Bill Klaproth (Host): This is Columbus Community Hospital Healthcasts. I'm Bill Klaproth. And with me is Dr. Anthony White, an orthopedic surgeon at Columbus Orthopedic and Sports Medicine Clinic, here to discuss total joint replacement. Dr. White, welcome.

Anthony White, MD: Thank you, Bill. Pleasure to be here.

Host: Absolutely, and great to talk with you. So, let's jump right into this. Can you start by explaining what total joint replacement involves and which joints are most commonly treated?

Anthony White, MD: Yeah. So, joint replacement can mean anything from just simple resurfacing of a joint to take out the damaged bone and cartilage, or it can go all the way to completely replacing an entire bone, just depending on the severity of the case and bone loss and other things that kind of go along with wearing out these joints over time.

The most common joints that are replaced are by far and away, number one, knees. They bear the brunt of every step we take. And then, followed pretty closely by hips, is kind of along those same lines, the two big weight-bearing joints. Next would be shoulders which are far less common. And that's mostly in patients that work with their hands at chest level or overhead repetitively for years and years and years. That usually tends to wear out the shoulder joint. There are joint replacements of ankles and toes and wrists and fingers, but those are far, far, far less common and much more specialized to the hand and foot specialties.

Host: Knees and hips are the most common shoulders also. So, those joints that we're always moving and using. That makes sense. Are there common conditions or injuries that lead patients to total joint replacement surgery? What are those conditions that would most likely lead to that type of a surgery?

Anthony White, MD: So, the most common patient that comes to see me is just somebody that has had a lot of birthdays and wear and tear on that joint. So, that would be osteoarthritis. That's just wearing away of cartilage. And the arthritis part of it is the inflammation that is stirred up by the loss of cartilage. That is, again, far and away the most common. The next would be along the inflammatory arthritis spectrum, including rheumatoid arthritis, psoriatic arthritis, the autoimmune conditions that attack the joints.

There's another thing called post-traumatic arthritis that after an injury, usually years later, the force required to break a bone is double the force required to kill cartilage cells. So usually, people that get in a car accident or fall and break a hip, years later, the cartilage ends up wearing away much quicker than it would with normal wear and tear. So, those are kind of the top three. There are other various reasons to have joint replacement, but they're pretty uncommon.

Host: So, I love how you said that, someone with a lot of birthdays. So as we get older, obviously, these joints do take a lot of wear and tear and of course arthritis. And that's interesting about delayed conditions. Somebody that maybe had an accident earlier on. And as the years go by, then it starts to show itself. So, that's really interesting. So, how has joint replacement surgery evolved in recent years, especially in terms of technology or recovery time?

Anthony White, MD: What I would say is the biggest evolution in the past 10 or 20 years would be the ultra-specialization of medicine. So, the general orthopedic surgeon that used to kind of run the show, somebody with hip and knee pain would go see a general orthopedic surgeon. Now everybody's doing fellowships in these ultra-specialized fields such as joint replacement, trauma surgery, foot and ankle surgery. And so, that experience and repetition, doing the same thing every day, seeing only hips and only knees really gets into the intricacies of what makes a good hip and knee replacement.

Besides that, though, as you can imagine, with everything evolving, the technology, the implants that we use, historical failures, the things that have caused joints to wear out too soon when we hoped that it would last a person their whole life, we've tried to correct those over the past, I would say, even 50 years that we really started doing these. And now, we have good implants that we can trust for the remainder of a patient's life. And that could be 50, 60 years. Now, we can't say that officially without the data that says it lasts 50, 60 years. But we've tried to eliminate every possible failure point with the plastic, with implant shape and design and the techniques we use to put them in.

One of the other big things now is robotic-assisted surgery, which we do here, where the robot unfortunately doesn't do the surgery, but it does help with precision and implant placement and make incisions smaller, less postoperative pain and faster recovery because of that.

Host: Well, all of those things certainly have helped. I like how you said, ultra-specialization, people that are working on the same body part over and over and over again, that repetition certainly hones their skills on that and the obviously better outcomes because of that and the better materials. So, it seems like if you have a total joint replacement, say your knee at age 55, chances are that thing's going to last through the rest of your life. Of course, there's variables, but it sounds like the technology has improved to that point. Would that be right?

Anthony White, MD: Yeah. I feel confident in telling patients that now. Even maybe as late as 10 years ago, we would try to push people off until they were 60, 70 years old because we couldn't trust the implants to last that long. Nowadays, it's a different story.

Host: This is really good information, especially for weekend warriors, people that are out playing basketball and pickleball and out in the backyard, and workers that are bending and using their knees a lot, being able to have that surgery done sooner is really important. So, what does the typical recovery process look like then for a patient after total joint replacement? And how can a patient set themselves up for the best outcomes?

Anthony White, MD: So, this is actually a hard question to answer just because everybody recovers so differently. But the science behind it is that it takes six weeks for all of the soft tissue on the inside to heal, so joint capsule, muscle ligament, tendon, everything around it. And then, another six weeks for that scar tissue to mature and remodel. So, the reality is full recovery takes three months. Now, that doesn't mean you're going to be laying in bed for three months. The recovery that we talk about when we say, you know, robotic-assisted surgery helps to provide faster recovery, and there's some other claims out there for faster recovery, that is more how quickly you get back to doing things that you need to do.

So, what I normally tell people is the first two weeks are obviously the roughest while your body's kind of getting used to the new normal, but I want people up same day of surgery. I want them walking multiple times a day. They should be able to get back home the day of or the day after surgery and get around, albeit slower, to do the things that they need to do to take care of themselves. And then, by week two, getting off of the walker, off of the cane, and working with physical therapy to get some of that strength and motion back. And usually, around the three to four-week mark, people really start to feel a lot better than they did before surgery, and are allowed to do a little more and a little more.

We don't let people do the higher level activities, pickleball, golf, hiking until that six week mark when we know the soft tissue inside is healed enough that they're not going to damage it. What patients can do to help and set their recovery on the right track is keeping the joint strong and mobile before surgery. So, the more motion and strength you have going into surgery, the more you have coming out, and that's less work that you have to do on the back end.

Host: And that is a good thing. Less work on the backend is a good thing, but it's amazing that you have them up and walking the same day.

Anthony White, MD: It really is.

Host: And after three or four weeks, they can lose the cane and they can really feel the difference. It's just amazing. I have several friends that have had total knee replacement surgery and they are back to normal. They're loving it. And one of them said to me, "I wish I would've done this way sooner." They were living with knee pain for years and years and years. Finally, they couldn't take it anymore. And then, they went to see the orthopedic surgeon, did the surgery and they're like, "Why did I wait? I wish I would've done this three years ago."

Anthony White, MD: I hear that all the time.

Host: I was going to say, I bet you do hear that all the time. So, let's talk about you and Columbus Community Hospital. Are there any specific advances or techniques that you are using at Columbus Community Hospital that set your program apart?

Anthony White, MD: So, there are multiple ways to do a joint replacement. What I tell people is a joint replacement is a joint replacement. If you're interested in a certain way of having a joint replacement done, then seek out somebody that does it that way. You don't want to go to somebody who says, "Yeah, I guess I could try it that way." You don't want something like that. So, everybody does things a little bit differently, because that's what they believe is right.

What I believe is right is robotic-assisted surgery. So, we have a surgical robot that we get a 3D scan of the bones before surgery. So, I can see where every bone spur is. I can see the unique patient anatomy, the leg lengths and everything and plan the whole surgery based on that. And then, in the surgery, what the robot does is just help us enact that plan to precision. And so, if I've seen everything ahead of time, the incision is less than half of what it used to be.

In fact, people come in for a revision or something. They had a knee or a hip done years before, and the incision is twice or three times the size of what we need. So, just seeing that and because of that less soft tissue disruption, which is what really causes a lot of the pain postoperatively, and faster recovery, less pain medication uses, so all the things that we just kind of harp on, is possible because of the surgical robot and because of the technology that we have to see everything ahead of time. But that's just one way to do it and one aspect of it.

We are always looking at improvements throughout the entire care process from the time that they meet me to the last time that they see me for their joint replacement and anywhere from an infection and patient satisfaction and how do we get people in faster, because they want their problem taken care of right now.

So, there are protocols and processes across the board that we're constantly improving. But aside from the surgical robot, the implants that we use are all the newest, least invasive way to perform the surgery. Now, don't get me wrong, there is no such thing as minimally invasive joint surgery. But we can do everything that we can to minimize the invasiveness, if that makes sense.

Host: Thank you for sharing that story about the scar size and how it shrunk over the years and how things are getting much better with these total joint replacements. Can you share maybe another success story or memorable patient experience that highlights the impact of total joint replacement on someone's quality of life?

Anthony White, MD: Yeah. There are a lot. And honestly, the unfortunate reality of surgery is not everybody achieves the goal that they had in mind. And sometimes, though rarely, complications can happen that are worse than the original problem. But it's the patients that have the great successes and that we're unable to walk before surgery and are now able to walk again. That kind of keep the fire burning and keep the drive there to continue on and get us through the rough times.

But there are a few patient success stories that really highlight how great joint replacement can be. I remember I had a sweet little lady come in that, unfortunately, didn't have a great experience and had a prior surgery and didn't achieve the goals that she wanted and actually she was unable to walk because of it. And if you can imagine the amount of trust that you would have to place into somebody, that they have your future and your life in their hands, for her to trust me to then try to correct the problem that she had was quite humbling, but also a huge honor. And so, we did her knee replacement. And not long after she woke up, all of the pain that had plagued her for so long was gone. And she was up and walking slowly and weakly, but for the first time in quite a while and lots of tears of joy and grateful hugs.

And that's why I got into this. And it's not because necessarily that I like doing only surgery, I like only Orthopedics, but it's the complex problems can be broken down into simple solutions with really, really good results. And the effects are almost immediate. And so, having that impact on somebody's life day in and day out is what does it for me.

Host: That's got to be a great feeling, I would imagine. And what a great story. Thank you so much for sharing that with us. So, we were mentioning earlier, I said I have a friend, "God, I wish I would've done this years ago." So, what advice would you give to someone who is living with chronic joint pain but is hesitant about undergoing surgery?

Anthony White, MD: So with all of the things that we've talked about so far, the advancements in surgery, the advancements in techniques and the availability of it now, along with the ultra-specialization, people that only do this, we're really good at doing this because we do it day in and day out.

The other thing that I would say to people is talk to your friends. I'm sure you have friends, family members that have done it and done it recently, and can tell you the same thing that you just said, "Man, I wish I would've done this years ago." The biggest deal is living with a painful joint, there's no endpoint to that pain. It only gets worse, and there are some things that we can't correct 10, 15 years from now as the deformity caused by the wear and tear of the joint gets worse. So if you're living with joint pain and it's keeping you from doing the things that you want to do, you're not as active, you're not as happy as you used to be. And that's the reason we can provide an endpoint to that pain. Yeah, surgery should be scary. It's scary for us every time that we walk into the OR. But we keep the end goal in mind that will get you back to doing what you want to do and what you need to do with a joint that functions appropriately. And one that you don't think about with every step, because it doesn't cause pain anymore.

Host: That really puts it in perspective when you say it only gets worse. So when you say that, you're like, "Wow. Yeah, you're right." If you're living in pain now, not going to get better. And I love how you said we can provide an endpoint to that pain and that's got to be comforting for people to hear.

Dr. White, this has been great. Thank you so much for spending some time with us today. Before we wrap up, is there anything you want to add at all?

Anthony White, MD: Just really hammering it home that you don't have to live with the pain. I wouldn't try to sell a surgery to somebody just to do a surgery. I try to treat every patient as if they're my own family member. And I wouldn't have talked to my mom into undergoing bilateral knee replacements if I didn't believe that it would make a significant impact in her life.

So if you are living with joint pain, we're happy to see you here at Columbus Community Hospital. We can hopefully make a difference in your life and if that's not the right answer for you, there are tons of other options for non-operative treatment. But, you know, it does get to a point when those non-operative treatment options like injections and medications and therapy may not do the trick for you anymore, but we are happy to see and figure out where you're at on that spectrum and work with your goals for the future and try to help you as best we can.

Host: I love that. And if it's good enough for Dr. White's mom, it is good enough. It is m-, tested and approved.

Anthony White, MD: That's right.

Host: I love it. Dr. White, thank you so much again. I really, really appreciate this. And for more information and resources, visit columbushosp.org. That's columbushosp.org. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Columbus Community Healthcasts. Thanks for listening.