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What many folks view as no-big-deal activities – like climbing stairs or walking – meant pain to her arthritic right knee.
After several arthroscopic surgeries and cortisone injections to the knee, Roman, 42, whose osteoarthritis is linked to her autoimmune disease of lupus, decided to move ahead with a partial knee joint replacement surgery in February with orthopedic surgeon Dr. Robert Belniak at The Hospital of Central Connecticut’s Bone and Joint Center.
Osteoarthritis is the primary reason more patients are opting for joint replacement therapy, with the knee the most frequent joint replaced at The Hospital of Central Connecticut (HOCC), followed by the hip and shoulder. The Baby Boomer generation is taking the biggest leap into the pool of joint replacement with the average age at 66, down from 72 within the last decade, notes orthopedic surgeon Dr. Robert Carangelo, also an HOCC medical staff member.
For some patients with knee arthritis, a partial knee replacement vs. full knee replacement may be an option, with partial offering several advantages, says Carangelo, including smaller incision, less bone removed, fewer complications, faster recovery and joint longevity of about 15 years.
The joint replacement process -- from early patient education to home-based physical therapy -- is a game changer in how care is now provided through HOCC’s Bone and Joint Center, which earned the Joint Commission’s Gold Seal of Approval for its Knee and Hip Replacement Program in 2014. Each care component is contributing to higher patient satisfaction for the center that uses a baseball theme to get the patients up and moving to make it to home –- with a walk vs. a run.
Patient education starts at the doctor’s office where patients receive a joint replacement notebook explaining both hip and knee joint replacement and the patient’s role in preparation, inclusive of exercises to help strengthen the area surrounding the joint to be replaced.
“Because it is elective surgery, education and preparation are very important in this type of surgery,” says Dianne Vye, RN, MSN, HOCC joint replacement coordinator. Hip and knee replacement patients also attend a preoperative class at the hospital. “By coming to class before surgery people are better informed. There’s a correlation between education and having favorable post-operative outcomes, less anxiety and better pain management,” Vye says.
At class patients learn about the Baseball Pathway initiative that has nursing staff, patient care coordinators and physical therapists coaching joint replacement patients toward achieving progressive goals – bases – starting on day of surgery. The initiative supports the hospital’s aim of increasing patient discharge to home where they would receive physical therapy vs. a rehabilitation facility.
Belniak notes that joint replacement materials are “vastly superior” than those 25 years ago and surgical instruments are more accurate. Today’s hip joint materials, for example, bolster bone growth into the stem, says Carangelo, reducing the need to cement materials in surgery.
HOCC’s advanced technology also includes computer navigation for partial knee and total hip joint replacements. Navigation, used by Carangelo, who has been trained in this technique, enhances alignment, sizing, balance and stability of the joint implants.
HOCC joint replacement patients average a three-day stay with more patients now going directly home vs. to a rehab facility. As part of Hartford HealthCare, the hospital also teams with Hartford HealthCare at Home for in-home physical and/or occupational therapy as well as nursing.
Recovery averages six to eight weeks for full knee replacement surgery, four weeks for partial knee replacement, two months for shoulder replacement, and six to eight weeks for hip replacement.
“There are very few procedures in medicine that really truly changes people’s lives. Joint replacement is one of them,” says Belniak, who suggests those with joint pain see a physician “when they can’t do the things they enjoy.”
Roman, who has two other daughters, is glad she had joint replacement and wishes she had it sooner. She’s back to her regular routine of activity, including climbing stairs and taking Amy for walks, noting it’s “much easier to push the stroller and go around and do things with her.”
Knee replacement: With a full knee replacement, surgery replaces the diseased or damaged femur (thigh bone), tibia (lower leg bone) as well as worn cartilage. Patients whose knees have been only partially affected by osteoarthritis may benefit from partial knee replacement, which uses a smaller incision and typically replaces damaged femur and tibia; it enables a quicker return to daily activities. Joint replacement parts for the thigh and tibia are made of metal and the knee cap is made of polyethylene (plastic).
Shoulder replacement: The ball of the shoulder is replaced with a metal ball with a metal stem that fits into the bone of the upper arm. The socket is replaced with a polyethylene piece. Reverse shoulder replacement is an option for patients with a severe fracture or long-standing rotator cuff (muscle) problems; a ball is placed where the socket was and a socket is placed where the ball used to be.
Hip replacement: During a total hip replacement, the damaged and diseased bone and cartilage are removed and replaced with prosthetic components. Stronger implant materials, namely metal, ceramic or combined metal and durable plastic are increasing joint longevity.
As patients in our communities continue to live longer, active lifestyles, The Hospital of Central Connecticut is proud to offer a more precise and less invasive surgical technique to help patients suffering from hip and knee pain.
Known as MAKOplasty®, this new robotic surgery for partial knee resurfacing and total hip replacement involves the use of a surgeon-controlled robotic arm system – called the RIO® Robotic Arm Interactive Orthopedic System – which enables accurate alignment and placement of implants.
The RIO® System features a patient-specific visualization system and robotic arm technology that is integrated with intelligent surgical instruments. It assists surgeons in preplanning and in treating each patient uniquely and consistently.
Dr. Obi Osuji, orthopedic surgeon practicing with Hartford HealthCare Medical Group Orthopedic Specialists, performed the first MAKOplasty® hip replacement procedure in Central Connecticut July 6 at HOCC’s sister hospital in Meriden, MidState Medical Center. MAKOplasty® became available at HOCC’s New Britain General campus July 31.
During MAKOplasty® total hip replacement surgery, RIO® provides visualization of the joint to guide the bone preparation and implant positioning to match the pre-surgical plan. After first preparing the femur or thighbone, the surgeon uses the robotic arm to accurately ream and shape the socket in the hip, and then implant the cup at the correct depth and orientation. The surgeon then implants the femoral implant.
MAKOplasty hip procedures have numerous benefits for the patient including:
For adults living with early to mid-stage osteoarthritis that has not yet progressed to all three compartments of the knee, MAKOplasty Partial Knee Resurfacing is a viable treatment option. It is less invasive than traditional total knee surgery. A presurgical plan is created based on a CT scan of the patient’s own knee, and the surgeon uses the robotic arm during surgery to resurface the diseased portion of the knee, sparing healthy bone and surrounding tissue for a more natural feeling knee. An implant is then secured in the joint to allow the knee to move smoothly again.
MAKOplasty Partial Knee Resurfacing also results in benefits for patients because it is a less invasive procedure. Patients typically note:
“This is a very advanced technology, and we are excited to offer it to patients in our community. The precise approach to fitting implants is not something we would be able to realize with traditional arthroplasty," said Dr. Robert Belniak, HOCC-affiliated orthopedic surgeon and physician with Grove Hill Medical Centers.
You can learn more about MAKOplasty® and find a list of community education seminars by visiting www.thocc.org/makoplasty.
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The spacious and welcoming Hartford HealthCare Cancer Institute at The Hospital of Central Connecticut was dedicated at a ribbon-cutting ceremony on June 16....