Orthopedics / Project Motion

Meet Arnie Engster, hip-replacement patient and Project Motion graduate:

"Worry, worry! That's all I could do when my family physician took an x-ray of my sore hip and said that I may need a new one," said West Branch resident E. Arnold "Arnie" Engster. His doctor referred him to an orthopedic specialist at West Branch Regional Medical Center, who confirmed that he needed hip replacement surgery.

Yet, as it turns out, Engster didn't need to be so worried. He became part of Project Motion, WBRMC's streamlined pre- and post-operative process known to some as "joint camp." Beginning with a preoperative interview and continuing through surgery and the hospital stay, the program focuses on the patient and his or her specific needs.

"They scheduled me for tests and a Project Motion class at WBRMC," Engster said. "At the class, we were given a hand out that further explained the replacement process and what we may need following the surgery, such as an elevated toilet seat, walker , crutches or a cane, and rehabilitation services.

"Surgery was scheduled and I arrived to find everyone ready to go. I was prepped and made to feel at ease. Following the surgery, I was taken to the third floor, where I couldn't have been in better hands," he added.

Engster is one of many patients in need of total knee or total hip replacement surgery who are taking advantage of Project Motion.

"Next to having the surgery done, being part of Project Motion was the best decision I made," said Engster, who is also a WBRMC Board Member.

According to Engster, the staff's partnership in his recovery helped him achieve his goal of becoming mobile shortly after surgery.

As part of Project Motion, patients interact with the caregivers and contribute to forming the plan that will take them from surgery to going home an leading an active lifestyle. The primary recovery plan entails using the new joint shortly after surgery and outlines how many actual steps the patients will take on day one and day two following the surgery, with day there being the planned day for them to return home. Because of the approach, patients feel fully involved in their recovery.

Patients often stand an begin walking the day after surgery, initially with a walker, crutches or a cane. The muscles around the joint, often weakened by favoring the joint prior to surgery, are strengthened throughout the recovery.

Project Motion was created to offer patients the best possible experience when undergoing hip or knee replacement. Dr. Mark Weber, who was Engster's physician, and Dr. Patrick Morse work closely with the program and are pleased with its results.

"Arnie progressed very nicely after surgery and through the recovery process," Dr. Weber said. "He improved extremely well from a walker to a cane to not needing any assistance. After four weeks, he walked nearly normal. Arnie was very positive about the program and I think he benefited greatly from Project Motion."

Kourtney Cingano, Regional Rehabilitation Director, sees patient involvement in the program as a key to their success.

"When we have the initial meeting with them, we tell them 'This is what's going to happen.' We're straightforward," she said. "We tell them it's going to hurt some, but you're going to be much better, much more successful if you get up on day one or walk this far on day two."

"It gets them motivated to get up and get moving," Cingano added.

Making the decision. Joint replacement in deemed necessary when a worn or arthritic joint becomes extremely painful to use, creating some level of immobility. The goal of the surgery is to relive the pain caused by the damage done t the cartilage that enables smooth joint movement.

The surgery involves replacing all or part of the natural joint with artificial components. In knee or hip replacement, the artificial joint is made out of metal and plastic. The surgeries have become increasingly common, enabling people to remain active after hips and knees are compromised from years of stress from walking, running, sporting activities or injuries to the cartilage. When the cartilage degenerates, the bone becomes exposed and begins to rub upon the adjacent bone.

According to Dr. Morse, total joint replacement is a significant surgical intervention that has a high rate of success.

"Most studies have demonstrated greater than 98 percent of all patients undergoing joint replacement are very happy that they've had the surgery," he said. "However, most patients feel quite anxious prior to their surgery. My patients that have participated in Project Motion have appreciated the camaraderie, support and information they have received. Most have commented that feeling part of a team helped to alleviate their feelings of isolation.

"The group approach from the preoperative evaluation through postoperative therapy and discharge planning has provided my patients with the opportunity to share their surgical experience with other patients. Just knowing that they are not alone in their questions and concerns have been a great relief for many."

Helping patients move. According to Nicole Gillette, Manager of WBRMC's Surgical Unit, Project Motion's goal is to better prepare patients for their upcoming surgeries by introducing them to exercises and activities related to their surgeries.

"We have found that the more prepared patients are pre-operatively, the better they do post-operatively," she said. "Our goal is for patients to have a successful recovery and return to an active life after surgery as soon as possible."

Project Motion is a result of a combined effort involving WBMRC's orthopedic surgeons, Surgical Unit nurses, Preadmissions Testing staff, Physical and Occupational Therapy, Case Management, Registration, Laboratory Services and Cardiopulmonary Services.

During preadmission, patients come to the hospital for a preoperative interview and any testing required prior to surgery. At that time, they are involved in a group meeting with others also having an upcoming joint replacement surgery. At the meeting, members of Nursing, Physical Therapy and Case Management discuss topics such as pre- and post-operative nursing care, medications and pain control options, equipment, exercises and post-hospitalization planning.

"All of the disciplines are continuously involved in each patient's care," Gillette said. "Progress or specific patient needs are communicated to the caregivers so the patient has the best experience possible."

During the hospital stay, patients are encourage to participate in group exercise with other joint replacement patients. They are also assisted in preparing for their usual home activities by dressing in their own comfortable clothing and getting in and out of bed for meals and exercises.

When it's time for the patient to go home, the staff makes sure they have the right equipment and care to complete the rehabilitation process. The follow-up care can range from therapy at home, at the hospital as an outpatient or a short-term stay at an extended care facility as an interim step.

Project Motion takes a successful approach to improving the quality of life for the medical center's patients and takes it one step further – improving the process of replacement surgery by listening to the patients and providing them with a support system of medical professionals and peers who are undergoing surgeries.

For Engster, Project Motion was just what the doctor ordered.

"All the personnel I came in contact with were the most friendly and yet professional folks I have ever met," he said. "Seven weeks after major hip replacement surgery, I was able to walk up and down stairs and actually go bowling."