Joey Wahler: Joint pain can adversely affect your daily activities, but there is a solution. So, we're discussing robotic surgery for restoring joint function.

This is the Jefferson Healthcare Podcast. Thanks for listening. I'm Joey Wahler. Our guest, Dr. Paul Naumann. He's an orthopedic surgeon and Director for Orthopedics at Jefferson Healthcare. Dr. Naumann, thanks for joining us.

Dr. Paul Naumann: Hi, Joey. Thanks for having me.

Joey Wahler: Great to have you with us. So first, how common is joint pain and what are the most common joints affected?

Dr. Paul Naumann: Joint pain is common particularly in my practice. I have an aged population. You know, our average age in the county is in the 70s. So, the most commonly affected joints are knee and hip. Knee and hip replacements are the most common procedures that I perform here.

Joey Wahler: And is joint damage typically caused just by wear and tear over the years as we get older or can there be other factors as well?

Dr. Paul Naumann: Yeah, the number one cause is the aging or osteoarthritis. And then, there's, of course, number of rheumatologic conditions that can affect the joint wear. But primarily, I see patients with aging joints.

Joey Wahler: So before joint replacement surgery is used, what other treatments are tried first?

Dr. Paul Naumann: Well, there's a conservative course of treatment that I recommend for most of my patients to thoroughly exhaust before joint replacement. Those include physical therapy, weight loss, activity modification, use of braces and assistive devices and injections such as corticosteroids and hyaluronic acid.

Joey Wahler: And what symptoms typically mean joint replacement may be needed? Where's that line would you say between trying to endure the pain, but then just needing to get something done because it's gone too far?

Dr. Paul Naumann: Once patients are experiencing pain, that limits activities of daily living, ability to care for themself or exercise for health and pain that wakes them at night, consideration of joint replacement arthroplasty is given.

Joey Wahler: So in terms of robotic surgery for this, simply put, how exactly is the joint replacement done?

Dr. Paul Naumann: Well, traditional joint replacement used instrumentation that would place a rod up the thigh in an external instrumentation on the shin bone. That's been replaced with robotic-assisted surgery, which it's not an autonomous robot, but it's a robot that assists in placing the implant in precise position, so as to allow for improved function and longevity of the joint.

Joey Wahler: And so from a procedural standpoint, as you're doing one of these or one of your colleagues is, how does that assistance make your job easier or better?

Dr. Paul Naumann: Well, the robot makes it easier to precisely place the implant, so as the mechanical axis of the hip and knee and ankle are centered and the knee is balanced precisely. This is key in an implant that is going to last the rest of the patient's life. There's a burr that is controlled by the robot so as to not remove too much bone, but allows precise removement of necessary cartilage and bone. Traditionally, we use an oscillating saw, but that's been replaced by a burr that's much more precise.

Joey Wahler: And so for joint replacement, how does that benefit the patient would you say? For those wondering, "Well, how does that benefit me compared with the traditional way," you would say what?

Dr. Paul Naumann: It allows me to cater the implant to the patient's anatomy and get it in precise position, that allows for increased function, range of motion and longevity as compared to prior techniques.

Joey Wahler: Gotcha. So, after having one of these done, what's the typical timetable for rehab and what can patients expect during that time?

Dr. Paul Naumann: When it's all said and done, it's about six weeks. But I have several patients after initiating robot-assisted surgery that are already without assistive device at two weeks and I've had full range of motion. In fact, it's remarkable the range of motion and flexion. I've seen at a couple of weeks where you can touch your heel to your bottom, which is great range of motion I hadn't seen prior to our robotic-assisted surgery.

Joey Wahler: And speaking of range of motion upon full recovery, what benefits do people ,typically experience?

Dr. Paul Naumann: A pain-free knee replacement with improved range of motion compared to pre-operative range of motion, flexion deep to 100 degrees with ability to fully straighten your knee.

Joey Wahler: What are some of the things patients are able to do after having this performed as a result? What are some of the things that people are typically robbed of, if you will, temporarily that they're then restored with once this is done?

Dr. Paul Naumann: You know, activities that require a lot of knee flexion. Surfing, I've had patients get back on a surfboard, playing tennis, back to downhill skiing competitively, cutting sports.

Joey Wahler: Cutting sports?

Dr. Paul Naumann: Basketball and football.

Joey Wahler: Things that involve quick movements back and forth.

Dr. Paul Naumann: Quick movements back and forth, yes.

Joey Wahler: Gotcha. Couple of other things. You mentioned that these often last a lifetime. Do they ever have to be done again down the road?

Dr. Paul Naumann: Yeah. There are very small risks of infection. If you develop infection after a joint replacement, that requires future surgery. Occasionally, there can be fracture around the implants after a fall, which requires future surgery. But what we're not seeing is the implants wearing out as we did a couple of decades ago. The technology and the implants has really come a long ways, and that combined with robotic assisted surgery, we're seeing implant survivorship increasing.

Joey Wahler: So when you look at that technology advancement in the years you've been doing this, how has that impacted your practice? For instance, can you do more of them as a result?

Dr. Paul Naumann: Yeah, the robotic-assisted surgery hasn't really decreased the surgical time. But what it allows us to do is to precisely place the implant. So, it has improved unit range of motion, as I said, and longevity of the implant, but not decreasing surgical time.

Joey Wahler: How about just a quick backtrack for a moment? Curious, what is it in your background coming up in the world that got you interested in this particular specialization, would you say?

Dr. Paul Naumann: Early on, as a medical student, my career goals and aptitudes lined up with orthopedic surgery. I have been a hands-on person. You know, grew up making things and kind of engineering things along the way, and that lined up well with orthopedics as a specialty. In addition, I've always been quite athletic and we see a lot of athletic injuries.

Joey Wahler: So, you were able to both incorporate a passion you already had on two fronts then, I guess, right?

Dr. Paul Naumann: Correct.

Joey Wahler: And how rewarding is it for you, doc, when you're able to see the difference you and yours are able to make on people in restoring range of motion and everything that comes along with it?

Dr. Paul Naumann: Oh, it's rewarding on a daily basis to get patients walking and functioning. That's another reason why I chose orthopedic surgery because we tend to make people better. And getting somebody active and walking and doing the things they love outdoors and sports is extremely rewarding.

Joey Wahler: And then, finally, just to sum up here, if you would, what's your overall message for those considering having this procedure done? Maybe they're a little apprehensive for whatever reason, what would you say to them?

Dr. Paul Naumann: I would engage with a surgeon that is reputable. Talk with your friends that have joint replacement surgery to get their overall experience. And do research on your own regarding joint replacement surgery.

Joey Wahler: All right. Well, folks, we trust you're now more familiar with robotic-assisted joint replacement. Dr. Paul Naumann, thanks so much again.

Dr. Paul Naumann: Thank you, Joey.

Joey Wahler: And for more information or to schedule a consultation today, please call 360-344-0400. Again, 360-344-0400. If you found this podcast helpful, please do share it on your social media. And thanks again for listening to the Jefferson Healthcare Podcast. Hoping your health is good health, I'm Joey Wahler.