Joey Wahler (Host): Painful joints can be
debilitating and adversely affect daily life. So, we're discussing total joint
replacement. Our guest, Dr. Jaspreet Sidhu. He's an orthopedic surgeon
specializing in hip and knee replacement for Dignity Health.

This is Hello Healthy, a Dignity Health Podcast. Thanks for
listening. I'm Joey Wahler. Hi there, Dr. Sidhu. Thanks for joining us.

Dr Jaspreet Sidhu: Hey, good morning. Thank you for
having me.

Joey Wahler (Host): Great to have you with us. So
first, hips and knees are always the most common joint replacements, right? Why
is that, do you think?

Dr Jaspreet Sidhu: Well, I think we're living longer.
We're placing much more value on living a active lifestyle and our joints
aren't designed to last for the entire duration of our life. So, in order for
people to maintain that quality of life, they're seeking definitive
intervention and definitive means of controlling their discomfort so they can
continue with that active lifestyle and enjoy life. Yeah, so we're certainly
seeing an increase in hip and knee replacement surgery.

Joey Wahler (Host): So when our joints do need
replacing, is it just that wear and tear that causes it? Or can there be other
factors in play?

Dr Jaspreet Sidhu: There are some other factors that
come into play. Some of the inflammatory arthropathies like rheumatoid
arthritis, lupus, psoriatic arthritis, those are some of the other reasons that
joints can deteriorate. But one of the most common reasons is your
run-of-the-mill wear and tear. The analogy I use with people is you've got a
car that you've put 25,000 miles on, the tires are going to wear out. The
treads are going to show some wear. So, that's what we're dealing with knees
and hips.

Joey Wahler (Host): Gotcha. So, what symptoms
typically indicate that our joints may need replacement? When has it gone
beyond just run-of-the-mill pain that could or should be tolerated?

Dr Jaspreet Sidhu: I've found most people have a
fairly high threshold for pain. So, pain can be a good determining factor when
to pull the trigger on a knee or a hip replacement. But primarily, what
patients will share is the impact that it's having on their day-to-day activity
and their day-to-day quality of life. So, one of the biggest questions I ask
patients is if there's something that you enjoy doing and you are waking up in
the morning wondering, "Hey, should I really do this? Because the next day
I'm really going to be paying the price," that's the time when I think
it's appropriate to really start thinking about symptom-wise, x-ray-wise, if joint
replacement is a good option.

Joey Wahler (Host): So, we'll get to what surgery
entails if needed in a moment. But first, what treatment, if any, is tried
before surgery is recommended?

Dr Jaspreet Sidhu: So before surgery is recommended,
we always talk about doing anti-inflammatory medications as long as there are
no other major contraindications like stomach upset or kidney disease. Using a
assistive device, either a cane to offload the joint, there are some braces
that we can utilize that offload the inside part of the knee.

Physical therapy is actually a really good modality. It
teaches people not only how to go about their day-to-day activity, but also
strengthening the joints and teaches them a regimen that they can incorporate
into a part of their day-to-day routine so it maintains the mobility in their
joints. So, those are some of the early, non-invasive interventions we can
discuss with patients. Cortisone injections are also a good option. They do
temporarily get rid of the discomfort and get the level of discomfort back to a
baseline so people can continue maintaining their mobility until they're fully
committed and ready to move forward with the surgical intervention.

Joey Wahler (Host): Okay. So that being said, if hip
or knee replacement surgery is needed, in layman's terms, simply put in each
case, hip, knee, what are you doing actually?

Dr Jaspreet Sidhu: There's a very common
misconception that I hear from patients with knee replacement surgery that
we're going to be removing the entire knee joint, the end of the thighbone, top
of the shin bone. That's not actually what we do. We remove a very small amount
of bone, which equals anywhere between 3 to 7-8 millimeters that includes the
cartilage on it. And we sort of put a cap over the top of the bone. So, think
of it like a resurfacing when you have a cavity or a crown put on your tooth,
as opposed to getting the entire tooth removed, we put a crown or a cap over
the top of your knee joint. So, that's when we have a knee replacement.

A hip replacement is in the sense of removing the entire
ball and replacing that with an artificial ball. And the cup that the ball sits
inside our native cup, that gets resurfaced as well with a metal cup, so we
have a completely brand new bearing. But a knee replacement, yes, that's the
most common misconception I hear, is we're removing the entire knee joint, but
think of it more of as a resurfacing.

Joey Wahler (Host): Gotcha. And when you say
resurfacing for a moment, doc, I thought you were going to go with another car
analogy and say it's like getting your rotors resurfaced instead of replaced,
right?

Dr Jaspreet Sidhu: Hey, if it helps, then by all
means,

Joey Wahler (Host): So, you use a minimally invasive
technique known as a muscle-sparing technique. What does that mean exactly?

Dr Jaspreet Sidhu: So, big into analogies, kind of
similar to hip replacement, there's the front approach, the back approach.
Ideally, the front approach is thought to be a little bit more minimally
invasive, less muscle damage. Knee replacement surgery in the same sense is an
invasive procedure. But when we talk about minimally invasive, it's really how
we're handling the soft tissues, all the muscles around the knee. So, the
traditional way of doing the knee replacement surgery is we go around the
kneecap and then cut into the quadriceps tendon. And what I had found was
patients even three to six months up to a year out would just constantly be
massaging that area, getting rid of some of the inflammation in their
quadriceps tendon.

So, what I've learned and what I've found in my clinical
practice is a minimally invasive way where we can remove the entire quad muscle
out of the way, including the kneecap out of the way to get access to the joint
without actually cutting into the quadriceps tendon, that has led to much
faster recovery anecdotally in my clinic. But also, there's literature that
backs patients are having earlier return to function, getting rid of their
assistive devices on a significantly earlier fashion compared to the traditional
way of doing knee replacement surgery.

Joey Wahler (Host): How about for a hip?

Dr Jaspreet Sidhu: So for a hip replacement surgery,
yeah, I talked about the anterior approach as opposed to cutting into the big
muscle in the back of the hip our butt muscle. Anterior approach, we're going
through a group of muscles, so really minimizing the damage that's occurring to
any particular muscle. And as a result, getting rid of the walker, getting rid
of the cane, earlier return to work. All that's happening at least on a three
to six-week period faster than the traditional way. And for patients, that's
very important to be able to get back to their quality of life, day-to-day
activity on a sooner, as opposed to waiting the longer period of time.

Joey Wahler (Host): Sure. So, let me ask you more
about that. You mentioned timetable. How about from going home to rehabbing
thereafter? What can patients actually expect? What's happening during that
time?

Dr Jaspreet Sidhu: So for knee replacement during the
first two weeks, most patients are utilizing a walker for about seven days or
so, and then transitioning to a cane in the comfort of their own home. And then
as they're doing that, they're constantly working on ambulation and range of
motion. Around that initial two to three-week period, sometimes two to
four-week period, people start feeling relatively comfortable with the use of a
cane and start getting around their home without a cane. And not uncommon
actually by six-week period for them to come into my office without the use of
a cane or they have a cane in their hand more for a peace of mind, but are not
necessarily using it. So, the first six weeks is getting back to their normal
day-to-day chores around the house, running some small errands outside of the
house, people start thinking about getting back to work if they're still in the
workforce.

Around that six to 12-week period is when that strength, the
stamina begins to come back. People start formally getting in touch back with
their employer, thinking about getting back to work and making arrangements for
getting back to work. So, I talk about it in six week increments. The first six
weeks, getting rid of the assisted device; six or 12 weeks, getting back to
kind of your increased activity, increased strength, thinking about getting
back to work. Full recovery from a joint replacement surgery is a year-long
process. We find that these disease states, they've been occurring for multiple
years before the patients have definitive intervention, it takes a while for
joint replacement to feel normal. That being said, if we're talking about zero
to a 100 for the entire recovery, zero to about 75, so 75% of it happens in the
first three months. So, it's very front-loaded and then the stamina, the
strength, the ability to go on a long walk three or four miles, if that's what
they do, that starts to happen over the course of three months to 12 months.

Joey Wahler (Host): Okay. So to use yet another
analogy, this time on my end, you're really kind of taking one step back with
all that rehab to take several steps forward in the long run. After struggling
pre-surgery, which activities do you find patients are most happy about,
eventually resuming normally, once they get to around that year out?

Dr Jaspreet Sidhu: All that is very patient-specific.
Ultimately for my elderly patients, being able to get back their independence.
So, driving is a big thing for them when they're rehabbing. And that's
something I'm very careful in discussing in the preoperative setting, especially
when it's a right knee replacement. If they don't have any support group, their
entire livelihood depends on them being able to get in and out of a vehicle,
being able to drive. So for those patients, typically about four to six weeks
where that recovery time, that reaction time is back to being able to slam on a
break in case of an emergency.

Those are sort of dependent more upon the age group. But in
terms of being able to go on a vacation with family, being able to go on a
hike, those are the things that patients really enjoy doing because that's what
helps them make those memories with their family. And that's what they share
most frequently, is they're not able to do or they are afraid to do before
surgery. So, that's the restoration of the quality of life that's very
gratifying.

Joey Wahler (Host): So, it could be anything from
resuming driving a car to driving a golf ball, right?

Dr Jaspreet Sidhu: Absolutely. Yeah, certainly I can
relate. I enjoy golf myself. So, it would be tiresome.

Joey Wahler (Host): Well, you're a doctor. It's the
law, right?

Dr Jaspreet Sidhu: That's right. Absolutely. It's
required.

Joey Wahler (Host): So finally, to kind of sum things
up, how rewarding is it for you? How long have you been at this, number one?
And number two, how rewarding for you to be able to make this kind of a
positive impact on people's lives so dramatically when they recover?

Dr Jaspreet Sidhu: So, I started with my practice in
September of 2017. So, I've been there for a little over five and a half years.
And as far as the gratification factor, you know, being able to restore
somebody's quality of life, get rid of their day-to-day discomfort, being able
to put a smile on their face. Words are escaping me right now, but I wouldn't
trade it for anything in the world. It's special gift to get to share with
other people. And I wake up every day thankful that I have the ability to offer
people that.

Joey Wahler (Host): That's awesome to hear. Well,
folks, we trust you are now more familiar with total joint replacement. Dr.
Jaspreet Sidhu, thanks so much again.

Dr Jaspreet Sidhu: My pleasure. Thank you very much
for having me.

Joey Wahler (Host): Thanks again and for more
information, please do visit dignityhealth.org/stockton/ortho. Again, that's
dignityhealth.org/stockton/ortho. If you found this podcast helpful, please do
share it on your social media. And thanks again for listening to Hello Healthy,
a Dignity Health Podcast. Hoping your health is good health, I'm Joey Wahler.