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Scott Vyverman (Host):  Your knees and hips are your largest joints. They support your body weight and work together so that you can stay physically active throughout your life. But sometimes the wear and tear on these joints leads to a need for joint replacement. Orthopedic Surgeon, Dr. Shawn Brandenburg is here today to talk with us about the latest in knee and hip replacement. Thanks for joining us today Dr. Brandenburg. What is total joint replacement surgery?

Shawn Brandenburg, DO (Guest):  Yeah, total joint replacement, in terms of the knee in particular, the entire knee is not actually replaced as some may be mislead to believe. But the bone ends on the femur, which is your thigh bone and tibia, the shin bone as well as the undersurface of your knee cap are resurfaced. These worn out or damaged cartilage surfaces are cut with a saw blade in surgery. Then are then recapped with a metal or plastic implant. A plastic insert between the femur and the tibia in combination with a plastic implant in the knee cap creates a nice smooth, a new smooth cushion and functional joint. The ultimate goal of joint replacement surgery is really to reduce or eliminate pain.

Host:  That’s really interesting and thanks for clearing that up because when I pictured knee surgery, or knee replacement surgery; I always think to myself well how do they do that? How do they take your existing knee out and put the new knee in? So, for us lay people, thanks for clarifying that. So, I’m 51 and I know what causes my joint issues trying to keep up with my kids, coaching baseball, but generally speaking; what are the causes of joint issues?

Dr. Brandenburg:  There are multiple causes of joint pain. Most commonly patients suffer from osteoarthritis which is a wear and tear condition that destroys the joint cartilage. Joint cartilage is a tough smooth tissue that covers the ends of the bones where the joints are located. It cushions the bones during movement and because it’s smooth and slippery; it allows the motion with minimal friction. Trauma, repetitive motion, or for unexplained reasons, the cartilage can wear down exposing the bone ends. Over time cartilage destruction can result in painful bone on bone contact, swelling and loss of motion.

Host:  You perform both knee and hip replacement surgeries and I’m going to use air quotes here, which is easier to perform a hip or a knee replacement?

Dr. Brandenburg:  You know I think that answer depends on your training and how you view the anatomy of the hip and the knee. For instance, I had a little more training on total knee replacements or partial knee replacements, but I also think total hips are just a little bit more complex in terms of the anatomy and just getting into the hip joint. In particular, with the knee, there’s a lot more technical challenges in terms of how you can balance the soft tissue around the knee either through the bone cuts or releases of soft tissue in surgery. I just think there are more variables to deal with, with knee replacement.

Host:  And not that you really get a choice per se, but do you have a preference? Is one more in your wheelhouse than the other or are you just open for all types of replacements?

Dr. Brandenburg:  Open for all. I do both total hip replacements, partial and total knee replacements with using the robot.

Host:  You mentioned the robot there. Can you tell us more about this new Mako Robotic-Arm that was recently purchased by Columbus Community? It sounds pretty cool, pretty high tech.

Dr. Brandenburg:  First of all, I would like to thank Columbus Community Hospital for purchasing the Robotic Mako Arm because I think it is an excellent tool for the armamentarium of the joint replacement surgeon as myself. I think it gives patients the best chance for an optimal recovery and great surgical outcome. Some patients may not know, but a CT scan is performed on their hip or knee prior to surgery. The information from that CAT scan and robotic software allows the surgeon to plan the patient’s surgery appropriately and predict the sizes of the implants, optimal position of the implants with great accuracy and control of other important surgical variables.

Host:  How much of the robotic arm is the robot, how much is being controlled by you? What’s that like for you in terms of the surgery itself? Does the robot do anything that you don’t tell it to do?

Dr. Brandenburg:  No, so, it’s a passive system. So, the robot will not do anything that I don’t tell it to do. So, I’m still able to direct the surgery but have the nice assistance of the robot that allows me to not injure the surrounding soft tissue structures in particular around the knee so that in recovery period for the patient, they have less pain and are able to get through the rehab process quicker.

Host:  So, it sounds like it makes a big difference for patients. Has that been you experience that since you have had access to the robotic arm, that this has been going smoother for patients, recovery is better and if in general, rehab is needed, how long is that rehab process?

Dr. Brandenburg:  Yeah rehab can vary from patient to patient. Every patient recovers at a different rate. Most patients are about 80% plus or minus at six weeks and I tell them 90% around the 12 week mark. They may be fully recovered at that point. Hopefully they are back to what they like to do, their normal activities such as hiking or biking or if they wanted to go on long walks. Hopefully they are back at that six week or at least the 12 week mark.

Host:  That’s amazing. I worked with a guy 25 to 30 years ago who had a hip replacement surgery and without being overly graphic, I remember him showing me his scar that went from like under his armpit all the way down practically to his knee and I’m guessing the scars a much smaller today.

Dr. Brandenburg:  They absolutely are. Especially with more muscle sparing approaches which I do in particular with total hip replacement and total knee replacement. In particular on the hip side, I do what’s called a direct superior approach where I go through the gluteus maximus muscle or simply your butt muscle and we get down to the hip capsule area and only remove a couple of tendons that are repaired at the end. But I’m able to do that through a small incision safely and effectively without compromising where I actually put those components.

And then on the knee side, as well, I do an approach called the subvastus approach where I do not cut into the quadricep tendon like most surgeons, so, what that allows me to do is move one of the main quadricep muscles called the VMO or the vastus medialis oblique and I place that to the side during surgery and there’s less repair at the end and ultimately the patient has less pain and is able to have a stronger quadricep muscle area to get them through the rehab process.

Host:  Sounds a little bit like the six million dollar man, we can rebuild him, we can make him bigger and stronger and faster. Is there anything else we need to know about knee and hip replacement Doctor?

Dr. Brandenburg:  You know total hip and total knee replacements are two of the most successful procedures performed in the United States. In reality, according to literature, there is roughly a 600% increase in demand for total joint replacement by the year 2030 especially as it relates to the baby boomer population. People are living longer and want to remain active so, if faced with a painful joint then joint replacement is a procedure that can get them back to their normal activities and improve their quality of life. That is really why I do what I do. I love to see the immediate improvement in patients’ quality of life.

Host:  Thanks Doctor. That’s Orthopedic Surgeon Dr. Shawn Brandenburg. If you’d like to learn more about the joint replacement options at the Columbus Orthopedic and Sports Medicine Clinic, visit www.columbushosp.org and click on the, our clinics tab. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics that may interest you. This is Columbus Community Hospital Healthcast. I’m Scott Webb. Thanks for listening.