From arthritis and fractures to sports injuries and joint replacement, there’s a good chance you’ll visit an orthopedic surgeon at some point in your life. Orthopedics is a specialty spanning a range of issues that affect the bones, joints, ligaments, tendons, muscles and nerves throughout the body. Whether your care plan involves surgical or non-surgical therapies, orthopedic health care is better than it has ever been.
“In addition to the technical improvements, there have been huge efforts directed toward patient satisfaction. Trying to develop multidisciplinary approaches to care involving multiple departments, pre-op teaching, patient expectations and monitoring outcomes,” says Dr. Richard Glad, board-certified orthopedic surgeon and chairman of the department of orthopedics at Dean. “What we want is patients satisfied to the point that they would recommend their physician to a friend or family member. That’s the critical parameter we’re seeking.”
To this end, Dean now offers Steady Strides, a “Total Joint Replacement Center.” Steady Strides is an innovative system of orthopedic care involving a comprehensive, multidisciplinary team approach from pre-surgery through recovery, guided start-to-finish by a care coordinator.
It’s a regional program that leverages the collective expertise of multidisciplinary teams to define and implement best practices, and consistently achieve the best possible patient experience and clinical outcomes.
“It was developed to establish consistency across the board so that everybody was taken care of in the same way, in the hopes that consistency would improve outcome. And I think it’s pretty clear that it has,” says Glad. “When you see how much better people do, it’s fairly dramatic.”
Glad says Steady Strides has improved standardizing protocols and streamlining communication and processes between nurses and doctors, physical therapists, anesthesiologists and other departments, and it has empowered patients and even improved pain management and recovery.
“It used to be that first day after surgery, you’d go into a patient’s room and it was difficult to get yourself to go in there because you knew people were going to be having a lot of pain,” says Glad. “Now I go in the next day and it’s more common than not that people are sitting up, reading the newspaper. They’re up, they’re dressed in their street clothes, they’re getting ready to go.”
The dramatic improvement Steady Strides has brought to joint replacement patients, their caregivers cannot be overstated, according to Dr. Jeffrey Stitgen.
“I’ve been an orthopedic surgeon at Dean for almost 30 years, and over that time there have been a lot of changes. But I think the most significant change I’ve seen is the Steady Strides program,” says Stitgen. “It’s not one particular thing, but we packaged about 20 little changes all into one program. And it has really had a profound influence.”
With Steady Strides, just about everything is different from last year. Preparation now starts one month ahead of time with group classes, operation-specific exercises, iron and multivitamin supplements, discussions with primary care docs, and family coaching sessions to prepare at-home caregivers for what’s to come. On the day of the operation, patients take an anti-inflammatory pill as well as medication that deadens the nerve response, both intended to control pain. A new medicine in the operating room cuts down on bleeding and swelling, and a new, waterproof dressing with a silver ion component not only improves healing, but allows patients to shower afterwards. Post-operation, patients have group therapy sessions and even friendly competitions as they rehab, and most everybody goes home within 48 hours, where physical therapists visit and work with them there.
Steady Strides – Total Joint Replacement Center is available at Dean Clinic, St. Mary’s Hospital, St. Mary’s Janesville Hospital, St. Clare Hospital Baraboo and Columbus Community Hospital. More information can be found at SteadyStrides.com.
“If you talk to anyone in our department who does total joint replacement, it’s universal that we’re all just totally impressed with what a big difference this has made,” says Stitgen. “It is just a profound improvement from the way it used to be.”
In addition to Steady Strides, all orthopedic surgery patients are benefiting from advancements in technique and technology, particularly instrumentation that has made surgery less invasive. Regional anesthesia is used more often than general anesthesia now, so post-op patients need less pain medication, they’re more alert and cooperative, and they don’t have nearly the levels of nausea and vomiting that people recovering from general anesthesia often have had. Physical therapy is now a standard part of rehab, and “hospitalists” are in the hospital 24/7 to act one-on-one in assisting patients with any medical management or medical emergency that may arise.
“We are able to do procedures in a less invasive manner than it used to be, which means smaller incisions, smaller surgical dissections, and hopefully quicker recovery as a result,” says Glad. “The multidisciplinary approach has been a big change, and I would say a huge change for the better, from my personal point of view.”
Dr. Emily Exten is a Meriter Medical Group orthopedic surgeon specializing in foot and ankle surgery and orthopedic trauma. She says technological advancements have created more successful outcomes for Meriter-UnityPoint Health patients, including: total ankle replacements (used to treat rheumatoid ankle arthritis, post-traumatic ankle arthritis, and ankle osteoarthritis); new devices that replace screws in some surgeries; and live ultrasound to diagnose conditions, guide accuracy of injections, and offer alternative treatments for some tendon surgeries.
At the ankle, there is a joint between the tibia and fibula held together by very strong ligaments. In a high ankle sprain or bad ankle fracture, these ligaments may be disrupted, and a screw is often used to hold these bones together while the ligament heals. However, not only is a second surgery often required to remove these screws—they may break beforehand.
“This new device is made of strong suture. It can be left in place and does not require a second surgery for removal,” says Exten.
TENEX is an FDA-approved ultrasound probe used to treat degenerative tendonitis and offers patients an alternative to traditional surgical treatment. It’s particularly beneficial for those with elbow tendonitis or Achilles tendonitis. The probe is placed through a small incision to debride unhealthy tissue. Although incisions are smaller and less anesthesia is needed, patients still take time to recover. Live ultrasounds are also used to guide injections and diagnose some conditions.
“Ultrasounds allow painless visualization of many anatomic structures. They allow us to visualize anatomy during an injection and perform dynamic exams while the patient is moving,” says Exten. “It helps with making a diagnosis in a claustrophobic patient or one who can’t get an MRI due to other reasons.”
Perhaps the most critical component for successful orthopedic outcomes still remains in a patient’s control: maintaining a healthy lifestyle. Staying active, controlling weight and strengthening bones and muscles through diet and exercise sound basic, but they’re important. It’s just one of many ways patients work with their care teams to ensure success. For Exten, that also means involving patients in the entire process and arming them with the information they need.
“We talk with our patients so that we can understand who they are and what their goals are. Then we give them several surgical and nonsurgical treatments to choose from and help them navigate through the process of deciding what is best for them,” says Exten. “I think it’s really important to know who they are and to have an understanding of them as individuals, rather than just thinking of them as a specific diagnosis.”
In the end, the goal of orthopedic care is really quite simple: to help people get their active lives back, which means something different for everyone. Whether you’re an elite athlete or elderly patient with a hip fracture, restoring mobility and quality of life is at the core of what orthopedic caregivers do.
“As orthopedic surgeons, we come to work every day to make our patients’ lives better,” says Exten. “We want each patient to have an active and full life. When physical injuries or problems get in the way of that goal, that’s when we help out.”