A friend of mine recently underwent a total knee replacement. Although he did well and was pain-free, he did say that he felt he was on an assembly line. I asked him what he meant. As he was talking, I flashed back 30 years, back to a time when by today’s standards I would be considered a “good old country orthopedist.”

Thirty years ago, I moved to a small community to join a small two-man orthopedic group. I did total knee replacements (TKR) and was quite proud of the results. I also handled every aspect of the care. A patient either came to our group directly or was referred by a primary who usually tried medication, maybe some exercises or physical therapy. We had an X-ray in our office —the hard copy kind — so after evaluation, I discussed the problem and the options. I was the one who ordered and performed what was needed, whether it be a change in medication, knee injections, braces and after all else failed, the TKR. I had a nurse that picked the OR date and pre-wrote admission orders that I reviewed then added what that particular patient needed.

The next time I saw the patient was the morning of surgery, answering any questions or concerns. I performed the surgery, skin to skin. I was the one that managed the patients post-op needs including pain control, blood thinners to prevent blood clots, dressing changes, and the physical therapy. I was the one the floor nurse called with any issues.We did have a home nurse/outpatient PT protocol that I ordered. I followed the patient in the office to the end of their care.

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