Day 3: March 24, 2012

"Si podemos!" Yes we can! has become the unofficial motto of this year's Operation Walk trip. The phrase was coined by one of our post-op patients walking the halls and encouraging her fellow patients. She and the other postoperative patients made great strides today. Passer-byers of the floor could hear intermittent clapping and cheers encouraging patients' on as they achieved new milestones. It was a day of firsts for many patients. For some it was the first trip up a flight of stairs just two days after a knee replacement. For for a few patients it was the first steps after over a year being confined to a wheelchair, including a 46 year old female who has been severely afflicted with rheumatoid arthritis, a systemic inflammatory disease that has involved numerous joints throughout her body. Severe debilitating left hip pain has kept her in a wheelchair for the past 18 months. The recovery of some of our patients has been truly remarkable. One woman could be seen navigating the stairs with her team of medical students and physical therapist just two days after bilateral total knees.

Many factors contribute to a patients recovery following surgery. We have done our best to optimize conditions for our patients. Great focus has been placed on appropriate pain control. Total joint replacements are performed under spinal anesthesia when possible to limit cardiopulmonary risk and postoperative recovery by using minimal sedation while providing adequate intra-op pain control. We optimize postoperative pain control with a multimodal injection of a mixture of diluted ropivicaine and epinephrine into the periosteum (a membrane that lines the outer surface of the bones and contains significant sensory innervation) and the soft tissues, including the posterior capsule. Similar injections have been shown to trend toward better pain control in the immediate postoperative period. More information on this, and other peri-surgical pain control techniques, are discussed by our very own Dr. David Dalury's in his paper entitled "Current and Innovative Pain Management Techniques in Total Knee Arthroplasty" published in the Journal of Bone and Joint Surgery in October of 2011. Additionally, femoral nerve catheters are placed and managed by our anesthesia staff to allow for improved pain control during the first 24 hours post surgery and our nurses work diligently to ensure that pain continues to be addressed adequately on the floor to facilitate recovery.

The goal of joint replacement surgery is to improve function and alleviate pain, making the postoperative physical therapy a key factor in a patients recovery and ultimate outcome. Our dedicated group of physical therapists includes Carolyn Beagan, Brooke Fontana, Emily Ellsworth Cohen, Scott Taylor, and Jillian Ng. Thanks to there tireless efforts, every patient begins therapy the first day following surgery to speed them on their road to recovery.

The intangible factors that contribute to a patient's recovery are often just as important as the medical components. The significance of factors such as motivation, resilience, and determination have never been so apparent to me as while watching the Op Walk patients approach their recovery. Many cannot wait to be out of bed and begin moving. They are so appreciative of the opportunity that lies in front of them, and that appreciation serves as a strong motivator not only for the patients but the medical personnel helping them on there journey. Si Podemos!