Transcription:
Advances in Joint Replacement Surgery

Deborah Howell (Host): Hello and welcome to the show. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Trong Nguyen, a board certified orthopedic surgeon with MemorialCare Joint Replacement Center at Orange Coast Memorial Medical Center. He received his bachelor's degree at the University of California, Los Angeles and attained his medical degree at the University of California, San Diego. He completed his residency at Albert Einstein Hospital in New York and was fellow-trained at Long Beach Memorial Medical Center. Dr. Nguyen specializes in sports medicine and joint reconstruction and started his private practice, the Center for Bone and Joint Care, in 2008. During his free time, he enjoys outdoor activities, going to the beach, as well as watching and playing sports. Welcome to you, Dr. Nguyen.

Dr. Trong Nguyen (Guest): Hi. Thank you for having me.

Deborah: You're most welcome. Anything for a fellow Wildcat. I went to Northwestern as well.

Dr. Nguyen: Okay.

Deborah: Who typically needs joint replacement surgery?

Dr. Nguyen: Joint replacement surgery usually is for people who have pretty severe arthritis of the hip or knee or shoulder. Typically, those patients have failed non-operative management of their arthritis. And there could be various forms of arthritis, including rheumatoid arthritis and osteoarthritis.

Deborah: Okay. So lots of elements there going on. What are some of the symptoms that may occur that would be a signal for somebody to see their doctor about possible joint replacement?

Dr. Nguyen: Well, depending on the joint, if it's in the hip or the knee, most patients who have severe osteoarthritis will have significant pain with walking activities, pain with activities of daily living such as getting out of bed, going to the bathroom, not being able to lift or kneel or squat or bend over to pick up objects. Usually, they're pretty debilitating pain to the point where people see a significant decrease in their quality of life. Usually, when their quality of life is affected by the arthritis, that's when patients are good candidates for joint replacement surgeries.

Deborah: Okay. So if you're having pains like this, it's certainly time to see your primary physician. At that point, he'll make the determination whether you need to see a specialist.

Dr. Nguyen: Yes, definitely. Usually, when patients come to me, they've already exhausted a lot of their non-operative means of managing arthritis, such as anti-inflammatory medications, exercise, therapy, injections into the knee, those sorts of treatments. So when those fail, when patients have exhausted that and they no longer respond to those non-operative management means, then joint replacement is one of their options.

Deborah: Okay. I am interested in something you just said. You said injections into the knees. You hear radio commercials and TV commercials about new techniques where they say it's almost like injecting like a new meniscus into your knee. I'd love to just hear you speak to that.

Dr. Nguyen: There are certain types of injections that have a good track record. The main one is the cortisone injection. That's mostly an anti-inflammatory pain injection into the knee. There are other what we call "lubrication" injections, which is essentially an injection of hyaluronic acid, which is a natural lubricant, in the knee. It's kind of like going and getting your oil changed. You get oil in your engine, you get oil and lubrication in your knee. That significantly improves people's symptoms depending on how severe their arthritis is. It's more effective for mild to moderate arthritis. When the arthritis gets more and more severe, those lubrication injections tend to be less effective. It's not a cure, but it does help with patients' symptoms.

Deborah: So early is always better. See your doctor if you're having any of these symptoms. What recent advancements in technology and care after surgery have helped in aiding faster recoveries for joint replacement patients?

Dr. Nguyen: Well, there are few technology advances in the joint itself, the implant itself. There also have been advances in the cutting guides that we use as part of the surgery. Some are patient-specific. Especially if patients have any significant deformity or abnormal bone structure, then the patient-specific guides that are custom-made can help with better outcome for patients. But a lot of the advances have been made in the pre- and postoperative care for joint replacements, including the therapy program and the rehabilitation protocols we use to help patients get up and going faster after surgery with less pain and less complication risk.

Deborah: Physical therapy, PT, President [Quintet] called his pain and torture team but, boy, did they get him back up and running.

Dr. Nguyen: Yes. A necessary evil. Well, the therapists that we use are fantastic. But what I usually tell patients is if therapy is 50 percent of your recovery, I can do 50 percent of the part. I'll do my part with surgery, but patients require the therapy in order to get a full recovery. So motivation is a very key factor in how people recover, as well as having a great positive attitude.

Deborah: Sure. It has to be a little frustrating for you as a surgeon to do this incredibly complex surgery, have a successful outcome surgically, and then have the patient do nothing afterwards.

Dr. Nguyen: Yes. And I really try to motivate people. One of the nice things that we do in therapy at the hospital is that we actually get people in the group therapy with their own individual coaches.

Deborah: That's wonderful.

Dr. Nguyen: We actually coach the coach to help the patient guide them through the therapy as well as doing group therapy after the surgery. So there's a kind of a sense of camaraderie during the therapy. The patients feel like they're not doing it alone. Even for some people, they get competitive. If you've done surgery the day before with somebody else who's one day after surgery, they'll start saying, "Well, he walked 50 feet. I'm going to try to walk 55 feet." So it kind of pushes people a little bit. That's one of the things that we've been changing with our Joint Replacement Center at Orange Coast Memorial, getting people to walk faster, do more therapy so that they recover faster.

Deborah: Makes it a little more fun too, not to be doing it all on your own.

Dr. Nguyen: Yes.

Deborah: About how long can a typical patient expect to be healing after surgery?

Dr. Nguyen: For both surgeries, hip and knee replacements, we get people up and going on day zero, which means the same day of the surgery. Typically, we will do the surgeries in the morning, and then we get the people up and out of bed that afternoon. With adequate pain control, people are able to walk a little bit in baby steps. But the earlier we start, the better.

Deborah: Yes.

Dr. Nguyen: For short-term recovery, for hip, depending on the patient, it can be anywhere between four to six weeks. For a knee, I would say four to eight weeks depending on their preoperative function and how well they were doing before the surgery.

Deborah: Okay.

Dr. Nguyen: Long-term recovery, meaning significant improvement in their lifestyle and movement and being able to walk long distances, can take anywhere between one to three to four months depending on how they recover. But typically, it's anywhere between four to six weeks for early recovery.

Deborah: Then it's back to those burpees.

Dr. Nguyen: Back to them, right. No rush.

Deborah: What are some of the other components to the expedited recovery after surgery aside from movement in physical therapy?

Dr. Nguyen: One of the things that a lot of patients do really well with are these cold therapy units that they use to help patients. Like if it's a knee replacement, I'll have them use an ice machine that actually circulates cold water and actually provides a little bit of a compression and essentially massages the knee while providing an anti-inflammatory effect to reducing the swelling with the ice. Patients love it. It reduces the swelling. It reduces the pain after the surgery, and it also reduces the need for narcotic medications or pain medications afterwards, because you always worry about side effects and long-term addiction to those medications. Usually, people will need it for long term, but this helps reduce their need for those medications. And the machine, I highly recommend it to everybody who does my knee replacements or joint replacements. Whether their insurance covers it or not is a completely different story.

Deborah: Just ask for cold therapy and ask your insurance company.

Dr. Nguyen: Yes.

Deborah: Okay. Well, we have 60 seconds left. We've talked a little bit about hyaluronic acid, and it's very important. One last question. How does group support and group therapy fit in?

Dr. Nguyen: Well, I guess, as we talked about earlier, group support, group therapy is fantastic. We get really good responses from patients with the group therapy because it motivates people, helps people talk, and can spread that positive attitude. It makes people competitive. Who doesn't want to do better than their neighbors when it comes to joint replacements?

Deborah: That's right. Thank you so much, Dr. Nguyen, for finding the time to talk to us today about the exciting advances in joint replacement surgery. We hope to have you back when we have some more time. It's been a pleasure to have you on today.

Dr. Nguyen: Thank you very much.

Deborah: I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have a wonderful, healthy day.