What is Total Joint Replacement?  Joint replacement may be necessary when the cartilage that protects the hip, knee or other joint wears out.  This cartilage normally cushions the bone in the joint, absorbing shock and helping with movement.  When the cartilage wears out and the joint becomes inflamed and painful this results in arthritis.  The most common causes of this wear and tear are aging, heredity, past injuries, and increased body weight.  Joint replacement surgery is performed to replace all or part of the joint with an artificial implant, and is well proven to relieve the pain of arthritis and can greatly improve functional status and quality of life.  More than 1,000 total joint replacement (TJR) procedures are done annually through the Baystate Medical Center (BMC) Hip and Knee Replacement Program. 

A longstanding, well established multidisciplinary team has been in place to continually review and improve quality of care and satisfaction of patients undergoing TJR procedures.  Many changes have been implemented, such as mandatory pre-operative patient and family education, pre-operative surgical risk screening, standardized orders and plans of care, optimal antimicrobial prophylaxis and pain management, hypotension management, temperature control, improving operating room efficiency, appropriate selection and use of supplies/equipment, adopting new technologies, such as the Navigator Robot, and competitive prosthetic pricing.  In addition, several patient-centered projects and research studies have been completed, resulting in peer review journal articles and national presentations.

In 2010, BMC was once again recognized as a Premier “Top Orthopedic Performer” in Premier’s Hospital Quality Demonstration (HQID) Project.  Other notable accomplishments include being named a Baystate Health President’s Quality Award “Distinguished Performer” and designation as a “Top 10 Orthopedic Performer” by Premier.

Highlights

Baystate Medical Center 

• The “composite” score represents overall quality (how well BMC reliably provides all appropriate care), and has improved steadily since adoption of ending antibiotics within 24 hours, and is currently 100%.
• The composite score for the TJR population includes the following measures related to antimicrobial prophylaxis:
  • antibiotics given 60 minutes prior to incision, currently at 100%
  • appropriate antibiotic selection, currently at 100%
  • ending therapy after 24 hours (a past focus area) currently is 100%

• TJR complication rates have consistently remained below the national averages (Premier Perspective Comparative Database, University HealthSystem Consortium). 
• The 2012 rates for post-operative dislocation, physiologic and metabolic dysfunction, wound infection, and mortality remain below the national orthopedic benchmark of 3%, and in most areas are less than 1%.
• Intensive screening for risk of post-operative complications, changes in anesthesia selection, and optimal pain and anti-emetic control, as well as easy access to on-unit rehabilitation facilities, have allowed patients to actively participate in their recovery, resulting in a length of stay consistently below the national benchmark. 
• Patient satisfaction remains high, with scores comparable to or above the Professional Research Consultants (PRC) norm scores. 
• Discharging patients directly to home or home with services continues to be a goal of the program. 

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