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When is it Time for a Joint Replacement Surgery?
Wondering if it's time for a joint replacement procedure? Listen as Dr. Aaron Koslin, an orthopedic surgeon with BayCare discusses when a joint replacement is needed and what's involved in the process.
Featured Speaker:
engineering.
Following college, he attended medical school at Nova Southeastern University in Ft.
Lauderdale, FL. After graduating from medical school, Dr. Koslin completed his internship and residency in orthopedic surgery at Largo Medical Center followed by a fellowship in adult reconstruction at Allegheny General Hospital in affiliation with Drexel and Temple Universities.
Dr. Koslin treats hip and knee conditions offering both surgical and nonsurgical
treatment options to form a treatment plan decided alongside his patients. His surgical specialties include direct anterior total hip replacements, robotic assisted total and partial knee replacements, same day and outpatient total joint replacements and rapid recovery protocols after total joint replacements. He also specializes in treating complications of previous hip and knee replacements.
Learn more about Dr. Aaron Koslin
Aaron J. Koslin, DO
Dr. Aaron Koslin is an orthopedic surgeon specializing in the treatment of hip and knee arthritis, hip and knee reconstruction. He attended Tulane University and Clemson University where he received an undergraduate and master’s degree in biomedicalengineering.
Following college, he attended medical school at Nova Southeastern University in Ft.
Lauderdale, FL. After graduating from medical school, Dr. Koslin completed his internship and residency in orthopedic surgery at Largo Medical Center followed by a fellowship in adult reconstruction at Allegheny General Hospital in affiliation with Drexel and Temple Universities.
Dr. Koslin treats hip and knee conditions offering both surgical and nonsurgical
treatment options to form a treatment plan decided alongside his patients. His surgical specialties include direct anterior total hip replacements, robotic assisted total and partial knee replacements, same day and outpatient total joint replacements and rapid recovery protocols after total joint replacements. He also specializes in treating complications of previous hip and knee replacements.
Learn more about Dr. Aaron Koslin
Transcription:
When is it Time for a Joint Replacement Surgery?
Intro: This is BayCare HealthChat, another podcast from BayCare Health System.
Joey Wahler (Host): Joint replacement, when is it needed and what's involved? This is BayCare HealthChat, a podcast from BayCare. Thanks for listening. I'm Joey Wahler. Our guest from BayCare, Dr. Aaron Koslin, an orthopedic surgeon, specializing in hip and knee arthritis and hip and knee reconstruction. Dr. Koslin, thanks for joining us
Aaron Koslin, DO: Thanks for having me.
Joey Wahler (Host): First, what conditions do you treat the most and what are their most common related symptoms?
Aaron Koslin, DO: Yeah. So the two most common conditions we treat are hip and knee arthritis. The symptoms and the main symptom that brings patients in to see us are pain. This is pain that starts interfering with their regular activities of daily living, such as just walking around, running errands and usually first, more kind of higher impact activities. Maybe it hurts if they're going to Disney for a weekend or, if they're going to the gym, they start noticing pain. Pain starts to be the limiting factor first, and then they start noticing some stiffness and limited range of motion in the joints also.
Joey Wahler (Host): And for those conditions, what are some non-surgical treatment options?
Aaron Koslin, DO: Yeah. So we always like to start trying from the most conservative treatment options and then getting more aggressive if we need to. So conservative treatment tends to start with activity modifications. If we're doing something that's particularly high intensity, if you're a long-distance runner, or maybe you like to walk 36 holes on the golf course, if we can kind of back off of some of those activities a little bit, or find alternatives that are lower impact, we start with that. Once we've kind of met the activity modifications that we can, we start talking about medications that can help, anti-inflammatories or analgesics such as Tylenol or Advil, if they're appropriate for us.
And then once we kind of progress beyond the medications, we start talking about injections. And when we talk about knees, we start talking about steroid injections into the joint to try and decrease inflammation or a type of lubricant or Visco supplementation into the joint. In the hips, we can do steroid injections as well, but we don't do them quite as often in the hip joints as opposed to the knee. And we don't do the gel injections typically in the hips as well.
Joey Wahler (Host): Gotcha. So since joint replacement tends generally speaking to affect people more as they get older, is there a general age range that you deal with most for that?
Aaron Koslin, DO: So typically, it does evolve as we get older, but more recently we've seen it in a younger group. With more activities that we're doing with sports and athletics as children, we're getting a little more wear and tear in our joints. So this is something that typically starts involving patients anywhere between the age of 60 and 80 years old. But with even wear and tear arthritis, I have patients that come into me in their 40s and 50s and sometimes, with hips in particular, can be in the 30s where they start having symptoms from this.
Joey Wahler (Host): So, when do you usually know when joint replacement is needed?
Aaron Koslin, DO: Yeah. So, you know, anytime, surgery should really be one of our last options. So in general, when we're trying to treat pain, pain is the limiting factor for us. We can usually accommodate most of our stiffness and range of motion. We can deal with a little bit of swelling. But once we have pain, that's really what stops us from doing the activities we enjoy. That's the time when, once we failed our conservative treatment, that we consider joint replacement surgery as an option for arthritis. We always want to exhaust all of our conservative treatment before proceeding with surgery, because there's a lot more risk involved with surgery.
Joey Wahler (Host): So, let me ask you about a few specific procedures. You do direct anterior total hip replacement, which is what exactly?
Aaron Koslin, DO: So when we do a total hip replacement, we remove the femoral ball. So we remove the ball that makes up the ball and socket joint of our hip. We put a type of stem in the thigh bone with an artificial ball that replaces that. We replace the socket as well. The direct anterior is an approach. It's a way to get down to the hip joint, where we make the incision on the front of the thigh. It lets us go between the natural interval between the muscles to get to the joint so that we're not cutting some of the muscles and it might speed up the recovery.
Joey Wahler (Host): And then there's partial hip replacement, which as it would suggest, isn't quite as involved.
Aaron Koslin, DO: It's still a fairly involved surgery. Partial hip replacement in general is not used to treat arthritis anymore. It's something that we really use to treat fractures, type of femoral neck fracture in a more elderly population. Even our younger patients, patients that are in their 60s, 70s that have a fracture of the femoral neck, we'll still treat with a total hip. There are some potential long term and longevity issues with the partial hip replacement that make it where we don't use that to treat arthritis and even some age groups who don't use it to treat fractures.
Joey Wahler (Host): Gotcha. And then how about robotic-assisted total and partial knee replacements? What do those entail?
Aaron Koslin, DO: Yeah. So there's a few different types that are out there. The type that I use, we get a CAT scan before the surgery. And it creates a computer model of the knee that we use to try and improve our accuracy during surgery. All of these techniques that we use are all gained at trying to get more information, to have us do a better job at the surgery, make the knee more balanced, try and prevent the chance of having stiffness or malalignment of the implant all by getting feedback constantly from the robotic software and helping that make some of the surgical techniques more accurate during the surgery. It doesn't change particularly the recovery protocols and it's still the same type of implants that we were using before for the most part, but it does help our accuracy and helps us be more reproducible in our joint replacement surgeries.
Joey Wahler (Host): And speaking of recovery, what kind of recovery, be it a hip or a knee, even though I'm sure there's a range depending on the circumstances, can people usually expect?
Aaron Koslin, DO: Yeah. So in general, most of the time, hip replacements maybe progress a little bit faster than knee replacements within the first couple of weeks. With both surgeries, patients are up and moving the same day of surgery. Many patients with both types of surgeries go home the same day as their surgery later in the afternoon because you're able to put full weight and walk right away. We've found a lot of benefit to our early mobilization and that's really what we encourage with both. Most people are using a walker or some type of assistive device for the first week possibly and then weaning off of that when they're comfortable with it and they've kind of regained some balance.
Joey Wahler (Host): And I guess sometimes, I know talking to some people that have had these procedures, when they're in that recovery and doing physical therapy, it can be a somewhat lengthy process where it can get a little bit frustrating that they're not able to do what they're used to right away. But I guess the good news is that they can rest assured knowing that the work has been done medically speaking, and that they will eventually have more capability than they did before, right?
Aaron Koslin, DO: Correct. You know, we know that after a hip and knee replacement, patients continue to have improvement in their symptoms for an entire year after surgery. Now, at some point between the day of surgery and that year point that's out from surgery, they'll bypass it and be better than they were before going into surgery. The worse someone's condition is going into the surgery, that point will be earlier on where sometimes with hip or knee replacements, they may feel better within a few days compared to how bad the pain was before surgery. Sometimes that takes several weeks. And particularly if it's taking a lot of work with physical therapy to regain motion and strength and we're doing a lot of work, that pain may persist a little bit longer. But ultimately, the outcomes do very well for both of these surgeries when the patient selection and the type of symptoms we're having before are appropriate.
Joey Wahler (Host): And the fact is, doctor, am I right, that some patients are able to have same day, an outpatient total joint replacement, that's pretty amazing, isn't it?
Aaron Koslin, DO: It really is. We've come a long way. You know, early on, they told everybody you needed to spend three months in the hospital after a joint replacement. They didn't really have a good reason why or a good reason of what we were doing for that period. And then, for the longest time, everybody spent three days and it just became normal you spent three days, maybe you went to a rehab facility afterwards. And we said, you know, these patients are going to these facilities. There's patients recovering from illness. And with arthritis, you're not really ill. You've just had surgery to correct a musculoskeletal problem. So when we get people up and we get you moving early and you're able to do all the types of activities that you're going to need to do at home, and you've already done them at the hospital, people recover much better at home. It's the food you're used to eating. It's being around family and friends, sleeping in the bed you're used to sleeping in. It makes a more comfortable environment to recover.
Joey Wahler (Host): What do you say to people if they're hesitant when they hear the word replacement, and you're talking about a long recovery time, in order to assure them that this is often the right thing to do?
Aaron Koslin, DO: Yeah. You know, really we focus on the types of activities that they should expect to be able to feel comfortable with after their joint replacement and noticing that those are things that are limited in doing now, such as going on a mile or two walk with a spouse or a friend. You know, these are things that people are limited and they stop doing it and they recognize they stop doing these activities. And joint replacement gives us a way of regaining some of that activity. It's not going to let us go back to being 18 years old and playing basketball or running a five-minute mile, but it's going to let us resume the regular activities that we were doing before that we had to maybe stop such as going on walks and low impact exercise, playing tennis, playing golf, those types of activities. We expect patients to be able to resume playing afterwards.
Joey Wahler (Host): And you also treat complications from previous hip and knee replacements. What are some examples of those issues?
Aaron Koslin, DO: Yeah. So we talked a lot about here mentioning some of the very good things about it and how great joint replacements do. But there are risks with surgery. You can develop infections and these infections can happen right after the time of surgery or they can happen 15, 20 years down the road. I treat a fair amount of those that get sent to me to manage because they usually require additional surgeries.
You can have complications with the implants, the way they adhere to the bone coming loose or the plastic can wear out, requiring it to be changed, to have a thicker piece in so that the knee is stable, that the hip is stable and these are all things that we manage. And usually, it's done by a specialist who does the higher volume of these because it's hard to treat these complications if we're only treating them sporadically.
Joey Wahler (Host): And so in summary, what message, doc, do you want our listeners to take away from our discussion regarding joint replacement in general?
Aaron Koslin, DO: I think the most important thing is really focusing on when's that right time. You know, it's making sure you've tried the right conservative treatment, making sure that the activities that you're hoping to get back to doing and the things you've stopped doing because of your pain or things you would expect to be able to do on a hip or a knee replacement and have minimal symptoms or manageable symptoms, if any, at all. When it's done in the right setting and it's done for the right reasons, joint replacements get very good results. It helps people regain their freedom, regain their activity. And usually, people have been dealing with this kind of chronic pain for months or years by the time they finally decide to do it. And it can be a liberating experience once you're done with it.
Joey Wahler (Host): Well, folks, having heard that, we trust you're now more familiar with joint replacement. Dr. Aaron Koslin, thanks so much again.
Aaron Koslin, DO: Thanks for having me.
Joey Wahler (Host): And for more information or to connect with a provider like Dr. Koslin, please visit BayCare.org. Again, that's BayCare.org. Please remember to subscribe, rate, and review this podcast and all the other baycare podcasts. For more health tips and updates, please follow us on your social channels. If you found this podcast helpful, please do share it on your social media and be sure to check out all the other interesting podcasts in our library. Thanks for listening to BayCare HealthChat, a podcast from BayCare. Hoping your health is good health. I'm Joey Wahler.
When is it Time for a Joint Replacement Surgery?
Intro: This is BayCare HealthChat, another podcast from BayCare Health System.
Joey Wahler (Host): Joint replacement, when is it needed and what's involved? This is BayCare HealthChat, a podcast from BayCare. Thanks for listening. I'm Joey Wahler. Our guest from BayCare, Dr. Aaron Koslin, an orthopedic surgeon, specializing in hip and knee arthritis and hip and knee reconstruction. Dr. Koslin, thanks for joining us
Aaron Koslin, DO: Thanks for having me.
Joey Wahler (Host): First, what conditions do you treat the most and what are their most common related symptoms?
Aaron Koslin, DO: Yeah. So the two most common conditions we treat are hip and knee arthritis. The symptoms and the main symptom that brings patients in to see us are pain. This is pain that starts interfering with their regular activities of daily living, such as just walking around, running errands and usually first, more kind of higher impact activities. Maybe it hurts if they're going to Disney for a weekend or, if they're going to the gym, they start noticing pain. Pain starts to be the limiting factor first, and then they start noticing some stiffness and limited range of motion in the joints also.
Joey Wahler (Host): And for those conditions, what are some non-surgical treatment options?
Aaron Koslin, DO: Yeah. So we always like to start trying from the most conservative treatment options and then getting more aggressive if we need to. So conservative treatment tends to start with activity modifications. If we're doing something that's particularly high intensity, if you're a long-distance runner, or maybe you like to walk 36 holes on the golf course, if we can kind of back off of some of those activities a little bit, or find alternatives that are lower impact, we start with that. Once we've kind of met the activity modifications that we can, we start talking about medications that can help, anti-inflammatories or analgesics such as Tylenol or Advil, if they're appropriate for us.
And then once we kind of progress beyond the medications, we start talking about injections. And when we talk about knees, we start talking about steroid injections into the joint to try and decrease inflammation or a type of lubricant or Visco supplementation into the joint. In the hips, we can do steroid injections as well, but we don't do them quite as often in the hip joints as opposed to the knee. And we don't do the gel injections typically in the hips as well.
Joey Wahler (Host): Gotcha. So since joint replacement tends generally speaking to affect people more as they get older, is there a general age range that you deal with most for that?
Aaron Koslin, DO: So typically, it does evolve as we get older, but more recently we've seen it in a younger group. With more activities that we're doing with sports and athletics as children, we're getting a little more wear and tear in our joints. So this is something that typically starts involving patients anywhere between the age of 60 and 80 years old. But with even wear and tear arthritis, I have patients that come into me in their 40s and 50s and sometimes, with hips in particular, can be in the 30s where they start having symptoms from this.
Joey Wahler (Host): So, when do you usually know when joint replacement is needed?
Aaron Koslin, DO: Yeah. So, you know, anytime, surgery should really be one of our last options. So in general, when we're trying to treat pain, pain is the limiting factor for us. We can usually accommodate most of our stiffness and range of motion. We can deal with a little bit of swelling. But once we have pain, that's really what stops us from doing the activities we enjoy. That's the time when, once we failed our conservative treatment, that we consider joint replacement surgery as an option for arthritis. We always want to exhaust all of our conservative treatment before proceeding with surgery, because there's a lot more risk involved with surgery.
Joey Wahler (Host): So, let me ask you about a few specific procedures. You do direct anterior total hip replacement, which is what exactly?
Aaron Koslin, DO: So when we do a total hip replacement, we remove the femoral ball. So we remove the ball that makes up the ball and socket joint of our hip. We put a type of stem in the thigh bone with an artificial ball that replaces that. We replace the socket as well. The direct anterior is an approach. It's a way to get down to the hip joint, where we make the incision on the front of the thigh. It lets us go between the natural interval between the muscles to get to the joint so that we're not cutting some of the muscles and it might speed up the recovery.
Joey Wahler (Host): And then there's partial hip replacement, which as it would suggest, isn't quite as involved.
Aaron Koslin, DO: It's still a fairly involved surgery. Partial hip replacement in general is not used to treat arthritis anymore. It's something that we really use to treat fractures, type of femoral neck fracture in a more elderly population. Even our younger patients, patients that are in their 60s, 70s that have a fracture of the femoral neck, we'll still treat with a total hip. There are some potential long term and longevity issues with the partial hip replacement that make it where we don't use that to treat arthritis and even some age groups who don't use it to treat fractures.
Joey Wahler (Host): Gotcha. And then how about robotic-assisted total and partial knee replacements? What do those entail?
Aaron Koslin, DO: Yeah. So there's a few different types that are out there. The type that I use, we get a CAT scan before the surgery. And it creates a computer model of the knee that we use to try and improve our accuracy during surgery. All of these techniques that we use are all gained at trying to get more information, to have us do a better job at the surgery, make the knee more balanced, try and prevent the chance of having stiffness or malalignment of the implant all by getting feedback constantly from the robotic software and helping that make some of the surgical techniques more accurate during the surgery. It doesn't change particularly the recovery protocols and it's still the same type of implants that we were using before for the most part, but it does help our accuracy and helps us be more reproducible in our joint replacement surgeries.
Joey Wahler (Host): And speaking of recovery, what kind of recovery, be it a hip or a knee, even though I'm sure there's a range depending on the circumstances, can people usually expect?
Aaron Koslin, DO: Yeah. So in general, most of the time, hip replacements maybe progress a little bit faster than knee replacements within the first couple of weeks. With both surgeries, patients are up and moving the same day of surgery. Many patients with both types of surgeries go home the same day as their surgery later in the afternoon because you're able to put full weight and walk right away. We've found a lot of benefit to our early mobilization and that's really what we encourage with both. Most people are using a walker or some type of assistive device for the first week possibly and then weaning off of that when they're comfortable with it and they've kind of regained some balance.
Joey Wahler (Host): And I guess sometimes, I know talking to some people that have had these procedures, when they're in that recovery and doing physical therapy, it can be a somewhat lengthy process where it can get a little bit frustrating that they're not able to do what they're used to right away. But I guess the good news is that they can rest assured knowing that the work has been done medically speaking, and that they will eventually have more capability than they did before, right?
Aaron Koslin, DO: Correct. You know, we know that after a hip and knee replacement, patients continue to have improvement in their symptoms for an entire year after surgery. Now, at some point between the day of surgery and that year point that's out from surgery, they'll bypass it and be better than they were before going into surgery. The worse someone's condition is going into the surgery, that point will be earlier on where sometimes with hip or knee replacements, they may feel better within a few days compared to how bad the pain was before surgery. Sometimes that takes several weeks. And particularly if it's taking a lot of work with physical therapy to regain motion and strength and we're doing a lot of work, that pain may persist a little bit longer. But ultimately, the outcomes do very well for both of these surgeries when the patient selection and the type of symptoms we're having before are appropriate.
Joey Wahler (Host): And the fact is, doctor, am I right, that some patients are able to have same day, an outpatient total joint replacement, that's pretty amazing, isn't it?
Aaron Koslin, DO: It really is. We've come a long way. You know, early on, they told everybody you needed to spend three months in the hospital after a joint replacement. They didn't really have a good reason why or a good reason of what we were doing for that period. And then, for the longest time, everybody spent three days and it just became normal you spent three days, maybe you went to a rehab facility afterwards. And we said, you know, these patients are going to these facilities. There's patients recovering from illness. And with arthritis, you're not really ill. You've just had surgery to correct a musculoskeletal problem. So when we get people up and we get you moving early and you're able to do all the types of activities that you're going to need to do at home, and you've already done them at the hospital, people recover much better at home. It's the food you're used to eating. It's being around family and friends, sleeping in the bed you're used to sleeping in. It makes a more comfortable environment to recover.
Joey Wahler (Host): What do you say to people if they're hesitant when they hear the word replacement, and you're talking about a long recovery time, in order to assure them that this is often the right thing to do?
Aaron Koslin, DO: Yeah. You know, really we focus on the types of activities that they should expect to be able to feel comfortable with after their joint replacement and noticing that those are things that are limited in doing now, such as going on a mile or two walk with a spouse or a friend. You know, these are things that people are limited and they stop doing it and they recognize they stop doing these activities. And joint replacement gives us a way of regaining some of that activity. It's not going to let us go back to being 18 years old and playing basketball or running a five-minute mile, but it's going to let us resume the regular activities that we were doing before that we had to maybe stop such as going on walks and low impact exercise, playing tennis, playing golf, those types of activities. We expect patients to be able to resume playing afterwards.
Joey Wahler (Host): And you also treat complications from previous hip and knee replacements. What are some examples of those issues?
Aaron Koslin, DO: Yeah. So we talked a lot about here mentioning some of the very good things about it and how great joint replacements do. But there are risks with surgery. You can develop infections and these infections can happen right after the time of surgery or they can happen 15, 20 years down the road. I treat a fair amount of those that get sent to me to manage because they usually require additional surgeries.
You can have complications with the implants, the way they adhere to the bone coming loose or the plastic can wear out, requiring it to be changed, to have a thicker piece in so that the knee is stable, that the hip is stable and these are all things that we manage. And usually, it's done by a specialist who does the higher volume of these because it's hard to treat these complications if we're only treating them sporadically.
Joey Wahler (Host): And so in summary, what message, doc, do you want our listeners to take away from our discussion regarding joint replacement in general?
Aaron Koslin, DO: I think the most important thing is really focusing on when's that right time. You know, it's making sure you've tried the right conservative treatment, making sure that the activities that you're hoping to get back to doing and the things you've stopped doing because of your pain or things you would expect to be able to do on a hip or a knee replacement and have minimal symptoms or manageable symptoms, if any, at all. When it's done in the right setting and it's done for the right reasons, joint replacements get very good results. It helps people regain their freedom, regain their activity. And usually, people have been dealing with this kind of chronic pain for months or years by the time they finally decide to do it. And it can be a liberating experience once you're done with it.
Joey Wahler (Host): Well, folks, having heard that, we trust you're now more familiar with joint replacement. Dr. Aaron Koslin, thanks so much again.
Aaron Koslin, DO: Thanks for having me.
Joey Wahler (Host): And for more information or to connect with a provider like Dr. Koslin, please visit BayCare.org. Again, that's BayCare.org. Please remember to subscribe, rate, and review this podcast and all the other baycare podcasts. For more health tips and updates, please follow us on your social channels. If you found this podcast helpful, please do share it on your social media and be sure to check out all the other interesting podcasts in our library. Thanks for listening to BayCare HealthChat, a podcast from BayCare. Hoping your health is good health. I'm Joey Wahler.