MDNews - Greater Boston

hip replacements. While the technology's application for knee surgery is reserved for uni- or bi-compartmental replacement, all patients needing hip replacement can benefit from its unimpeachable precision. Additionally, MAKOplasty significantly reduces the chances of postoperative hip dislocation, sometimes a complication of total hip replacement. Patient anatomy, the presence of comor- bidities and expected postoperative activity levels determine whether surgeons utilize the posterior, anterolateral or direct anterior approach for hip replacement. However, the direct anterior approach offers preferable outcomes for patients who are candidates, says Edward A. Klein, DO, orthopedic surgeon with Hawthorn Medical Associates. "The benefit of direct anterior approach is that there are no muscles removed or cut during the procedure," Dr. Klein says. "This approach is of enormous benefit to active people. Additionally, this pro- cedure eliminates the need for certain precautions against the risk of dislocation following surgery." Outpatient Total Knee Replacement and Other Innovative Care Innovative technologies enhance the total joint reconstruction offerings avail- able at Saint Anne's Hospital's Center for Orthopedic Excellence, but multidisci- plinary collaboration among surgeons, anesthesiologists, rehabilitation specialists and certified nurses with special training in orthopedics offers a unique treatment and recovery option — knee surgery performed on an outpatient basis. "We recently performed the first out- patient total knee replacement procedure in southeastern Massachusetts," Dr. Klein says. "Younger, active patients who are motivated to begin rehabilitation may find this an exciting opportunity." To assist patients' rapid rehabilitation, anesthesiologists at Saint Anne's Hospital's Center for Orthopedic Excellence developed a pain management strategy utilizing a concerted deployment of multimodal anal- gesic and regional anesthesia medications (see sidebar). Traditionally, total knee replacements were painful and required days of postoperative hospitalization, but with these strategies, patients return home sooner and are more active participants in physical therapy. "These patients are ambulating on postoperative day zero — only a few hours after they reach the dedicated recovery floor — and their pain control is excel- lent," says Vijay Sudheendra, MD, Chair of Anesthesia at Saint Anne's Hospital and Medical Director for Southern New England Surgery Center. "Our thinking was, if patients' pain is managed effectively, they ambulate quickly and effectively, they go home sooner, and they resume their normal activity earlier, as well." Coordinating Post-hospital Care Patients discharged to home also benefit from Steward Home Care's seven-days- a-week, in-home rehabilitation services. While the team works to have most patients return home with in-home or outpatient rehabilitation, there is also an option for quicker discharge to a skilled nursing facility for some patients unable to safely return home. As part of the Steward Pioneer ACO, Saint Anne's has a Medicare waiver to forgo the three-day hospital stay traditionally required for coverage for SNF admission. Commitment to Patients Saint Anne's Hospital's Center for Orthopedic Excellence employes innovative techniques and technologies, which provide patients in the area with high-quality treat- ment and have earned it accolades such as its designation by Blue Cross Blue Shield as a Blue Distinction Center for Knee and Hip Replacement. However, its hallmark is a dedication to patient-centered care. To that end, the hospital established a task force to optimize patients' outcomes and their care experience. The task force includes all disciplines that care for ortho- pedic patients, and it works to continually refine and improve all processes, from the patient's decision to have surgery through their recovery, says Toni-Ann Nunes, RN, Director of the Operating Room and Saint Anne's Hospital's Center for Orthopedic Excellence. Additionally, a presurgical patient educa- tion program (PEP), comprising a group session and one-on-one conversations with providers, meets weekly to help patients prepare for surgery and rehabilitation. Newly developed handbooks for patients having a total knee or hip replacement provide detailed information covered in the PEP class. Patients can attend PEP classes as soon as they are booked for surgery. "We know our patients have choices of where they have surgery performed," says Nunes. "We value patients who choose to come to Saint Anne's Hospital and we ensure they have the best possible experience while they're here and during their recovery." For more information about Saint Anne's Hospital's Center for Orthopedic Excellence, visit saintanneshospital.org. ■ Since 2011, Saint Anne's Hospital has been named a Blue Distinction Center for Knee and Hip Replacement by Blue Cross Blue Shield. Reviewing the scorecard used to evaluate and refine the Center's performance are (L-R) orthopedic surgeon Edward Klein, DO; Jerald Katz, MD, Chief of Orthopedics; Betty Medeiros-Beattie, MD, Associate Chief of Anesthesia; Toni- Ann Nunes, RN, Director of the OR and Center for Orthopedic Excellence; and Vijay Sudheendra, MD, Chair of Anesthesia. COURTESY OF SAINT ANNE'S HOSPITAL M D N E W S . CO M ■ MD NEWS Greater Boston | 7

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