CONCENTRATING ON INNOVATION AND RECOVERY TECHNIQUES, SIUH IS ON THE CUTTING EDGE OF ARTHROPLASTY
BY JESSICA JONES-GORMAN • PHOTOS BY AMESSE PHOTOGRAPHY
As generations of Americans continue to age gracefully and greater attention is placed on health, wellness, and nutrition, the overall life span of the U.S. population is increasing – it’s even estimated that by 2030, 19% of U.S. citizens will be age 65 or older.As a result, more importance has been placed on physical maintenance, and the number of total joint replacements is rising dramatically. At Staten Island University Hospital, the Total Joint Replacement Team is constantly evolving to meet this need.
“Total joint replacement is constantly changing, and there is so much innovation in terms of the design of the implants and the materials we are using,” noted Dr. David Drucker, director of SIUH’s joint replacement program, who has been with the hospital since 1991. His areas of focus include revision of hip and joint replacement, total joint replacement for hip and knee, arthroplasty, prostheses, and hip and femoral resurfacing.
“Hip and knee replacement surgeries are two of the best operations in all of medicine,” continued Dr. Drucker. “As a doctor you can immediately witness the patient’s improvement in quality of life. These are life-changing procedures.” Detailing improved anesthesia and pain management techniques, Dr. Drucker spoke about significant improvements in patient recovery.
“Years ago, a four to five-day hospital stay and a subsequent week or two in a rehab facility were common after surgery,” he said. “Now, 85% of patients go directly home, and all patients are on their feet the same day of the procedure.”
Offering a wide range of comprehensive nonsurgical and surgical approaches to ease or halt arthritic pain, SIUH’s Joint Replacement Team treats everything from minor aches to major injuries. Averaging more than 400 procedures annually and recognized for excellence in orthopedic care, the department introduced its Enhances Recovery After Surgery (ERAS) program several years ago to reduce recovery times and essentially eliminate narcotic usage.
“Our ERAS technique dramatically improved the metrics of this program,” said Dr. Drucker. “Length of stay went from just under four days to under two, and the percentage of patients going home instead of to rehab increased to almost 90%.”
Under the ERAS umbrella, patients undergo extensive examination prior to surgery for health risks like diabetes, sleep apnea, depression, anemia, narcotic use, smoking, and weight reduction – all conditions which can impact recovery. Patients are also encouraged to attend educational classes to reduce anxiety that often precedes a surgical procedure.
Avoiding the use of post-op opiates because of their undesirable side-effect profile, the team instead makes use of local infiltrative analgesia which blunts pain, has minimal side effects, and results in earlier discharge. Dr. Drucker’s surgical staff also utilizes preemptive multi-modal opioid therapy – Tylenol, non-steroidal anti-inflammatories, steroids, and Neurontin – which is distributed around the clock before the patient experiences any pain after surgery.
“The medical field in general has used a disproportionate amount of narcotics because surgeries are painful,” noted the doctor. “But those narcotics have created a ton of complications – nausea, lightheadedness, increased hospital stays, and of course addiction. Since introducing this multi-modal approach to pain – controlling it before the patient even enters the OR – we’ve seen much success.”
Patients immediately receive physical therapy on the day of their surgery to help lower the risk of blood clots and foster a quicker recovery. A post-discharge Nursing Leadership call-back process focusing on education, discharge instructions, and pain management has also greatly improved the patient experience.
“The hospital has made a significant investment in infrastructure to make this a true Total Joint Replacement Program,” said Dr. Drucker. “We’ve implemented monthly huddles with the PAST, AmSurg, OR, and PACU teams and distribute academic articles and educational materials to the nursing units for their reference. We also update staff on performance improvement outcomes and program initiatives.”
Together with Dr. Jules Hip-Flores and Dr. Yevgeniy Korshunov, both board-certified orthopedic surgeons who also specialize in joint replacement, Dr. Drucker works to establish excellent protocols, explore techniques, and share ideas that would be beneficial to their patients.
“I honestly love the technical aspect of surgery,” said Dr. Hip-Flores. “It’s extremely satisfying to replace a joint that’s not functioning properly and offer a patient immediate relief. These are surgeries that people do well with from day one. Joint replacement almost immediately resolves many pain and mobility issues and patients quickly move onto the road to recovery.”
Dr. Hip-Flores, who earned his bachelor’s degree from Rutgers University and attended medical school at UMDNJ, served as a major in the U.S. Army Reserve and worked as an orthopedic surgeon in different hospitals and clinics throughout Afghanistan before going into private practice.
Dr. Yevgeniy Korshunov, who graduated magna cum laude from the University of Nevada with a B.S. in biology and received his medical degree and completed his orthopedic residency training at SUNY Downstate Medical Center in Brooklyn, completed his adult reconstructive fellowship at Lenox Hill Hospital. Specializing in reconstruction of the hip and knee, he is proud to offer these advanced surgeries in his home borough.
“Having these innovative procedures right here in Staten Island is a major advantage for the residents of this borough,” Dr. Korshunov said. “Patients receive the best care possible and benefit from the collaboration of this talented team of doctors, nurses, and caregivers.
And during the pandemic SIUH expanded their orthopedic surgery options even further, relocating all joint replacement services to the South Site and implementing changes to make patients feel safe and comfortable about their surgery.
“We intentionally moved all of our surgery to SIUH South, the hospital’s Prince’s Bay Campus,” Dr. Drucker said of the hospital’s relocation of the Orthopedic Center of Excellence.
“SIUH South is a COVID-contained hospital so prior to admission, all patients must test negative for COVID-19 and of course all of the safety measures you find elsewhere – sanitizing, masks, and social distancing – are also in effect. Our pre-op patient education is taught online.”
The transfer of services is just one of the network’s focused moves to build upon the Joint Replacement Program.
“We have wonderful support from the administration here at SIUH,” explained Dr. Drucker. “In the coming months and years we will only continue to grow this program.”
Northwell Health Physician Partners
Orthopaedic Institute at Richmond Road / 1551 Richmond Road, Suite 1A
Todt Hill / 718.727.6945 / siuh.northwell.edu/orthopaedics