Understanding Total Knee Replacement

Of all the orthopedic surgeries available to patients, perhaps one of the most common is total knee replacement surgery. While this surgery has historically been reserved for older patients—typically mid-60s and on—newer technology is opening the door for younger patients to reclaim an active lifestyle following a knee replacement.

According to Dr. William Tucker Jr., an orthopedic surgeon at Methodist Hospital for Surgery (MHFS), the most common reason for a patient to undergo total knee replacement is arthritis, although the reason for the arthritis can vary. While arthritis is typically the result of cumulative wear and tear or medical conditions such as rheumatoid arthritis or lupus, some arthritis is brought on by previous sporting injuries.

For Dr. Tucker, the average age of one of his patients undergoing total knee replacement is approximately 63, although this age has decreased over time because the implants within the knee are more durable and the results much more predictable. Previously, patients would be advised to “tough it out” for many years before having their knee replaced. Nowadays, Dr. Tucker says he recommends patients undergo surgery as soon as their symptoms start to interfere with their quality of life or desire to remain active.

Newer techniques, such as minimally-invasive knee replacements, partial knee replacements and implant design have changed the way many orthopedic surgeons look at joint replacement. The newer knee implants are expected to last more than 20 years and give patients a better range of motion, so it’s easier for them to bend their knee, making the prosthesis feel more like a natural knee. This technology helps younger patients decide to go forward with total knee replacement surgery because they can better be assured that their quality of life will improve if they are no longer in constant pain and discomfort.

According to Dr. Tucker, total knee replacement is one of the most successful surgeries in all of orthopedics. Most patients are able to return to virtually all of their normal activities. The primary goal of the surgery is to relieve pain while also improving mobility and range of motion. Following surgery, patients can typically return to walking, playing golf, traveling, gardening and even lower impact sports such as doubles tennis or snow skiing, if they are comfortable doing so.

For Dr. Tucker, who is been in practice for 19 years, MHFS is set apart from other hospitals because it offers patients a facility which specializes in the care of surgical patients with a streamlined model that decreases wait times, minimizes the amount of time patients need to spend in the hospital after surgery, lowers the risk of infection and other complications, all while providing an unsurpassed patient experience.


Treat Your Feet Right

April is National Foot Health Awareness Month, which means now is a good time to take a closer look at your own feet and ask whether your shoe choice is helping or hurting them. According to Dr. Rick Miller, a podiatrist at Methodist Hospital for Surgery (MHFS) who’s been in practice for more than 35 years, shoe choice can play a major role in the overall health of feet.

Among the more common foot problems he treats, including bunions and hammer toes, most are found in women who wear high-heeled shoes (higher than an inch and a half) with an enclosed, pointy toe. This pushes toes upward and causes them to cramp, and also causes corns when toes rub against the inside of the shoe.

While Dr. Miller isn’t suggesting a woman should never pull out some killer heels for a special evening out, he does encourage sensibility in daily shoe choice. For instance, if a woman knows that in the course of the day she’ll be doing a lot of standing or walking, wearing high heels is not a good choice. However, if she’s going out to dinner and doing more sitting, then making a great entrance in high heels would be more appropriate.

But it’s not just women who need to match their shoe choice to their activities. For example, Dr. Miller often sees people at amusement parks walking around in flip-flops that offer no arch support and no protection for the toes. This shoe choice will fatigue the person wearing them more quickly than if they were wearing shoes with proper support. In a casual situation that requires lots of walking, Dr. Miller recommends a walking or running shoe that offers good support, lots of cushion and plenty of room for toes.

So what is the long-term outlook for those patients Dr. Miller sees who continue to make the wrong shoe choice? He said those patients could probably expect pain in the lower back, knees and arches, as well as deformities of the toes and ingrown toenails. To properly treat the effects of poor shoe choice, such as bunions, calluses and corns, patients should seek a medical professional to have them properly removed or trimmed, and then wear padding to keep them comfortable. If patients continue making poor shoe choices, then surgical procedures to correct deformities or even nerve damage may become necessary.

To learn more about what the podiatrists at MHFS can do to keep your feet healthy, please call 469-248-3900.


Ready, Set, Go: Sports Season & Adolescent Injury

The warming days of spring are right around the corner, which means parents and kids are gearing up for sports season. Whether it’s organized school or community sports or just playtime in the front yard with friends, kids are exceedingly active—and far more prone to injury—when weather gives them the freedom to be outdoors.

That means parents need to be ready for the risks of sports and outdoors activities.

This month, Dr. John McGarry, an orthopedic surgeon at Methodist Hospital for Surgery (MHfS), sheds some light on the precautions that could help prevent unnecessary injuries. In Dr. McGarry’s experience, the three most common sports injuries in children and adolescents are strains and sprains; overuse injuries such as stress fractures, apophysitis (inflammation of the bone) and periostitis (inflammation of soft tissue); and contusions.

Sprains and contusions are the most difficult kind of injury to avoid because they usually occur during play as a result of falls, collisions or missteps. On the other hand, overuse injuries can be readily avoided by gradually increasing intensity during practice or training, until the participant has re-attained the desired level of fitness; moving too fast from winter stillness to high-speed summer activity is what quickly leads to overuse injuries. Similarly, strains can be avoided by properly warming up with stretches and slow, simple exercises before high-intensity activity begins.

But injury can still be unavoidable. If your child sustains an overuse injury, Dr. McGarry recommends the following as treatment:
• Ice
• A non-steroidal anti-inflammatory drug (NSAID, such as ibuprofen)
• Rest
• Stretching
• Slow return to sports

Treating strains, sprains and contusions depends on the severity of the injury, though initial treatment will mirror the above (ice, NSAID, rest, stretching). In worst case scenarios, fractures or muscle tears may require orthopedic surgery, in which case the concerns include risks of surgery, healing time and how quickly a child can return to normal activity or sports involvement.

While every parent hopes to survive the sports season with their kids injury-free, medical intervention is almost always necessary for someone. In Dr. McGarry’s opinion, MHfS is exemplary in the field of child and adolescent orthopedic surgery thanks to fellowship-trained sports medicine surgeons who routinely care for adolescent athletes. For specific questions about adolescent orthopedic surgery, call Methodist Hospital for Surgery at 469-248-3900.


Simple ENT Surgery Can Make a Big Difference

Many people are skeptical that a simple ear, nose and throat (ENT) surgery can dramatically improve their quality of life. But the truth is ENT surgeries aim to do just that. With allergy season right around the corner, more and more people are aware of just how aggravating their chronic sinus and allergy problems are, but did you know there reasons beyond allergies to consider visiting an ENT? You might be surprised to learn just how many conditions these specialists can correct with simple surgery.

Some of the most common ENT surgeries and procedures performed at Methodist Hospital for Surgery (MHFS) include endoscopic sinus surgery, septoplasty, turbinectomy, tonsillectomy, thyroid surgery and tympanoplasty. While most of these procedures sound intimidating, an experienced surgeon at MHFS can help you understand why one of these procedures may be the ideal solution to your condition.

According to Dr. Rajiv Pandit, an ENT surgeon at MHFS since it opened four years ago, the typical cases they see in their office that could benefit from a surgical procedure include chronic sinus infections, snoring, sore throat, hearing loss, neck masses and thyroid nodules. Not all of these cases require surgery, but many patients are surprised to learn that a simple surgery can do more than alleviate their symptoms—it can effectively cure the underlying cause.

In addition to improving a patient’s overall quality of life, ENT surgery can also improve special senses, such as hearing, smell and taste, as well as special functions like speaking and hearing. As with all surgeries, the patient will need time off from work and select daily activities in order to recover. Dr. Pandit believes the state-of-the-art facilities and best equipment available help ensure patients a successful outcome.

So how do you know if ENT surgery is the answer? The first step is a consultation with the ENT team at MHFS. If it turns out your symptoms are recurrent or last more than three weeks, further evaluation will be sought in order to determine the right course of treatment. The unique thing about ENT specialists is they are both medical doctors and surgeons, so problems are first treated medically. However, if further treatment or surgery is needed, the same ENT specialist can follow through with surgery, so a referral to another doctor is not needed.


Methodist Hospital for Surgery Partners with Texas Surgeon for Operation Walk USA

On Monday, December 2, Christmas came early for Shelia K., of Bella Vista, AR, and Susan S., of Waxahachie, TX, when they received the unique gift of surgery, courtesy of Methodist Hospital for Surgery, orthopedic surgeon specialist, Dr. Kurt Rathjen, and charitable surgical program, Operation Walk USA.

Now in its third year, Operation Walk USA has provided free orthopedic surgery to almost 500 people in the U.S., and they provided both Shelia and Susan with a free knee arthroscopy.

Shelia K. spent her entire life suffering severe knee and leg pain and was first introduced to Dr. Rathjen after he’d replaced her dad’s knees.

“I don’t remember exactly when my first visit with Dr. Rathjen was,” recalled Shelia. “I want to say it was March 2012.” It was her parents who made the introduction and even paid for her initial visit, since Shelia’s physical state had cost her her job and left her without insurance.

“I was born with my hips out of socket, so my muscles and tendons didn’t develop properly,” Shelia explained. “As a kid, my knee would pop out of place. Doctors previously tried to shorten the muscles and insert some pins, and then they went in a few times to clean debris out.

“Right off the bat, Dr. Rathjen took X-Rays, and he asked me how I got up every day and made the decision to stand and walk. I didn’t know how bad they’d gotten, but he told me ‘you have permission to hurt worse than you’ve ever dreamed about.’”

Dr. Rathjen explained that Shelia’s right knee was the worst he’d ever seen, especially in someone her age—she was only 55 at the time—and that, in addition to severe arthritis, she had no cartilage remaining in her knee. After thorough examination, and knowing what Shelia faced without work or insurance, Dr. Rathjen presented her with an opportunity from Operation Walk USA.
“I quizzed him about it, just to make sure I wasn’t part of a lottery, but he reassured me that day, right then, that there would be nobody else who would come in and be worse [physically].” At that time, Dr. Rathjen had already selected his 2012 candidate, but said Shelia would be among his selections for 2013.

While the assurance of surgery the following year gave Shelia hope, she still faced 18 months of coping; but even for this she had Dr. Rathjen’s support. He schedule Shelia to receive regular cortisone shots and provided Tramadol for her pain. For her part, Shelia agreed to do anything Dr. Rathjen requested that might improve her physical condition before surgery so, following his instruction, she succeeded in losing weight and even quit smoking.

Following Shelia’s December surgery, she was admitted to the Remington Medical Resort, a transitional care facility in Richardson, TX, where she spent almost two weeks working through physical therapy.
“He gave me my life back.” She minces no words in trying to explain what the free surgery and after-care have meant for her future. “It’s been incredible. My surgery went perfect.”

Asked about plans for her new-found mobility, Shelia is quick to say that she wants to volunteer with her local Red Cross, which she describes as a very active chapter. Curiously, she then starts to laugh; she reveals that she is a widow who has shied away from new relationships, fearing that she’d be a burden.

“Now that I’m feeling better and feeling good about myself, the Lord may send me my Mr. Right.”
Susan S. also received surgery on December 2, and while her story begins in a very different place, it echoes the same resounding hope of a successful surgical outcome.
“Three or four years ago, the pain started getting unmanageable—it was bone-on-bone and there was nothing left to do except surgery.” After many years as an avid softball and tennis player, Susan had developed advanced arthritis in both knees. She tolerated the condition as long as possible, but when pain forced her into part-time hours at work, she felt the early pangs of desperation.
“I Googled ‘free knee replacement surgery’ but never dreamt there was an organization that did this.”
She was quick to contact Operation Walk USA once she discovered them, but was told she didn’t quite meet their financial criteria. At that time, Susan was faced with a minimum cost of $20,000 for one knee arthroscopy, and the only alternate plan she could conceive to cover such a price tag was to start selling her possessions.

“I’m only 54 and I couldn’t imagine how this was going to be,” she explained. “It was too painful to sit or walk or anything. [My knees] would lock in place and there was constant grinding. You take for granted the things you can do. Feed the dog, grocery shop, work in my garden; I couldn’t do any of them.”

In 2012, when Susan’s pain escalated to the point that she was forced to quit work, she wondered if Operation Walk USA might reconsider her case. She reached out one more time.

“Next thing I knew, [Operation Walk USA] had set me up an appointment with Dr. Rathjen. I thought I was going in for an initial evaluation; I didn’t realize they’d already contacted him and given him the go-ahead to do my surgery.”
After full evaluation of Susan’s condition, Dr. Rathjen told her that both knees needed to be replaced. Then, to her surprise, he told her simply to “pick one.” That’s when she realized she was a candidate.

“Dr. Rathjen is the nicest, most compassionate man I’ve ever met; I could tell he really empathized with my situation and his whole call was to restore my quality of life,” Susan recalls fondly. “It’s a godsend. It’s like you win the knee lottery—you can’t imagine a better gift to be given than a surgeon’s time. They open the doors and say ‘We got the cost, you just focus on getting well.’”

After Dr. Rathjen successfully replaced Susan’s left knee, she set her sights on employing him to replace her right.
“One way or another I’ll get the second one done and I’ll go back to Dr. Rathjen, too.” Following her surgery, Susan spent much of December working with an inpatient physical therapist who came to her home for private sessions. “There’s pain involved for sure, but I could tell the first time I put weight on my knee that the pain wasn’t the same I’d had, it was just the surgery site—I’m a
totally different person now.”

Methodist Hospital for Surgery and Dr. Rathjen have participated in Operation Walk USA since the program’s inaugural year, and once again, the surgeries they provided were a success. Working alongside Dr. Rathjen was the Methodist Hospital for Surgery staff, including two anesthesiologists and an attending physician, who donated their time during these unique procedures.
Both Shelia and Susan received their entire episode of care—consultations, surgery, physical therapy, follow-up—free of charge and their recovery is now well underway. Their joint replacement implants were donated by Smith & Nephew.

“We look forward to continued participation in Operation Walk USA,” said Chris Shoup, Methodist Hospital for Surgery president. “It’s impossible to ignore a call like this, when you know that by participating in the Operation Walk program you’re completely changing and improving the course and outcome of a person’s life. This is our mission and the foundation on which Methodist Hospital for Surgery was formed—it’s our calling, and knowing Dr. Rathjen, I’m confident he feels the same.”

Learn more about Operation Walk USA by visiting www.opwalkusa.com.


MHFS Offers a Pre-Operative Joint Wellness Class

While surgery can be a stressful and sometimes frightening event, Methodist Hospital for Surgery (MHFS) is working to take the uncertainty out of joint replacement surgery by offering a pre-operative class to its patients. This unique class, offered since June 2012, has served more than 400 patients and their families.

The class was created based largely on the idea that total joint replacement surgery is a well-person’s surgery; these patients are not having surgery because they are sick or have a life-threatening emergency. Instead, they are electing to do surgery to improve their quality of life. Since these surgeries typically take place with plenty of notice, patients and their families have time to prepare and have all their questions answered; this means patients go into their surgery knowing exactly what to expect.

During the class, patients and their coaches learn how to prepare for at-home recovery after surgery, what to expect from MHFS over the course of their stay, and what happens when they are discharged. Participating patients will have all of their questions answered, and they’re able to meet other patients facing similar orthopedic surgery. Each class lasts between 1.5-2 hours, which is a minimal time commitment considering the payoffs.

The class is free for both patients and their “coaches.” MHFS encourages patients to bring a friend or family member as a coach who will be part of the recovery process. By attending the class, the coach is able to be more involved in supporting the patient and is able to better encourage them after discharge.

Candace Callegan, the MHFS Joint and Spine Coordinator, has said the patient feedback about the class has been nothing but positive. Two comments the staff hear most often are that the entire process “happened just like you said it would,” and “I feel so much better and less nervous since I came to the class.” These patients have decreased anxiety going into their surgery and the surgical experience overall becomes a more positive one because of their personal level of preparation.

This decreased anxiety prior to surgery is why the MHFS physicians and staff feel so strongly about the importance of the pre-op class; patients who are better prepared typically do better post-operatively. By being prepared and knowing exactly what to expect, patient stays are more pleasant and they have an overall better experience.

For more information about the pre-operative class at MHFS, please click here.


Importance of Handwashing Highlighted this Month

This year, National Handwashing Awareness Week is observed December 1-7, 2013. Campaigns associated with this annual event highlight the importance of proper handwashing in preventing the spread of communicable diseases, including the flu, common cold, pink eye, pneumonia and strep throat, to name a few.
As December is typically the start of cold and flu season, too, the observation is especially timely.
By frequently washing your hands, you wash away germs that have been picked up from other sources like people, contaminated surfaces, animals or animal waste. Although simple, the act of consistently and properly washing your hands will make a big difference in keeping your household well this winter. Additionally, it can help protect those you come into contact with at work, school or other public settings.
While experts recommend that you always wash your hands after using the bathroom, changing diapers, cleaning up after a pet or handling money, statistics suggest that people are not following this advice. In fact, only two-thirds of adults in the U.S. wash their hands after using the bathroom, while one in four adults fail to wash their hands after changing diapers. Additionally, fewer than half of Americans wash their hands after cleaning up after pets and fewer than one in five wash their hands after touching money.
The proper way to wash your hands is to use warm (not hot) water with soap. Rub your hands together vigorously, making sure to scrub all areas, for at least 15 seconds (approximately the amount of time it takes to sing “Happy Birthday”). Rinse your hands thoroughly and be sure to dry them with a clean towel. Turn the faucet off with the towel, not your hands, to ensure you are not re-contaminating clean hands.
Experts recommend that you always wash your hands when they are dirty or before eating, and rather than cough or sneeze into your hands, do so into the crook of your arm instead. If you do sneeze or cough into your hands, be sure to wash your hands immediately after. Also, refrain from putting your fingers in your eyes, nose or mouth (known as the “T Zone”). This is an especially important lesson to teach children when they are young, as they are more prone to put their fingers in all those places. Always be sure to wash hands before and after handling food, especially raw meat, as one in three E. coli occurrences is caused from not washing hands before handling food.
These simple safeguards will help keep you and your family well this winter!


The Great American Smokeout is in November

The American Cancer Society marks the Great American Smokeout each year on the third Thursday of November and encourages smokers to use the date to make a plan to quit, or to plan in advance and quit smoking that day. Quitting smoking lowers the risk of diabetes, lets blood vessels work better, and helps the heart and lungs. Studies show that quitting while you are younger will reduce your health risks more, but quitting at any age can give back years of life that would be lost by continuing to smoke.
Because of the unpleasant withdrawal symptoms associated with quitting smoking, only about 4-7 percent of people are able to quit smoking on any given attempt without medicines or other help. Studies in medical journals have reported that about 25 percent of smokers who use medicines can stay smoke-free for over 6 months. Counseling and other types of emotional support can boost success rates higher than medicines alone. Behavioral and supportive therapies may increase success rates even further and may even help the person stay smoke-free.
While there is no one right way to quit, there are some requirements for quitting with success. These four factors are crucial:
• Making a decision to quit
• Picking a Quit Day and making a plan
• Dealing with withdrawal
• Staying tobacco-free
If a smoker is thinking about quitting, setting a Quit Day and deciding on a plan will help the smoker move closer to their goal of being smoke-free. Some smokers choose a date with special meaning, like a birthday or anniversary, or the date of the Great American Smokeout. If you are planning to use a prescription drug to help quit, you will need to talk to your doctor about getting it in time of your Quit Day. Also keep in mind some prescriptions require you start taking them a full two weeks prior to your Quit Day.
Many experts agree that quitting smoking is a lot like losing weight: it takes a strong commitment over a long time. Successful quitting is a matter of planning and commitment, not luck. For more information about the Great American Smokeout and suggestions about quitting smoking, please visit www.cancer.org .


Joint Wellness Program at Methodist Hospital for Surgery

In order to better serve its patients, Methodist Hospital for Surgery has created a joint wellness program to teach patients and their families about what to expect before, during and after a surgical procedure. The program was launched earlier in the summer with the intention of reducing potential fear and anxiety for each person coming to the hospital, regardless of if they are a patient or a caregiver.
Central to the program is a joint class, which is taught by Candace Callegan, who brings over 25 years of nursing experience to the job of joint coordinator. In the class, Callegan walks patients and caregivers through the joint replacement process, including helping with the coordination of their pre-op testing and ensuring they have medical clearance prior to their procedure.
Each joint class runs 1.5 to 2 hours in length and contains no more than 10 patients and their family members or friend who will serve as coach during the process. Each class begins with a brief history of Methodist Hospital for Surgery and includes introductions to staff members, such as the CEO, respiratory therapists, physical therapist, case management and the manager of pre-op and recovery – all of the individuals a patient will encounter during their stay. Class content covers both knee and hip replacement surgery.
Classes are typically scheduled several weeks prior to surgery in order to fit into the patient’s schedule. Because patients go through the class in groups, they are able to build connections with other patients who are having the same surgery, possibly even on the same day. While the class is not mandatory for patients facing surgery, staff members at the hospital – including nurses, surgeons and physical therapists – have noted more positive patient attitudes and greater compliance and understanding, as well as less anxiety and fear from those who attend the class.
Following surgery, patients can expect to receive several follow-up phone calls from Callegan, the joint coordinator, inquiring about their progress and if they have any questions. For information regarding Methodist Hospital for Surgery’s joint wellness program, please visit http://www.methodisthospitalforsurgery.com/specialties_and_services/joint-program.cfm.


September is Healthy Aging Month

Healthy Aging Month takes place each September and is an annual observance month designed to focus national attention on the positive aspects of growing older. The main objective of Healthy Aging Month is to provide inspiration, encouragement and practical ideas for adults, ages 50-plus, to improve their physical, mental, social and financial well-being.
Now in its second decade, Healthy Aging Month was first introduced when the baby boomers were about to turn 50. September was chosen for the observance because no matter how old we are, that “back-to-school” mentality has been ingrained in us since we were young, so September seemed like the perfect time for older adults to take stock of where they have been and what they would still like to accomplish. One of the premises of Healthy Aging Month is that it is never too late to find a new career, sport, passion or hobby.
The founder of Healthy Aging Month, Carolyn Worthington, saw a need to draw attention to the myths and stereotypes of aging and let people know it was not too late to take control of their health or to try something new. It is her belief that careful attention to the combination of physical, social, mental and financial fitness was powerful in the pursuit of a positive lifestyle.
Through her magazine, Healthy Aging Magazine, Worthington does not focus on the typical topics of growing older, such as retirement planning or health concerns. Instead, she focuses on vibrant, active, 50-plus individuals who are taking charge of their lives, following their passion and who are happily looking forward to what is next in life.
Among the suggestions for starting a reinvention of yourself in September, you could try going back to school or taking online classes to refocus your career, enhance your skill set and increase earning potential. Additional tips include:
• Take a volunteer vacation to give back, fulfill a dream and experiment with living in a different place.
• Take up dancing to increase physical activity levels and to try something new.
• Travel as much as possible, and consider going with friends or family to help share the cost burden.
• Follow your passion, such as a hobby or sport you left behind in your youth.
For older adults, the thought of reinvention may seem scary or daunting, but once you give it a try, you may discover it is also a lot of fun!