Lily Hall lost the extra pounds that strained her knees for years, but couldn’t escape the damage it caused with wear and tear that left discs thinned and ligaments fatigued.
“I was having trouble walking and I could hear the bone clicking,” said a much slenderer Hall.
“It was bone on bone. There was nothing between them,” she said of her absent meniscus that once served as a cushion between the bones that made up her knees.
“The (extra weight) put too much pressure on them,” she said.
But weeks before Dr. Andrew Petrella of Citrus Surgery Center put scalpel to her knee and replaced the joint with composite materials and plastics that would allow her to walk normally, Hall had to attend Joint Camp.
Joint Camp is a 1½-hour meeting between a group of patients soon to have joints replaced or repaired and hospital staff. Bayfront Health Seven Rivers, Petrella, and Citrus Surgery Center, require patients to attend the meeting weeks before their operations.
The meeting is part of a national trend requiring patients to learn and regularly perform exercises that mimic the kind of physical therapy patient will have to do after their operations. It’s also a time when patients thoroughly learn about their procedure and what to expect during recovery.
It is a program Citrus Surgery Center, whose doctors perform orthopedic surgeries for Seven Rivers hospital, developed along with the hospital to improve recovery time and success.
“It really does help,” Hall said. “If I hadn’t gone to Joint Camp I wouldn’t have gone as far as I did.”
Hall’s left knee was replaced in 2018 and right knee in April 2019.
In both cases, her operation at Bayfront Health was on a Monday and she was back home Wednesday.
The hospital has an orthopedic wing on its third floor where joint patients recover.
The international Surgical Review Corporation designated this week Seven Rivers’ Bone and Joint Center a Center of Excellence in Orthopedic Surgery.
A decade ago patients did therapy work after their procedures, Petrella said. Therapy exercises beforehand wasn’t something hospitals offered, he said. Petrella is also Bayfront Health Seven River’s director of bone center. The hospital performs more than 1,000 hip and knee replacements annually.
Studies have shown that when patients learn about the physical therapy they’ll have to do and start working those muscles weeks in advance of their operations, they recover better, he said.
“If they do exercises ahead of time it’s more effective. It’s training the muscle,” he said.
When knees or hips are replaced, “we shock the system” and the body’s natural response is to not let the nerve fire to move the effected muscles, he said.
That’s part of how we evolved in that when we injure ourselves, that part of the damaged body didn’t want to move, he said.
But exercising the muscles near the joint not only prepares the muscle, but also the nerves, for the operation. And after the procedure, the muscles and nerves respond better when asked to move, Petrella said.
A couple of decades ago pre-operative physical therapy didn’t exist, and patients were left to rest during the first day of after the operation, he said. Now pre-operative therapy is becoming more common and patients are expected to get out of bed just hours after their operations.
The pre-operative therapy especially helps with knee replacements, Petrella said, where scar tissue forms and will stiffen the joint unless its moved.
But the idea of Joint Camp didn’t come about overnight.
It’s been a process. We’ve done a lot of work with the hospital,” Petrella said. “I definitely think it’s made it easier.”
The Joint Camp meetings are mandatory if the patient wants orthopedic surgery at the hospital. If the patient doesn’t show up for the group meeting, they’re scratched from the surgery list, said Pam Stiles, the director of the hospital’s third floor orthopedic patient floor.
More than a million Americans undergo knee and hip replacements annually, according to the National Institutes of Health
Physical therapy before joint replacement surgery can reduce the need of postoperative physical therapy care by nearly 30 percent, according to a study published in 2014 in Journal of Bone & Joint Surgery. That translated into an average savings of $1,215 per patient in skilled nursing facility care, home health agency, and other post-operative care.
Petrella said surgeries are typically planned three weeks out to give patients ample time to prepare muscles and nerves for surgery. Petrella said he can perform either a knee or hip replacement in one hour.
One 2014 Ohio study showed 80 percent of patients who didn’t receive pre-operative physical therapy needed post-acute care after their hips and knee replacements. That dropped to less than 55 percent for patients who received even moderate amounts of physical therapy before their procedures.
Olan Deguzman, the hospital’s director of outpatient therapy, said during pre-operative Joint Camp, patients meet some of the physical therapists, review the physical therapy they will do after their operations and exercises they need to do in advance, they learn about medications to ease recovery pain, and what they can expect about recovery and its pace.
“Part of the reason for Joint Camp is expectation,” Deguzman said. “What to expect and what motions to expect…because we need to get the motion going.”
“The more you know about what to do before the surgery, the easier it will be to regain movement,” he said. “We also give pain medication …that way they can’t use pain as an excuse not to do anything.”
Deguzman estimates that about 90% of his Joint Camp patients complete all of their post-operative physical therapy, “because we’re setting up our expectations from the get go.” The industry average is about 60 percent, he said.
Stiles also gives patients booklets almost 60 pages long educating them about their procedures, what they can expect and what’s expected of them.
“It’s an amazing program,” Stiles said.
The hospital’s orthopedic recovery wing has 16 rooms, so patients can motivate each other and help each other during the recovery process, she said.
The Joint Camp program has been such a success Stiles updated and improved upon it.
Watching other patients doing their physical therapy motivates others to try too and a friendly competition is often the result, Stiles said.
Kathleen Guillen, 66, is a retired nurse who once worked at Bayfront Health Seven Rivers. She had her left hip replaced in 2013 before the hospital offered Joint Camp. She wishes she had known about pre-operative physical therapy then.
“I was fine when I was standing up and walking around, but when I got up, then I would feel a catch. He pain was an eight out of 10,” she said of her hip pain before the surgery. “Eventually it was bone on bone.”
“I was getting steroid injections in my hip. The first one lasted six months. The second one lasted half that, and the third a few weeks,” she said.
In July, 2013 she had her hip replaced. She did the physical therapy the doctors wanted and went back to work. But pre-operative care would have been helpful and informative, she said.
Maybe recovery would have been smoother.
“Had this been available to me, I would have gone,” she said. “They’ve put in a lot of preparation in this. They tell you what to expect. And the more information you get, the better the outcome.”
“By going to Joint Camp, you get information and you can ask questions,” she said.
Guillen said that her recovery went well, but that was because she pushed herself.
Had Joint Camp been available, she would have participated and prepped her muscles and nerves.
“When he patients that do the exercises,” Guillen said, “they will be helping themselves and benefit too.”