JEN SKERRITT / MIKE APORIUS

Using a new way of working that is unique in Canada, a Winnipeg hospital has more than doubled the number of hip and knee replacements it can perform. Reporter Jen Skerritt and photographer Mike Aporious were allowed to gown up and observe this pioneering method that is slashing wait lists and reducing the time patients are in pain.

IT'S shortly after 9 a.m. Tuesday, and Dr. David Hedden slams a metal hammer into the softball-sized hole in a patient's bloody, dislocated hip.The man, 65 is getting a hip replacement, and Hedden wastes no time drilling away chunks of bone, and filing it down, before screwing in the new joint and snapping the metal and plastic hip socket squarely into place.

Minutes later, Hedden strips off his gloves and his gown, washes his hands, and gets suited up to perform a total knee replacement on patient Don Hallock, 51.

Clinical assistant Kerry Tenyck takes control of the remaining hip surgery, by stitching up the patient, cleaning the wound, and taking him to recovery -- a job that up until recently, surgeons were responsible for.

Concordia Hospital has the only operating room in the country where clinical assistants are helping orthopedic surgeons perform twice as many hip and knee replacements than 18 months ago.

Clinical assistants work with a team consisting of a scrub nurse, anesthesiologist and two circulating nurses to help alleviate some of the before-and-after surgery jobs from surgeons like Hedden so they're able to perform overlapping joint replacements.

Each week, the surgical team sets aside two days for "double room" surgeries for patients getting their first knee or hip replacement. Surgeries to repair replacement joints occupy the other days of the week, and can't be done on "double room" days since they are more complicated and time-consuming.

Surgery for a first-time patient takes about two hours, start to finish. Joint replacements last about 15 years.

While Hedden operates on one patient, a clinical assistant is busy getting the next patient positioned, draped, and sterilized on another operating table. An anesthesiologist administers drugs in the next patient's spine, while a nurse prepares the necessary tools.

Hedden just has to move from one operating room to another.

"All I have to do is put on my gown and do the surgery," Hedden said, scrubbing his hands. "This makes a huge difference on the productivity on my part."

The new system is saving surgeons from about 45 minutes of prep time and 25 minutes of post-op stitching and "closing" per patient, and has hospital staff raving about its efficiency. Surgeons are now performing an average of seven or eight surgeries a day, compared to the three a day they were performing last year.

Wait lists have already dropped from between 12 and 18 months to between six and 12 months, and has Concordia staff hoping the wait could be as short as three or six months by next year.

Most of all, Hedden said a shorter wait means patients spend less time in pain, and have a better outcome after surgery.

Orthopedic surgeon Dr. Eric Bohm said the idea sprouted after a visit to a clinic in Philadelphia where physician assistants help push more patients through surgery. Vancouver uses a similar model, but has a surgeon and surgeons-in-training working in the "double rooms."

"We were frustrated only doing three joints a day," Bohm said.

The first clinical assistants were certified by the College of Physicians and Surgeons Manitoba in 2003 and three now work for Concordia's joint replacement program. All have a medical background, and are either former military doctors like Tenyck, foreign medical graduates like Jose Araneta, or physiotherapists and nurses who complete hands-on training for the job.

Bohm said formal training programs for clinical assistants are set to begin at the University of Manitoba faculty of medicine in the fall of 2007. They expect to enrol another 12 clinical assistants, and help ease the burden caused by an aging population, and a wave of surgeons who are set to retire in the next few years.

"We're going to go from three and a half (orthopedic) surgeons per 100,000 people to two and a half per 100,000 people over the next 30 years," Bohm said. "Even if you double the number of (medical) training spots, we will still face a decline."

Shortly after 9 a.m., Hedden slices open Hallock's right knee, exposing the bone, cartilage and tissue that had been giving the avid marathon runner pain for the past two years. He drills a hole in Hallock's kneecap, sending bits of bone and blood flying in the operating room, and hammers a rod down the centre of his thigh bone.

With the help of Araneta, Hedden files the bone jutting out the centre of Hallock's shin and fits him for a prosthetic kneecap -- before cutting off part of the knee altogether and securing a new one in its place.

By 10:10 a.m., Hedden dashes into an adjacent operating room for his third of nine surgeries scheduled for Tuesday, leaving Araneta to stitch, staple and clean Hallock's leg. As Araneta helps wheel a groggy Hallock into the recovery area, he says he's proud of the work he does and the impact it has on both patients and physicians.

"That is satisfaction itself," he said. "Patients in the ward appreciate what you're doing. You get a pat on the back and it means a lot."

Hallock learns his procedure was part of the new "double rooms" system from his hospital bed, and is surprised at how it works.

"This has been a very positive experience," he said. "They're very efficient and I find them very caring."

jen.skerritt@freepress.mb.ca

What's new?

WE'RE THE FIRST: Winnipeg is the only city in Canada with clinical assistants helping physicians with overlapping surgeries. While the orthopedic surgeon finishes a surgery, a clinical assistant prepares the next patient for a surgeon.

FILLING THE GAP: Clinical assistants can help fill staffing shortages. If the program expands further, they may be able to address shortages caused by surgeons who are retiring and the burden of an aging population.

EXPANSION IN WORKS: Concordia Hospital surgical staff are discussing expanding clinical assistants to other areas of Canada with the Canadian Orthopedic Association and the Canadian Medical Association to help reduce wait times.