Joint replacement: out with the old, in with the new

 

Physical therapist Raymond Scherer, DPT, focuses on N’tegrity Quiñones’ shoulder
Physical therapist Raymond Scherer, DPT, focuses on N’tegrity Quiñones’ shoulder following an arthroscopy procedure to remove torn tissue.

 

What do a 36-year-old breakdancer and a 63-year-old retired physician have in common? N’tegrity Quiñones and Carolyn Thompson both had successful joint replacement surgery at Greenwich Hospital last year – Quiñones got a new hip, Thompson a knee.

Then they both immediately began physical therapy and have steadily regained range of motion and muscle strength in their new joints. Most important, though, they’re getting back to doing the things they love, which keeps them happy and healthy.

Positive outcomes like these are the hallmark of the hospital’s Total Joint Replacement Program, which has received the “Gold Seal of Approval” from the Joint Commission, the premier accreditor of healthcare organizations and programs, due to its consistent commitment to excellence. That commitment revolves around superior care provided by specially trained staff, including surgeons, nurses, physical therapists, physician assistants, nursing assistants, rehabilitation specialists, case managers and the program coordinator, who guides each patient through their individual journey.

The program’s high marks also reflect its use of state-of-the-art diagnostic, surgical and pain-management techniques, as well as outstanding patient education and support throughout the entire process. And while there’s an emphasis on replacing hips, knees and shoulders, the program also offers care for rheumatoid arthritis, osteoarthritis, congenital deformities and sports injuries.

Quiñones is a bundle of energy, a competitive breakdancer whose footwork, freezes and windmills would put a whirling dervish to shame. The Woodbury, Conn., resident runs her own dance school and is aspiring to compete in the 2024 Summer Olympic Games in Paris, which will feature “breaking,” as it’s officially called, for the first time.

Thompson has never breakdanced, yet has remained fit and active her entire adult life with Baby Boomer-appropriate activities, including bicycling, hiking, downhill skiing and tennis. Along their separate roads to athletic prowess, however, Quiñones and Thompson each experienced agonizing setbacks that ultimately required joint replacements, followed by months of physical therapy.

Quiñones’ travails date back to 2018, when a car crash left her with a torn labrum and a partial rotator cuff tear in her left shoulder – and lots of pain, especially when breakdancing and working out. Fast-forward to last March, when Quiñones made an appointment with Craig Tifford, MD, a Yale Medicine orthopedic surgeon who practices at Greenwich Hospital.

 

Yale Medicine orthopedist Craig Tifford, MD, prepares to perform an outpatient procedure
Yale Medicine orthopedist Craig Tifford, MD, prepares to perform an outpatient procedure at the Helmsley Ambulatory Surgical Center at Greenwich Hospital’s Holly Hill campus.

 

After reviewing an MRI of the lingering damage and discussing her persistent pain, “I recommended she have shoulder arthroscopy to remove the torn tissue,” Dr. Tifford said. Quiñones underwent the minimally invasive outpatient procedure at the hospital’s Helmsley Ambulatory Surgical Center.

Within days, Quiñones began physical therapy at Greenwich Hospital’s outpatient facility at 2015 Main Street in Stamford. “We worked on loosening the tight muscles around the shoulder joint to restore its range of motion,” said Raymond Scherer, DPT, her therapist and coordinator of the center. “The goal was to enable her to perform all her activities again, pain-free and with full strength and stability.”

 

Diren Arsoy, MD, an orthopedist with Yale Medicine
Diren Arsoy, MD, an orthopedist with Yale Medicine, has experience performing muscle-sparing anterior hip replacement surgery that typically leads to a speedier recovery.

 

Even as she rehabilitated her shoulder, Quiñones dealt with chronic pain in her left hip, which had plagued her for years. Dr. Tifford referred her to Diren Arsoy, MD, a Yale Medicine orthopedic surgeon who specializes in treating hips. X-rays and an MRI revealed, much to her surprise, that Quiñones had been born with hip dysplasia, a condition where the “ball and socket” joint of the hip does not properly form, causing it to become dislocated.

If not diagnosed and treated early, dysplasia can damage the surrounding cartilage and lead to painful arthritis. “After trying to self-diagnose the problem for years, it felt comforting to have some security and get some answers,” Quiñones said.

“We discussed her quality of life, things she could and could not do, and that she could either live with the arthritis or replace the hip,” Dr. Arsoy said. They agreed on the latter, and in early October, while still recovering from shoulder surgery, Quiñones had muscle-sparing anterior hip replacement surgery. “This approach allows for a speedier recovery because we cut between the muscles instead of cutting through the muscles to get to the hip joint.”

Considering the rigors of breakdancing, Dr. Arsoy opted to use a prosthetic hip with a larger ball than ones used in standard cases. “This implant has been used in Europe for more than a decade and has an excellent track record,” he said. “The bigger ball is harder to dislocate from the socket and gives her more range of motion.”

During her short stay at Greenwich Hospital, Quiñones began walking, first with a walker, then a cane. Shortly after discharge, she began outpatient physical therapy, again with Scherer. “My progress has been slow and steady as we work on strength and range of motion in my new hip and lower body muscles,” she said. “I don’t feel the pain I used to, which is huge.” Scherer said she can begin exercising and breakdancing after about four months, then should be fully recovered within a year – and ready to resume training to qualify for the 2024 Olympics.

Coincidentally, a past sports injury haunted Thompson’s active lifestyle for years. She was just 17 when she tore the lateral meniscus in her right leg playing basketball and had surgery to repair it. “My doctor said I would wind up with arthritis by age 40, but that was a long way off,” she recalled.

Sure enough, the knee became arthritic and painful in her 40s. She eventually had to give up skiing and tennis, but continued to hike and bike, right up until retiring as an internist about two years ago. Since then, Thompson received cortisone and lubricating gel injections, “but they didn’t significantly reduce the pain and discomfort,” she said.

 

Orthopedic surgeon Christopher Mattern, MD, and team
Orthopedic surgeon Christopher Mattern, MD, (center) with the operating room team of anesthesiologists, physician assistants, surgical technologists and nurses following a joint replacement surgery.

 

She had been treated for several years by Christopher Mattern, MD, an orthopedic surgeon at Greenwich Hospital. “Her treatment was conservative at first,” he said, “and then her pain became too much to bear.” Indeed, Thompson added, “the knee hurt all the time, and the only activity I could do was cycling.” She and Dr. Mattern finally concurred that it was time for a total knee replacement, and the procedure was performed in September.

“She sailed through surgery and was able to go home two days later,” Dr. Mattern reported. Thompson began physical therapy immediately upon her return home. Her routine included resistance bands, light weights and range-of-motion exercises.

A few days later, she started outpatient physical therapy twice a week at a facility near her home in Norwalk, while continuing home exercises on off days. “The therapy has helped me gradually strengthen the muscles in my leg – the hamstring, glutes and quadriceps – as they heal,” she said. By mid-November, Thompson was cycling again. “I took it slow at first,” she admitted, “but it was really nice to be back on the bike.”

 

Carolyn Thompson riding bike
Carolyn Thompson has resumed her passion for biking following knee replacement surgery.

 

Her road to recovery has been long, but Thompson recognizes the quality of care provided by the Total Joint Replacement Program, as well as the benefits of sticking with a physical therapy regimen. “I know from my previous experience in caring for joint replacement patients that those who stuck to their physical therapy got the function back in their new joint,” she said.

Back on the breakdancing front, Quiñones hopes her road to recovery leads to the podium in Paris to receive an Olympic medal in 2024, knowing the orthopedists and therapists who treated her and gave her the “confidence to have a successful recovery” should join the celebration. She’s even producing a documentary of her healing process, hoping to inspire future generations of breakers and medical practitioners who treat these unique injuries. “They are excited to be helping me prepare for the Games.”

 

N’tegrity Quiñones works with physical therapist Raymond Scherer, DPT
N’tegrity Quiñones works with physical therapist Raymond Scherer, DPT, on strengthening her hip following a joint replacement.