The Joint Replacement Center at Nyack Hospital: Skilled Surgery to Help Patients Stay Active

By Jennifer Webster
Sunday, March 30, 2014
Specialty: 

At Nyack Hospital, a dedicated team of physicians, nurses, therapists and other professionals works together to perform advanced procedures and provide excellent care so joint replacement recipients can resume their active lives.

In the past 13 years, the orthopedics program at Nyack Hospital has grown, culminating in the establishment of the Joint Replacement Center, which received certification for its hip and knee programs from The Joint Commission in 2014.

“In my tenure, Nyack Hospital has brought on a core group of well-trained orthopedic surgeons,” says Jason Fond, MD, Director of Orthopedic Surgery at Nyack Hospital and Assistant Professor at Dominican College. “The impetus has been to create a center in the community where patients can get the orthopedic care they need, rather than traveling to Manhattan or to a teaching hospital.”

In 2005, Nyack Hospital’s physicians decided to follow the model of other, similar institutions and create a center for orthopedic medicine within the community.

“It was a large undertaking,” Dr. Fond says. “Meeting The Joint Commission’s guidelines took time and energy. Additionally, we had to educate patients who had not previously had surgery in the community about what we had to offer.”

Jordan Simon, MD, Director of the Joint Replacement Center at Nyack Hospital and Assistant Clinical Professor of Orthopedic Surgery at New York University Hospital for Joint Diseases, also became affiliated with Nyack Hospital in 2001. A member of the medical community in Rockland County for many years, Dr. Simon was instrumental in the founding of Nyack Hospital’s Joint Replacement Center.

Since its inception eight years ago, the program has been a success. Drs. Simon and Fond have assembled a multidisciplinary team of surgeons, nurses, physical and occupational therapists, and other staff members, all working together to make successful joint replacement in a community setting a reality.

“We have been meeting as a team over the past seven years to cultivate the Joint Replacement Center,” Dr. Simon says. “We continued to evolve until we were able to obtain Joint Commission certification this year.”

Certified Care

Recognition by The Joint Commission required the program to review its procedures and demonstrate its commitment to excellent, reproducible medicine. Through performing every measure, such as deep vein thrombosis prevention, the same way every time, the program demonstrated the methodical thoroughness needed to keep patients safe and ensure the best surgical outcomes.

“Certification informs patients and referring physicians that we adhere to very strict guidelines,” Dr. Fond says. “From infection control to patient satisfaction, we have to follow exact systems pre- and postoperatively to maintain good outcomes. The Joint Commission sent a senior orthopedic surgeon to review our charts, interview our staff and make sure we were doing what we needed to attain high standards.”

“It took us two years to prepare, research and meet the requirements of Joint Commission certification,” Dr. Simon says. “We made sure we had achieved all the quality measures required, and we obtained certification on the first try.”

“In the past, patients and referring physicians have seen community hospitals as way stations to larger medical institutions. At Nyack Hospital, we have created a center where patients can receive the definitive care they need with respect to joint replacements and complex surgeries of the knees, hips and shoulders, while remaining happily in their own community.”
— Jason Fond, MD, Director of Orthopedic Surgery at Nyack Hospital, Assistant Professor at Dominican College

In January 2014, the Joint Replacement Center at Nyack Hospital was the first program of its kind to receive Joint Commission accreditation in Rockland Westchester, Orange, Putnam, Sullivan and Ulster counties in New York. Patients from these areas travel to Nyack Hospital for hip, knee and shoulder arthroplasty procedures. Surgical volume has doubled since the Joint Replacement Center was founded, a testimonial to patients’ satisfaction with their results.

Teaming Up

At Nyack Hospital, teamwork and standardization provide excellent care for patients undergoing orthopedic surgery. Anesthesiologists, nurses and rehabilitation therapists work together to help make each patient’s surgery successful.

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Jason Fond, MD, follows up with a knee replacement patient postoperatively.

“We run a tight ship,” Dr. Fond says. “Our patients receive personal, hands-on care, and at the same time, their providers have been trained to high levels of expertise and follow the same rigorous standards as any major joint replacement center.”

“We take a standardized approach to each patient,” Dr. Simon says. “Working as a collaborative team, including physicians, nurses, social workers and physical therapists, we start from preoperative classes all the way through postsurgical follow-up to provide a reproducible, systematic approach to patient care.”

Among the rigorous protocols ensuring patient safety and good outcomes, Dr. Simon notes that joint replacement classes, preoperative testing and surgical clearances ensure a patient’s surgery will proceed as scheduled. This relieves patients’ anxiety about their procedures by keeping them fully aware of what to expect at each step.

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Jordan Simon, MD, follows up with a total hip replacement patient prior to discharge.

“Our preoperative class is extremely important,” Dr. Simon says. “Surgery is a major step in our patients’ lives. Two weeks before surgery, each patient attends a class with representatives from nursing, anesthesia, social work and physical therapy. The patient discusses individual aspects of his or her case. Concerns, from pain control to comorbidities, are addressed in a one-on-one fashion, allowing the patient to go into surgery with a great deal of peace of mind.”

The nursing staff in the Joint Replacement Center receives special training in the care of orthopedic patients. Many have been with the center for a number of years and participated in The Joint Commission certification process. They approach their patients with compassion and experience.

“Our patients are treated like VIPs,” Dr. Simon says. “They have private rooms, and each nurse oversees only three or four patients. Physical therapists visit with patients twice a day. As a result of our systematic, multidisciplinary approach, patient stays have decreased from six to two and a half days.”

Pain Management

Anesthesiologists make up an important part of the multidisciplinary patient care team at the Joint Replacement Center. In the past, patients undergoing orthopedic surgery experienced significant postoperative pain. The fear that they may suffer unnecessarily following their procedure still makes patients hesitant. However, a skilled anesthesia team with a versatile, proactive approach to pain management makes postsurgical discomfort more easily managed.

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Barry Kraushaar, MD, and Dr. Fond review X-rays in the operating room.

“Our system incorporates pain management before, during and after surgery,” Dr. Fond says. “When patients are more comfortable after surgery, they rehabilitate more quickly, leave the hospital sooner and experience fewer complications. They are much happier about their surgical outcomes.”

Dr. Simon explains: “During and after surgery, we use catheter-delivered pain medications to target the joints, keeping the extremities partially numb for the first two or three days. Patients are able to participate in rehabilitation with confidence, while their postoperative pain is managed with simple oral medications.”

Community Partners in Care

Referring physicians and patients’ other specialty doctors make up a key part of each patient’s care team, Dr. Simon points out. Seeing their longtime physicians in the hospital after surgery helps patients experience one of the benefits of community care — familiar physicians who know their history, looking after them alongside their orthopedic surgeons.

“We work as a collaborative team — physicians, nurses, social workers, and physical and occupational therapists — to provide a reproducible, systematic approach to each patient, and satisfied patients are our best testimonials.”
— Jordan Simon, MD, Director of the Joint Replacement Center at Nyack Hospital, Assistant Clinical Professor of Orthopedic Surgery, New York University Hospital for Joint Diseases

“When we bring patients in for surgery at Nyack Hospital, their physicians have access to them postoperatively,” Dr. Simon says. “If the patient has a heart or pulmonary condition, their specialist will see them immediately after surgery. The specialist will follow them in the hospital, and if there are difficulties afterwards, the physician, who knows the patient best, will treat him or her.”

Keeping Patients Safe

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Mark Medici, MD, educates a patient considering joint replacement surgery.

Teamwork and standardized processes have earned Nyack Hospital a 100 percent score on Surgical Care Improvement Project (SCIP) quality measures. Associated with The Joint Commission, the SCIP is an association of organizations that promulgates quality measures, in particular infection control, supported by research. Each measure, such as administration of prophylactic antibiotics prior to surgery and removal of urinary catheters after surgery, includes a strict time frame for performance.

“Specific measures are required to be completed at certain times for every patient,” Dr. Fond explains. “Our 100 percent success rate depends on the participation of nurses, surgeons and administrators, all working to achieve better patient care with fewer complications.”

Skilled Surgeons, State-of-the-Art Surgeries

The orthopedic surgeons at Nyack Hospital are highly trained, respected experts in their fields. Many have pursued fellowships in their areas of specialty, says Dr. Fond, who completed a sports medicine fellowship in Arlington, Va., with Robert Nirschl, MD. Additionally, several orthopedic practices associated with Nyack Hospital have recently merged into a single group, Northeast Orthopedics and Sports Medicine.

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Jason Fond, MD, Director of Orthopedic Surgery at Nyack Hospital and Assistant Professor at Dominican College; Jordan Simon, MD, Director of the Joint Replacement Center at Nyack Hospital and Assistant Clinical Professor of Orthopedic Surgery at New York University Hospital for Joint Diseases; and Barry Kraushaar, MD, suited in “space suits” for surgery

“We have always worked together collegially,” Dr. Fond says. “Now, patients can benefit from the combined skills of a host of experienced orthopedic surgeons, working together to tackle everything from basic arthroscopy to complex revision cases.”

In addition to Drs. Fond and Simon, Barry Kraushaar, MD, and Mark Medici, MD, are central members of the orthopedic surgery team at Nyack Hospital. Dr. Kraushaar, who performs anterior hip replacement, was one of the physicians who helped originate the Joint Replacement Center, Dr. Fond says.

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Dr. Kraushaar consults with Teresa Hoffmann, RN, Administrative Director, Perioperative Services.

“He is active in adopting new techniques in hip and knee surgery,” Dr. Fond says. “In complex cases, he is able to make excellent use of innovative intraoperative techniques to achieve good outcomes. He is one of our busiest, most experienced surgeons.”

Like Dr. Fond, Dr. Kraushaar uses computer-guided technology and preoperative templating for better outcomes.

Another extremely busy surgeon, Dr. Medici focuses on joint replacement surgery for patients suffering from arthritis.

“He can treat difficult cases that were not previously treatable in the community setting and perform surgery here, so patients do not have to travel to an academic center,” Dr. Fond says. “He is instrumental in keeping complex cases here in the community.”

Dr Medici Knee Patient 250
Dr. Medici performs an ultrasound-guided knee injection, a conservative treatment used for arthritis prior to a patient’s needing a joint replacement.

Active in research and publication, Nyack Hospital’s physicians examine new technologies critically and adopt new procedures selectively to ensure their patients receive advanced, yet tested, care.

“I adopt new technology with a cautious approach,” Dr. Simon says. “In orthopedics, it is common for advances to be followed by a realization, two or three years after becoming popular, that they may not improve on older procedures or may even cause problems for patients. I take a different approach. When I see something new, I investigate it, learn it and, if it is a sound evolution of a previous technology, incorporate it into my practice. However, with brand new technology, I wait a year or two for results to appear before making it part of my routine surgical approach. This judicious approach has kept many of my patients out of harm’s way over the years.”

Templating

One advanced technology with the potential to make preoperative planning more accurate and efficient is templating, or using digital imaging software to analyze deformities and plan surgeries.

“If a patient has an abnormality in his or her joint, the surgeon can use templating software that incorporates preoperative CT scans or MRIs,” Dr. Fond says. “This software creates planning models that permit exact bone cutting and prosthesis positioning, allowing better outcomes. Templating is especially important when a patient has a difficult anatomy.”

Reverse Total Shoulder Replacement

Total shoulder replacement used to be performed only at large academic centers. Dr. Simon and Dr. Fond not only perform standard shoulder replacements, but they have also brought the newer technology of reverse total shoulder replacement to Nyack Hospital. This benefits patients who have suffered large rotator cuff tears. With the reverse shoulder replacement procedure, the “ball” and “socket” are reversed, thus shifting the work of moving the shoulder joint from the rotator cuff muscles to the deltoid muscle. Elderly patients who have severe fractures to the head of the humerus are also candidates for this surgery, as are patients who have failed standard shoulder replacements.

In a reverse total shoulder replacement, an incision is made into the anterior of the shoulder. The deltoid muscle is moved to the side, allowing the surgeon to visualize the joint. The surgeon then removes the humeral head and prepares the inside of the upper humerus for the stem portion of the prosthesis.

Afterward, the surgeon prepares the glenoid cavity to receive the upper portion of the prosthesis. This portion comes in two parts: a base plate and a ball. The socket portion of the joint is inserted into the humerus, and the joint capsule is repaired, after which the incision is sutured.

“With procedures such as total reverse shoulder replacement, we are taking care to the next level,” Dr. Fond says. “Patients no longer need to drive to New York for these complex surgeries. If they need arthroplasty performed, they can have their operation here, using the same technology and implants they would receive at any major surgical center.”

Dual Articulation Hip Replacement

One advanced technology Dr. Simon employs, the dual articulation hip replacement, responds to the problem of hip dislocations after arthroplasty, and the concern that the joint may wear out prematurely. By using a two-part prosthetic head known as a dual articulation system, surgeons are able to minimize the risk of dislocations postoperatively. The dual articulating head is also larger than the traditional prosthesis, which contributes to its stability.

“We place a metal shell in the pelvis, which is standard, but instead of a plastic liner locked into the shell, we use a ceramic ball attached to the stem with a plastic ball on top of that,” Dr. Simon says. “These components link together and fit into a polished metal shell, which allows for thick plastic and a large head diameter, translating to greater stability and range of motion. The prosthesis also wears more slowly, meaning younger patients can go about their routine activities with a lower risk of dislocation, secure in the awareness that their new hip should last a long time.”

Satisfied Patients: The Best Referrals

Despite the emphasis on community care — or perhaps because of it — word about Nyack Hospital’s Joint Replacement Center is spreading. In addition to the steady increase in patients from the community, joint replacement candidates travel from nearby states, and occasionally from abroad, to the Joint Replacement Center.

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The Joint Replacement Center team: Savitri Guzman, PCA; Teresa Sanders, AA; Patti Callaghan, Case Manager; Elizabeth Texidor, RN; Aibel Herrera, RN; Gerry Ryan-Gardner, Case Manager; Maureen Manigault, PCA; Reenu Alappat, PT; Maureen O’Brien, RN, Nurse Manager; Corinne Siracusa, RN; and Kay Murray, RN

“Patients recommend us to their family members,” says Dr. Simon, who recalls a patient from India who came to stay with local relatives for surgery. “Our patients are extremely satisfied, leading to a lot of word-of-mouth referrals.”


To learn more, visit www.nyackhospital.org.