Chinese Doctors2

Local orthopedic surgeon Aaron Altenburg shows a synthetic knee joint to Chinese surgeons Lao Shan and Zhou Liping, with interpreter Lucy Yang at right, in Pocatello on Monday.

POCATELLO — Would it surprise you to learn the average stay for joint replacement patients in China is tenfold what it is at Portneuf Medical Center’s Total Joint Center in Pocatello?

Part of this success belongs to Aaron Altenburg, an orthopedic surgeon and fellowship training joint reconstructive surgeon practicing at PMC. His knowledge will soon travel over 7,000 miles across the Pacific Ocean.

“Technology is vastly different between countries,” Altenburg said. “I’ve done over 500 revisions with the system that we’re using, and they’re just getting it in China. For them, this is brand new technology. So to be able to see six surgeries in one day and how to use the system gives them a big jump back home.”

Altenburg’s latest trainees include surgeons Lao Shan from Guangxi and Zhou Liping from Guangdong, China, who, on Monday, observed several joint revision surgeries performed on cadavers.

The observation is part of an education process focused on improving the recovery from joint surgery that will benefit both patients and health care providers.

According to Pat Rasmussen, the Total Joint Center nurse manager, about 1,000 patients will undergo joint replacement or revision at the Total Joint Center this year.

Most of the patients undergoing joint repair or replacement at PMC typically stay about two days after surgery. In China, the same surgery can keep patients in the hospital up to 20 days.

By implementing a rapid-recovery program, Altenburg’s patients see better pain control, become mobile quicker and encounter common consequences like clotting or infection far less often.

“I do some work with DePuy, which is one of the many implant companies,” Altenburg said. “They’ve asked, because of my expertise, to help teach other surgeons. I’ve been fortunate enough to teach, both domestically and internationally, how to do joint revisions and replacements.”

Altenburg said putting patients through joint school before surgery is a major reason this program is so successful.

“Before patients even come into the hospital, we explain the entire process,” he said. “We explain how their hospital stay is going to go and what their options are when they go home. They are very prepared when they get here, and they know that by day two they’re going to go home.”

By reducing the length of time a patient remains in the hospital, Altenburg said this lessens the financial burden on the patient and health care system as a whole.

Nationally, many U.S. cities have adopted a Bundled Payments for Care Improvement initiative, or BPCI. It’s composed of four broadly defined care models that bundle payments for multiple services that beneficiaries receive during an episode of care.

In essence, a patient who receives a joint replacement under this initiative pays a single flat-rate regardless of their length of stay or additional care.

According to Todd Blackinton, the director of marketing and public relations for PMC, this initiative has not yet reached southeast Idaho, but will soon become a national standard.

“That’s why length of stay and low infections are crucial,” he said. “Because if you have complications, that could potentially affect profits. This bundled payment is used in a couple dozen cities across America and will eventually get to everybody. We want to be ready so that when it does hit, it doesn’t shock the system.”

According to Altenburg, joint replacements have drastically changed in the past 10 years. The incisions are half the length. Lower extremity numbing has replaced general anesthesia, and pain management education has drastically changed the dynamics of each surgery.

The quicker a patient can become mobile, the less likely they are to develop pneumonia, MRSA staph infections or urinary tract infections, Altenburg said.

Altenburg, who is joined at PMC’s Total Joint Center by orthopedic surgeons Greg Ford and Rich Wathne, hopes to get patients moving the same day of surgery, something he said currently happens about 30 percent of time.

“There’s no hospital in southeast Idaho that has the program that we have,” Altenburg said. “With our preoperative program, hospital stay program and outpatient program our satisfaction scores consistently rank in the 90-99 percentile in the country.”