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Joint Progress Project
We are living in the modern world and this requires speed and flexibility in our movements. The key role here is played by our joints. Joints are complex mechanisms which, just like a clock, consist of many parts. However, sometimes, the human body, the same as a clock, breaks or wears out. We then need to recover quickly to move on. Due to a unique project called Joint- Progress, headed by Schulenburg Jorg Christian M.D. at the Merian Iselin Clinic, it is now possible to perform joint surgery and get a patient back on their feet very quickly. Thanks to this project, patients no longer have to stay in hospital for a long time.
Doctor Schulenburg, there is a stereotype that if you have undergone surgery, especially joint surgery, then you will have to spend at least a week in the hospital…
– We started the Joint-Progress project in order to do the treatment as efficiently and fast as possible. Previously, the patients who had to undergo a hip or knee replacement surgery had to stay for a long time at the hospital. Switzerland, when compared with other countries, has longer periods of hospital stay. Perhaps it is somehow connected to the mentality of our patients or maybe this can be explained by economic reasons, since earlier all hospitals were financed according to different principles. Until 2000, a patient who had to undergo hip replacement surgery would stay almost 2 weeks at the hospital on average. In 2005, this time was reduced to 10–12 days and in 2013 to 9–11 days. The Joint-Progress project allows for the shortening of this period even more. Our main goal is to make sure that our patients get on their feet as quickly as possible, start walking independently, and return home to their familiar way of life. To make this happen, this project involves everything starting from the patient and ending with the doctors and staff members who are responsible for their treatment. As a result, our patients get more effective treatment in a shorter time.
– Don’t you think it is dangerous for a patient to be discharged from the hospital so soon?
– I think that the fact that people think that the longer they stay at the hospital, the better it is for them is a delusion. A prolonged hospital stay may harm them. After all, it increases the risk of thrombosis and you might get some hospital infections which can be very dangerous…
– Why is this happening?
– The people who are discharged just a couple of days after surgery move more. Therefore, it improves blood circulation and reduces the risk of thrombosis. They get back to their familiar way of life faster and easier. It is a proven fact that by being discharged from the hospital earlier, patients reduce the chances of getting some risks.
– But it happens that people want to stay longer under the supervision of doctors. Perhaps this is more psychological and it feels safer at the hospital than at home?
– The decision on how long a patient will stay at the hospital is taken on the basis of medical expediency, not their desires. Previously, it happened that patients were allowed to extend this period, but today this is only possible if doctors deem it
necessary. People do not know all the pros and cons. They think that if they are under the supervision of doctors, it means they are completely safe. On one hand, it is true, but there are certain risks.
At the moment, things are structured better. A patient is prepared in advance for the fact that they might, for example, be discharged on Friday. And all the psychological factors, of course, are taken into account during the preparations for surgery.
– Are you the first one who started this project in Switzerland?
– Yes, it happened a year ago. Joint-Progress is about 15 years old in the USA and Asia. In Europe this project was introduced in 2003 (in Denmark, in the Netherlands and the UK). If, previously, a hospital stay lasted an average of 13 days, that period can now be shortened to 4–6 days. Patients are satisfied that the treatment is effective.
The problem is that for such a project you have to create a whole service chain starting from the administration, informing patients and ending with anesthesiologists, surgery, treatment, and recovery. Everything must work well, without delay.
The anesthesiology department should improve the anesthesia technique so that a patient can be mobilized after only 2–3 hours after surgery. I am talking about restoring the mobility of joints, so that a patient can get back on their feet. We do not use opiates. Painkillers should be very accurately chosen. They must deal with the pain and not cause illness, nausea, etc. Therefore, drugs that are also able to change the pain threshold and pain perception are used. For example, in such cases where we apply local anesthesia, whereby we inject the entire area of the wound in order for a painkiller to work, anesthesia no longer affects the spinal canal afterwards. Thus, a patient feels no pain. In addition, we use drugs which reduce the risk of bleeding during surgery.
Surgeons have to adapt to innovations. For example, we no longer use tourniquets during surgery. Therefore, special attention to the vessels should be paid. However, the fact that we no longer use tourniquets is beneficial to patients, as it reduces the risk of bruising, bleeding and swelling later on.
– Which diseases are better treated using this method? And for which diseases is it not recommended?
– I think Joint-Progress is applicable to all kinds of surgeries. We are talking about the motor apparatus. But in the case of the same approach when it comes to internal organ surgeries, this concept can also be used, albeit with some modifications. Just by simplifying the process we can buy a lot of time and this will be a plus for patients. The project can be compared to a puzzle in which patients remain the central piece.
– What can you tell us about post-surgery rehabilitation?
– Physiotherapy is fully involved during the postsurgery rehabilitation period. Just after 2 or 3 hours after surgery, physiotherapists should be close to the patient during mobilization, which is the process of stimulating the joint with the hands in order to restore mobility. Today, it is a well-controlled process: for example, a patient who had surgery at 10 am can, at one o’clock, be sent to the department where they perform mobilization.
Upon returning home, the rehabilitation continues. It has been proved that patients who undergo hip surgery walk much better by themselves. Such patients need less physiotherapy procedures than those who have had knee surgery. Here, the situation remains the same: you need to work your knees out, bringing back mobility. And a physical therapist should pay special attention to this.
– Do you work as a chiropractor? Or just as a surgeon?
– Our clinic does not offer manual therapy, but we use all possible types of medical treatment before a patient is delivered to us. The attending physician, whether a rheumatologist or conservative orthopedist, tries all known techniques, including manual therapy, chiropractic, and Chinese medicine. But most of all, of course, we are talking about the usual physiotherapy.
I use my education and expertise in the chiropractic field more for diagnosis than treatment. There are many manual therapists who do their job well, but my main activity is to perform surgery. Chiropractic help is very good for people who make a diagnosis. And if I see that it is not yet possible to operate on the joint of the knee because it is too early, I recommend a patient see a chiropractic specialist, or go for acupuncture.
We do not offer something extra, but will do everything necessary.
– Do you treat sports injuries? Many famous athletes have joint problems and they need to get back on their feet as quick as possible.
– Yes, our clinic offers a wide range of services. We have very great potential in terms of repeated orthopedics problems and injuries. We have experts working
with various parts of the body, such as the shoulders or arms.
The only thing that we don’t have in the clinic today is spine specialists, although people with old sports injuries of the musculoskeletal system who then had problems after surgery have happened to seek our help.
– What should foreign patients do before coming to you?
I believe that this question is relevant not only to athletes but also to amateurs who love skiing and are engaged in other types of normal sports.
– It all depends on how far away the person lives. We should see them before surgery at least once. It is our requirement. Of course, any information from the attending physician and previous X-rays will be of help. Everything plays a big role in deciding whether you need surgery or not. But it can also be discussed during the very first visit to the doctor if everything you need in advance cannot be sent via email.
We plan all surgeries carefully. My schedule is booked 2–4 weeks ahead. And it is very difficult to add someone to this. In addition, a person’s decision must be well balanced. Another thing is that if a former patient of mine feels worse, I would, of course, immediately include them in my schedule. After all, I should know what emergency measures are needed in this particular case better than anyone.
It often happens that you see a patient for the first time and right away you realize that the hip joint has already been destroyed. In this case it is necessary to operate as quickly as possible. Then we accelerate the entire process and after 4–6 weeks we do the surgery.
But before you decide to go with a joint replacement surgery, it is necessary to think about it for a while. Therefore, each case is carefully inspected by us, we study it from all sides, weigh the pros and cons. The patient should know what they are in for.
Schulenburg Jorg Christian M.D.
is a specialist in orthopedics, and in sports medicine. In 1977 he got his high school diploma from Alten Kantonsschule in Aarau. In 1986 he graduated from the University of Basel (Switzerland), majoring in health and medicine. Area of activity: hip and knee replacement surgeries.
In 1994 he was certified as an orthopedic surgeon and trauma surgeon (taught by professors Ochsner, Muller, and Morscher). In 1996 he opened a private practice in Basel. He is currently working as an affiliated doctor at the Merian Iselin clinic. Since 1999 he has been a member of the Swiss Society of Sports Medicine (SGSM) and a member of the Swiss Society for Manual Medicine (SAMM). Also, at different times, he was chairman of the Northwest Orthopedic Surgeons Section (2000–2008); he is also a member of the Medical Society in Basel; a member of the Swiss Society of Orthopedics and Traumatology (Swiss orthopedics); a member of the AGA-Society for Arthroscopy and Joint Surgery; and a member of the Swiss Association against Osteoporosis.