Groff was scheduled for a knee replacement at Glens Falls Hospital. But a nagging hip and groin pain that was keeping her up at night sent her back to the surgeon before her slated implant.
“I thought I better have him check it out before my knee replacement,” she said.
Two X-rays later, all Groff’s plans changed.
“He took two different views of my right hip. He said, ‘This is really bad. You’ll have to have this done first,’” Groff, 63, of Granville, said, referring to her surgeon, Dr. Thomas Varney of Orthopedic Specialists at Glens Falls Hospital. “I was in shock and disbelief. I was going to end up with two joint replacements.”
On Dec. 28, Groff got a new hip.
Barely two weeks later, she was standing before an audience and belting out a Linda Ronstadt song.
“She was doing her act on stage 17 days after the surgery,” her husband and surgical coach, Joe Groff, said, obviously amazed at his wife’s progress. “She was singing, ‘You’re No Good.’ Want to see the video?”
Each year, hundreds of thousands of American patients similar to Groff get damaged joints replaced, the most common being hip or knee implants. According to the Agency for Healthcare Quality and Research, in 1993 there were 133,566 total hip replacements and 195,684 total knee replacements in the U.S. Eleven years later, there were 371,605 total hip replacements and 680,886 total knee replacements.
And health experts predict a continued increase.
“There are a total of more than 600,000 knee replacements, and that number is expected to rise 600 percent (by 2030),” said Dr. Thomas Muzzonigro, a Pittsburgh orthopedic surgeon hip and knee specialist who is a spokesman for the American Academy of Orthopedic Surgeons. “There are more than 325,000 total hips, expected to increase 174 percent.”
Why the increase?
Muzzonigro and other orthopedic surgeons point to several possible reasons, including the fact that people are living longer, there is an epidemic of morbid obesity that stresses weight-bearing joints, an increase in younger people unwilling to give up active lifestyles and improved implant materials.
“Thirty years ago, people were not getting a total joint replacement until their mid-70s,” said Dr. Douglas P. Kirkpatrick, a Glens Falls orthopedic surgeon at North Country Orthopedics in Queensbury. “Now the age could be 55.”
In the past, a new joint might last 15 years or less. As a result, younger patients were unwilling to undergo a procedure if ultimately the metal in their new joint would loosen or wear out and they would have to have it replaced for a second time.
But with the advent of new materials, the implants have become more flexible and last longer.
“The products over the last decade have improved. It now feels more like your bone,” said Muzzonigro. “Certainly the new materials in the lab last much, much longer. But even on a perfect knee, that could last 35 years, each individual is different.”
To accommodate such growing surgical and orthopedic needs, Glens Falls Hospital took on a $2.3 million renovation project and four years ago created the “Harry M. ‘Mac’ DePan Surgical Care Unit.”
There are now 27 private surgical rooms on the fourth floor. According to hospital officials, the updated unit was designed for the maximum comfort of patients recuperating from major surgery, with an emphasis on getting them back to living their lives faster and more completely.
“People can get the care here,” said Groff’s surgeon, Varney. “The hospital made a significant effort and revamped the surgical floor. There used to be double rooms and it made it difficult to get equipment into the rooms.”
“People with elective orthopedic surgery are healthy people and it is nice to give them the comforts of a private room for that surgical intervention.”
Kirkpatrick and Varney, both Glens Falls natives, said there are misconceptions about local orthopedic surgical options and capabilities. The two Glens Falls Hospital orthopedic surgeons admit that some local residents have a skewed perception of the hospital, adding that some think they need to travel to a larger city for joint replacement surgery.
“We offer a comprehensive orthopedic service,” Kirkpatrick said. “This is evidence-based medicine ... Some have a preconceived notion and we take the time to educate the patient. The people we take care of value our care.“
Kirkpatrick said that if a patient goes to a major metropolitan center, they can become just one of many. But locally, the surgeons can get to know the patient and what they need.
“We see our patients in the grocery store,” Kirkpatrick said. “We have the local ability to treat conservatively and get to know them.”
In Consumer Reports’ 2016 national hospital safety rankings that examine how well patients fared during and after elective surgery, including hip and knee replacements, Consumer Reports gave Glens Falls Hospital a safety score of 57 out of 100.
Rated ahead of Albany Memorial, 44; Albany Medical Center, 46; Samaritan Hospital in Troy, 53; Ellis Hospital in Schenectady, 54; and St. Peter’s Hospital in Albany, 54, Glens Falls Hospital trailed only Saratoga Hospital, with 62, when it comes to patient perceptions of care during their surgical experience and low hospital-acquired infection rates in the region.
No New York hospitals made it into the list of top performers with scores of 80 and above, but New York City’s Hospital for Special Surgery almost made it with a 79.
According to Consumer Reports, Glens Falls Hospital reported to the Centers for Medicare and Medicaid Services one MRSA infection — a type of staph bacteria that is resistant to many antibiotics — between Jan. 1, 2015 and Dec. 31, 2015. This means Glens Falls Hospital rated 61 percent better than the national average in this category.
The hospital also reported 34 C. difficile infections — a common cause of antibiotic-associated diarrhea — which is 21 percent better than the national average.
As far as hip and knee surgery patient perceptions, 97 percent reported that nurses communicated well, and 96 percent reported the same for physicians.
“Dr. Varney was so nice and so laid back,” said Groff. “And before the surgery I had a whole list of questions. The staff was reassuring and gave me straight answers. I kept calling and asking, ‘What about this?’”
“And the nurses — if I rang my buzzer I never had to wait more than a minute and they would send someone right away,” she said about her inpatient experience.
Exercise, diet and preparing for surgery
There’s been a twist in pre- and post-surgical approaches for hip and knee replacement patients. And according to Muzzonigro, there is a real focus on what he calls “prehabilitation” and the medical optimization of the surgical candidate.
Things like getting an obese patient to drop some weight, stabilizing a diabetic, getting a smoker to stop smoking and starting strengthening exercises and physical therapy before surgery now figure into the equation.
According to a recent study published in the Journal of Bone and Joint Surgery, knee replacement patients receiving preoperative physical therapy showed a 29 percent reduction in post-operative care following a total knee replacement.
Still, before talking about surgery with a patient, Muzzonigro, like local surgeons, wants to make sure less invasive methods have been tried.
“A patient may come to me and say, ‘I’ve tried a brace, Tylenol, Motrin, shots and physical therapy,” he said. “They would have to be at end-stage arthritis clinically and radiologically. At that juncture, we could talk about a total hip or total knee.”
Even so, for some patients, like Groff, the joint damage is so severe and the pain so debilitating that surgery is the best option upfront.
To explain, Muzzonigro said that over time the cartilage can wear away and become roughened, acting like sandpaper against sandpaper, making movement difficult and painful. When this happens, the joint may become stiff, swollen and sore, and the pain may interfere with activities.
“There are hundreds of types of arthritis,” he said, breaking it into three main categories of osteoarthritis wear and tear; inflammation like rheumatoid arthritis; and post-traumatic arthritis after an injury.
Groff, who is trim and is used to exercise, like riding her horses, still completed a series of physical therapy-prescribed hip, leg and core strengthening exercises for about six weeks before her surgery to make certain she could get back on her horses afterward.
“You need to be in the best shape you can ahead of time,” she said. “Don’t be afraid to do the exercises. The joint class was good, I just wish it was sooner to have more time to do the exercises ahead of time.”
“I’m glad I did it, I’m sleeping better. And I can’t wait to be out with my horses again. I think the first thing I will do is groom them.”