Knee Replacement Success

A knee replacement was needed—but it wasn’t the first time. Years before, he had undergone a knee replacement in the other leg—and it was incredibly painful. This time he was determined to do something about that pain. So for his next knee replacement he chose Desert Regional—one of America’s 100 Best Hospitals for Joint Replacement according to Healthgrades.

Just one day after surgery at Desert Regional, Claypool was on his feet. “I mean walking in 24 hours unassisted is just unbelievable,” he said. “It’s amazing.”

Steve Bigley – Hip Replacement

Desert Regional Medical Center is the only hospital in the Coachella Valley with Disease Specific Care Certification for hip and knee replacement from The Joint Commission. Achieving this certification is a voluntary process in which the hospital submitted outcome data including length of stay, complication rates and management protocols for rigorous review which demonstrated compliance with the highest national standards in joint replacement.

An independent, not-for-profit organization, The Joint Commission accredits and certifies more than 20,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards. Desert Regional also has earned Joint Commission Disease Specific Care Certifications for its programs in stroke and congestive heart failure treatment.

"The Joint Commission National Quality Approval" sticker.

The average hospital stay for hip and knee replacement patients at the Joint and Spine Pavilion at Desert Regional Medical Center is just two nights. Some patients only stay one night and check out the next afternoon.

“We have geared our program to promote rapid recovery,” said Douglas Roger, MD, Medical Director of the Joint Replacement Program at the Institute for Clinical Orthopedics and Neurosciences at Desert Regional Medical Center (ICON). “We know that patients do better at home, recovering in their own, comfortable surroundings.”

There are several reasons today’s patients can go home sooner than they once could. Among these reasons are minimally-invasive surgical techniques, multimodal pain management – focusing on preventing pain before it starts and minimizing narcotic use, on-site rehabilitation and a dedicated team of orthopedic nurses and physical therapists. The less-invasive surgical techniques the ICON surgeons use not only allow for a shorter hospital stay, they also contribute to the need for less pain medication and a quicker return to activities.

“This is our second full season in the new Joint and Spine Pavilion. It’s a much more wellness-oriented environment,” said orthopedic surgeon Louis Stabile, MD who has performed more than 600 anterior-approach, minimally-invasive hip replacements. “The rooms are ergonomically designed for the patients with wheel-in and wheel-out showers and there are circular railings in the hallways and no carpet which makes it easier to use a walker. Seeing other patients up and walking around also breeds healthy competition and just encourages people to go, go, go.”

Steve Bigley, 51, of Palm Springs had both hips replaced by Dr. Stabile this past year.

“Younger people do not present such a physical challenge, but you need to be concerned about the longevity of their implants,” said Dr. Stabile.

“In Steve, I used a ceramic head with a low-wear, highly cross-linked polyethlene plastic liner. These combinations wear about a half-millimeter every 10 years. So, theoretically, his joint replacement can last 100 years,” said Dr. Stabile.

“I was feeling pretty old last year,” said Bigley. “I used to be very active. Over the years, I’ve had to cut out running and hiking and had to modify my golf swing. The only thing I was still able to do was bike. Then last winter, it got so bad I couldn’t even turn the pedal. When I couldn’t bike anymore, I knew it was time to get new hips.”

“The recovery was great,” said Bigley. “I went back to work in three weeks with no cane, no walker and driving myself. As far as exercise, I went back to the gym on day 11.”

Prior to his second hip replacement, he went on a few hikes to try out his new hip. “I hadn’t done any hiking in years. I wanted to see that I did the right thing. Is the joint good? The hike was a good test.”

The recovery on the second hip has been a little slower for Bigley. “But I’m back on my bike and I occasionally commute 26 miles roundtrip to work,” he said. “When I got home from a recent commute, I told my wife ‘it felt smooth, like butter spinning the pedals.’ It was like going back years.”

Paul Reeves, 53, of Desert Hot Springs, made the decision to have a total knee replacement this past year by Dr. Roger who has performed more than 2,000 less-invasive total knee replacements at Desert Regional Medical Center to date.

“I’ve had moderate arthritis for a while and it finally got to the point when it was so painful that I could hardly get around,” said Reeves. “It’s in both knees, so I’ve only had one done so far.”

“Everything was just absolutely fantastic the way I was treated,” he said. “I haven’t spent any time in a hospital that I can remember and it was a very pleasant experience, really.”

Reeves was standing a few hours after surgery, walking some and by day two, he was doing laps around the nurse’s station. As he passed by another patient walking, he would call out encouragement sharing the contagious spirit that flows throughout the floor. “‘Go get ‘em girl,’” he said. “That’s seemingly the whole attitude of the floor – Go get ‘em, get out of here and get back to life.

Steve Garvey – Hip Replacement

Steve Garvey standing with his family.Home Run

By Mona de Crinis
By Erika Z. Byrd
Photography by Mark Davidson

Having played in 1,207consecutive Major League games, both for the Los Angeles Dodgers and the San Diego Padres, baseball great Steve Garvey earned the nickname “The Iron Man” for setting the National League record.

Today, the strength of this 10-time All-Star athlete also comes from titanium – DePuy titanium hip implants, to be exact.

In 1998, at age 50, Garvey had his left hip replaced via a traditional posterior procedure at UCLA Medical Center. In 2010, the years of professional baseball, along with general wear and tear, had finally affected his right hip, as well.

Having visited the desert for years, Garvey and his wife, Candace, and their three children – Ryan, 17, Olivia, 16, and Sean, 11 – moved to the desert full time in 2004. Garvey could have returned to UCLA or gone anywhere else for his hip surgery.

Steve Garvey and his wife.

The Institute of Clinical Orthopedics and Neurosciences (ICON) at Desert Regional Medical Center offers comprehensive orthopedic and neuroscience services, from diagnosis to treatment, under the direction of specialty-trained, board-certified physicians. Garvey underwent the procedure in July.

“At 61, Steve Garvey is still quite a physical specimen,” Dr. Stabile, Garvey’s orthopedic surgeon, notes. “He has done great following surgery and has a full range of motion in his right hip. I walked out of the OR very confident that he would be able to do whatever he wants to do following recovery”

The advantages of anterior over posterior hip replacement include a smaller incision and a faster recovery time, as the former does not involve cutting muscles or tendons to insert the implant. Patients are able to resume an active lifestyle and get back to the sports and hobbies they enjoy, with little to no limitations on their mobility.

“After the operation, I was in my room for about an hour and a therapist came in and asked ‘Are you ready?’ And I said, ‘For what?’ ‘To do some walking, if you can” Garvey recalls. “So Candace and the therapist got me up; and by the third step, I remembered the feeling I had after my first operation about the pain being gone. I walked 100 feet out and back. Then later, I did another lap; the next day, two or three laps; the following day; three laps. Then I left the hospital. I just walked out. I had no need for a cane or walker.

The therapist came to my home three to four times over the first two weeks, along with a nurse. Then I said, ‘I don’t need you guys anymore.’ By the third week, I was driving.”

A month following surgery, Garvey began lifting weights and exercising on an abductor machine. “I never had any real pain, just some aching” he says. “But that’s pretty normal for major surgery. At one month out this time, I was probably where I was with my previous hip surgery at about two and a half months.”

Garvey’s advice for people considering hip replacement is to have it done sooner rather than later.

Steve Garvey emitting confidence.

“There’s never a good time to do this,” he says. “Even in the summer, we have a lot of activities. I was going to put the surgery off until after Labor Day, but then I had a speech to give back east and then there’s [my stepdaughter’s] wedding, so I found two weeks when I didn’t have to fly and said, ‘Let’s do it now.’ It was a very good decision. It positively affects what I can do for the family – my ability to be a husband and father. It’s important to be conscious as an older dad and be sensitive to what your body tells you. I’d like to get another 25 to 30 years out of this body.

“This new procedure is less invasive. There’s very little pain, per se. The recovery time is significantly shorter than the posterior procedure; and your quality of life will increase significantly. Those four factors should convince anyone who is experiencing hip pain to make the decision, not only for them, but also for their family,” Garvey says.

“I’ve been on world championship teams, and the job [Desert Regional Medical Center] did was a world champion experience for me. It couldn’t have been a better experience. I highly recommend this procedure to others.”

Garvey not only amassed an illustrious baseball career, but also escaped the rigors of professional baseball with incredibly few injuries. “I had a hamate [bone] fracture and a torn ligament in my left thumb from sliding into home plate,” he says. “I also ruptured a tendon in my biceps and got hit in the chin once, and that required 22 stitches.” Years later, his left hip gave out.

A four-time winner of Major League Baseball’s Gold Glove, the former first baseman now dons a golf glove. He is a member of Indian Wells Country Club and plays golf in numerous corporate outings and charity tournaments. He also hosts the Steve Garvey Celebrity Softball Classic tournament in Los Angeles in July benefiting Lou Gehrig’s Disease.

A sought-after motivational speaker, Garvey is a hit with corporate audiences who enjoy hearing about his baseball days and the sports analogies he’s applied from success on the field to the corporate world and even to the game of life itself. His book – My Bat Boy Days, Lessons I Learned from the Boys of Summer –summarizes his key principles.

In addition to corporate speaking engagements, he runs Garvey Media Group, capitalizing on the connections he’s made over the years. He serves as a marketing consultant for several high-profile clients, including California Pizza Kitchen and Natural Balance Pet Foods. For the latter, he’s been busy working on a Rose Bowl Parade float, a blimp, and promoting Bark in the Park events at ballparks around the country. Bark in the Park allows dog owners to bring their dogs to the stadium to enjoy a pup rally, pup parade, prizes and an evening of baseball for charity. The Garvey’s English cocker spaniel, Charolette, even got a little air time this year, appearing with him on a Los Angeles news broadcast.

This year’s Bark in the Park at Dodger Stadium was held just a month after Garvey’s hip surgery. Part of his hosting responsibilities including walking Tillman, the famed skateboarding dog, onto center field and posting for photos. “The question was whether I’d be able to walk Tillman out,” he says, “but I could have done that easy two weeks after the surgery.”

Steve Garvey and his wife on a couch with their dog.

Garvey’s fitness routine involves exercising three to five days a week: stretching, weight lifting, stationery bicycle, golf, and occasional tennis. “[Good health] is a balance of eating properly, fitness, weight training, spending as much time with your family as possible, and laughing a lot,” he says.

The entire Garvey family is very athletic. “Candace is a good tennis play and skier. It’s not just dad’s genes. Speed comes from mom’s side of the family,” Garvey says. “All the girls have played volleyball and swim and ski. Sean is playing football for PDLQ Peewees and a traveling baseball team called the Desert Longhorns. Olivia is a Palm Desert High School varsity cheerleader and plays softball. Ryan plays varsity baseball for Palm Desert and several colleges and a few pro teams are interested in him; but it’s still a little early for that,” Garvey says.

Besides a swimming pool and fitness room, the Garvey home has something you find in your typical desert home; a batting cage. With three school-age children, along with visits from the Garvey’s grown children, the home bursts with activity.

“We’re the house for a lot of our kids’ friends and their teammates to hang out at, and we like that,” Garvey says smiling with pride. “We have a simple philosophy. We’re a Christian, loving family that believes we’ve been blessed and it’s important to give back to our community.” Garvey acknowledges that having a highly visible name from the world of sports helps.

“We try to do as much as we can,” he says.

Susan Jo Paquin – Hip Replacement

Susan Jo Paquin speaking to a medical professional.

How do you perform a hip replacement for less pain and for a faster recovery? That’s the question that orthopedic surgeon Dr. Douglas Roger asked himself. As the Director of the Joint Replacement Program at Desert Regional’s Institute of Clinical Orthopedics and Neurosciences, Dr. Roger has been performing minimally invasive total hip arthroplasty for many years. In his quest to provide even better results for his patients, he developed a new technique called the Direct Superior Approach.

To achieve less pain and a faster recovery, he focused in on the trauma produced during surgery. “The way to achieve this is by decreasing muscle trauma and soft tissue trauma during the surgery while still being able to fully visualize the hip to complete the surgery successfully,” he said.

Dr. Roger has been exclusively performing the Direct Superior Approach for hip replacement for the past five years. To date, he has performed more than 600 hip replacements with this new minimally-invasive approach. But his own surgeries are only the beginning. Dr. Roger also teaches this technique to other surgeons around the country.

There are many benefits of the Direct Superior Approach including:

  • Less muscle/tendon damage
  • Lower dislocation rate
  • Lower dislocation rate
  • Less blood loss compared to traditional hip replacement
  • Faster recovery
  • Shorter hospital stay
  • No post-surgical precautions

The Direct Superior Approach involves one small incision, minimal muscle trauma, and one small tendon detachment – the conjoined tendon – which is then reattached, to obtain access to the hip socket. This procedure spares the iliotibial band (IT band) that runs from the iliac crest of the pelvis along the lateral part of the thigh to the outside of the leg. The access point to the hip is through separation of the fibers of the gluteus maximums. Compare this to traditional hip replacement where all six of the external rotator muscles are cut.

“You have to be able to get in and out of the hip joint by disturbing as few of the important structures as possible,” said Dr. Roger. “We’re trying to preserve the tissue which makes the hip more stable and virtually eliminates hip dislocation.”

In developing this technique, Dr. Roger worked with a biomechanical engineering company to design and patent about a half dozen curved retractors, angled reamers and other instruments. According to a 20ll article in Clinical Orthopaedics and Related Research, the average postoperative Harris Hip Score was 96.5, there were no dislocations, no sciatic nerve palsies, no wound complications and low transfusion rates (8%).
Following development of the instrumentation, Dr. Roger began collaborating with Dr. Anthony Hedley of the Hedley Institute in Phoenix, AZ. Soon, surgeons from around the country became interested in learning his technique – including surgeons from the University of California at San Francisco, the Mayo Clinic in Rochester, MN, and Washington University in St. Louis, MO.

Another relatively new minimally-invasive approach to hip replacement that has gained popularity over the past decade is the Direct Anterior Approach. In 2014, an assessment of the two approaches was done by an independent evaluator from the Mayo Clinic, and the findings showed that the Direct Superior Approach produced 60 times less muscle damage during the surgery compared to the Direct Anterior Approach.

Susan Jo Paquin of Palm Springs has seen the results firsthand. She had her left hip replaced via a traditional open procedure by another surgeon in October 2013. She had her right hip replaced by Dr. Roger via the Direct Superior Approach just a few months later in June of 2014.

“It’s interesting to have this other surgery and the comparison to this one,” said Paquin. “I woke up and asked, ‘Did he do the operation?’ I had no pain.”

“In 10 days of this recovery, I am feeling better than four months of my other hip,” she said.

“I was up and walking the next day after the surgery,” she said. “I was thrilled.”

Paquin also appreciated that the right hip only has a small scar on the right buttock. “The other scar was vertical and goes five inches below the panty line. It’s not that I’m a Victoria’s Secret model, but I swim and I’m not at the skirt stage of bathing suits.”

Desert Regional Medical Center has received Joint Replacement Certification by the Joint Commission – an independent organization that accredits and certifies more than 20,000 health care organizations and programs in the United States. The hospital also received a specialty award from Healthgrades as one of America’s 100 Best in Joint Replacement.

Back in the Swing

Popular TV newsman John White got his groove back after undergoing anterior approach to total hip replacement at Desert Regional Medical Center

By Mona de Crinis
Photography by Elena Ray

TV NEWS ANCHOR JOHN WHITE leads a full and active life. He loves to golf, although concedes he’s hardly the world’s best. He likes to get out on the water, toss a line, and even race around on skis once in a while. He enjoys quiet strolls with his wife, puttering around the yard, and playing with his daughter. And he relishes the simple act of walking without a limp. Most of all, he’s elated that he is now able to be this active and pain free.

John White lining up his putt.

His renewed freedom was a few years in the making, since a freak accident left him with a broken hip — an uncommon injury for a 37-year-old otherwise healthy man.

In fall 2004, White was teaching his daughter to ice skate at the Ice Garden in Cathedral City. Once she was going solo, he decided to engage in some more ambitious athletics. “I started racing around the rink, and I caught an edge or something,” White recalls.“I went up in the air, came down on my hip, and had a right femoral fracture.”

Back then, doctors screwed his hip back together, and it felt fine for a while, he recalls. But the following year, he began feeling a lot of pain and was treated with ibuprofen and cortisone. “I was getting older by the day,” White says. “It got to the point where, going to a ballgame, I had to ask my family to drop me off at the door and have them park the car.” Walking had become difficult.

In October 2006, fed up with the chronic pain, White scheduled an appointment at Desert Regional Medical Center’s Institute of Clinical Orthopedics and Neurosciences (ICON).

John recalls how Dr. Stabile, his orthopedic surgeon, spotted the problem immediately. “He wasn’t even all the way in the room when he saw my X-ray and said, ‘Oh, that doesn’t look good at all! That’s a square peg going into a round hole.” Within 15 minutes, they had decided on total hip replacement. “John had broken the femoral neck and already had four screws in there,” Dr. Stabile says. “Sometimes when those injuries happen, the blood supply to the ball of the hip becomes disrupted, and occasionally that portion of the bone dies and causes what’s called ‘avascular necrosis.’ During the revascularization process, where your body tries to restore circulation, it weakens the bone, and the bone often collapses. You go from a spherical femoral head to a head that flattens. You end up with a flat head in a round socket.
White’s femoral head had already collapsed at that point. And that collapse can lead to arthritis and chronic pain.”

White received a hip replacement using the anterior approach — a minimally invasive procedure with far less downtime compared to the standard posterior approach.

The key to the anterior approach is that no muscles or tendons are split or cut during the surgery, thus reducing healing time. Using a special surgical table that precisely positions the patient — the PROfx table — surgeons can replace the hip through a single front incision without detaching the muscle.

There are minimal post-operative precautions or restrictions. Conventional hip surgery limits hip motion for six to eight weeks, in particular the flexing of the hip, which puts a decided cramp in daily activities.

Not so with the anterior approach, Dr. Stabile says. “You can bend and lean over. People tie their shoes the day after surgery,” he says. “Patients love that freedom where they can push themselves as far as their pain will let them.”

A medical professional examining an xray.

White knew only a few hours after the operation that he had made the right decision in choosing the anterior approach. “I could just tell getting out of bed, when I put my leg down and there wasn’t that ‘click.’ I knew right away, that first walk, that I was much better off,” he recalls.

White credits the pre- and post-operative care he received at Desert Regional Medical Center with making the procedure as palatable as possible. From preparation to discharge, doctors and staff considered his comfort. “The whole thing could not have gone more smoothly,” he beams. “I walked in and they were just waiting for me. It was like checking into a hotel.” Within 45 minutes of arriving, he was rolling into surgery.

A few hours later, around 1 p.m., they took him for a walk. “It was a walk with a walker and we just went up and down the hallway a little bit, but I was taking steps on my own weight within hours after the surgery. Everybody was very helpful.”

White even gives high marks to the physical therapist who made him go for a walk after a rough night. “It’s 6 or 7 in the morning and this physical therapist shows up,” he says. “I just looked at him and said, ‘No, we’re not going anywhere.’ But he had a good, positive approach and he got me up. That was probably the best walk I’ve ever taken in my life.”

After three days in Desert Regional Medical Center, White was released and continued physical therapy at home. He was on a walker for a few days, then on a cane for about a week. A month later, he was back on the golf links, as good as new — maybe even better. “I played well! I shot an 85. I’m not a great golfer, so that was a really good score for me.” It took about four to six months for his confidence to build to 100 percent.

John White on a golf car.

“But the day I put down the cane, which was only a week and a half or two weeks after the surgery, I was already 10 times better than I was the day I walked into the hospital,” White says.

Today, nearly three years later, John can do anything that he could before the hip replacement surgery. “Ninety-nine percent of the time, I don’t even think about it,” he says, “unless maybe I’m ice skating.”



The Anterior Approach

Minimally Invasive Total Hip Replacement

Many people suffering with arthritis, hip pain, and stiffness, whether degenerative or due to injury, have the option of choosing a minimally invasive procedure when hip replacement is the treatment of choice. One of the least invasive surgical options is the anterior approach, a technique that results in minimal pain and reduced recovery time. Using a special surgical table called the ProFx table, the surgeon can minimize trauma to the skin and muscle with precise patient positioning.

Anterior Approach

  • Allows surgeon to reach hip joint from the front (anterior) rather than the back (posterior) or side (lateral)
  • No detachment of muscle from femur or pelvis
  • Surgeon works through natural separation between muscles
  • Gluteal muscles are left undisturbed and, therefore, require no healing process

Special Surgical Tables

  • Used for anterior approach replacement of hips
  • Allows frontal access to hip with minimum tissue damage
  • Allows X-ray imaging during surgery for accurate control of implant placement and leg length
  • Total hip resurfacing
  • Hip pinning
  • Supine and lateral positioning

Advantages of the Anterior Approach

  • Average hospital stay: two to four days (conventional requires three to eight days)
  • Smaller incision: four to five inches (conventional requires 10 to 12 inches)
  • Less muscle trauma: no muscle cut from bone (conventional requires muscle cut from bone)
  • Faster recovery: two to eight weeks (conventional requires two to four months)
  • Reduced blood loss
  • Less trauma; faster healing time
  • Reduced risk of dislocation
  • More accurate leg length control
  • More rapid return to normal activities

A Physical Therapist’s View

John White in mid-swing while golfing.

The Anterior Approach

Lilia Angel Singh, PT, is a lead physical therapist at Desert Regional Medical Center who completes the initial evaluation on about 90 percent of total hip replacement patients at DRMC. In the four years she has worked at DRMC, she has witnessed firsthand the remarkable difference in ambulation and recovery time in patients who have undergone the anterior approach to total hip replacement as compared to conventional methods.

Singh’s detailed observations and treatment plans for post-operative hip replacement patients include the following points:

Treatment Plan and Observations for Anterior Approach

  • Patient seen three hours post-op, assisted out of bed, and allowed to perform as much as possible independently
  • On average, patients need minimal assistance to manage the hip
  • Sometimes able to lift legs off bed with minimal supervised assistance
  • Patient is walked as far as tolerated, usually from 50 to 300 feet, often with minimal pain
  • Patient is instructed in active range of motion
  • By day two, patient is almost off assistive devices
  • Patient works with therapist on training to walk with a normal gait
  • Patient is seen by an occupational therapist for training in activities for daily living
  • Patient is sent home usually with only a walker as an assistive device

Treatment Plan and Observations for Conventional Approach

  • Patient generally experiences greater pain in bed the day of the surgery due to extensive tissue trauma
  • Patient requires total to maximum assistance in getting out of bed, sometimes requiring two therapists
  • Day two, usually needs moderate to maximal assistance to manage the hip
  • Patient receives education on hip precautions
  • Abductor pillow is required; patient is advised to be extra cautious when getting to the edge of the bed
  • Patient is often only able to walk to door and back initially — perhaps 40 to 150 feet by the time of discharge
  • Patient often transitions from hospital to skilled nursing facility prior to going home
  • Patient requires several assistive devices at home

Post-Op Precautions for Anterior Approach

  • None

Post-Op Precautions for Conventional Approach

  • No crossing legs
  • No internal rotation of leg
  • No sitting on low surfaces or putting the hip at an angle greater than 90 degrees
  • Must use a special pillow while sleeping for up to three months