As the baby boomer generation comes into its mature years, the grinding pain of hip and knee joints from decades of wear-and-tear on the cartilage begins to appear along with the inevitable gray hair and wrinkles.

While good skin care and a talented hairstylist can remedy the laugh lines and silver threads, it takes a skillful surgical and rehabilitation team to fix the joint pain and stiffness that can sideline even the most active person.

While joint replacements are done at many hospitals, only one in our region, Blue Mountain Health System's Gnaden Huetten campus, has earned Blue Cross of Northeastern Pennsylvania's Blue Distinction award for knee and hip replacement.

The designation is given to medical facilities that have demonstrated expertise in delivering specialty care in joint replacement or bariatric surgery, cardiac care, complex and rare cancers, transplants or spinal surgery.

"The Blue Distinction designation is based on a facility's ability to meet objective, evidence-based quality criteria established in collaboration with expert physicians and medical organizations. Studies indicate Blue Distinction Centers® have better overall outcomes and lower costs for certain procedures when compared to non-designated medical facilities," according to the company's website.

It has awarded only about 800 of the designations nationwide.

The large number of successful joint replacements done at the hospital, and the lack of subsequent problems, helped Gnaden Huetten earn the award.

"The Blue Mountain Health System and Gnaden Huetten Hospital did perform a large number of joint replacements that were quite successful," said surgeon Dr. Robert B. Grob, D.O. Joint replacements are also done at the Palmerton campus, he said.

"Our infection rate is extremely low with total joint replacements, which gives us a distinction, which means that the quality of nursing care and surgical technology care in our operating rooms is very high," said Gnaden Huetten's director of Surgical Services, Trish Green.

"I keep them at that standard," she said. Green's staff constantly monitors the room and equipment, making sure all instruments and surfaces are sterile. "It's a very large team effort here at Blue Mountain Health Systems, between both campuses."

The "safety rates are high and the complication rates are low," at Gnaden Huetten, Grob said. "The hospital should be proud of the unique award that it has received."

Grob, who works with Mahoning Valley Orthopedics, said that "Over the past 10 years, I've probably performed over 1,000 joint replacements."

Over that decade, the technology behind joint replacements has evolved.

Grob cited two significant changes.

"One is the manufacturing process of the components. They are made to last much longer than the original ones made in the 1970s and 1980s," he said. Now, the artificial joints last at least 15-20 years, although their life-span depends on a variety of factors.

Grob said that the surgical technique has also been refined.

"Smaller incisions, minimally-invasive surgery. The instrumentation to do the knee replacements have been much more streamlined," he said. "The smaller the incision, the less muscle or tendon damage, and the patients can be mobilized much more quickly."

Green coordinates the team that is involved in the replacement the surgeon, surgical and rehabilitation staff. She spoke about the changes in joint replacement surgery over the years.

"The equipment has changed, so we can do a total knee replacement one way today, and the next day, they have a new technology out a new metal, a new way of doing a procedure, and we adapt to that," she said.

Grob said patients typically stay in the hospital from 1-3 days. While there, "after surgery, the rehabilitation starts it even starts the night of surgery. The patient sits up at the end of the bed, dangling their toes and possibly even taking some steps that night. We promote mobility. That's why we do the surgery, to decrease pain and increase function, so why not start mobility as soon as we can?"

The rehabilitation is guided by highly-trained physical and occupational therapists, he said.

How much rehabilitation a patient needs depends on the patient.

"It can range anywhere from six to 12 weeks," he said. "That does not limit them right away from doing activities such as walking or driving. They can drive as soon as they feel confident with the leg, as soon as their muscle strength and motion are at a functional level. Walking we encourage from day one, and other activities, such as sports, including golf and tennis, we judge that on a patient-by-patient basis."

The youngest person to have had joint replacement was a 27-year-old, Grob said. The patient had been born with a joint problem.

"If we hadn't done the surgery, he probably would be confined to a wheelchair by now," Grob said.

The oldest joint replacement patients were in their 90s.

"They couldn't walk any more," he said. "By doing joint replacement, they increased their mobility significantly."

Gnaden Huetten is the only hospital in the region that has been so honored, said BMHS spokeswoman Lisa Johnson.