By Maryellen Apelquist
Native Randolph resident Teresa Bradley possesses many of the personality traits attributed to Vermonters. She’s hardworking, closely connected to her community, and stoic—that last quality at times giving way to stubbornness, as demonstrated by her decade-long reluctance to undergo surgeries to replace her arthritic knees. In 2017, after years of chronic pain, she decided she’d had enough, and turned to Gifford providers for help.
“My quality of life began to suffer,” said Bradley, who works full-time as Gifford’s purchasing specialist and part-time tending bar and working in the kitchen at Valley Bowl, owned by her brother, Wayne. When not at work, she spends summer weekends camping in Addison on Lake Champlain.
“The pain got to the point where even climbing up the steps to our camper was difficult,” said Bradley, who was diagnosed with rheumatoid arthritis 19 years ago. “I also have osteoarthritis. The bone-on-bone grinding is very painful, but you learn to live with it. I was told 10 years ago that I needed knee replacements.”
She isn’t alone. Joint replacements are on the rise in the United States, particularly among baby boomers.
“Hip replacements in the United States more than doubled between 2000 and 2014—from 160,282 to 371,605 a year—according to the most recent data from the Healthcare Cost and Utilization Project, which tracks hospital discharges. Knee replacements increased at an even faster clip in the same period, from 274,467 to 680,886,” reported The Boston Globe in an April 2018 article.
While Bradley waited a decade, she scheduled surgeries for both knees within about a year of each other. She had her first surgery on March 27, 2017; her second on April 2, 2018. She was back to work at Gifford six weeks after her second surgery, eager to share her experience and her take on Dr. Alexander Orem.
“He was awesome, right from the get-go,” Bradley said. “He’s just very easy to talk to, low-key, pleasant, down-to-earth, nonjudgmental, and just all-around nice.”
She describes her surgery and recovery as fast, and the outcome as life-changing.
“I was up walking by 1 or 2 p.m. the same day as my surgery, just as Dr. Orem promised,” said Bradley.
She went home the next day, started physical therapy in Sharon the following week, and admits to not always following doctor’s orders—or those of her husband, Gary.
“I felt so good,” she said. “I used no crutches, no walker, no cane. I wouldn’t have dared to do that with my first knee. My husband had our grandkids throwing me under the bus, telling them to report to him when I did more than I should.”
Bradley plans to resume her part-time work at Valley Bowl in the fall. She also looks forward to fewer trips to the doctor’s office. “I no longer have to see my rheumatologist for regular visits.” She had been going every three to six months for 19 years.
For others considering knee replacement surgery, Bradley has this advice: “Don’t put it off. It will be the best decision you ever made. I can get down [on the floor] better. I can get down with my grandkids. They think I’m bionic.”
And she can get down on the dance floor.
“I love to dance,” she said. “There are a lot of dances at the campground.”
Readiness Improves Results
Orem, who has been a member of the Gifford orthopedics team since 2017, is also a provider at Dartmouth-Hitchcock Medical Center (DHMC). He works with patients at various stages of life, from early adulthood to late geriatric, and many of his patients have arthritis.
While Bradley was told many years ago that she needed knee replacements, to clarify, Orem said, “It’s never true that you need to have knee replacements. We’re trying to get you back to an improved quality of life. We see a lot of patients who put it off.”
“We really help patients understand their options and move forward with what they would like to do,” he said. “I am here to help patients understand risk and benefits.”
The decision-making timeline looks different for every patient.
“A patient who had never before been told they have arthritis may come back a year later and say that gardening, or golf, isn’t possible anymore and ask for help,” said Orem, “or it might be two weeks later.”
In terms of recovery, he said, patients “will do worse if they haven’t arrived at the decision to have surgery themselves.”
Physician Assistant Brad Salzmann, who has worked in orthopedics for 22 years and at Gifford for five, agrees.
“People do much better when they are ready for surgery,” said Salzmann, who, in addition to assisting with surgeries, keeps patient office hours and provides treatment in less-complicated cases. “If you’re not sure, then you’re probably not ready.”
Part of achieving readiness before surgery is making sure the patient, with their provider’s support, modifies behaviors and conditions affecting their health, such as smoking, a body mass index (BMI) over 40, and uncontrolled diabetes.
“We want to see them motivated to have the best outcome they can have,” Orem said.
Knee Surgery Not What It Used to Be
Knee surgery has changed significantly over the last few decades.
Ten years ago, “patients would spend four to five days in the hospital after knee surgery, connected to a catheter and all kinds of things,” said Orem. “And 20 years ago, knee surgery would have meant a two-week hospital stay, plus potentially another manipulation under anesthesia. There’s been a shift in how we think, toward value-based, efficient care.”
“Knee replacements should last 20 to 25 years,” Orem said. “They used to last 10 to 15.”
Once a patient decides to have knee surgery, Orem identifies any issues. During an initial visit, he talks his patient through what to expect and encourages a caregiver to be a part of the conversation. He visits patients just before surgery, which lasts an hour to an hour-and-a-half and is performed under spinal anesthetics. His patients typically spend one hour in recovery and are usually out of bed that afternoon.
“My main goal is to get them out of bed, up and moving, as soon as possible,” Orem said. “And just about everyone goes home the next day. Our physical therapy team works with patients prior to discharge, then our patients either go for PT or receive home-based PT if they don’t have transportation.”
He sees patients the day after surgery and, in most cases, not again until four weeks later, to check in, with another check-up after one year.
“Patients by and large do really well,” said Orem, who finds most rewarding “the patients who have discovered they can walk without pain, doing things they thought they’d have to give up.”
Orthopedics at Gifford
Until recently, 2017, Gifford had seen a lot of transition in its orthopedics team. Today, the team is strong with, in addition to Orem, who lives in the Upper Valley, orthopedic surgeon Dr. Derek Chase, a native Vermonter. Both providers are assisted by Salzmann and committed to treating everyone holistically and personally.
“We have two very good, very dedicated surgeons,” said Salzmann, who lives in Royalton. “We provide the best overall care for the individual. There is no perfect recipe. We determine what will work best for the individual patient.”
“The inpatient experience at Gifford is really marked by top-notch care,” said Orem, who sees an equal mix of knee and hip cases. “People who come to Gifford want a good surgeon, a private room, and a personalized experience—and they get them.”
Dr. Alexander Orem operates on Mondays and sees clinic patients on Tuesdays in Randolph. Dr. Derek Chase performs surgery on Tuesdays and sees clinic patients on Mondays in Berlin and on Wednesdays and Thursdays in Randolph. Chase also offers expanded hours on Wednesdays until 7 p.m., to meet patient needs outside of normal business hours.
For more information about orthopedics, visit giffordhealthcare.org/service/orthopedics.