Jaime Lewis (Host): Orthopedic surgery has evolved tremendously over the past decade with innovative techniques and technologies, improving outcomes for patients facing joint pain and mobility challenges. Here to discuss orthopedic surgery and joint replacements is Dr. Emile Li, a Board Certified Orthopedic Surgeon from Iowa Specialty Hospitals and Clinics.

 This is the Ish Dish Podcast from Iowa Specialty Hospitals and Clinics. I'm Jaime Lewis and Dr. Li, thank you for being here.

Emile Li, MD: I'm glad to be here and thanks for having me, Jaime.

Host: Of course. So when someone's looking at getting a knee replacement or a hip replacement, what should they expect? How should they prepare for something like that?

Emile Li, MD: So of course after meeting with their doctor and scheduling the surgery, in our institution, we have a class that they and their family member can attend and they will go over such things as preparing the home for their recovery. Things like removing tripping hazards, throw rugs on the floor. And it may include adding grab bars in the bathroom, in the shower. And also lining up meals sometimes, as well as transportation to and from the hospital as well as to and from physical therapy after they get home, and are recovering.

Host: And what does the timeline look for with recovery? What are the milestones that patients should be expecting?

Emile Li, MD: Yeah. So, typically after a hip or knee replacement, we tell the patients to set aside six weeks. During this six weeks, they usually attend physical therapy two to three times a week. And, we have them go to therapy, so that they have an educated physical therapist to guide them through the recovery process and make sure they're hitting certain milestones in terms of range of motion and walking distance and that sort of thing.

Host: Well, you've been practicing for a while now and I wonder what the advancements look like to you in your field, especially in the most recent years.

Emile Li, MD: Yeah. So, I've been in practice for 30 years, and things were vastly different when I started in 1995. If you had a hip or knee replacement back then, it was common to spend seven days in the hospital. Nowadays the, probably one of the largest advancements is this surgery is done on an outpatient basis in about 40 to 50% of the patients now, so they spend five hours in the hospital.

There's been advancements in terms of robotics, helping to align the implants. There are patient specific guides that we use at the time of surgery, that help us implant the prosthesis with a very high degree of accuracy as well. And then probably one of the biggest things that, I would consider, a huge advancement is in anesthesia techniques.

And this has really led our patients to be able to go home, because they're not having excruciating pain after these types of surgeries. And so they do things like abductor canal blocks, inner scalene blocks for our shoulder surgery. And this renders them relatively pain-free. They're comfortable enough to get up, within an hour after surgery and walk with our physical therapists.

Host: Incredible. Well, on the medicine side of things, it sounds like advancements have really come a long way. As far as having a successful surgery, how much does a person's overall health matter to a successful surgery?

Emile Li, MD: It matters quite a bit. We spend a lot of time trying to optimize the patient's condition and health before they ever get to surgery. So for example, if they're a smoker, we counsel them to try to get them to cut way back, if not, stop completely. Because it has an impact on wound healing. If they're a diabetic, we routinely check their hemoglobin A1C, months in advance.

And in fact, we try not to operate on anybody that has a A1C above eight. And so, this may lead to them going to see their primary care doctor and getting a little better control of their blood sugars. And then also if patients are overweight, we sometimes do spend time, counseling them on weight loss.

And this can include sending to our weight loss clinics. And there's a lot of new medications, as you know, on the market for weight loss. Weight is a big issue. If they're grossly overweight, it can lead to things like poor wound healing, prolonged wound drainage, higher infection rate. And also a higher rate of developing blood clots, after surgery. So all of these things, we spend a lot of time trying to optimize their health and their condition before surgery.

Host: That makes a lot of sense, considering the hardware that's underneath them as they move through the world. It has to be able to sustain that. For people who are very active though, what does the timeline look for them after they come out of surgery? What do you tell them in terms of what they can expect on the horizon?

Emile Li, MD: Yeah. So again, the first six weeks are spent doing physical therapy and their recovery. After six weeks, we do let them try to ease back into their prior lifestyle. And so I usually let folks resume chipping, putting for example, in golf right at about eight weeks, driving, and playing golf right at about 12 weeks.

And same thing, hiking. Usually at eight weeks short distances and then gradually increase the distance that they're walking. Certainly we let them get back on bicycles right at about eight weeks as well. So, life gets a lot better after the first six weeks.

Host: Yeah, and that's not very long really considering what you said about how things used to be when you first started your practice, and I'm thinking as we look ahead, what are some of the biggest challenges in orthopedic research right now? Where do you see things heading?

Emile Li, MD: Yeah, I think, there's a continued, interest in robotics, also virtual reality helping surgeons align and position the implants in the optimal position. But one of the big challenges, these robots and these newer technologies, and newer implants, they cost a tremendous amount of money.

And so one of the big obstacles is obviously, having access to these new technologies as they come out because they are very, very expensive to the hospital and in turn to the patients as well. So I think that that's probably one of the biggest things. Cost is a barrier sometimes.

Host: Well, thank you so much for all your insight, your information, and for all of your work in helping people get back out there.

Emile Li, MD: Thank you.

Host: That was Dr. Emile Li, Board Certified Orthopedic Surgeon with Iowa Specialty Hospitals and Clinics. To learn more, schedule an appointment, or just get to know these doctors, visit www.ishorthopedics.com and thank you for listening to the Ish Dish Podcast.