Scott Webb (Host): This is the HealthWorks Here Podcast from Emerson Health. I'm Scott Webb. And today, we're discussing joint replacement surgery and recovery with orthopedic surgeon, Dr. Matthew Sloan. Dr. Sloan, it's nice to have you here today. As I've gotten older into my 50s and the osteoarthritis has sort of been turned up, you know, in my knees, I've been thinking, "When is a time that I speak with an orthopedic surgeon? When is a time I consider joint replacement?" So, I'm glad to have you here, glad to have you expertise. Let's start there. Why do folks generally end up reaching out to you? What type of stuff do folks suffer from?

Dr. Matthew Sloan: I usually patients once they start having pain from their hip or knee arthritis that brings them to usually their primary care doctor first. And then, they'll have them come see someone like myself. But oftentimes, people don't know exactly what's going on. But maybe pain in the knees, pain in the hips, and it's interfering with their day-to-day activities and impacting their quality of life.

Host: Yeah. I was thinking you were going to say that, quality of life. And I can definitely check those boxes, Doctor. It's the knees, it's the hips, it's the age. And I've come to learn from speaking with so many great experts at Emerson Health that we don't have to suffer just because we've gotten older. So, when do we know? What's like the threshold for folks generally know when it's time to see their primary, get that referral, come see you, and start talking about their joint pain and possibly joint replacement?

Dr. Matthew Sloan: It's a good question, and I think it's different for everyone. Some patients will come to my office just because they're starting to experience some symptoms they're not sure about. They just want to form a relationship and make sure that everything's okay or they know that they've been told they have arthritis in the past and they just want to know that they have someone to go to down the road if they ever need a hip or a knee replacement.

Some folks just don't know, and they start giving up certain activities because "My knee hurts too bad, I'm not going to be able to walk across that field" or "I don't want to go on that trip because going to be too much walking or hiking or things like that." But really, once people come to see me, I usually tell them that when you're having more bad days than good, it might be time to think about doing something more serious. And then, until then, we usually pursue all the non-surgical options that just help you get through your day and minimize any pain symptoms.

Host: Yeah, I think that's maybe a key point that folks think, "Well, once I go to see Dr. Sloan," for example, then it's, you know, immediately rushing to the room to get the new joints, knees, hips, whatever it might be. But there is a process of sort of, you know, going through some things, more conservative measures, right, before we get to joint replacement.

Dr. Matthew Sloan: Yeah, absolutely. I'd say the majority of people I see do not end up having surgery.

Host: Okay.

Dr. Matthew Sloan: But the ones that I do meet with, it would be pretty unusual for a first time that someone comes in and they're ready for a joint replacement. But sometimes people have seen multiple doctors before, they know they have a problem and they're just trying to meet the person that they feel comfortable having a surgery with.

Other folks, if it's early on and they're first starting to have symptoms, it's only been going on a few weeks or a few months, then, usually, you start just with medications, over-the-counter sorts of things like Tylenol and Advil or Motrin, Aleve, and physical therapy. If it's really bothering them, sometimes people are thinking about something like a cortisone injection. But generally, we'll start there and do that for quite some time before people end up progressing to the stage where they want joint replacement.

Host: Yeah. So, definitely some conservative things to try out, as you say, possibly for a long time before joint replacement. And when it comes to the actual replacement of joints, Doctor, is it pretty much standard, like you have the standard knees that you, you know, put into folks, you have the standard hips. Maybe you could just tell us what's involved in the actual process of, you know, choosing the right knee replacement or the right procedure or whatever it might be.

Dr. Matthew Sloan: I specialize in robotics-assisted joint replacement. So with robotics, we get a CT scan of the patient's knee or hip before the surgery. And then, we build a 3D model. And on that 3D model, we figure out exactly the right size and position of the implant. When we go into the surgery, it actually makes things move a lot quicker because we know exactly what we're doing. We don't have to measure everything by hand. But there are different size options. They usually change at one or two millimeter interval so that we can get the implant that fits the patient best.

Scott Webb: Yeah. So, it's literally not one-size-fits-all. And I'd love to do a separate podcast with you just about robots and how much it's changed, you know, the way you do your job. Folks can't see you today, but I know you're wearing your scrubs. So obviously, it's a workday for Dr. Sloan.

And so, let's assume, doctor, that you've done joint replacement, whichever joints it may be. Let's talk about the recovery, right? I think that that's the thing that maybe scares folks off is, you know, what happens after I get the joint replacement and the physical therapy or whatever it might be. Let's talk about post-op.

Dr. Matthew Sloan: Once a patient decides that their symptoms are bad enough to have a surgery and you make it to surgery day, we do your joint replacement, almost everyone goes home the same day as long as you have support at home, family or friends that can stay with you for the next few days. About 80% of our patients will go home the same day. And then, once you get home, usually, the first three weeks or so, home physical therapist will come visit you twice a week, and then you do the exercises the rest of the day on your own. And then, generally, around three to four weeks, you'll start outpatient physical therapy. That's around the same time that most people start driving again.

With knees, usually, it takes about eight weeks to get all your motion back, hips by about eight weeks. Most people are doing pretty well off a cane and crutch walking on their own and feeling pretty close to normal. But it generally takes about three to six months to feel like you've fully recovered from a hip replacement. It takes about six to twelve months to feel like you've fully recovered from a knee replacement. That just has to do with getting all your strength back, getting back to your regular activities and stop thinking about your knee and your hip as much.

Host: Yeah. That was my experience with my mom and her knee, was to get her to the point where she would stop kind of thinking about it, you know, and convincing her that, "You've healed, you did all the good stuff, you've got the clean bill of health from the surgeon," so to speak. "It's okay, mom. Get out there and do the things that you want to do."

And along those lines, Doctor, I want to give you An opportunity here to talk about some success stories, if you will, just of folks, you know, having these joint replacements and not just going to Costco and living the daily life, but doing some pretty remarkable things, right? Mountain climbing, skiing, running, whatever it might be.

Dr. Matthew Sloan: Yeah. We have a lot of patients who are doing a joint replacement to get back to a very active lifestyle. So, we had one patient who returned to their New Hampshire mountain climbing activities. And in the year after their surgery, they had climbed multiple mountains that they hadn't been able to anymore because they were limited by hip pain. Skiing is a big one, especially around here. Lots of folks just get to a point where they feel like they can't ski anymore. And we certainly have people get back to skiing even at an instructor level.

So, certainly not limited in doing those things. And we have all sorts of patients who are just trying to get back to regular activities like golf and exercise and swimming. And those things are certainly more than welcome and, actually, will help you maintain your health going into the future and make sure you keep a healthy weight, which is good for the joints.

Host: Sure. Yeah, I'm sure pickle ball's on the list too. But as you say, skiing very popular in the area. Just give you a chance here, Doctor, at the end, and I appreciate your time and your expertise. Just final words of encouragement maybe, just to get folks, if they're suffering, if their lives are suffering and they can't do the things they used to be able to do, you know, reach out, right?

Dr. Matthew Sloan: Yeah, absolutely. I said it earlier, but most of the people I meet with don't end up having surgery. I think a lot of people are a little bit nervous to come see me just because they think that once they see me it's going to be time to have a surgery. But we have lots of non-surgical and conservative treatments that you can try for hip and knee replacement. And those are always the road that we go down before we decide on doing any sort of joint replacement.

Host: Yeah, that's perfect. Right, I think we all sort of picture we walk in the room with you and you're going to be sitting there with a scalpel in your hand.

Dr. Matthew Sloan: Yeah.

Host: You know, just ready to go. It's like, "No, we're going to do a bunch of stuff before we get there." So, again, thank you so much for your time, your expertise. I'm not quite there yet in my mid to late 50s-ish, we'll say, Doctor, but I'm getting there, so I appreciate it.

Dr. Matthew Sloan: All right. Well, thanks so much, Scott.

Host: And visit emersonhealth.org/orthopedics or call 978-369-5391 to learn more and to make an appointment with Dr. Sloan or one of his colleagues.

And thanks for listening to Emerson's HealthWorks Here Podcast. I'm Scott Webb. And make sure to catch the next episode by subscribing to the HealthWorks Here Podcast on Apple, Google, Spotify or wherever podcasts can be heard.