Scott Webb (Host): Today, we're going to get to know Dr. Joseph Serino. He's an orthopedic surgeon specializing in hip and knee replacement. And in addition to learning more about him, he's going to discuss some of the latest innovations in hip and knee replacement surgeries.

Welcome to A Bone to Fix from Orthopedic Associates of Central Maryland Division. I'm Scott Webb, and I've got a bone to fix with you. doctor, it's so nice to have you here today. Today, we're basically going to have you talk about you a little bit, you know, and some of the stuff you enjoy doing. But before we get to that, like what drew you to orthopedics and maybe was there a defining moment or experience for you?

Dr. Joseph Serino: My uncle actually was a pretty formative character in getting me into Orthopedics. He's an orthopedic surgeon and growing up, I used to shadow him in the operating room during the summers. And he primarily does upper extremity surgery. But one day, he had me jump into the operating room with one of his partners who does hip and knee replacements. And I saw him do a knee replacement. He was actually doing both sides of a knee replacement on a patient. And it absolutely blew my mind. I thought it was the coolest thing I've ever seen. It combined my passions for science and physics and engineering.

But also, what really drew me to medicine was a desire to help patients and that kind of built a lot both through shadowing the orthopedic surgeons at that practice, but especially in medical school. You know, a lot of what we do in medicine in general is kind of treating silent diseases. For example, if a patient has high blood pressure, they don't necessarily feel the symptoms of high blood pressure. They know it's bad for them, but they take a medication, theu may have side effects. That's maybe not the most satisfying experience for patients or for doctors. But if a patient comes to me with hip or knee arthritis, they're like, "Look, it's killing me to walk. I can't do the things that I enjoy doing anymore," I love having a solution that I can offer them that will quickly and dramatically improve their lives.

Host: Yeah. As you say, you know, most of us don't know that we have high blood pressure. Hopefully, we see our doctors and we check our blood pressure and we take our meds if we need to. That would be me, of course. But as you say, like, you know, if your knee hurts, there's a reason why your knee hurts. And it's possible and probable that Dr. Serino can help. So, tell us about your training and what, you know, fellowship-trained means for your practice.

Dr. Joseph Serino: Sure. So, I did both college and medical school at Georgetown University in DC. I really enjoyed it. I thought it was a great experience, and I thought the orthopedic training there in particular was excellent. And then, I went to Rush University Medical Center in Chicago for my residency training, which was five years. And it was during that time where I really decided to specialize in hip and knee replacement. And I was lucky to work with some truly phenomenal world-renowned surgeons, all of whom taught me a lot about both simple primary hip and knee replacements, but also a lot of complex reconstructions as well.

And I got to learn a lot about outpatient hip and knee replacement, which at the time was a very new, emerging concept. It's since changed. It's become a lot more popular, but the guys there were among the first to really start that practice. I got to learn a lot about their minimally invasive techniques, which they have found to be incredibly helpful for minimizing pain after surgery, helping patients mobilize quickly after surgery and basically accelerating their recovery.

In terms of the fellowship training, that was an additional year that I chose to spend training specifically in hip and knee replacement. During residency, we do all of orthopedics. That includes everything from hand to spine to trauma, and of course, joint replacement. But I wanted to spend an extra year just focusing on hip and knee replacements. And I did that at OrthoCarolina in Charlotte. And I was very excited to have the opportunity to train there, because they were able to train me in a lot of techniques that I think are important. The first is direct anterior hip replacements, which is a minimally invasive approach that is muscle-sparing. We're not splitting through any muscles. We're just gently moving them to the side to access the hip joint, which has been found to dramatically improve recovery after hip replacement. And many studies show a benefit in terms of the stability of the hip replacement and reducing the risk of dislocation.

I got excellent training in robotic knee replacement as well. And using some alternative approaches called a quad-sparing approach or a subvastus approach where we don't actually disrupt the insertion of the quadriceps muscles onto the kneecap, which can also reduce pain and improve biomechanics after knee replacement.

 And the last reason I went there was they see a lot of complex problems in patients who have already had a hip or knee replacement. And it's either infected or loose or they just are having some pain and are not sure why. And so, learning how to diagnose and manage those problems was a big part of my fellowship experience as well.

Host: Yeah, it's a lot. And we're going to roll up our sleeves a bit more today in this podcast, and you're going to be back a couple more times. We're going to really squeeze a lot out of you, Doctor. I just want to get a sense though, like, outside of medicine, what activities keep you grounded? Like, do you have a sport or a hobby that informs your work?

Dr. Joseph Serino: Yes. I actually probably have too many hobbies. There's far too much that I want to do with very little amount of time. But basically, I enjoy almost anything outside. I love traveling and especially going on hiking or camping trips. During the summers, I like to spend time on the water. I used to sail competitively, and I still enjoy sailing, or water skiing, wakeboarding playing golf, tennis. I love skiing or snowboarding during the winters and just being active in general. I try to work out almost every day if I can. It's nice having so many hobbies, just because I feel like there's always something I can relate to with my patients. And also, it helps me understand that the types of things that they want to get back to and the mechanics and muscles that are important to engage in those kind of activities.

Host: Right. Are there some new techniques or technologies? You know, we've talked about-- I mentioned before we got rolling here some of the stuff that all patients want to hear-- me anyway. I want to hear about robots. I want to hear minimally invasive. You know, I want to hear all these little buzz things in medicine, but are there some new techniques or technologies that you're excited, you know, that you can offer now that maybe weren't able to before?

Dr. Joseph Serino: Yeah, absolutely. So, starting on the hip side, like I mentioned, I think being able to offer patients a direct anterior hip replacement is incredibly helpful for their recovery and long-term outcome. But specifically, because the direct anterior approach is not particularly new, one thing I offer for some patients is a bikini style incision, so that's a very small incision, kind of tucked in the bikini line, which leaves a very minimal scar and typically is very well hidden. Patients enjoy it because it's a very cosmetic incision. It's almost impossible to see for most patients once it heals. I also like it, because I've found that it tends to heal better than the traditional kind of longitudinal incision. Although the studies on that are not particularly conclusive one way or the other, that's just my personal experience.

The other thing I do for hips, which I think is very helpful, is I use it's called the Alexis retractor. It's a special sleeve that we put inside the incision during surgery. And basically, what that sleeve does is it basically allows a direct visualization of the hip joint while keeping the muscles out of the way. And during a hip replacement, we're always using a variety of instruments, saws and mallets and things like that, all of which are sharp and have potential to, you know, do as much harm as good.

And the thing that I find really helpful about this sleeve retractor is it keeps all the muscles out of the way and it's very durable so that, as we're moving instruments in and out of the hip, it protects the muscle. And a lot of times, the pain that happens after a hip replacement is caused by stretch or damage or, you know, irritation of the muscle by these instruments and keeping it out of the way and protected. By the end of the case, the muscle just looks absolutely pristine. And I think that helps patients a lot.

In terms of the knee side, like I mentioned before, one of the techniques, again, I offer in some cases is this quad-sparing approach where we don't disrupt the quadriceps muscle. And that has been found to improve recovery and accelerate recovery after knee replacement. And like I mentioned, it also does improve the mechanics of the knee, specifically how the kneecap moves as we flex and extend our knee. Again, the studies are a little bit mixed on that as a whole, but just through my personal experience, that's certainly what I've found and patients seem to benefit from it quite a bit.

Host: So, Doctor, are there some misconceptions or some myths that people have? Like, we think we know because we saw something on social media, or we had a friend who had a knee replacement 30 years ago. When we come into the office, what are some of those misconceptions that you have to tackle?

Dr. Joseph Serino: A common misconception after hip replacement is that patients can't bend over or cross their legs or sit in a low chair. That has been the standard historically, often in patients who've had a posterior approach to their hip replacement because, in the first few months after surgery, there's a concern for dislocation. But those precautions or restrictions, I almost never prescribed to my patients because, again, the direct anterior approach is just so stable. They can pretty much start yoga right after surgery if they want. Another misconception is that the hip or knee replacement won't necessarily last their lifetime, and they may need to get it exchanged at some point down the line.

Host: Exchanged, I like the way you put that. You picture, "I'm here to exchange my hip, please." Yeah.

Dr. Joseph Serino: Yeah. But that's a common thing patients ask about is, you know, "How long did these things last? I've heard they only last, you know, so many years." And again, that's a little bit of a historical problem. The plastic piece that is found in both hip or knee replacements was made from a certain type of polyethylene that was prone to wear, and that could lead to a whole slew of problems down the line. And so, joint surgeons were aggressive about exchanging it after a certain period of time. But now, the technology in this plastic has improved dramatically and we are really not seeing much wear, if any, at all. So, you know, for the overwhelming majority of patients, I expect these hip or knee replacements to last them their lifetime.

Another one that patients often ask about is, "How long do I need to stay in the hospital? Will I need to go to a rehab facility after the surgery?" And I would say, the majority of patients are actually able to go home the same day as surgery. I work with my patients to actually try to decrease the need for any sort of rehab facility. Usually, that means having a friend or family member stay with them for just a few days, or at least being willing to come check in on them for a few days after surgery or help with groceries. But most patients are very mobile after surgery. They're up, they're walking, they're able to go up and down stairs, the same day as surgery. I try to encourage patients to remain independent after surgery. I think that's really helpful for their own recovery. It's certainly a lot more comfortable and enjoyable to be resting and recovering in your own home than a rehab facility where you might have to share a room with someone or, you know, have inconsistent care. And there's been quite a few studies that show that the complication rate is actually much higher, especially the infection rate is much higher in patients who end up going to a rehab facility. And sometimes, you know, it's necessary and there's not a lot we can do and we work as hard as we can to mitigate any risks that might be there. But for the majority of patients, we really try to help them get home after surgery.

Host: Right. How do we differentiate, let's say the normal, if you will, aging discomfort that people like me in their 50s experience from something that really needs medical attention?

Dr. Joseph Serino: A really common complaint, for example, about knees is "My knee clicks." And that can be totally normal. Normal knees click, arthritic knees click, sometimes replaced knees click. I would never really worry too much about that. Really, certainly if there's an acute injury, you know, "I fell off a ladder," "I fell at home," "I twisted my knee in a pothole," things like that definitely deserve some medical attention. But kind of those chronic aches and pains, you know, you wake up in the morning, it's a little stiff or go for a particularly long hike or walk and your knee's a little swollen or sore the next day, of course, it's never wrong to seek medical attention. But when I really start encouraging patients to go see a doctor is when it's interfering in their quality of life. You know, I think staying active is one of the most important things for all of us at any age, but certainly as we get older, it's important for our overall health. It's important for our hearts, our lungs, and just to have a full and enjoyable quality of life. So if hip or knee pain or any other joint pain is preventing you from doing the things that you enjoy doing or certainly that you need to do, that's really when I would start seeking care.

Host: So then, Doctor, let's talk about-- because we're thinking, you know, chronic anyway, like chronic knee pain, aging, those kinds of things. What can we do to help ourselves, right? To protect or improve our joint health so that we, no offense, but don't have to come see you.

Dr. Joseph Serino: That's a great question. And it's honestly an easy answer. By far, the number one thing we can all be doing to improve our joint health is exercise. It's incredibly important to stay active and move. That maintains full range of motion of our joints and helps prevent them from getting stiff. Strengthening our muscles and maintaining a healthy amount of muscle mass is incredibly helpful to protect our joints from injury or damage. It's also been shown to correlate with life expectancy, and is just important as we get older to take care of ourselves and others around us.

And exercise is also important for maintaining a healthy weight, which is a big factor in joint pain. For example, the knee sees about four times our body weight and pressure or your hip can see up to seven times our body weight and pressure. So, maintaining a healthy weight, maintaining good, strong muscles to protect and stabilize our joints, I think, is absolutely critical for all of us to maintain our joint health and our overall health.

Host: That's perfect. Well, as I said earlier, Doctor, we're going to get our money's worth out of you. We're going to speak a couple more times in the near future. But for today, appreciate your time, your expertise, great to learn more about you and how you became who you are. So, thanks so much.

Dr. Joseph Serino: Excellent. Thanks so much. I appreciate your time.

Host: We now have online scheduling. Please visit mdbonedocs.com and click the new online scheduling button to instantly make an appointment. Find out more about us online at mdbonedocs.com. And please remember to share and subscribe to this podcast. And that's all for today. I'm Scott Webb, and that was a bone that's fixed.