STEPPING FORWARD August 31, 2021 A Miramichi woman walked into the hospital in the morning for surgery and walked out the SAME DAY with a new knee – thanks to a new innovative knee replacement surgery. You would never know Colleen, 66, was ever slowed down by anything if you had just met her – she is energetic, optimistic and full of life – but in the fall of 2020, Colleen Jimmo met with Dr. Abdurahman Adoubali, Horizon’s Consultant Orthopaedic Surgeon, and his team (at Horizon’s Miramichi Regional Hospital) to discuss her upcoming knee replacement surgery which would help relieve pain and restore function in her diseased knee joint. She knew that the procedure involved cutting away damaged bone and cartilage from the thighbone, shinbone and kneecap and replacing it with an artificial joint. She knew this because only a year prior, she had the surgery on her other knee. She now walked with one artificial knee and was about to have a second. She knew that if it went well, she would experience even better mobility, pain relief and quality of life. Colleen learned that she was a good candidate for same-day knee replacement surgery. Same-day surgery meant that she would leave the hospital within a few hours, rather than spend the two to three days of in-hospital recovery that one would typically experience. Colleen Jimmo and her husband Roy. She would soon find out that she would bethe first patient in New Brunswick to participate in this innovative day surgery protocol. She met with Renée Duffy, Registered Nurse, for an assessment. Renée reviewed and updated her file and asked several questions before explaining the entire process and ensuring Colleen had all the information needed to participate in the successful procedure. “Colleen’s optimism and motivation made her the perfect patient for this type of procedure,” recalled Renée. The Qualifier: Emotional and Physical Support In order to qualify for the day-surgery, she needed to be in good general health with no significant medical conditions, such as sleep apnea or history of heart attack, and most importantly she needed to have strong, dedicated, emotional and physical support at home. Her loving husband, Roy, was at the ready! He matched her positive energy, sopped up the information needed to care for his recovering wife and played the roles of coach, cheerleader and team player leading up to and after the surgery. With the global pandemic taking center stage in our world at the time and visitor restrictions in place, he would not be able to take her into the hospital or be at her side before and after the procedure. He patiently waited outside and was there when she slowly walked out of the hospital with a smile several hours later. He rushed to her side and helped her to the vehicle. Roy lived her surgical experience through her recounting of the day’s events, and took the role of caregiver seriously. Colleen and her husband reminiscing about her same-day knee replacement surgery and at-home recovery. “He really babied me!” said Colleen. “He put rails up throughout the house, helped me put my feet up, massaged my leg, fed me and doted on my every need. He was the one that made recovery a breeze!” The Day of the Surgery On the morning of her surgery, she arrived to find herself the center of attention. Her health care team had multiple checks, tests and questions for her. “I couldn’t help but feel like a celebrity.” she said. Then came a “cocktail” of pre-operative medications that would help to anesthetize her body to prepare it for the big surgery ahead. She remembers feeling instantly comfortable when Dr. Adoubali walked into her room with his warm, confident smile and sense of humour. During the surgery, Colleen was partially awake (though groggy) as Dr. Adoubali and his team cut out her old knee and replaced it with the implant. The procedure took just over an hour, after which she was sent to recovery. A couple of hours later, a physiotherapist was at her bedside, measuring the mobility of her new knee and getting her up walking. “I was even going up and down steps,” she recalled. The Innovation Dr. Adoubali explained that the surgery procedure itself is essentially the same knee replacement performed across the country. But the same-day version selects people who are motivated to recover quickly and have good support for a post-operative recovery at home. “It requires good communication and education with the patient so that they understand exactly what needs to be done for a healthy recovery at home,” he explained. The innovation, he explained, is in the anesthetics used: the short-acting epidural anesthetics and the peripheral nerve blocks that can last longer but allow patients to move their legs. With this approach, the patient can be more mobile more quickly after surgery. “With this same-day method, we are able to not only manage symptoms, but lower the risk of infection and get the patient up and moving more quickly,” said Dr. Adoubali. By recovering at home, the program frees up urgently needed hospital beds for other patients too. “Introducing this method helps to make health care delivery more efficient, in the face of high occupancy rates and long waits for joint replacements,” said Dr. Adoubali. Although he noted that overnight hospital stays will still be required for those with other health problems or lack good support at home. The Dream Team Dr. Adoubali is a Consultant Orthopedic Surgeon and isn’t your typical orthopedic specialist. In fact, on top of joint replacements, he specializes in orthopedic oncology and his dream is to have a local NB oncology team which can serve New-Brunswickers and the neighbour provinces n his field of interest. “I believe we can build an excellent New Brunswick team to be at the cutting edge of joint replacements and treat bone and soft tissue sarcomaslocally,” said Dr. Adoubali. Dr. Abdurahman Adoubali, Horizon’s only Consultant Orthopedic Surgeon, and his surgical team at Horizon’s Miramichi Regional Hospital. Together they performed the first same-day knee replacement surgery in New Brunswick. He credits his team for the success of Colleen’s surgery and the other innovative surgeries he’s performed. “Without the entire team – the Anesthesiologist, the Perioperative Nurses, the other Physicians, the Physiotherapist, the Extra Mural Nurses and many others – it would not be possible,” said Dr. Adoubali. “They are hardworking and well-trained.” Since Colleen’s surgery, the team has gone on to perform several more same-day knee replacements for other patients. The Future The road ahead is exciting for Dr. Adoubali and his team. He plans to introduce a surgical navigation system to the surgical suite for joint replacements and says, “why not robotic surgery in the future!” Because of the innovative work of Dr. Adoubali in the small but mighty Miramichi Regional Hospital, Colleen has recovered well and the future of orthopedic surgery in our region looks bright. For Colleen, her new knee replacement surgery has given her a new lease on life and confidence in stepping forward, like never before. She’s grateful for the experience and is excited to see what the future has in store for her and her new knee(s)! Dr. Abdurahman Adoubali, Horizon’s only Consultant Orthopedic Surgeon.