CARMEL MOORESVILLE MOORESVILLE CARMEL

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1 inspiring health

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3 We specialize in DANCE STEPS, GOLF SWINGS and LONG COUNTRY WALKS The Center for Hip & Knee Surgery is known nationwide for its expertise in total joint replacement and specialized orthopedic care. But we don t just specialize in hips, knees and shoulders. Our real focus is leading you back to the activities you love best, through the most effective treatment options available. Founded in 1986 by Merrill A. Ritter, MD, the Center for Hip & Knee Surgery quickly developed into one of the first orthopedic centers of excellence in the nation. Since then, the Center s surgeons have performed approximately 40,000 joint replacements and perform about 2,500 each year. You can count on the Center for personalized care, backed by the latest advancements in joint replacement technology. Our physicians are nationally recognized leaders in their field, and our entire Center is dedicated to meeting the specialized needs of orthopedic patients. At the Center for Hip & Knee Surgery, we understand the dayto-day battles waged by people with arthritis against pain and disability. We also realize you may be apprehensive about surgery and hope this booklet will help. Knowing the facts about total joint replacement should help you make better-informed decisions regarding your health and treatment. With our outstanding facilities, educational programs and specially trained staff, the Center for Hip & Knee Surgery has helped thousands of people regain independence, mobility and freedom from pain. Those who once suffered severe joint damage, primarily caused by arthritis, are once again traveling, shopping, hiking, swimming, golfing and dancing their way through life.

4 ABOVE and The Center has been ranked consistently among the top joint replacement facilities in the country using Medicare data and quality measures, such as complication and infection rates. Three major factors combine to achieve these outcomes:» Internal medicine physicians based in the hospital, called hospitalists, closely manage surgical patients in cooperation with their surgeons, starting with pre-operative assessments and continuing throughout their hospital stay to address any non-surgical issues that may arise.» Special air flow and ultraviolet lighting, as well as antibiotic drapes and other measures, help reduce infections, resulting in an infection rate well below the national average. Many of these measures were originally developed by the Center s surgeons. BEYOND» The surgical team of experienced and well-trained surgeons, internists, nurses, physical therapists and support staff are dedicated to clinical excellence and compassionate patient care. Because of its reputation and expertise, the Center has been chosen as one of the sites of instruction for The Knee Society John N. Insall Traveling Fellows and The Hip Society Rothman-Ranawat Traveling Fellows, the world s top knee and hip surgeons who pursue further study at internationally recognized centers of excellence. Center surgeons have trained hundreds of surgeons throughout the world in the latest techniques and methods for joint replacement. They also participate in numerous research studies to improve implants and joint replacement techniques and publish research articles regularly in medical journals.

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6 Starting out HEALTHY A joint is a junction where two or more bones meet. Each type of joint is responsible for specific functions and movements. The hip, for instance, is a ball-andsocket joint, and the knee is a hinge joint. When the joints of your body are in good condition, they are incredibly strong structures. In fact, when you lift a box weighing 20 pounds, your hips are carrying three times the weight of that box, a full 60 pounds! Even more weight is carried through your knees. When lifted, the same 20-pound box places six times its weight, a hefty 120 pounds, through your knees. The knee, the largest joint in the body, is formed by the tibia (shin bone), the femur (thigh bone) and the patella (kneecap). The ends of each bone are covered with a layer of cartilage which cushions and protects them from each other. Surrounding these structures is the joint lining, called synovium, which produces a moisturizing lubricant. Tough fibers, called ligaments, connect the bones of the joint, keeping them aligned and balanced. Muscles and tendons also play an important role in keeping the joint stable. The hip joint forms where the femur meets the acetabulum (the socket of the pelvic bone). The top of the thigh bone is ball-shaped and fits snugly in the socket. Like the knee, the bones of the hip joint are covered by a layer of smooth, shiny cartilage and enveloped by the synovial lining. Ligaments connect the bones of the joint and hold them in place while adding strength and elasticity for movement. Muscles and tendons provide support.

7 femur knee cap What s SLOWING you down cartilage tibia fibula HEALTHY KNEE knee cap When our joints are in good working condition, we generally don t give them a thought. Problems arise when a joint becomes damaged from wear, injury or disease. Arthritis is one of the main causes of joint damage. It can afflict men or women of any age, social, racial or economic group although research indicates women may be slightly more prone to acquiring the disease than men. It is estimated that 37 million people in the United States have some form of arthritis. Of the more than 100 types of arthritis, the following two are most common. OSTEOARTHRITIS, sometimes called the wear and tear disease, can result from injury or overuse of a joint. In osteoarthritis, the layers of cartilage and synovium become damaged and wear away. When this happens, the bones of the joint are left unprotected from each other. During movement, bone begins to grind on bone, resulting in serious joint deterioration. Osteoarthritis typically remains isolated in the joint in which it originates. However, just as injury and overuse can occur in more than one joint, so can osteoarthritis. Symptoms include joint pain, stiffness and swelling. RHEUMATOID ARTHRITIS is considered a systemic disease because it may attack any or all joints of the body. Experts believe damage occurs because the synovium is tricked into producing chemicals that attack and destroy the protective cartilage and the joint surface. Generally, if the right knee is affected, so is the left. If the center fingers of the left hand are affected, so are the same fingers of the right hand. Symptoms may include fever, general weakness, swelling, inflammation and joint pain. damaged cartilage prosthesis pelvis ARTHRITIC KNEE KNEE REPLACEMENT femur damaged cartilage HEALTHY HIP ARTHRITIC HIP prosthesis HIP REPLACEMENT

8 Know YOUR options Whatever the cause of joint damage, the area surrounding the joint reacts by becoming inflamed, stiff and painful. This condition can result in chronic pain and serious disability, especially when it occurs in the hip, knee or shoulder. Because of the pain and stiffness, you may not use the affected joint as you normally would, causing the muscles surrounding the joint to weaken. This makes it even more difficult to move without pain. Treatments and prescriptions to reduce the swelling and pain associated with severe arthritis are available. And for a time, these measures may help to keep you active enough to participate in the activities you enjoy. However, if your pain is not relieved by rest, pain medication or a combination and if you find it difficult to walk even short distances or climb stairs, you owe it to yourself to investigate other treatment options. Total joint replacement has been proven an effective surgical treatment for people who suffer from severe arthritis. The surgeons and specialists at the Center for Hip & Knee Surgery and your family physician will be happy to discuss total joint replacement with you. It may be one of the nicest things you ve ever done for yourself and result in a giant step forward for you.

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11 The COMFORT factor Education is an important part of your health care. Those considering total joint replacement at the Center will spend a day learning about the total joint replacement process and what it will mean on a personal level. Your physician and a nurse educator will discuss the total joint replacement procedure and explain any complications and the possibility of those occurring. You also will receive a binder of information to take with you that covers the joint replacement process from beginning to recovery. An internal medicine physician will perform a preadmission exam to evaluate your medical conditions and help to ensure your safety for total joint replacement. A social worker is also on staff to discuss any concerns or questions you may have during your stay at the Center for Hip & Knee Surgery. All along the way, you will meet nurses, doctors, physical therapists and other staff members, who are dedicated to helping you return to a more active lifestyle as a result of total joint replacement. And you ll be encouraged to ask questions throughout the process to ensure that you feel informed and secure about your treatment. BE SURE TO ASK QUESTIONS Here are just a few of the initial questions you may want to ask as you consider whether total joint replacement is the right choice for you: What is the surgeon s experience? Studies have shown that surgeons who perform specific procedures more often tend to do them better. You should specifically ask how many procedures are done annually at the hospital you are considering and how many of those procedures are done by your surgeon. The Center for Hip & Knee Surgery performs about 2,500 total joint replacements annually. What kind of specialty training does the surgeon have? All the surgeons at the Center for Hip & Knee Surgery are fellowship or specialty trained in total joint replacement surgery (a fellowship involves very intense study in a specific area). What are the alternatives to the surgery you are considering? Ask what conservative measures, such as medication, you could use to avoid surgery and yet improve your condition. Surgery should be recommended only after all conservative measures have failed to improve the condition. Our goal is to provide the most accurate, current information possible to enable you to make educated, informed decisions about your health care. We believe that the more informed patients are, the more success they will have in their treatment and recovery process.

12 TRUST the experts Having performed approximately 40,000 total joint replacements at the Center for Hip & Knee Surgery, our surgeons have been able to generate a substantial body of research. In fact, the Center is a national leader in collecting outcome data thanks to our extensive 30-year database of joint replacement procedures. Our research findings have made it possible for the Center to achieve improved results through constant advancements in technique and technology. In addition, our surgeons are all specialty trained in total joint replacement surgery and are leaders in their professional organizations. They are actively involved in researching, exploring and studying the various aspects of total joint replacement, constantly working to improve results and quality of life for their patients. This considerable expertise has led to the publication of hundreds of research articles, in nationally respected medical journals, by the Center s physicians on a variety of joint replacement and orthopedic topics. The Center for Hip & Knee Surgery has become a model for other orthopedic centers throughout the United States and worldwide. Each year, more than 200 visiting orthopedic surgeons from around the world visit the Center to study our highly successful surgical procedures. What does all of this mean for our patients? Research conducted at the Center shows that total joint replacement surgery significantly improves an individual s general health and quality of life. Patients feel that their mobility greatly increases and that they have more energy. Their mental outlook greatly improves and they experience a new outlook on life. These results occur as soon as six months after the surgery and continue for years afterward. WE PERFORM:» Difficult revision procedures referred to us from other orthopedic surgeons because of our expertise and proven results.» More bilateral total replacements than any other facility in Indiana. (This is when two joints are replaced at the same time, which eliminates the need for two separate hospitalizations and two recovery periods.)» Hip, knee and shoulder arthroscopy; ACL reconstruction and shoulder implants in appropriate patients.» Partial knee replacements, where the arthritis is confined to a single part of the knee. The healthy part of the knee is left alone. This approach results in less blood loss, less pain after surgery and a quicker recovery.

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15 What to EXPECT During the total joint replacement procedure, your surgeon will remove the ends of your damaged joint and replace it with a man-made prosthetic joint. The prosthesis is designed to function just as your natural joint did when it was healthy. The artificial knee joint is made of three components like the natural joint. Two of the synthetic components securely fit over and into the top end of the tibia (shin bone) and the bottom end of the femur (thigh bone). The other component fits behind the kneecap. The parts of the prosthesis form a new joint, allowing a return to near-normal activities. The entire procedure is usually completed in less than two hours. Afterwards, patients return to their rooms to begin rehabilitation and physical therapy. Although there is initial soreness from the procedure, some people find that the arthritic pain they once experienced has been dramatically reduced or eliminated. With new technology and pain-management techniques, most patients are able to go home the day after surgery, and some may even go home the day of surgery. Your surgeon will decide what is right for you based on the complexity of your surgery and other medical conditions you may have.

16 Regaining your STRENGTH As any total joint replacement patient will tell you, physical therapy is hard work, but worth the effort. During recovery, you will work closely with therapists and nurses to improve your muscle coordination and strength. Even with your new joint in place and decreasing pain, you may limp for a time because the muscles surrounding the new joint are weak from non-use. The reason is simple. Because you experience pain when you move a damaged joint, you don t move it as much or as often. When a hip or knee joint is damaged, you limp, using your strongest leg to support most of your body weight. It s your body s way of protecting an injured joint. With your new joint in place, your muscles must be retrained and strengthened so they can assume their rightful jobs of weight-bearing and movement. Our physical therapists explain and demonstrate how muscles work together to create specific movements. Your new joint, like your healthy, natural joint, will flex, rotate and glide to carry you smoothly through the motions of everyday living. During your stay, you probably will get to know your nurses on a first-name basis. They are skilled in working with total joint replacement patients. Assessing and anticipating your needs is their top priority. Our nurses monitor and evaluate your progress while providing top-level care. With the press of a button, they will be at your side to offer medical care, assistance and encouragement. Our team will guide you through your rehabilitation, hand in hand, step by step. Because our concern for you does not end when you leave the Center, we teach you how to care for yourself once you return home. We stress the importance of keeping your post-surgical appointments, even if you re experiencing a smooth recovery on your own. Staying in touch with your surgical and rehabilitation team enables us to track your progress and manage potential problems as they arise. Together, we can help ensure that you ll grow stronger every day following your hip or knee replacement surgery.

17 What do you want to do NEXT If you suffer from painful arthritis of the hip, knee, shoulder or elbow, it s important for you to know that help is available. By consulting your family physician and the Center for Hip & Knee Surgery, you re already on the right track for proper diagnosis and treatment of your joint problems. Our specialists are here to discuss which treatment options are most appropriate for you. Relief from the problems caused by arthritis and other joint disorders is as close as the Center for Hip & Knee Surgery facility. If you re ready to find out if total joint replacement can help you, we invite you to contact our expert staff anytime. They can help set up an appointment, answer your questions about total joint replacement or simply provide more information about the Center. It s the first step toward getting back to whatever it is you want to do next! Call (317) or toll free (800) Or visit us at CenterForHipAndKneeSurgery.org.

18 MERRILL A. RITTER, MD, FOUNDER, CENTER FOR HIP & KNEE SURGERY Dr. Ritter is an internationally respected lecturer, teacher and researcher who has presented intra-operative instruction throughout the world. He has published hundreds of professional articles and given numerous presentations. Dr. Ritter studied in England with Sir John Charnley, master surgeon and pioneer of the world s first workable total hip replacement. Dr. Ritter s past experience includes: Founder of the Center For Hip & Knee Surgery Professor of Orthopedic Surgery, Indiana University School of Medicine Clinical Professor of Orthopedics, Louisiana State University Medical Center Dr. Ritter is president of Operation Walk Mooresville. Operation Walk brings the gift of mobility and relief from pain to the destitute people of third world nations. He and a team of surgeons, internal medicine specialists, physical therapists, bio-engineers, nurses (many of whom are staff members) and others bring care and hope to some of the poorest citizens of the world. E. MICHAEL KEATING, MD, SURGERY EMERITUS RETIRED Dr. Keating is a graduate of the Louisiana State University School of Medicine where he also completed his internship and residency training. He is board certified in orthopedic surgery. Dr. Keating specializes in total joint replacement and has received national acclaim for his research on the hip and knee. His findings have been published in many medical and surgical journals. He has traveled worldwide training surgeons in the latest techniques. Prior to joining Joint Replacement Surgeons, Dr. Keating was associate professor of orthopedic surgery at the Louisiana State University Medical Center.

19 Carmel Office to Airport 29.5 mi., 38 min. Carmel Office to Mooresville 33.7 mi., 45 min. Joint Replacement Surgeons CARMEL H Franciscan St. Francis Health-Indianapolis Center for Hip & Knee Surgery MOORESVILLE Mooresville Office to Airport 10.7 mi., 22 min. MOORESVILLE 1199 Hadley Road Mooresville, IN (317) (800) FranciscanHealth.org/chks 4 mi 4 km CARMEL B N. Meridian St. Suite 325 Carmel, IN (317) (800) inspiring health *Franciscan Physician Network physicians and independent physicians choose to practice at Franciscan St. Francis Mooresville Center for Hip & Knee Surgery