Far from seeing total joint arthroplasty as a commodity, Robert Sterling understands the value of mastery when performing complex hip and knee replacements, and guiding patients through postoperative care and rehabilitation. As a leading Johns Hopkins orthopaedic surgeon, Sterling has lent his expertise to the Johns Hopkins Hip and Knee Program, having performed more than 4,000 arthroplasties in his 15 years of practice. “The more a hospital does of something, the better the outcomes are, and these factors—volume and outcomes—work together synergistically,” he says.
As the department’s vice chair for quality, safety and service, Sterling is focused on the value and quality of the patient experience. “I’m interested in trying to maximize our patient outcomes and minimize the expense on the health care system as a whole,” he says.
Sterling works closely with Paul Khanuja, chief of adult reconstruction for hip and knee replacement. Their collaborative research involves analyzing national databases, zeroing in on patients who undergo hip or knee arthroplasty who have other, less common conditions. Their aims are to help surgeons gain a better understanding of the risks these patients face during and after surgery, and to develop ways to reduce those risks.
Sandy Fenton, a travel broadcaster and journalist and former patient of Sterling, has firsthand experience with the exceptional level of care from the Johns Hopkins Hip and Knee Program. Born with hip dysplasia and having undergone multiple corrective surgeries as a child, Fenton understood the importance of quality care. As she reached a point when her chronic hip pain prevented her from traveling, she looked for the best hospital and orthopaedic surgeon to handle her complex hip arthroplasty. Fenton decided on Johns Hopkins and Sterling.
“Sandy’s hip was malformed, and the leg was short. She had been highly functional and active despite having a shallow acetabulum and a lateralized femoral head, making her case a particular challenge,” Sterling recalls. Understanding that this would be a life-changing surgery for Fenton, Sterling took into consideration her long-term goals to ensure she was satisfied with her outcomes; namely, walking 3 miles daily.
Sterling’s objective of maximizing patient outcomes goes beyond expert surgical care. It includes postoperative care tailored to each patient’s needs. “Most of our joint replacement patients are taken care of on the Wenz Orthopaedic Unit,” explains Sterling. “What we have there are physician assistants, nurses and physical therapists who really understand our patients and their unique challenges because they provide dedicated care to them every day.”
In Fenton’s case, this meant engaging in physical therapy in the immediate postoperative period, including assisted walking one day after surgery. When she visited her primary care physician one week after surgery, her scar had healed. Only two weeks after her surgery, she was able to walk a quarter of a mile. Months later, she was walking more than 5 miles on most days.
“I was so pleased with every precaution Hopkins had taken,” says Fenton. “For the first time in my life, I walk straight—not crooked or with a limp. A day doesn’t go by that I am not grateful.”