The Exciting Development of Joint Centers
by Dr. Nathan Cafferky
Increasing joint centers around the country are also an exciting development in joint replacement surgery.
In the last 10 to 20 years, studies have shown that specialized joint centers improve patient outcomes. These are centers that educate patients, improve patient outcomes, and streamline the experience altogether.
What is a Joint Center?
Joint centers are made up of multiple providers, from your primary care physician to orthopedic surgeons, anesthesiologists, hospitalists, nursing staff on the floor and in the OR, physical therapists, dieticians and case managers that follow you throughout your hospital course, as well as home healthcare that will follow you once you go home.
We want to make sure that you're moving everything, you're walking, and you're getting back to your normal life. Most importantly, these joint centers follow patient outcomes.
Joint Replacement - A Team Effort
There’s a whole team working together for the benefit and the safety of you - the patient. Primary care physicians are the ones that keep you healthy. They can help manage non-operative arthritic pain with NSAIDs or injections or physical therapy. They can also help refer you to orthopedic surgeons once non-operative treatments are failing and no longer working.
Orthopedic surgeons are the doctors that take care of the bones and the joints and the muscles. We manage non-operative treatment and the operative treatment of all forms of arthritis. Hip and knee replacements are my specialty.
We inform and educate you the patient and their family members on the risks and benefits of total joint surgery. We guide patients through the surgical experience.
We perform the operation. We provide pain medications at the time of discharge. And we are the ones that you follow up with in-clinic after you've had surgery.
The anesthesiologists are the doctors who take care of you during the perioperative period. Preoperatively they identify which type of anesthetic is right for each individual patient. Intraoperatively they keep patients safe and comfortable during surgery.
And postoperatively they manage multimodal pain management. Multimodal pain management utilizes multiple different types of medications, not just narcotics, to help control your pain from every different aspect. This has shown significant improvement in patient pain scores in the literature over the last five to ten years.
Hospitalists are the internal medicine doctors who help manage patients with more difficult medical problems such as heart disease, lung disease, kidney disease, diabetes and so on. They keep patients healthy and safe during their hospitalization.
The Nursing Staff
The nursing staff are the ones who take care of you on the floor 24/7. Certain hospitals including St. Anthony Summit Medical Center with specialized orthopedic joint centers, there are designated rooms for joint replacement patients only. They also now have certified orthopedic nurses with specialty training in how to take care of total joint replacement patients. They'll be the only ones that help take care of you during your hospitalization if that's what you decide to do.
Physical therapists and occupational therapists
The physical therapists and occupational therapists are really your coaches throughout this experience. They help you get back on your feet following surgery. They utilize rapid recovery in total joint therapy protocols. What that means is we want you to get back to life as fast and as safely as possible.
We expect that all patients will be up out of bed and walking the day of surgery if not by the next day. They teach you how to walk safely with the use of walkers, cane, and crutches. They teach you the appropriate exercises and the precautions that may be necessary depending on what pain you have.
And finally, they help you safely perform the activities of daily living with the goal of getting you back to normal life as quickly and safely as possible.
The dieticians are the ones who follow you throughout the hospital and make sure you're eating the right foods, to ensure you heal appropriately following surgery. The case managers are the ones who work closely with you during your hospitalization to help arrange the safest form of discharge.
Recovering from Total Joint Replacement
I actually expect most of my patients to go home at least one to two days after surgery, but some patients may require a brief stay in a nursing home or rehabilitation center before they’re able to go home. You have to be able to eat and drink and go to the bathroom normally before being discharged.
Once you have been deemed ready to go home, we set up home health for you. There are specialty care providers that check on you at home on a regular basis for about two to three weeks after being discharged.
They'll help you get in and out of the house if you need to and will help you with therapy at home for a brief period of time after surgery. They'll also make sure that home is really a safe environment for you, minimizing risks such as tripping. So they're a great team to have on your side.
Historically, including when my Dad was in medical school, patients spent a week in the hospital after joint replacement, if not longer. But now we're getting to the point where patients can safely be discharged in about one to two days.
Risks of Total Joint Replacement
However, surgery is not without risk. Unfortunately, things can happen.
Certain diagnoses actually set you at a higher risk for having complications during or after surgery. Diabetes is the big one that we're hearing a lot more about in the United States.
In medicine and specifically in orthopedics, poorly controlled diabetes can increase your risk of infection and delay wound healing and also have significant and severe complications after total joint replacements, such as heart attack and stroke.
Another diagnosis that increases your risk of complications during and after surgery is obesity. Obesity patients with BMIs over 40 are at significantly higher risk for complications after total joint surgery. These complications include:
These are the most severe complications you can have. The good news for obesity patients is that with weight loss, you can improve your pain status, minimize the pain felt across the joint, improve your outcome and lower the chance of associated risks.
Additional diagnoses that potentially could increase your risk complications are neuromuscular disorders, congestive heart failure and heart disease, COPD, kidney failure, dialysis, liver failure, previous joint infections and a history of bleeding problems with blood clots. Surgery can still be performed as long as you are as medically optimized as possible prior to undergoing surgery.
What can you do from a personal standpoint to help improve your own outcome for surgery?
see your primary doctor on a regular basis to make sure your heart, lungs and everything else are healthy.
Remember you want to keep those joints moving, keep those muscles strong around the joints. And you want to sleep well.
Going into surgery is like preparing for a marathon. So you want to do all the right things to get you through that experience.
Overall, the most important thing is to stay positive.
A lot of patients can get discouraged at about the six-week mark when they’re not back to skiing or golfing or doing things they like to do. Realistically, it can take certain patients a while to recover. It's important to stay positive throughout this experience.
Meet Dr. Nathan Cafferky
As a total joint surgeon specializing in adult reconstruction, Dr. Cafferky focuses on patients with hip and knee conditions who require replacement surgery. His fellowship training in joints and adult reconstruction at the University of Colorado Anschutz Medical Campus gave him the expertise to treat these conditions appropriately. The most common conditions he treats include hip and knee arthritis, ranging from osteoarthritis to rheumatoid arthritis to post traumatic arthritis.