North Memorial and Fairview partnered to create the new hospital that answers the needs of the northwest metro communities: Superior health outcomes delivered through excellent communications, care coordination and attention to the individualized needs of patients and their families. The hospital opened with 30 private patient rooms complete with modern amenities and the latest safety features and can be quickly expanded to 90 rooms. Orthopedics is one of several medical services offered at the new facility.

Offering patients a modern healing environment where intelligent, patient-centered design leads to the highest level of care, Maple Grove Hospital is the first new hospital built in the Twin Cities in a decade. The hospital believes personal choices and control over your environment help make a hospital experience more comfortable.

Visit the Maple Grove Hospital website at www.maplegrovehospital.org.For more information about TCO physicians in Maple Grove please call 763-520-7870.

In the case of joint replacement surgery, the TCO staff has worked closely with the staff at the Ridgeview Medical Center, Center for Joint Replacement; the Joint Center at North Memorial Medical Hospital; and the Joint Replacement Center at Abbott Northwestern Hospital to develop an educational and therapeutic experience for patients that has proved to improve both patient outcomes and patient satisfaction.

The group experience
The experience begins with a pre-operative educational session filled with as little as four or as many as 20 patients; most of whom will also participate together in group physical therapy sessions following surgery.

While attending the pre-operative educational session, patients are given educational reference guides filled with answers to common questions such as: What does my new joint replacement look like? When will I be able to walk again? When will the pain go away? Sessions are guided by occupational and physical therapists who are also available to help answer additional questions and calm anxieties.

Patients are encouraged to bring a friend or family member to act as a coach. “We encourage the coach to come to all of the hospital visits including the pre-operative educational session, the therapy sessions, and the nursing education sessions,” said Katie Trent, a physical therapist and program coordinator at Ridgeview Medical Center,Center for Joint Replacement. “There is so much going on, it is helpful for the patient to have someone listening and learning with them. It also makes everyone more confident when it’s time to go home.”

Joint Replacement Education Program

In addition to Ridgeview Medical Center, North Memorial Medical Center and Abbott Northwestern Hospital, TCO physicians have also worked with the staff at Fairview Southdale Hospital to develop the Total Joint Replacement Education Program. This comprehensive and popular class prepares patients and their families for surgery, their hospital stay, rehabilitation, and long-range goals that might include returning to an active lifestyle.

“Our patients love the education they receive,” said Deb Smith, RN, a clinical nurse/educator at Fairview Southdale Hospital. “In fact, one total knee replacement patient comes to the class every Monday to tell others who are contemplating joint replacement how valuable the information is and how happy he is with his outcome.”

Pre- and postoperative physical therapy
Patients at Ridgeview Medical Center, North Memorial Medical Center, and Abbott Northwestern Hospital are encouraged to participate in a pre-operative physical therapy session. Exercise participation prior to total joint arthroplasty dramatically reduces the odds of requiring transfer to a swing bed or another inpatient facility, according to research noted in Arthritis & Rheumatism, the official monthly journal of the American College of Rheumatology.

Patients also participate in postoperative group physical therapy sessions prior to being discharged. Group physical therapy sessions give patients extra motivation and allow opportunity for greater support as they begin their road to recovery. Targeted postoperative care has resulted in more patients being discharged directly home after hip or knee arthroplasty, as indicated in research that appears in the Archives of Physical Medicine and Rehabilitation.

The results
Ridgeview Medical Center began offering this group approach to education and therapy when it opened its Center for Joint Replacement in April 2007.

“Prior to opening the Center for Joint Replacement, 65 percent of our patients went home after surgery and 35 percent required nursing home care,” Trent said. “Now, only 20 percent of patients are discharged to a nursing home and 80 percent return home.”

In addition to the improvement of discharge status, the average hospital stay following joint replacement has decreased from 3.8 days to 3.15 days. In 2007, the center achieved a zero percent infection rate for all knee replacement surgeries and a 0.77 percent infection rate on all hip replacement surgeries. At North Memorial Medical Center, the improvements are similar. “The results of our program have been amazing,” said Chuck Lister, program coordinator at the Joint Center at North Memorial Medical Hospital. Since starting the program, the North Memorial Joint Replacement Center has seen a zero percent infection rate and the average hospital stays have decrease from 3.5 days to 3.1 days.

Abbott Northwestern Hospital is just starting their Joint Replacement Center but they are optimistic they will have similar results.

In addition to outcome statistics, patients are also more satisfied with the care they receive. “Today’s patient wants to take an active role in the treatment and recovery process,” Lister said. “Since implementing joint replacement classes, patients have been more satisfied with their ability to be involved and expedite the recovery process.”

Constant improvement

While the results of improvement in patient education and pre- and post-operative physical therapy have helped improve patient recovery and patient satisfaction, TCO and the hospitals it is affiliated with are continuously researching and looking for new ways to improve care.

For more information about TCO physicians, locations, and services offered, visit www.tcomn.com.

Joint replacement surgery has revolutionized the treatment of late-stage arthritis for most patients. Enhanced surgical techniques and modern care during and after the hospital stay have helped speed patients to quick recoveries back to near-normal function.

Designing engineers and orthopedic surgeons hope improvements of implants will allow longer lasting function of the replacements. These improvements may allow the replacement of joints in younger patients and provide an alternative to patients who fail to get adequate relief from more conservative treatments.

The hip is a good example of a large weight-bearing joint that is frequently replaced. It is made of two main parts: The ball at the top of the thighbone that fits perfectly into the round socket in the pelvis; and the shape of the bones and “ropes” of tissue between the bones, called ligaments that provide stability to the joint. The ball and socket are both covered with a smooth durable layer of cartilage that cushions the ends of the bones and enables them to move easily. It is this layer that “goes bad” in most forms of arthritis. Doctors and researchers continually try to find a way to replace healthy living cartilage effectively, but success is likely many years away.

Varied designs
At this time, the best medical science has to offer is to replace the entire joint. Many different designs and materials are currently used in artificial hip joints. All of them consist of two basic components: the ball component (usually made of polished metal) and the socket component (usually made of strong plastic). Both components are attached to the normal bone with either a rough surface (into which bone will grow) or bone cement.

The “weak link,” according to most studies of joint replacement, is the contact surface between the ball and socket. Just as the surface that nature makes can wear out with time (arthritis), the plastic surface of the joint slowly wears away with time and can eventually cause the metal parts to loosen from the bone. Even the most polished ball’s surface has tiny scratches that scrape against the plastic cup and cause the loss of tiny pieces of polyethylene plastic. These tiny pieces are recognized as foreign and stimulate the formation of cells that clean up the body. The cleanup cells in bone dissolve the bone (osteolysis) near the metal pieces of a joint replacement and can cause them to become completely loose and in need of rereplacement.

The second operation, or revision, is much more difficult and has higher risks of complications and lower rates of patient satisfaction.

It used to be that total hip replacement (arthroplasty) was the only option for these patients. Although the traditional surgery offers pain relief, it is often accompanied with limitations. Many patients are prevented from maintaining a more active lifestyle.

A new pain-relieving procedure known as hip resurfacing can be benefi cial for younger hip arthritis patients. Current studies show that after 10 years, 95 percent of patients with a resurfaced hip are functioning well.

Pluses and minuses
Compared with conventional total hip arthroplasty, hip resurfacing off ers distinctive advantages in the appropriate patient with end-stage hip arthritis. Th e most obvious advantage is bone preservation, because bone on the upper femur is maintained rather than resected, or removed. Another advantage is a more physiologic transfer of stress to the proximal thigh with activity.

These two advantages may make revision surgery at a later date less difficult because more femoral bone remains.

Another advantage is that with hip resurfacing the incidence of dislocation is lower. The larger diameter femoral head used reduces the dislocation rate when compared tothe smaller 28mm and 32mm heads used in a conventional total hip arthroplasty. For younger patients, the larger head also offers a greater range motion, which is essential for physical activities.

The risks of resurfacing are similar to those of total hip arthroplasty. They include infection, venothrombolic disease, neurovascular damage, wear, loosening, limb length inequality, and the physiologic stresses associated with surgical intervention. Hip resurfacing patients are also at risk for fractures of the femoral neck below the resurfacing, which occurs in roughly 2 to 3 percent of the procedures.

Dramatic changes
Hip resurfacing can produce dramatic changes in patients’ lives and activity levels. Several TCO patients have returned to skating, skiing, and bike riding. Some physicians will also allow patients to return to running and contact activities after the first year. There is hope for high activity and mobility after hip replacement surgery, even though patients might not feel as if they have returned to their athletic prime.