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Chicago surgeons try to fill gap in joint replacements

Operation Walk Chicago helps needy afford restorative procedures

 Drs. Victoria A. Brander and David Stulberg, co-founders of Operation Walk Chicago, tend to a patient last month. The not-for-profit group provides joint replacements for Chicagoans and others in need. (José M. Osorio, Chicago Tribune / July 26, 2011)
By Kelly April, Tribune reporterAugust 2, 2011

When the Cook County Bureau of Health Services discontinued non-emergency joint replacements more than two years ago, it left many poor people disabled, in pain, unable to work and with few options for surgery.

But Operation Walk Chicago, a not-for-profit organization run by two local doctors, is trying to meet that need by offering free joint replacements. Whether it will be enough is the question.

April Randle, 47, is excited to ride her bike again. The West Garfield Park woman is one of eight people who received new joints in March through the nonprofit group, in partnership with Norwegian American Hospital in Humboldt Park.

After years of suffering from a disabling hip condition that rendered her stationary and forced her to leave her job, Randle is free of hip pain. She is eager to get moving and return to work.

Arthritis is the leading cause of disability in the United States, according to the Centers for Disease Control and Prevention. Hip and knee replacements are sought when osteoarthritis causes severe pain and limits the activity of the sufferer.

But these replacements are expensive — from $60,000 to $80,000, according to Dr. Victoria Brander, associate clinical professor at Northwestern University’s Feinberg School of Medicine and co-director of Operation Walk Chicago.

For some, the need for hip or knee replacement means playing fewer rounds of golf until the doctor performs surgery. But for others — people without health insurance or reliable access to medical care — waiting for joint replacement may leave them unable to work or get groceries for their family. The irony of disabling osteoarthritis is that it often forces people to leave their jobs — and therefore lose their insurance coverage.

“I had to stop being a medical assistant because the pain was too bad,” Randle said.

Randle had a bad fall at age 11 that damaged her hips, but she was too young for joint replacement. In her 30s and suffering from osteoarthritis, she was scheduled for hip replacement surgery but postponed it after her mother fell ill. In the meantime, she lost her job and her insurance. By her 40s, her condition had worsened to degenerative joint disease.

“It was bone rubbing on bone,” Randle said. “It was so painful I was thinking of things I could do to end my life.”

For the nearly 600,000 uninsured in Chicago, medical procedures like these are often unattainable. More than half are of working age and employed either full or part time, according to the 2009 Gilead Report compiled from U.S. Census Bureau data. But 31 percent of working-age Americans with arthritis report work limitations, according to the CDC.

Deitra Farr, 54, of Lincoln Square, is a blues singer. It’s her work and her passion, but it doesn’t provide her with insurance. She has osteoarthritis in both knees but is unable to afford replacements. She said many stages where she performs have high steps that are difficult to navigate, and the number of stairs at some venues causes her to panic.

“I’ve suffered for a long, long time, but I am not able to do anything about it. Now it’s gotten worse, and I am using a cane,” Farr said. “It’s made it hard for me to do my work.”

Operation Walk Chicago cites at least one study showing nearly all employed people return to work and more than half of those not working regain employment after hip replacement.

“Hip replacement surgery is the most cost-effective of all orthopedic surgeries — all surgeries, period — because it restores function and reduces pain so dramatically,” Brander said. “It gets people back to work.”

Elective joint replacement surgeries were once performed at Provident Hospital, but the county cut the procedures in 2007 because of budget issues and controversial staffing reductions. Stroger Hospital was supposed to pick up the slack, but it was already bursting at the seams with orthopedic surgeries, the Tribune reported at that time. Patients were waiting up to five years for procedures.

Stroger, the last place in Chicago performing elective joint replacement surgeries for the uninsured, stopped doing the procedure a little more than two years ago. The county Bureau of Health Services declined to comment about the cessation of its joint replacement program.

For seven years, Operation Walk Chicago has been setting up free joint replacement programs for underserved people in places such as China, India and Nepal, traveling as a team to perform surgeries, educate medical staff and develop sustainable systems of care.

Dr. David Stulberg, co-director of Operation Walk Chicago and professor of clinical orthopedic surgery at the Feinberg School, said the large number of uninsured in Chicago combined with the void left by Stroger motivated the group to begin exploring partnerships at home.

Its pilot program in Chicago launched in March.

Norwegian American Hospital provides primary care for many uninsured patients and patients with Medicaid. For the March pilot, Operation Walk Chicago trained the hospital’s doctors to provide joint replacements and brought together volunteers to spread the burden of providing equipment, supplies, surgical services, physical therapy and rehabilitation, as well as money to cover what is not donated.

Many of the volunteers are local businesses, as well as patients in Brander’s and Stulberg’s private practices who were so affected by their own joint replacement surgeries that they were inspired to give back.

“Our whole world is one community. I am so pleased they are in Chicago … and give back to the people who need it,” said Ginny Carlson, of the Gold Coast neighborhood, a volunteer who received knee replacement through Stulberg’s practice. She is a fundraiser for Operation Walk Chicago.

But not everyone is so optimistic. Daniel Ivankovich, a Rush University Medical Center-trained orthopedic surgeon, was a casualty of Provident’s layoffs in 2007 but has since been performing 200 to 300 joint replacements a year by securing Medicaid for patients without insurance. Ivankovich hails Operation Walk Chicago but said he thinks that the need is greater than either he or that group can address.

Ivankovich also stresses that orthopedic problems are only one part of a host of medical issues plaguing poor people, such as obesity and diabetes. And many patients in need of joint replacement end up in expensive nursing homes or relying on relatives for their care. He said more must be done to prevent people from getting so sick in the first place.

“How many poor patients are really healthy? The system is a problem, and they (Operation Walk Chicago) are treating the symptom rather than the disease,” he said.

Ivankovich is part of a team of local doctors committed to providing more than orthopedic services to underserved people in Chicago. He has established orthopedic outreach and patient education programs throughout the city and works with the Chicago Musculoskeletal Initiative to approach orthopedic problems from a holistic perspective.

Ivankovich is trying to help Farr get Medicaid so she can have knee replacement surgery, since the county health system is no longer an option. She has previously been turned down. Medicaid told her that because she was still employable, she wasn’t eligible unless she became disabled or met one of several criteria.

“I will keep fighting because I will not be able to walk if I don’t get these knees,” Farr said. “It’s not like I’m trying to get a facelift. It’s about trying to walk.”

The exact number of people in need of joint replacement in Chicago is unknown, and Operation Walk Chicago and Ivankovich and his team are doing what they can to meet the demand.

Operation Walk Chicago plans to team with Norwegian American on a quarterly basis to provide free joint replacement surgeries. After the pilot program, the staff at Norwegian is now trained and has equipment.

Operation Walk Chicago also wants to expand to other community hospitals. Its model stands to benefit both the patients who receive care and its partner hospitals, which receive training, equipment and supplies.

“I liken it to the ripple effect — you throw a pebble in the ocean and it changes the nature of the sea,” Brander said. “Do one or two and that affects a person, they get back to their house and job — that has a ripple effect. Other hospitals start doing it, and they see an effect and others see it work.”