Joint Replacement Meant a World of Difference to Chatham Woman

Brenda Williams returned to her job in the Chatham County Soil and Water Department eight weeks after having both of her knees replaced at FirstHealth Moore Regional Hospital. Before her surgery, Williams was so impaired by the pain in her knees that she had to ask co-workers to run errands for her because she couldn’t climb the stairs in the building where she works.

CHATHAM COUNTY – Brenda Williams spent a week in the Center for Inpatient Rehabilitation at FirstHealth Moore Regional Hospital after having both of her knees replaced.

Four months later, after a follow-up appointment with her surgeon, she went back for a visit – on a day, as it happened, when several other joint replacement patients were in the throes of their own daily therapy sessions.

According to the two therapists who had worked with her earlier, Williams was eager to share details of her progress and happily illustrated how well she was doing by lifting a foot and bumping it against her backside while announcing, “See what I can do!”

This display of physical agility would have been an achievement for almost anyone, but it was especially notable for Williams. Just weeks before, the Chatham County grandmother and county department administrator was so impaired by her arthritic knees that every aspect of her life had begun to suffer.

“It was really affecting my life,” she says.

When quality of life becomes an issue
The 22-year department administrator of Chatham County’s Soil & Water Conservation program had been having knee problems for the better part of a decade. The right knee was the first to give her trouble, and then the left one began to act up as well.

Eventually, she developed a limp, a change in her condition that prompted her observant 6-year-old grandson to ask, “MawMaw, why do you wiggle when you walk?”

The “wiggle” was only part of Williams’ problem. The pain in her knees had become a quality-of-life issue that was affecting her both personally and professionally. She had begun to ask co-workers to run errands for her in the elevator-less Chatham County Agriculture Building where she works. She had her husband put blocks under their sofa so she could get up and down more easily. She was resorting to late-night moves from bed to sofa in an attempt to get comfortable.

During one especially revealing episode, her 92-year-old father-in-law offered her the loan of his walker when he noticed how difficult it was for her to get around.

“I was doing about as bad as he was,” she recalls.

The ultimate game-changer came when she realized that she was no longer enjoying her grandchildren as she once had.

Instead of taking the hand of her 2-year-old granddaughter and going outside to play, she was corralling her “Tomboy Diva” on a swing so she could stand in one spot and push. Instead of playing ball with her 11-year-old step-grandson, she was reduced to watching him play.

The diminishing return on the quality of their companionship convinced her that greater measures were necessary, and she began to think that knee replacement surgery was her best option.

Bilateral knee replacement surgery
On the recommendation of another physician, Williams sought out David J. Casey, M.D., an orthopedic surgeon with FirstHealth Moore Regional Hospital and Pinehurst Surgical. She was convinced that she needed surgery, but he wanted more information.

“You don’t let anybody operate on (just the basis of) your X-rays,” he says.

According to Dr. Casey, joint pain is often referred pain – discomfort that is felt at one site but is actually caused by a problem at another location. In Williams’ case, Dr. Casey wanted to rule out the possibility of a problem with her back before deciding to operate on her knees.

He also wanted to exhaust the various other treatment options that were available to her. “We have a successful surgery for (joint pain),” Dr. Casey says, “but it definitely should be a last resort.”

Treatment possibilities included medication, physical therapy, weight control and diagnostic testing. “I want to make sure (my patients) have tried all these options,” Dr. Casey says.

There was another reason that Dr. Casey wanted to delay Williams’ surgery for as long as possible: her age. At 56, she was younger than the average joint replacement patient, a factor that can mean the replacement part(s) will eventually need to be replaced – usually in about 20 years. Putting off surgery until the patient is at least 60 decreases that likelihood.

Williams’ obviously impaired quality of life – coupled with the cortisone shots that by relieving her pain helped identify the knees as the source of her problem – led to an “informed decision” to proceed with surgery.

Williams had hers in late January and immediately knew she had done the right thing. She was still in pain, but it was a “different pain” from the constant popping-and-cracking bone-on-bone aches that had kept her awake at night and on a regular routine of ibuprofen and ice.

In less than a week, Williams was ready for another step on her road to recovery.

Inpatient Rehabilitation
According to Dr. Casey, successful joint replacement surgery “is more than just the doctor; it’s the team.” Brenda Williams would certainly agree. The week she spent in the Center for Inpatient for Rehabilitation in Pinehurst wasn’t easy, but it helped her return to the lifestyle she had come so close to losing.

“I’ll rave about those folks,” she says about her inpatient rehab team.

Therapists Dana McLean, O.T., and Heather Fraley, P.T., recall Williams as an eager and motivated patient.

“She was ready to do whatever she needed to do,” says McLean. “She had a drive.”
 
As the occupational therapist, McLean helped Williams “troubleshoot the obstacles” that often hinder a patient’s return to an independent lifestyle after replacement surgery. They worked on getting in and out of the bath tub, reaching for items in a cupboard, climbing stairs.

Fraley, the physical therapist, had the down-and-dirty task of helping Williams regain the flexibility, strength, endurance and coordination she had lost over years of chronic pain, not to mention the trauma of surgery.

By the Friday of Williams’ inpatient rehab week, McLean and Fraley believed she was ready for discharge. Williams, however, was not so sure.

“She had met most of our goals, but she really didn’t have the confidence she needed,” Fraley says.

Williams puts it more bluntly. “I was scared to death,” she says.

By the end of the weekend, Williams realized they had been right, however, and she went home on Tuesday, for all practical purposes a changed woman.

“My husband says I’m a completely different person,” she says. “He says I had no patience, because I hurt all the time.”

Six weeks later, Williams was back at work, climbing stairs and no longer depending on others to make the two flights to the Finance Department for her. Soon she was able to fully enjoy her grandchildren again.

Dr. Casey and the therapists give a lot of the credit for Williams’ success to her personal motivation and hard work, and she is happy to share her success with them.

“The people in the hospital were so good to me and so kind,” she says. “I’m very pleased.”

Nearly 1,500 joint replacement surgeries were performed at a FirstHealth of the Carolinas hospital – either FirstHealth Moore Regional in Pinehurst or FirstHealth Richmond Memorial in Rockingham – between Sept. 1, 2011, and Aug. 31, 2012. Most were knee or hip procedures, but nearly 100 involved shoulder replacement. For more information on FirstHealth’s orthopedics program, call (800) 213-3284 or visit www.firsthealth.org/ortho.