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The Joint Replacement Center’s multidisciplinary staff works individually with each patient before and after surgery to develop a customized treatment plan.

NEW ORLEANS — With the aging baby boomer population and the prevalence of arthritis, knee replacement surgery is now the most common joint replacement surgery in the United States.

Currently, about 400,000 of these surgeries are performed annually, a number that is expected to exceed 1 million by the year 2015, and 3.48 million by 2030.

Recognizing the increased demand for joint replacement surgeries, Touro launched the Gulf South Joint Replacement Center in uptown New Orleans this February. After Hurricane Katrina, Touro found the space to create the new unit when a long-term care facility tenant on the seventh floor failed to return. Knowing that joint replacement surgery is an elective procedure, officials created the most comfortable, state-of-the-art center possible to treat patients.

The facility consists of a 15-bed unit, complete with scenic views of the Central Business District and the Crescent City Connection. These spacious private rooms have a “hotel-like” feel, featuring oak furniture, crown moldings, plasma screen televisions, and a comfortable chair that converts to a sleeper for family, friends or “coaches.”

Besides the luxurious amenities, the facility is unique in its comprehensive educational, assistance and support program. Beginning in the physician’s office, surgical candidates view videos showing what to expect throughout the surgical process. Once surgery is scheduled, patients go to the pre-op center, where they receive a notebook informing them about everything that will happen from two weeks pre-surgery through post-surgery rehabilitation. “So, they have a continuum of what to expect over the next 10 weeks of their lives since they made the decision to have surgery,” explained Touro spokesperson Lillian O’Cain.

On the week prior to surgery, patients attend a pre-op educational class. At that time, they meet with the anesthesiologist to address all of their concerns. Then, they go to the joint replacement center, where patient care manager Al Trevino explains the exact surgical process.

“As individuals, we are apprehensive towards surgery to begin with,” O’Cain said. “And, if we can at least educate them and let them know what is going to happen to them, then their anxiety level is diminished tremendously by the time they leave our education unit.”

Upon admission, patients are encouraged to have a friend or family act as a “coach” to assist them through the joint replacement process, starting at the training session and continuing to home after-care. These designated cheerleaders stay in the room with patients, and help with post-surgery care and physical therapy. “The coaches encourage patients to do a little more,” Trevino pointed out. “And, towards the end of the patient’s stay, we like for the coach to get more and more involved. Because, they are actually going to be spending more time with these patients at home when they are discharged than they have been in the hospital.”

On the morning after a patient’s procedure, the staff removes all of the surgical paraphernalia, and gets the patient bathed and dressed in street clothes. Then, the patient and coach enjoy a pre-ordered breakfast. Later that day, the two go to physical therapy. In the afternoon, they share a light lunch with other patients and coaches.

“We think the group aspect is very important, so that they can encourage each other,” Trevino explained. “It’s kind of like a support group–they can see what’s going on with other patients, and things of that nature. So, it’s kind of a homey, family atmosphere.”

As part of the wellness program, the facility offers a hair washing and styling on the patient’s last day. Then, patients and their coaches are treated to a celebration meal. Entrées are served on fine china, and include choices such as steak or salmon.

“We are so big into promoting wellness because this is elective surgery,” O’Cain said. “It is a big step for these individuals, because they have been suffering with pain for several years, if not more, and have kind of begun to withdraw from the things that they used to enjoy. So, they’ve taken an active step to reengaging in quality of life.”

Prior to discharge, the center’s case manager, Heather Uhl, reviews all of the patient’s equipment and other needs at home. She also meets with the doctors, the physical therapist, Leslie Perry, and/or an occupational therapist to facilitate the transition back to home life. The patients are also given a DVD of exercises to perform at home.

“We know from treating people that if they don’t exercise, their recovery is going to be a little slower,” O’Cain acknowledged. “So, this DVD provides them with kind of a motivator to do the exercises. And, we actually encourage the coach to sit there and do them with the patient also.”

Joint replacement center personnel report that patient feedback has been phenomenal. “Our philosophy is that we don’t want our unit to look, smell or taste like a hospital,” Trevino said. “And, I think we’ve achieved that.”



Newest Techniques

Last year, renowned orthopedic surgeon Dr. Richard Meyer became the first doctor in Louisiana to do knee replacement surgery with computer-assisted navigation. Today, this board-certified, fellowship-trained hip and knee reconstructive surgeon practices this cutting-edge technique at the Gulf South Joint Replacement Center at Touro.

With this procedure, Meyer places arrays on the femur and the tibia bones of the knee joint. A special camera in the room keeps track of the probes’ location in real time. As the surgeon touches different areas of the knee, the camera communicates with computer software, generating a computer model of the patient’s knee joint. This model visually guides the doctor to the precise location where he should make the cuts for the knee replacement.

“The computer allows us to have implants that are in better alignment,” Meyer explained. “It’s just like building a piece of furniture–if your knee joint fits together better and everything moves together in a more anatomical manner, then hopefully the prosthesis will feel better, and last a lot longer, too.”
Meyer uses minimally invasive surgical techniques combined with the computer navigation to insert the prosthesis. This allows him to perform the knee replacement with less soft tissue exposure, drilling of bone and bleeding. With this process, the patient has a decreased risk of pulmonary emboli.

“I think between better alignment, less blood loss, and hopefully a lower incidence of blood clots, use of the computer will be the thing of the future for knee replacements,” Meyer said.

After the computer-assisted procedure, patients tend to regain motion more quickly than with conventional surgery. So far, the six-month outcome is not much different. But, Meyer believes the long-term benefits with the computer-navigated surgery will be evident in the long-run.

“Where we’re going to see the difference is in five years, 10 years, and 15 years,” he said. “Because if the prosthesis is implanted in a more anatomic alignment or position … it’s going to last longer. And so, I think the long-term results will likely be better.”

While the software is available for hip replacements, Meyer believes that it is not quite ready for prime time. However, he foresees the technology will be used for both hips and knees in the near future.

Another new technique that Meyer has been using for the past year and a half is a pain catheter. During a hip or knee replacement, the anesthesiologist places a small catheter adjacent to one of the nerves in the upper thigh, which infuses a local anesthetic into the soft tissues after the surgical procedure. This process dramatically reduces the amount of pain that patients experience after having a replacement surgery.

“I think that has made a huge impact on patients, because people are anxious about surgery and doing the therapy afterwards,” he said. “So, the use of these pain pumps has been a tremendous benefit to the patients. If they are more comfortable, they are able to participate in all of the physical therapy, which helps to insure an even better result.”

Meyer said the feedback from patients about the new techniques, as well as the center itself, has been very positive.

“It’s phenomenal when the patients write to the CEO just to rave about how pleasant their stay was, and how pleased they were with the hospital,” he said. “When you have patients that are happy with their doctors, they love the physical layout of the unit, and they are getting tremendous service from the nurses and physical therapists–it’s just an awesome experience. And I think that’s what it’s all about. If the patients are happy, they are going to do better. It really makes a tremendous difference.”



October 2007

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