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At Advanced Surgical Hospital, Physical Therapy is a Key to Successful Knee Replacement
By Nancy Kennedy

Nicole Stanko

For Advanced Orthopaedics and Rehabilitation (AOR) physical therapist Nicole Stanko, D.P.T., the most gratifying moment in her work day comes when a patient turns and walks out of her department for the last time – without a walker, without a cane, without pain, and without all the severe restrictions of living with a deteriorated, arthritic knee. Stanko's post-operative care of patients who have undergone knee replacement at Advanced Surgical Hospital (ASH) brings her a great sense of satisfaction and even joy. "Seeing my patients walk out of here and back into their lives, fully functional and ready to enjoy life again – it's the best feeling in the world," she says. "For many people, knee replacement is life-changing."

A successful knee replacement depends on many factors, including the skill of the surgeon and the motivation of the patient, but the quality of the physical therapy and rehabilitation is critical to a positive outcome. Stanko, who has a degree in neuroscience from the University of Pittsburgh and a doctorate in physical therapy from Chatham University, serves as the Director of Physical Therapy for AOR at the McMurray location, where physical therapy is state-of-the-art, goal-oriented, and highly individualized to the specific needs of each patient. "Our approach reflects the overall philosophy of AOR and Advanced Surgical Hospital, which is patient-centered and detail-oriented," she says. "The quality of care is superb; it's all about the patient."

Patients who have knee replacements at ASH have femoral nerve blocks during the operation. Stanko explains that this provides post-op pain relief, which is not only essential to patient comfort, but also to successful physical therapy. "The rationale is that if you're pain free, you'll be better able to perform the exercises that are a key to recovery. It's critical to stay ahead of the pain. If you don't exercise due to pain, scar tissue can form, and the joint will be stiff. The patient is weaned off the nerve block by discharge day." Knee replacement patients are assisted to perform basic exercises that strengthen the quadriceps and improve joint motion; they get out of bed and transfer to a chair on the first post-op day. They do short distance walking, as tolerated, and with each day, walk longer distances. By the third day, they're starting to climb stairs. "In the immediate post-op period, the goal is to reduce swelling and increase motion and strength," Stanko says. "The overall, long term goal is to progress from a walker to a cane to no assistive device at all."

At ASH, a typical admission is three days, followed by in-home physical therapy for three weeks. Most patients go home at discharge, but Stanko says that for some, transfer to a rehab facility is indicated. "This depends on your general health and the presence of any medical complications. But it can also be a practical matter. The home environment is a concern after joint replacement – do you live alone, or do you have someone to help you? Does your home have stairs? Is there a bathroom on every floor? You have to be able to manage at home, and that requires help and support as you recover."

For some patients, therapy begins before surgery. "Not everyone needs pre-op P.T., but if the person has had osteoarthritis for a long time, and their legs are weak, they'll benefit from exercise to strengthen their quadriceps leg muscles. It's a good idea to come in a few weeks ahead of time to get a program from us that you can do at home. The better conditioned you are going in for surgery, the better you will do afterwards," Stanko says. "You'll be familiar with the exercises, and that will make things easier."

Stanko, who has been with AOR since 2008, has recommendations for persons contemplating knee replacement:

1) attend ASH's pre-op classes to become as prepared as possible for the surgery and rehabilitation;

2) exercise to increase overall flexibility and strength, especially in your legs;

3) prepare your home environment as much as possible, so that when you return it is safe, easy to navigate and conducive to recovery.

Advanced Surgical Hospital is a 14-bed, fully licensed hospital established by the eight orthopaedic surgeons of AOR and dedicated to orthopedic specialty care. Successful joint replacement demands teamwork, and ASH has an expert interdisciplinary team of surgeons, anesthesiologists, nurses, pharmacists and physical therapists, including Nicole Stanko, who give each patient the best possible experience and outcome.

To contact Nicole Stanko, call (724) 941-0111. To learn more about Advanced Surgical Hospital, visit www.ashospital.net. The web site features a guide to knee replacement exercises that can be downloaded.

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