Hip replacement surgery was inevitable for 77-year-old Peter Nowlan. An x-ray six years ago showed arthritis was at the center of Peter’s discomfort. At the time, physical therapy helped him feel better, but last spring, discomfort turned into pain and stiffness.
That’s when Nowlan recalled contacting his primary doctor care provider and saying, “I think it’s time.”
As a retired Vietnam War veteran, Nowlan was receiving care through the VA in White River Junction. However, the VA doesn’t perform joint replacement procedures. That sent Nowlan on an informational mission to find where he would receive the best care for his hip. He consulted with friends who had joint replacement surgeries and spoke with other local doctors.
Once Nowlan’s provider at the VA learned that he was a Randolph resident, the decision became pretty clear.
“My provider told me, you want Dr. Orem at Gifford,” Nowlan said. “Not just for his reputation, but for the convenience of Gifford’s location since my wife would be doing most of the traveling with me.”
Dr. Alexander Orem joined Gifford Orthopedics in 2017. He serves on the orthopedic faculty at Dartmouth Hitchcock Medical Center and the Geisel School of Medicine, a member of Dartmouth Health. Dr. Orem was a resident at Dartmouth Hitchcock Medical Center from 2009-2015. He returned there in 2016 following a one-year joint replacement fellowship in Boston.
At Gifford, Dr. Orem and his colleague, Brad Salzmann are performing about a dozen arthroplasty or joint restoring procedures a month.
“Joint replacement is something that spreads by word-of-mouth. Because we live in such a close community, if people know somebody who had a good outcome at Gifford, then they’re much more likely to want to come here,” Dr. Orem said.
Serving in an academic medical center like Dartmouth Hitchcock Medical Center and a rural facility such as Gifford gives Dr. Orem unique insight into the stresses each facility faces, but he is working to help both hospitals alleviate that pressure.
Capacity and bed count are at the forefront of issues plaguing hospitals throughout Vermont and the region. According to Dr. Orem, Dartmouth Health’s strategic plan over the last few years has been to move straightforward primary joint replacements to smaller community hospitals for safe and effective care. That allows Dartmouth Hitchcock Medical Center to handle the increasing number of complex and tertiary-level cases.
“It hasn’t built any more operating rooms. So, because of the limited space, we’re trying to move the cases that can be done safely elsewhere, reserving the operating time for patients who actually need that high-end level of care,” Dr. Orem said.
Another solution to the capacity issue is to perform more outpatient procedures. Tying up precious bed space with straightforward joint replacement surgery patients isn’t ideal. Dr. Orem says institutions are now changing their prior thinking on the effectiveness of outpatient joint replacement procedures.
“It’s been a silver lining that we’ve been trying to push for a long time,” Dr. Orem said.
This is encouraging for patients who live closer to these small, rural hospitals. Dr. Orem says they are more apprehensive about having an outpatient procedure at a facility that’s 30 minutes or more away from where they live, but a patient at Gifford can have the surgery and know they’re just minutes from home to rest and recover. Peter Nowlan was planning to have an outpatient hip replacement surgery at Gifford, but because he was having the procedure later in the day, the decision was made to keep Peter overnight and send him home the next morning.
“Having your joint replacement at Gifford is like flying out of Manchester or Burlington rather than driving to Boston to fly out of Logan International Airport,” Dr. Orem said. “The safety protocols, airplanes and crew are the same. But parking, security check-in and boarding is an overall less stressful experience in Manchester and Burlington.”
This solution to push more straightforward joint replacement procedures to smaller hospitals may call into question success rates. Surgeons at small hospitals may not have the experience needed to perform these procedures efficiently. Studies show that surgeons who perform fewer than 30 hip replacements a year had a higher number of patients requiring revision surgery. Gifford is fortunate to have
Dr. Orem, who performs over 100 hip replacements each year thanks to his work at Dartmouth.
“For that reason, there’s no medical or technical reason the vast majority of folks can’t have their surgery at smaller hospitals like Gifford, “ Dr. Orem said, “I tell my patients if I couldn’t do it safely and effectively here, I wouldn’t offer it to them.”
Peter Nowlan is doing well following his hip replacement surgery. He’s finishing up rehab and looking forward to walking pain-free. Nowlan credits Gifford for making him feel comfortable every step of the way.
“I understood what was happening,” Nowlan said. “My questions were answered. I could look at the nurse or provider and say, ‘What does this mean?’ That’s important.”
Peter Nowlan’s Journey Continues
Gifford’s role in Peter Nowlan’s replacement surgery didn’t stop with Dr. Orem. Following the procedure, Nowlan received rehabilitation therapy from Jim Pratson at Gifford’s Kingwood Health Center in Randolph. He started at the end of October 2022 with twice-a-week visits.
“Having local rehabilitation therapy is very important to most people in our area because of its convenience,” Nowlan said. “Everyone is very helpful and receptive.”
It takes Nowlan just five minutes to drive to Kingwood. Convenience is one of Gifford’s strong suits having rehabilitation therapy services available in Berlin, Sharon and White River Junction as well.
“When it comes to Gifford, if you walk into the hospital, if you walk into the physical therapy or any of the other clinics, they are actually happy to see you.”
When Nowlan had his annual physical at the VA following surgery, Gifford made sure his primary care provider had all of the necessary information from surgery and his ongoing rehab.