Sunday, March 25, 2012

Day 4: March 25, 2012

It's hard to believe that today marked the last day of surgery for the 2012 Op Walk trip. Despite long hours and hard work, the days have flown by. 47 total joints have been performed over the last 4 days due to the concerted effort of the entire operative walk teams. Days have begun at 6am with early arrival of the floor teams to round on patients and the operating room staff to prep for the day so that cases could begin by 7:30am. Each day we have had four operating rooms running with two to three cases per room depending on if they were bilateral or unilateral joints. Thanks to the diligent work of the operating and sterile processing staff, in addition to the tireless efforts of our DePuy representatives, the ORs consistently ran efficiently maintaining the outlined schedule. The PACU nurses have performed tremendous work taking care of the steady flow of fresh post-op patients undergoing femoral nerve blocks and close monitoring as they recovered from surgery prior to returning to the floor.

Surgeries have varied from routine to complex, tackling severe debilitating degenerative disease due to either osteoarthritis, rheumatoid arthritis, or post-traumatic changes. Many of our patients have been severely afflicted for a number of years resulting in significant joint contractures, further adding to the complexity of surgery. The sensation of instability can often be just as debilitating as the pain. A good example is provided by one of our cases from today. Preoperative xrays and clinical photo are pictured here. Years of destructive rheumatoid arthritis have left this 76 year old female with significant bone loss on the lateral tibial plateau and a significant valgus deformity of the knee with an associated flexion contracture. Her valgus deformity worsens significantly with weightbearing as the femur collapses into the defect, leaving her with a functionally shortened leg that is unable to support her weight without maximal assistance. However now following a total knee arthroplasty her leg is now not only straight, but stable.

While total joint replacements are often considered a procedure of the middle age and elderly, there are unfortunate cases of end stage degenerative changes in young patients usually associated with trauma. The youngest patient of this Op Walk Trip, who is only 20 years old, is one such case. A motorcycle accident resulting in an acetabular fracture (a fracture of the hip socket) treated with traction 1 1/2 years ago has left him with severely altered hip anatomy and resultant post-traumatic arthritis causing a painful and poorly functioning hip. This is a difficult problem to face at a young age with few palatable solutions. Faced with a lifetime of discomfort and limited activity and with disease beyond the scope of salvage reconstructive procedures, his only options are a hip fusion or hip replacement. After lengthy discussion with patient, it was elected to proceed with a hip replacement. However, as a result of his previous trauma his acetabulum was deficient requiring the use of the resected femoral head as a bone block to reconstruct the acetabulum prior to insertion of the cup. Preoperative and postoperative images can be seen here, but the true testament of the success of the procedure could be seen on the wards the following day where he could be found walking with a single crutch.

These are just a few examples, but for each procedure performed over the past four days there is a patient who has their own individual story and individual struggles. However, thanks to the expertise of the surgeons who have volunteered their time and the efforts of the Op Walk team, they all now have an opportunity a better quality of life that otherwise might not have been available to them. Apparently, this sentiment was enough to cause one of our patients to dance in bed just a few short hours after surgery!

While there is still work to be done as we help our patients on there path to recovery, a sentiment of accomplishment and joy was palpable in the hospital after the completion of the last case. This marks the culmination of months of hard work and preparation, and we could not be happier with the result!

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