Jeannie Harrington, who lives in eastern North Carolina, remembers the exact date when a car broadsided her motorcycle: October 8, 2014. While Jeannie is grateful to be alive, that day was the first of many in which she would need surgeries on her right leg.
Jeannie’s team saved her leg from being amputated, but because of the many surgeries, her right leg became an inch and a half shorter than her left. Her surgeon referred her to Joseph Hsu, MD, director of the limb-lengthening and deformity program at Atrium Health Musculoskeletal Institute (MSKI), who is a national leader in limb-lengthening and reconstruction.
“We had a great first meeting,” Jeannie says of her introduction to Hsu. “I felt confident leaving after I met with him the first time, so that was a big, big reassurance. He knew what his approach was going to be and explained it so that I’d understand.”
After that meeting, Jeannie decided to return to Charlotte for limb-lengthening surgery with Hsu. It was a decision that would give her the treatment she needed and empower her to return to an active lifestyle.
“When you realize you have the right doctor, you want to stick with them. Seeing Dr. Hsu’s confidence and seeing those results were big things for me,” Jeannie says.
A National Leader in Limb-Lengthening and Reconstruction
Hsu has been a leader in limb-lengthening and reconstruction since his time as a U.S. Army trauma surgeon, when he focused on maximizing outcomes for soldiers who had limb reconstructions. In addition, he was the past president of the Limb Lengthening and Reconstruction Society of North America, the field’s leader in instruction and innovation. Hsu now applies these battlefield innovations to help civilians like Jeannie return to the lives they love.
“The surgeon who salvaged Jeannie’s leg did tremendous work. In a lot of hands, she would have probably lost her leg,” Hsu says. “The surgeon referred her to us mainly for management of her limb-length discrepancy because there are very few of us who do this kind of work. For someone like Jeannie, who’s very young and extremely active, we needed to have a very accurate correction and have her legs level out exactly right.”
Hsu found that Jeannie was the perfect candidate for a limb-lengthening process that uses an internal magnetic lengthening nail: She had no infection and the bone was straight. Hsu cut her right tibia, then inserted the magnetic nail. When activated, the magnet inside the nail spins an internal motor to very slowly stretch the bones a little each day, allowing natural growth to fill the gap. Jeannie applied a large external magnet to her leg daily to activate this process.
“Almost instantly, I was using the magnet three times a day. Each time, it would stretch one third of a millimeter at a time,” Jeannie says. “Within a month, I had the length I needed. I didn’t feel anything – the changes were so miniscule that I didn’t realize they were happening. It was a pretty fool-proof method.”
Prioritizing the Patient Experience
Atrium Health Musculoskeletal Institute prioritizes patients’ comfort and convenience in its limb-lengthening services. Jeannie’s limb-lengthening surgery was an outpatient procedure, allowing her to recover at home instead of remaining in the hospital for days.
“We are very patient-centered. We make small incisions, we can do many of these surgeries as outpatient procedures, and the limb is weight bearing that same day,” Hsu says. “We’ve proven that our patients’ long-term outcomes are just as good or even better than traditional, inpatient surgeries, but our patients’ short-term outcomes are very different. They can return to their lives as quickly as possible,” Hsu says.
MSKI even works with Global Healthcare Services, which helps out-of-town patients who travel to Charlotte for care, whether they come from across the state or around the world. From coordinating appointments to helping with travel arrangements, these services support patients before, during and after their visit to the institute.
A Comprehensive, Low-Opioid Pain Approach
Before she came to MKSI, Jeannie received lots of prescriptions for pain medications. She didn’t feel comfortable taking opioids, so she didn’t take many of them. When Jeannie came to Atrium Health and met with Hsu, she realized he was more aligned with her low-opioid philosophy of pain management.
Hsu embraces a multimodal way to manage pain, which relies on low amounts of opioids – and, in some cases, none at all. He uses evidence-based techniques that incorporate pharmaceutical, physical and cognitive strategies, which range from ice or meditation to music and aromatherapy. He stresses that the right approach differs for each patient and it’s important to work with each individual to find the best approach.
MSKI is a leader in safe pain management, and the team has published national clinical practice guidelines for safely tapering patients off low levels of opioids. Hsu has lectured on this topic for a decade and multimodal pain management is a focus of his research. The goal for pain management is for it to be safe, effective and accessible to all.
“We can taper the opioids very, very appropriately, so people only take opioids for a few days maximum or for a couple of weeks or so,” says Hsu. “We have discussions up front about this so that patients understand what we’re doing and why we’re doing it. Then we’re there to walk them through it.”
Jeannie’s Next Steps
It’s been seven years since Jeannie had the accident that almost took her right leg and three years since her last surgery with Hsu. She doesn’t expect to need another procedure any time soon. While her life isn’t quite as active as it was before her accident, she embraces new ways to stay active, including yoga and swimming. It’s quite an accomplishment for a woman who nearly lost her leg.
“If I was still walking around with an inch and a half difference in the length of my legs, I’m sure by now I would be hurting in other places,” Jeannie says. “While you’re dealing with an injury like this, there will be days when you feel like it’ll never get better. Then one day, you look back and realize how far you’ve come.”
Learn more about limb-lengthening and deformity services at Atrium Health Musculoskeletal Institute and connect with @AtriumMSKI on Twitter and Facebook. To learn more about Dr. Joseph Hsu, follow Dr. Hsu on Twitter.
