Small Wins Lead to Big Recovery

With the Help of Vanderbilt Rehabilitation Center, Double Total Knee Replacement Surgery Patient "Gets Through It All"

Clayton Combs is known as “do-it-all-in-a-day-Clay” for many reasons. He expected that same spirit and drive that motivates him to excel in sports, business, and everything he sets out to do would also get him through double total knee replacement surgery. It did. But it was the support and guidance of the multidisciplinary team at the Vanderbilt Rehabilitation Center at Newport Hospital that got him to add the word “enough” to his moniker.

Enough Pain

Since high school soccer days, Combs, 52-years-old, would simply pop his “bad knee” back in place. It was a dislocated patella. That wasn’t enough to prevent him from marrying his high school sweetheart, reaching the C-suite of a successful insurance career, and raising two daughters. It was the torn meniscus in the other knee, the result of a slip behind the grill of Monahan’s Clam Shack, a decades-old, family-owned restaurant and Narragansett establishment where he was pitching in, coupled with a torn ACL to his bad knee achieved during a pickleball game that finally beat him down. He faced enough pain.

Cortisone treatment was no longer effective. Full knee replacement was needed. The patient opted to have both done at the same time.

“I limit bilateral knee replacement to those patients who are very active and functionally quite independent before surgery,” said Valentin Antoci, MD, PhD, medical director of the Newport Hospital Total Joint Replacement Program. “Clay was already in good shape. Most people don’t have the focus and bandwidth that he did for his recovery. He was able to put in the hard work, the hours of therapy, and could sustain a high level of physical activity.”

From Prehab to Rehab

Similar to his approach to business and getting things done, Combs committed to two weeks of prehab (an exercise therapy program recommended weeks before surgery), hired a personal trainer, and worked out seven days a week prior to surgery. After the surgery, he knew an inpatient rehabilitation program would suit him best. He reflected on what led to his decision to commit to a rehabilitation program.

“I don’t know what I don’t know,” Combs said, during a recent four-mile walk near his home in Narragansett, his cavapoo, Olive, at his side. He had started the day with a 30-minute ride on his stationary bike. “I wouldn’t have known what was considered too much pain or not enough pain. I wanted someone to teach me what is enough.”

Dr. Antoci noted that having surgery on both knees at the same time can make a significant difference in the amount of time it takes a patient to return to work or their normal routine. Individual surgery for one knee at a time could require between four to six weeks for rehabilitation. Having surgery simultaneously on both knees can reduce it to one to two weeks.

Within eight weeks after his surgery and a subsequent weeklong stay at Vanderbilt Rehabilitation Center, Combs reached a 100 percent range of motion in both knees.

Combs’ energy is palpable. He has an engaging personality, and amicable manner. He is a self-proclaimed control freak.

“I was one of those guys who made a list you could never get through in a day,” he said. “I’d feel like a failure if I didn’t get through it all.” After a few days of physical and occupational therapy, he learned about “small wins.” His Vanderbilt care team and even the housekeeping staff helped him recognize his achievements and get him to slow down. “I’d be dressed, shaved, and have my bed made before the staff would come for me. All I did was get ready. But they taught me I had already done enough when I wanted everything at once. They put it in perspective.”

At Vanderbilt, patients are not required to make their beds! Combs will agree they are required to adhere to a regiment led by trained and experienced occupational and physical therapists. “I looked forward to it every day,” he said. The accommodations played a significant role in his recovery, too. “It was amazing. I had a private room (with a view of the water), a TV, every morning I’d choose my breakfast, lunch, and dinner from a menu. I can’t recommend Vanderbilt enough.”

His determination, work with the rehabilitation staff, his previous good physical condition, and the expertise of Dr. Antoci all contributed to his remarkable recovery.

Roberta Lui, MD, a board-certified physiatrist with Lifespan Physician Group Physical Medicine and Rehabilitation, was among Combs’ care team. “While we provide both nursing and rehabilitation services, the level of complexity that we can handle and the resources we have are unparalleled,” she said. “We have greater nursing-to-patient ratios, provide more hours of therapy services to patients per week, have daily physician oversight, and provide rehab psychology and recreational therapy services. These resources often lead to greater levels of patient satisfaction, greater improvements in function upon discharge, and shorter lengths of stay compared to other facilities.”

When October comes, they’ll close for the season. By then, he will have completed prehab for his next surgery. Not as complex, he’ll be having arthroscopic surgery on his shoulder for a torn rotator cuff. As much as he would like to sign on for another stay at Vanderbilt, it probably won’t be necessary.

“Do-it-all-in-a-day-Clay” gets when enough is enough.