Total Joint Replacement: New Lease on Life

William LaFontaine

William LaFontaine is back to riding his motorcycle and other activities he loves following a total knee replacement.

Business owner William LaFontaine ignored the pain in his left knee for years, even though simple tasks such as kneeling to fix appliances or pedaling a bicycle were challenging. But when getting out of a chair became troublesome, it was time to take action.

"That’s it,” the 68-year-old said at the time. “I’m getting a new knee.”

LaFontaine’s search led to Greenwich Hospital’s Center for Joint Replacement and Brian Kavanagh, MD, an orthopedic surgeon who specializes in total knee and hip replacements. Certified by the Joint Commission as one of the nation’s best joint replacement programs, the center has helped thousands of people throughout the region regain their independence.

“People are healthier and living longer these days. They want to maintain their active lifestyles for as long as possible,” said Dr. Kavanagh, the program’s medical director.

A fresh start

State-of-the-art surgical techniques enable patients of all ages sidelined by congenital deformities, sports injuries, rheumatoid arthritis, osteoarthritis, and chronic hip, knee and shoulder pain to regain their mobility. The team includes specially trained surgeons, hospitalists, nurses, physical therapists, case managers and a program coordinator.

LaFontaine said he didn’t mind driving 106 miles from his Stonington home to Greenwich Hospital, given its track record for providing high-quality, safe patient care.

“I was impressed with the hospital’s very low infection rates,” he said. The program also ranks among the top 15 nationally for lowest readmissions, and patient satisfaction scores are in the 98th percentile.

“The procedure went smoother than expected,” said LaFontaine, who spent two nights in the hospital followed by six weeks of physical therapy at an outpatient rehabilitation facility. “My quality of life is so much better now. I don’t know why I waited so long.”

An evolving field

Joint implant techniques have changed dramatically throughout the decades due to redefined surgical instrumentation, effective pain management techniques and durable implants that can last up to 25 years. Surgical approaches have evolved, as well. Dr. Kavanagh, for example, developed and redefined a muscle-sparing approach that is less invasive and speeds recovery.

Not everyone, though, is a candidate for total joint replacement. Experts recommend patients first consider nonsurgical options, such as anti-inflammatory medications, cortisone injections, hyaluronic acid injections, therapeutic exercises, activity modifications and more.

“These techniques can reduce the pain and inflammation for a while,” Dr. Kavanagh said. “But for some patients, a total joint replacement is the only way to relieve the pain and restore mobility.” Patients range in age from their 30s all the way up to their 90s.

Educating patients

As the program coordinator, Ann Nardi, PT, DPT, works one-on-one with patients and their caregivers, offering practical information and emotional support as needed. “We pride ourselves on providing personalized, patient-centered care,” said Nardi. “Patients receive individualized attention every step of the way to ensure a successful recovery.”

Nardi provides patients and their caregivers with continuous education from presurgery classes to inpatient instruction at the bedside, to follow-up calls after discharge and throughout the recovery phase.

The presurgery class includes detailed information about the procedure, hospital stay, pain management, discharge planning, rehabilitation and more.

“Patients do much better when they know what to expect during their hospital stay and the rehabilitation process,” Nardi said.

Get Moving

While every patient’s experience differs, most joint replacement patients spend two to three nights at the hospital, and many can expect to start moving the same day of surgery. Effective pain management options enable patients to begin physical therapy within 24 hours of surgery, in most cases. LaFontaine was taking steps just hours after surgery, and he experienced minimal pain thanks to a nerve block and Tylenol. He didn’t need any opioid pain medication.

“Early return to mobility is important,” said Julie Wahnish, PT, DPT, who coordinates inpatient physical therapy services.“Patients start their therapy right after surgery.”

Physical therapists instruct and educate patients on how to safely transfer or move from bed to chair, stand, walk, and climb up and down stairs. They also prescribe targeted exercises to strengthen the muscles and improve range of motion, endurance and balance. “Our goal is to ensure patients are able to go home and navigate their environment safely,” added Wahnish.

LaFontaine credits his smooth recovery, in part, to his physical therapy regimen. “Physical therapy is a must if you want to heal completely,” he said. Now he focuses on getting back to the activities he enjoys the most – racing his four-year-old grandson and riding his motorcycle – without pain. “I can do things that I haven’t done for years,” he said.

These days, LaFontaine’s only knee-related concern is finding the right time to see Dr. Kavanagh again. “I’m going back to Greenwich Hospital to get my right knee replaced. I want a matching set!”