Walker bends her knee as Forbes takes measurements to determine her range of motion.
Pam Walker, 52, has battled osteoarthritis for 20 years. Finally, this summer, her left knee had deteriorated to a point that if she wanted to walk, surgery was her only option. It was "the smallest things" that she couldn't do, she says, like squatting or getting in and out of a boat. "I couldn't do much of nothing. It's quality of life. I'm too young for that," she said.
She jokingly asked her doctor if she could stay out of the hospital, and July 7, she became the first person in Virginia to receive a total knee replacement as an outpatient.
"Someone had to be first. It wasn't just for me, but for all the other people," said Walker, who lives in Poquoson and is a 12-month employee of the Norfolk Public Schools. "It's exciting to be on the cusp of something new in the medical field."
Her surgeon, Dr. Boyd W. Haynes III, who practices with the Orthopedic & Spine Center, has been performing partial knee replacements on an outpatient basis for seven years. He conducted Walker's surgery in a little over one hour at Bon Secours Mary Immaculate Hospital in Newport News. In all, Walker spent less than 10 hours in a medical setting before heading home. Haynes says the advantages are the lowered risk of infection and getting a good night's sleep in the patient's own bed.Haynes noted that all the necessary pieces have come together over the past few years: "We have different techniques in surgery; the incisions are smaller; we have different anesthesia, pain management has improved; and we now have the necessary protocols for home care." The latter weren't available when he first became interested in the 1990s. "By developing comprehensive patient care protocols for the home, our patients receive the same clinical care (monitoring of vital signs, wound care, etc.) and physical therapy at home as they would in an in-patient setting," he said. "We know we can do it and it's safe."
However, every patient is not a good candidate. Haynes looks for patients who are highly motivated, in reasonably good physical condition and have an excellent support system at home. Also, Medicare patients are ineligible because there is no reimbursement for this outpatient procedure. (In January 2009, Medicare changed its policy on payment for outpatient partial knee replacements, and Haynes is optimistic that its policy will change for total knee replacements in the next couple of years.)
Walker fit the bill as an outpatient candidate. "You have to trust your doctor and you have to trust yourself, but it's not like they'd have let me go if there was a problem," she said. She describes herself as overweight from years of being immobilized, but otherwise in good health, though her right knee also is deteriorating and will need to be replaced. A few years ago she moved in with her mother, Ethel, who received a new left knee herself in 2004 (and spent just one night in the hospital). They live in a spacious, airy ranch with a curving driveway and four steps up to the front door.
After the surgery, a friend drove her home. "It was very exciting for me, the opportunity to go straight home," said Walker, who negotiated her way from the car to the house unaided on the day of her surgery. She heard her neighbors exclaiming as they saw her get out of the car and maneuver a walker.
The home care group Bayada Nurses had all the necessary equipment in place and monitored her closely for the first few days. A friend and former neighbor, Cindy Challoner, also stayed with her. "I was like her watchdog," said Challoner. Challoner marveled at her friend's alertness, her ability to think through the process and to follow the directions she'd been given. Her previous experience had been with caring for older relatives who had been through the same surgery and didn't show the same alertness and motivation. "For her age group and younger, I think it's great," she said.
A month later, Walker has graduated from using a walker to a cane, her progress steady but slow because of the prior extensive damage and weakness to her knee. Her limp is barely noticeable as her physical therapist, Shaunalee Forbes, of Bayada, walks with her in a cul-de-sac in her neighborhood.
She now receives therapy twice a week at home, but also works out three times a day for an hour each time, along with several one-hour stints daily on a machine that slowly bends and straightens her leg.
For Forbes, it was exciting to evaluate Walker's knee before the surgery and then to follow her afterward. "She had very limited range of motion before; she's getting to where she was before. ... In time you won't be able to tell. It will be better than before," she said.
Both therapist and patient agree that there have been no issues connected with having the surgery as an outpatient. "I never had any misgivings. It went so smoothly," said Walker.
NEWS TO USE
Orthopedic and Spine Center is located at 250 Nat Turner Blvd., Newport News. For an appointment, call 596-1900, and for more information on the practice and its physicians, go to osc-ortho.com
Poquoson woman gets new knee without hospital stay