A modern, patient-centered facility and renowned medical director ensure orthopedics patients in South Central Pennsylvania have access to advanced orthopedic procedures, including total joint replacement, at WellSpan Health. Last year, Dexter Bateman, MD, joined WellSpan Orthopedics to lead the Total Joint Program. Bateman brings with him nearly 10 years of experience as an adult reconstructive total joint surgeon.
“My role is to ensure we're following the latest evidence-based guidelines for all aspects of total joint care and implementing standards across our system to help with the preoperative optimization process,” Bateman said. “This process helps patients prepare for surgery and minimize their risk of perioperative complications by coordinating all phases of care. The goal is to have a seamless process from the time they're scheduling surgery, to the day of surgery, and throughout recovery. We provide a full complement of surgical options for all levels of complexity.”
Dexter Bateman, MD
Surge in Surgeries
According to a 2019 study published in The Journal of Rheumatology, the number of hip and knee replacements, or arthroplasty, continues to grow. WellSpan's renewed focus on joint replacement comes at an opportune time for an aging population that is either suffering from osteoarthritis or experiencing breakdown after decades of physical activity.
The study predicted total annual counts for total hip arthroplasty by 2025 and 2030 to be 475,000 and 610,000, respectively. For total knee arthroplasty, predictions for those years are 937,000 and 1.2 million. Compared to 2014 numbers, the percent increases for those years for THA are 75 and 129, and for TKA 110 and 182.
The American Joint Replacement Registry published its 2022 Annual Report on hip and knee arthroplasty procedural trends. The ninth annual report shows a growth of 14 percent over the previous year and points to more than 2.8 million hip and knee procedures since 2012.
“Some of the growth in our practice results from patients who delayed their care due to the Covid-19 pandemic,” Bateman said. He also noted that the vast majority of his patients are aging Baby Boomers with osteoarthritis.
“Arthritis results from a combination of factors. Cartilage and joints wear at different rates, and age-related wear and tear is primarily influenced by genetics, activity level and weight,” he added. The methodology for total joint replacements has evolved in a generation, as evidenced by WellSpan's team approach. “If you look back just 20 years ago, patients would be admitted to the hospital prior to a total joint replacement,” noted Bateman. “They'd be donating blood in the weeks before to the blood bank, and the average length of stay would be multiple days, sometimes weeks, for a standard joint replacement."
“Since then, there has been a paradigm shift toward more accelerated recovery pathways that involve judicious use of anesthesia, improvements in surgical techniques, medications to help reduce blood loss, and minimizing opioid pain medications or medicines that lead to grogginess or other side effects.”
These improvements have led to the push toward outpatient surgery or same-day discharge. “A lot of that was nudged in that direction due to Covid-19 and some of the restrictions around staying in the hospital afterwards,” Bateman said. However, these improvements have allowed us to provide high-quality care and accelerate the recovery timeframe, allowing patients to return home sooner. WellSpan's team approach to total joint replacement helps patients recover better, faster.
“Introducing all the various team members, such as coordinators and schedulers, creates more touchpoints for patients, increasing their ability to efficiently communicate any concerns,” Bateman said. “The less time you spend in the facility after surgery, the less time you have with nurses, and you may forget to ask certain questions. It's important to have these outlets for patients to get in touch with us, and for us to check in with our patients.”
Any surgery is not to be taken lightly, and the Total Joint Program at WellSpan urges a conservative approach. “The first stage is usually non-operative treatment,” noted Bateman. If that initial treatment is unsuccessful and surgery is recommended, another set of strategies is implemented by the team.
“We make sure the patient's health and immune system are optimal,” he added, “so the patient is in a good position to heal and recover. We view this as the preoperative optimization pathway, which, from a medical perspective, involves bloodwork, coordinating with primary care physicians and other specialists to make sure that chronic medical conditions such as diabetes are in a good spot to minimize the risk of complications.”
Innovative Teamwork
A hip and knee replacement specialist, Bateman brings to the Total Joint Program nearly a decade of experience in orthopedic surgery. After earning his degree in biomechanical engineering from the Georgia Institute of Technology, he pursued medical school at Thomas Jefferson University in Philadelphia. He completed his residency at Rutgers University and spent an additional year of sub-specialty fellowship training in hip and knee replacement at the University of Texas Health Science Center in Houston. Bateman served as Adult Reconstructive Total Joints Surgeon at Prisma Health's Blue Ridge Orthopedics program in Seneca, S.C. for more than two years before relocating to York to assume the role of Medical Director for WellSpan's Total Joint Replacement Program.
With the addition of three orthopedic surgeons, WellSpan’s program is poised to quickly accept referrals for their innovative and quality joint program. “We perform between four and six routine surgeries a day. More involved surgeries can be associated with a fall or a fracture, infections, or mechanical complications such as loosening or wear of the plastic components. If patients require a revision procedure because of that, they are usually staying overnight for at least one night following the procedure.”
The Facilities
Total joint replacement surgery is performed at WellSpan Surgery & Rehabilitation Hospital (WSRH) located at 55 Monument Road in York and at the WellSpan Health and Surgery Center location at 1227 Baltimore St. in Hanover.
A full-service, elective surgical hospital, WSRH is designed for patients who require additional time to recover from surgery. In addition to offering private rooms for recovery, WSRH also provides acute inpatient rehabilitation. Specialized outpatient rehabilitation supports patients who have returned home but require ongoing therapy following an amputation, brain injury, concussion, spinal cord injury or stroke, as well as patients living with specific neurological conditions or movement disorders.
WellSpan Health & Surgery Center (WHSC) makes it easier for Hanover area residents to get the care they need closer to home. The surgery center includes more than a dozen primary care, specialty care, surgical and ambulatory services under one roof. At 80,000 square feet, it is one of the largest and most technologically advanced outpatient surgery centers in central Pennsylvania.
“When we identify a patient as a same-day total joint replacement candidate, typically at a higher functional status at baseline, with well-controlled medical conditions, their surgeries are performed earlier in the day,” said Bateman. Those patients also receive a level of care catered to their healthier status.
For these candidates, physical therapy is scheduled more immediately after surgery and there are modifications to the anesthesia. “For example, shorter acting spinal medicines that will wear off sooner so the patient will be able to ambulate shortly after surgery,” Bateman added. “The whole team is working toward getting that patient home successfully that same day.
“We have patients that live closer to the Surgery Center who would rather not drive to WSRH in York,” Bateman continued. “I was able to do a same-day partial knee replacement for a patient that lived across the street from the Surgery Center. It was wonderful for that patient to be able to go home the same day very easily to recover.”
If patients encounter complications or need more time to recover, WSRH is also a full hospital equipped with private rooms in the event the patient needs to stay overnight. “That gives us a bit more latitude for patients who may need extra time,” Bateman noted.
Both facilities utilize the latest technology for optimal patient care. “We have state-of-the-art facilities at both the ambulatory Surgery Center, as well as our elective Surgery & Rehabilitation Hospital,” Bateman continued. “We're finalizing plans to integrate robotic technology in the upcoming months. Most importantly, we have that closed-loop system from the medical specialists to the surgeons to the therapists to ensure everybody is on the same page and working together as a team to help every step of the way.”
For more information, visit WellSpan.org/Programs/orthopedics or call (717) 812-4090.