Scott Webb (Host): Joint replacement surgery has become commonplace, and many patients wonder how long the recovery will take and when they could get back to pickleball and other normal activities. I'm joined today by Dr. Robert Malinzak. He's a joint replacement surgeon practicing at Franciscan Health and he's here to let us know what we can expect after total joint replacement.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, so great to have your time today. We're going to talk about folks safely returning to activity after joint replacement. So once a patient's had their surgery and they've successfully been discharged to go home, when is it safe for them to return to their "normal activities"?

Dr. Robert Malinzak: The quick answer is it depends. A lot of that depends on the patient's preoperative strength, meaning the stronger someone's legs are, they're typically the ones that'll be back quicker, it could be as soon as two to four weeks. Whereas our weaker folks, it might take longer. And then, the other caveat is, well, what kind of activity is that person doing? Meaning, if we're going to the grocery store or Costco, for that matter, that can be done in the days to weeks. But we have folks that climb trees or power lines, that can take months before they're safe to return.

Host: Yeah, I see what you're saying. So, it's not a one-size-fits-all, depends on how fit they were to begin with and what normal is for them. So, what role then does physical therapy play in safely returning to normal activities?

Dr. Robert Malinzak: Physical therapy or PT is super important, and we often advocate even pre-surgery therapy, we call it prehab. That can be done with a therapist or some patients do it on their own or they hire a physical trainer. It depends on their preference and the economics of where they might live. But again, the stronger our legs before, the better we do after.

And after surgery, the therapists are very helpful in giving that patient very specific information about themselves as opposed to, "Hey, by now, everyone's doing this or doing that." The specific stuff is what the one patient wants. "Hey, am I okay to go to church? or "Can I go to my grandkids ballgame?" or "Can I go to the store?" and then eventually, "When can I drive?" And those types of things come up. So, a therapist is integral to maximize the recuperation time.

Host: Yeah, they really are. And that's been my experience. My mom has had a knee replacement, hip replacement, and PT wasn't all that pleasurable, we'll say, for the knee. A lot easier with the hip and she was back to normal for her, much quicker with the hip; driving, as you say, and going to Costco, whatever folks tend to do. Are there any physical activities that no matter what they were like before the surgery, no matter how fit they were, that you just say, "You know what? We really don't recommend these things."

Dr. Robert Malinzak: The high-impact activities are ones to probably avoid, but not everyone does. Things like, you know, running, jumping, I mean, if a bear's chasing us, sure, run. But you know, some folks like to run...

Host: You had no choice really in that case.

Dr. Robert Malinzak: Yeah, make that choice for sure. But the equipment we put in is designed for walking, swimming, biking, those type of low-impact activities. But the repetitive high impact, the parts that we install, they're just not designed for that amount of impact over a long period of time. If we're playing pickup basketball with the grandkids or that type of thing, tennis, pickleball, all that's okay. But like jogging miles at a time, there are folks on the internet that are saying, "Look at me, I ran a marathon or half-marathon," that's not good for longevity currently.

Host: Yeah. Right. For the longevity of the implants, I want to talk to you about that. Like when might a patient or when do patients generally come and check back in with you, see how things are going? Is it a pain or noise in whatever they've had replaced? Is that normal? Let's say when they're exercising. I'm just trying to figure out, get a sense of, you know, when someone should be like, "That doesn't sound right. I should probably check with the doc and make sure everything's okay."

Dr. Robert Malinzak: Well, and you probably know yourself having a family member with a total knee and a total hip, the hips should be pretty quiet for decades. The knees, they can make little noises where the plastic and metal hit each other. And often, that'll be with folks when they're bicycling or something like that.

Host: Yeah. And I wanted to have you just talk a little bit about sort of how long these things are meant to last, right? And I'm guessing you're going to say, "Well, it really depends on when you get it." So if you get a total knee in your 30s, you may need another one, right? But if it's more in your 60s, 70s, then maybe, you know, that'll get you to the finish line, so to speak. So, just wondering how long do these joints, these new joints, how long are they meant to last?

Dr. Robert Malinzak: If you ask the engineers out of Warsaw, Indiana, they're going to say 20, 30, 40 years. But again, it also depends on what we're doing to the implant, meaning the more we're hauling, the quicker it wears out. I tell folks, think about our car tires. If we haul a bunch of heavy things, our car tires tend to run out quicker. Whereas if we're more modest with what we're hauling, the longer they'll last. We do like to check on our patients every three to five years. I think it's reasonable to get an x-ray of your parts just to make sure they're performing and not showing any premature wear.

Host: Yeah, that makes sense. As you say, the analogy of your tires, if you're peeling out and burning out and carrying heavy loads, those tires they're going to run down quicker, same thing with these new hips and knees and all of that. It's good stuff today.

I just want to find out just a general advice. You know, I know in the case of my mom, after she had the knee, and after physical therapy wasn't so fun for the knee, she kept putting off the hip as long as she possibly could to a point where, you know, her life was really suffering, the quality of her life was really suffering. And I'm guessing that's the case for a lot of folks, that they put these things off as long as they can and they suffer, maybe in silence, maybe not. But what would be your advice? You know, words or wisdom, final thoughts or takeaways, when we think about folks who probably need these things, how do we get them in the office?

Dr. Robert Malinzak: What you mentioned is exactly right. We use the phrase quality of life. And every person's a bit different. The x-rays that we get in the office are used to determine how much arthritis there may be, but it also depends on how much that arthritis is affecting the individual. So, I tell folks, "Coming to the office doesn't mean you're signing up for surgery. So, don't be scared to come visit." We're here to say, "Hey, let's look at the x-rays. Let's examine the legs and see where we are on that side of it." But then more importantly, where are we on the quality of life? And as far as the timing of surgery, again, one of the keys there is the strength of the individual. If we wait too long, then the patient's legs get weaker and their recuperation is going to be harder and longer.

Now, you know, obviously, we try not to do surgery first thing. We try non-surgical items for everybody. But it's when the patient's bone-on-bone and they've exhausted their tolerance and their quality of life's miserable, well, let's get in there and fix it. And the word miserable is obviously different for everyone. I would suggest we try not to wait until the total end of the road, because then the patients are very weak and debilitated and the recovery takes longer.

Host: Yeah, right. You know, everybody has a different tolerance for pain. Of course, my mom has a tremendous tolerance for pain, so she put it off as long as she possibly could. And as you say, you try some other things, physical therapy, medications, injections, things like that. But if you find yourself there, confronting surgery in the hands of an expert and it will improve your quality of life, why not, right?

Dr. Robert Malinzak: And that's what we're there for, to hopefully give sound advice. It's not to say we have to do this or we have to do that. It's seeing where the patient and the family are in their journey. How much pain are they having? What's their debility? Or are they doing quite well? If they're doing well, then obviously we can continue without surgery as long as they'd prefer.

Host: There is this feeling I think that some folks have that, "If I walk through that door and they take x-rays, they're taking me right off to the OR," but that's not really the case, right?

Dr. Robert Malinzak: That's not. No, no. The surgery is obviously a group decision. On our end, we want to make sure it's end-of-the-road arthritis, but the patient and family are there to help us determine how much the arthritis is affecting their quality of life.

Host: Yeah, absolutely. As you say, it's a sort of a team effort, a group effort, a group decision making. You're just saying, "Okay, well, we've tried everything else and here we are. Are we ready for this? Does everybody agree that we should do this?" Or, you know, "Do you want to put it off a little longer?" But as you say, the downside of putting it off is maybe it's going to take longer to recover. Maybe you never really get back to the things that you love and so forth, right?

Dr. Robert Malinzak: Correct. What you're saying there also, just a thought came to me that, you know, age plays a role in what we would tell a patient and family. Meaning, the younger we are, the longer we try to wait for replacement. Meaning like the 30-year-old that had a car accident and a bad arthritic knee, well, the implants, you know, if we hope they last 30 years, well, we hope that 30-year-old might live to a hundred, so we try to wait a bit longer. Whereas similar type scenario in someone that's 65, that 65-year-old might say, "Hey, I'm ready for surgery," and that would be more reasonable.

Host: As you say, the 30-year-old, if they live to be a hundred, they may need a couple of new knees along the way, maybe on both sides. Whereas someone in their 60s, that one maybe gets them to the finish line, right?

Dr. Robert Malinzak: Goal is one surgery per joint. And hopefully, it lasts the rest of their long life.

Host: I love it. Well, this has been great today. Really educational. We just want to encourage folks to reach out if they're suffering in silence or not. If they're suffering, help is available, they don't have to suffer. So, thank you so much. You stay well.

Dr. Robert Malinzak: Thanks a bunch, Scott.

Host: If you have lingering joint pain that doesn't allow you to enjoy your daily life, reach out to Franciscan Health's team of joint replacement specialists. We can help determine a course of care that'll get you back to enjoying the activities that you love. For more information or to request an appointment, visit centerforhipandkneesurgery.org. That's centerforhipandkneesurgery.org.

And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.