Christine Gooley, APRN, BC

Recently, I had the pleasure of attending a talk about Total Knee Replacement surgery given by Dr. Elizabeth McLarney of Southern Vermont Orthopaedics and Sports Medicine. Dr. McLarney and her colleagues, Dr. William Vranos and Dr. Jon Thatcher, perform approximately 350 Total Joint Replacement surgeries per year. On the evening of Dr. McLarney’s educational session, the room was full of people who came to hear her discuss surgical and non-surgical options as well as hear from a patient who had undergone a Total Knee Replacement. The large turnout didn’t surprise me. Patients nowadays typically want to be more informed than they have in the past, and this seems especially true of the Brattleboro community.

It’s important for anyone considering Total Joint Replacement — whether it’s on the knee, hip or shoulder — to gather as much information as possible. It’s a complex process involving multiple hospital departments and providers. Many things are happening at the same time so it really takes a team approach to ensure each patient is prepared to have a safe and successful outcome.

The whole process begins at the time the decision is made to have the surgery. That same day, patients can then go right downstairs from the orthopaedist’s office in the Richards Building to have the pre-surgery lab work and tests taken care of. Sometimes the patient’s primary care provider will want to see him or her before giving medical clearance. It’s also routine that a patient schedule a dental visit to make sure there is no dental or periodontal infection.

Every patient attends a Total Joint Replacement class where they are introduced to some of the members of the hospital staff who are responsible for every facet of his or her care. The classes are held twice a month in the Brew Barry Conference Center. Class size is limited to 10 patients plus their loved one(s). The feedback from patients who have attended the class has been truly very positive. Patients say they feel like they’re talking to the expert for each part of their care such as the operating room nurse, the physical therapist, or the care manager.

Usually, the patient will have attended the Total Joint class before the visit with the nurse practitioner for their onsite preoperative appointment. That way everything they learned in the class can be reinforced. It’s also a good opportunity for patients who may have been shy in the group setting to express their fears and have their questions answered privately. A conversation about infection control takes place in the preoperative appointment rather than during the class in case a patient feels he or she is especially at risk. BMH is very proud of its low infection rate, which is a direct result of our aggressive approach toward detection and treatment.

Another focal point during the pre-op assessment is the patient’s medical history. We spend a good deal of time getting an accurate history from the patient and obtaining pertinent records from other providers and facilities. We look at that along with their lab test results, EKG, chest x-ray, and any other ordered tests and discuss any concerns with existing medical conditions or medications they are currently taking. This is also when patients learn what medications they need to stop ahead of time and what medications they must take at home on the morning of surgery.

The nurse practitioner will also perform a physical examination of the patient to make sure he or she is as fit as possible for surgery. All of this information becomes part of the evaluation report that gets prepared for the Department of Anesthesia so the anesthesiologists can determine the best approach to each individual patient. On the morning of surgery, there is plenty of time built into the schedule for the one-on-one meeting with the anesthesiologist. This is when the options for anesthesia are presented to the patient based on the patient’s medical status and type of surgery being done.

A Total Joint Replacement surgery takes approximately one to two hours to perform. Then, a patient spends about an hour in the Recovery Room (also known as the Post Anesthesia Care Unit or PACU) before moving into their own hospital room. While the prevention of blood clots and infection are huge focuses following surgery, control of any pain or nausea and the comfort of the patient is our top priority.

Patients stay at BMH about 2-3 days following a knee or hip replacement, less than that for a shoulder or partial knee replacement. Many of our patients are able to go directly home following their stay at BMH and do their physical therapy on an outpatient basis. Every patient is also asked to give feedback on their stay before being discharged. The nursing staff supervisor or care manager conducts a one-on-one interview and results are discussed by a committee that meets several times a year. Based on these reports, we continually improve on the Total Joint Replacement classes. Everyone in the community, in addition to the hospital, truly plays an important role in the safety and quality of care for our orthopaedic patients.

Christine Gooley, APRN, BC, is the Preoperative Assessment Clinical Coordinator at Brattleboro Memorial Hospital.

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