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Published on July 11, 2017

Hip, Knee Prehab Program Helps Improve Patient Recoveries, Outcomes

X-ray of medically replaced hipWhen individuals with severely arthritic hips and knees exhaust conservative medical treatments, the prospect of joint replacement surgery and follow-up therapy can seem overwhelming. Primary care physicians can refer patients to North Kansas City Hospital’s orthopedic surgeons, who will connect patients to the hospital’s new prehab screening program designed to lessen complications, reduce hospital readmissions, speed recoveries and improve outcomes.

Navigating a Course

Robert F. Paul, DO, an orthopedic surgeon with Orthopedic Surgeons Inc., recognizes that primary care physicians are concerned about whether their patients can prepare for their surgeries, but also thrive after their procedures. “They can be confident that this prehab program will get their patients in the best possible shape prior to surgery,” Dr. Paul said. “Just as one would prepare for a marathon, patients will prepare for their joint replacement surgeries, so they will have the least amount of problems afterward. North Kansas City Hospital is going the extra mile to provide a realistic path for these patients.”

As the NKCH orthopedic nurse navigator, Jillian Knudsen, MSN, RN, coordinates patient care. Ninety days before surgery, she conducts a comprehensive assessment with the patient. That sets in motion a plan to educate the patient, identify risk factors, make referrals to appropriate care providers and establish expectations for discharge.

During the assessment, Knudsen identifies risk factors – unmanaged blood sugars, undiagnosed sleep apnea, pneumonia, medication use and other predisposing issues – that can cause postoperative complications and readmissions. Before progressing to surgery, patients are referred for any needed care that can stabilize their conditions and prepare them for surgery. They also receive an incentive spirometer, undergo pre-surgery testing and attend a class on the total joint replacement process.

“We want to address anything that might cause a complication after surgery by addressing it before surgery,” said James L. Stewart, MD, CHCQM, medical director of Case Management. “We want our patients to be as functional as possible, which may allow them to return home with outpatient therapy or home health care.”

Patient Perspective

Paul Robert, DO

Robert F. Paul, DO

Dr. Paul earned his medical degree from Kansas City University of Medicine and Biosciences and completed his residency in orthopedic surgery at Park Lane Medical Center.

Dr. Paul has long been a proponent for prehab total joint replacement screening, having conducted such a program on his own. “Patients absolutely love the thorough approach, which brings rewards. When they come in, I may say, ‘We can’t do your surgery in the next couple weeks. It might be three months from now because you need to lose weight and get your BMI down. We want this to be safe for you,’” said Dr. Paul, noting the risk of complications after elective surgery for an obese patient is considerably higher – upward of 12 times higher – than a patient who is not obese.

He described a patient who was so confident about her success in the prehab program that she asked to put her surgery off for two months so she could lose more weight, telling Dr. Paul, “I’m feeling better and stronger. I need to have the surgery, but I want to be in better shape because what I’m doing is working.

Total Joint Replacement Prehab Screening