Boot camp before joint repair helps get people back in the game
Before patients get a new knee or hip, should they have to go to boot camp? It’s a two-hour training program that teaches them what to expect before, during and after surgery, and how they can make the process easier.
Dennis Dairman has a 5-month-old hip, his second hip replacement. He says his hip problems date back to the 1960s, when he played forward and guard for Arizona state’s Sun Devils. This time, he went to joint boot camp before surgery.
“When I get up and start to walk, I can do it better," he said. "And she explained what exercises to do, and I’ve done them about 1,000 times now.”
“She” is registered nurse and social worker Joan Bolzan, who’s had hundreds of patients in her joint boot camps over the years.
Before patients get joints replaced, they have to take the two-hour training program. They learn about pain management, get an orientation of their upcoming surgery and start learning their rehab exercises.
“It’s 101," Joan said. "The more the patient knows, the better they do. It decreases their fear, their anxiety. It helps the outcomes on the back end when they are done with surgery.”
Joan says in the five years since joint boot camp began, average hospital stays have dropped from three days to two. Dennis believes boot camp is helping him get better faster.
“It’s slower than I want, but it’s getting better," he said. "Just takes a long time when you’re 76 years old.”
His doctor told him it might be a year before he can walk unassisted, but he plans to ditch the walker in a few weeks.
Mercy Gilbert’s Joint Boot Camp also educates family members with its coaches program.
Boot camp has been so well-received and so successful, there are plans to use a similar program before spine and bariatric surgeries.
BOOT CAMP BEFORE JOINT REPAIR
BACKGROUND: Joint replacement surgery, first performed in the 1960s, is on the rise. In fact, it has become one of the most common orthopedic surgeries in the United States today, done in ever-increasing numbers as improvements in technology and techniques have made these procedures steadily safer and more reliable over recent years. According to the American Academy of Orthopedic Surgeons (AAOS), when it comes to joint replacement surgery, hips and knees are definitely at the top of the heap, with over a million hip and knee replacements performed in the U.S. alone in 2013. Approximately 1 of every 12 adults over the age of 25 in the U.S. will have knee replacement procedures within their lifetimes. According to The Journal of Bone & Joint Surgery, the number of revision total knee replacements is predicted to reach 268,200 in 2030, representing a 600 percent increase over the number of procedures performed in 2005. Other interesting facts about joint replacement surgery include that women are much more likely to need knee replacement than men, and rates of joint replacement due to rheumatoid arthritis have been dropping, while surgeries due to osteoarthritis are on the rise. Lastly, although there are many people in their 80s and 90s having these procedures, the largest increase in joint replacement in recent years has occurred in patients below the age of 50.
A PROGRAM THAT MAKES SURGERY EASIER: Dignity Health Mercy Gilbert Medical Center offers a boot camp that is a comprehensive, planned course of evidence-based education and treatment designed specifically for joint replacement patients. The class is taught by a registered nurse as well as a member of the physical therapy team and a care coordinator RN. “This was a whole lot better than my first hip replacement,” stated Dennis Dairman, a 76 year old retired judge and basketball player. “I think from going to that class, I knew what to do and did it. It got me going faster. The class teaches you what’s important. You have a little apprehension and it makes you more comfortable,” he continued. One two-hour course is required. Mercy Gilbert and Chandler Regional Medical Center can also provide a video for patients who can’t attend a session due to work or travel issues. Both hospitals offer one-on-one classes for special circumstances. “We feel strongly that education is really the key to the patients’ postoperative success,” stated Joan Bolzan, the former orthopedics program coordinator at Mercy Gilbert . “Knowledge is power, and it helps patients prepare mentally and physically for surgery. It really empowers them,” she continued. Mercy Gilbert and Chandler Regional each conduct about 500 joint replacement operations annually.
THE FUTURE OF JOINT REPLACEMENT: The move of joint replacement surgery from the inpatient hospital environment to the outpatient setting has become an almost certainty. Experts like the consultants at Sg2 have been predicting the rise of outpatient joint replacements for many years, and their recent data has been showing an acceleration of the trend, with 2012 to 2015 showing a 47 percent increase in procedures nationally. In September the agency received comments from both sides of the industry. Hospital groups expressed concerns, as joint replacement surgery usually represents a large profit center within the institution. Surgeon practices and ASC leaders promoted the move. This month CMS finalized moving knee replacement off the “inpatient only” list so it can be performed on Medicare patients in ambulatory surgery centers (ASCs) in the future. Hospitals that do not have an outpatient surgical setup have been seeking to acquire surgery centers or form joint ventures with them to capitalize on the movement. Hospital teams will need to learn new key skills to embrace this trend and prepare to do outpatient joint replacements.b