A Joint Venture

April 01, 2013

Hip and knee replacement patients get back on their feet faster thanks to advanced techniques.

A self-described do-it-yourself kind of guy, Gary Smidderks suspected he was headed for joint replacement surgery when he no longer could get down on his knees to tinker with the sprinklers in his yard. “If I didn’t have something to use as a crutch to get up, I couldn’t get up,” says the 75-year-old Granada Hills resident.

Finally, his discomfort encroached upon his favorite activity: golf. “I couldn’t walk and carry my clubs any longer. It put too much stress on my knees.”

To learn more about knee replacement surgery, Smidderks attended a joint replacement lecture hosted by Providence Holy Cross Medical Center. There, he met Ramin Ganjianpour, MD, chief of the division of orthopedic surgery at Providence Holy Cross Medical Center. Dr. Ganjianpour, who estimates he has performed thousands of minimally invasive joint replacements, had the experience Smidderks sought. In February 2012, Dr. Ganjianpour replaced Smidderks’ right knee.

Now past the one-year mark in his recovery, Smidderks recently finished first in a golf tournament—while carrying his own bag—and he’s back to tinkering in his yard. He is even considering having his arthritic left knee replaced, too.

“I’m glad I did it,” he says. “Within less than a year, I had more flexibility and substantially more strength.”

Smidderks is just one of the many patients who have benefited from recent advancements in joint replacement surgery.

Continuum of Care

In this era of healthcare reform, fewer complications and improved clinical outcomes are going to drive reimbursement for both hospitals and physicians. Albert Reff, MD, a fellowship-trained orthopedic surgeon at Providence Little Company of Mary Medical Center Torrance, already has taken the first step in ensuring this high quality of partnering with clinical staff to develop a team approach to joint replacement care.

“Creating the best clinical outcomes doesn’t just happen in the operating room. It begins well before and continues well after that,” Dr. Reff says. “When you take a team approach to providing care, everyone is encouraged to contribute and innovate; to learn and promote the best practices across the whole patient experience continuum, rather than in singular, isolated segments. That helps promote the best outcomes, every time for every patient. With that kind of program, you can show consistently strong outcomes.”

Cutting-Edge Techniques

First, before joint replacement surgery is discussed, each patient’s case is reviewed to ensure that nonsurgical remedies have been tried. “When we first encounter patients, we make sure they have tried conservative treatments that might give enough relief to make them happy and content,” Dr. Reff says.

When conservative measures fail, joint replacement surgery may be the next option.

Providence orthopedic surgeons such as Drs. Reff and Ganjianpour perform minimally invasive hip and knee replacements using newer techniques that utilize both smaller incisions on the outside and less cutting into muscles and ligaments on the inside. “This is less painful for the patient and more cosmetically appealing,” Dr. Ganjianpour says.

In fact, minimally invasive joint replacement results in:

  • Less post-operative pain
  • Faster soft tissue healing
  • Less scarring
  • Quicker recovery

Smidderks speaks candidly to the last point. “To put it bluntly, I’m 75 years old. I didn’t want to spend one-tenth of the rest of my life recovering from knee surgery. I wanted to get active and back to life.”

Improved Pain Control

Dr. Reff points out that pain is often a concern for patients, and he incorporates pain control techniques as part of the integrated continuum of care approach. Pain medications administered prior to surgery can calm nerve pathways, making it easier post-surgery to manage pain.

“As a result of this early pain intervention, many patients are able to manage their entire post-operative stay without narcotics,” he says. “The goal for the patient is to be able to have pain relief and resume as many normal activities as possible.”

Modern pain-management strategies are as key to quick rehabilitation as are minimally invasive incisions, says Shaun Chandran, MD, an orthopedic surgeon at Providence Little Company of Mary Medical Center San Pedro. “There is a period of time after surgery where the patient may experience a high level of pain. If you get rid of that pain, people are willing to do more in their rehab,” he says. “How we manage pain has really changed joint replacement surgery, making it a procedure that more patients are willing to undergo.”

State-of-the-Art Technology

Minimally invasive joint replacement also has ushered in an era of special instruments and technology. “Special instrumentations allow for optimal placement and performance of the joint,” Dr. Ganjianpour says.

At Providence Little Company of Mary Torrance, Dr. Reff utilizes computer navigation, which he likens to GPS. “This means greater accuracy in each incision and can help result in a better-aligned joint,” he says.