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Thursday, October 15, 2015

New Hip, New Hope

Posted By: Advancing Care

Try as she might, Lise Crapella, 64, couldn’t seem to shake the pain in her hip. In the course of nearly 30 years, the Suffern grandmother of two had put her body through a lot, including 22 New York City Marathons, two Boston Marathons, half Ironman triathlons and group expeditions to climb Mount Kilimanjaro and Mount Everest. After a while, she reluctantly cut out running in favor of hiking and biking. But last winter, the pain in her hip grew so acute that she couldn’t even bend to tie her shoe.

An adult/geriatric nurse practitioner specializing in wound and ostomy care at Good Samaritan Hospital, a member of the Westchester Medical Center Health Network, Crapella finally turned to Arup Bhadra, MD, head of Good Samaritan’s Total Joint Replacement Center. Dr. Bhadra ordered an MRI and immediately noticed extensive arthritis, or lost cartilage—partly from repetitive physical motion, partly from normal bone degeneration. Without cartilage to cushion and protect the hip joint, the pain would continue.

“We talked about getting injections for temporary relief, but the X-ray showed it was too far gone,” Dr. Bhadra says. “She was fit, but in pain for four years, and every day it was getting worse.”

The verdict was clear: Crapella needed a hip replacement.

“I didn’t expect to run marathons; I just wanted to take a nice long walk,” she says. “I had no range of motion; I hadn’t even slept on my left side for 10 years.”

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Still, Crapella put off the surgery for nine months, hoping the pain would be tolerable.

“Dr. Bhadra looked at the X-ray, told me then and there that I needed a hip replacement, and said I’d know when I was ready,” she says. “He was right. When the pain grew progressively worse, I came to the conclusion if I wanted to be active and do the things I enjoy, I had to get the surgery done.”

In late March, she called Dr. Bhadra’s office, “I think I’m ready; I can’t tie my shoe.” With the assistance of Camille, the GSH Total Joint Program Nursing Navigator, the preoperative process was streamlined, efficient and hassle free. Her surgery was scheduled within two weeks.

“My department was shocked, yet supportive, that I was scheduled so soon,” Crapella recalls. “My family also said, ‘What! Already?’ But they all said, ‘Go ahead, do it now.’ And because the surgery would be at Good Samaritan, they knew they could easily visit and take care of me.”

Due to Crapella’s level of fitness and good bone health, Dr. Bhadra chose the anterior approach to hip replacement, accessing the hip joint through an interval between muscles, without cutting any muscles or tendons. This technique facilitates the initial recovery over the traditional, posterior method. “Around the world, most surgeons still approach the joint through the back,” says Dr. Bhadra.

“I didn’t expect to run marathons; I just wanted to take a nice long walk.”

Instead, Dr. Bhadra created a small incision at the front of the hip, locating a natural interval between Crapella’s muscles. Extracting the damaged head of the thigh bone, or femur, he replaced it with a ceramic ball and titanium socket, insulating both with a high-quality polyethylene in between that works like cartilage.

“We didn’t cut the tendon, ligament or muscle,” says Dr. Bhadra. “She regained full range of motion without any pain. Recovery is quicker; pain is reduced. Almost all my patients return home within a day or two and have minimal blood loss.”

“In the past, complex cases involving hips, knees and shoulders would often get transferred to Westchester or New York City,” adds Dr. Bhadra. “Now they don’t have to cross the river. Minimally invasive bloodless surgeries facilitate rapid recovery for the patients. We can now care for them here in the community, close to home and get ‘big-city quality’ in our local state-of-the-art facility.”

To protect his patients, Dr. Bhadra has specific selection criteria for this type of surgery.

“Careful patient selection is very important in order to achieve the best outcome. Anterior approach is not for everybody,” he says. “But aside from the damaged joint, Lise was in great shape.”

Without the need for general anesthesia, Crapella was awake and alert  immediately after her surgery. “I didn’t have to worry about intubation or sore throat.” And because of the frontal incision, she didn’t experience pain while sitting or lying down. Resting comfortably in bed, Crapella texted the organizer of the trips to Everest and Kilimanjaro.

“His reply came back: ‘How can you text just after surgery?’” she recalls. “I laughed and replied I hadn’t had surgery on my thumbs.”

On the evening of the surgery, Crapella was out of bed and taking steps. The next day, she was walking up and down steps, with a physical therapist. And the following day, she checked out of the hospital—easily taking the flight of stairs up to her house. “No pain,” she marvels. “It was just as successful and straightforward as Dr. Bhadra had promised.” She was even able to return to work—and care for others—after a month.

And her friend, the trip organizer, found that not only could she text, she was also game for a third expedition. At press time, she was planning on hiking the Grand Canyon this fall. “I have no doubt I’ll be ready,” she says.

Dr. Bhadra suggested regular follow-ups with  an X-ray every year to make sure Crapella can continue her adventures. This way, any aberration in the artificial joint can be identified and rectified early. “She got back to her regular lifestyle,” he says. “Hiking, biking, sports. Less pounding will make the hip joint last longer, but she has no restrictions.”

In the meantime, thanks to weekly physical therapy, Crapella  has steadily increased her level of activity. She can easily take the stairs, enter and exit the car and “get up off the floor much faster and more gracefully.” To gear up for her Grand Canyon trip, she returned to walking and biking. And she can easily keep up with her grandsons, 11 and 14.

“I’m glad I made the decision,” she says. “Dr. Bhadra’s team made me feel so well taken care of, and the nursing staff was exceptional. It was major surgery, yes; it was also a really good experience.”


Total Joint Replacement Surgery At WMCHealth: Total joint replacement surgery is available throughout the Westchester Medical Center Health Network at: Westchester Medical Center (knee, hip) | Good Samaritan Hospital (knee, hip, shoulder) | St. Anthony Community Hospital (knee, hip, shoulder) | MidHudson Regional Hospital (knee, hip)
Visit www.WMCHealth.org to learn more.