Travis Baumgarten (Host): Welcome to Mile Bluff Unscripted, where we bring you real conversations with the people behind your care. I'm Travis Baumgarten. And today, I'm joined by orthopedic surgeon Dr. Thomas J. Bramwell to talk about orthopedics and robotic knee surgery. Welcome, Dr. Bramwell. And as an orthopedic provider, what are the most common reasons patients are referred to you by primary care providers? So, you know, how should patients and providers decide when it's time to see an orthopedic specialist rather than continuing with conservative treatment?

Dr. Thomas J. Bramwell: Good morning. Thanks for having me on. The most common things we see referred to us are things like chronic pain, osteoarthritis, soft tissue injuries, all things that can be lingering and get worse over time. Often acute injuries sometimes come through primary care as well. So, all those things get referred to our office on a regular basis.

Host: Yeah. And really going in a little bit deeper, what are some of the biggest myths or misconceptions you encounter in orthopedics? For example, rest is always best, or cracking your joints causes arthritis, or you can't run if you have arthritis. How do you address those misconceptions with your patients?

Dr. Thomas J. Bramwell: Yeah. Really by trying to provide insight to patients, informing them. It's often a thing where, for example, when you say you can't run if you have arthritis, well, that may be true. Running might not be your best option, but there are many other things you can do instead, like riding a bike, walking a lot, doing hiking. Pickleball has become something that people really enjoy. So, all those things can be alternatives to some myths like that where people take it and mean they can't be active, but, really, you can be.

Host: Yeah. And fracture care has definitely evolved significantly over the years. For common fractures of the wrist, ankle, hip, shoulder, when is surgery truly necessary? And when can a cast, brace, or maybe a sling still be the best treatment?

Dr. Thomas J. Bramwell: Yeah. So, most commonly when things require surgery, it's when fractures are displaced or moved. Oftentimes when they're weight-bearing extremities or the lower extremity, those fractures, such as a hip fracture, may require surgical intervention. When fractures involve a joint, the alignment needs to be very good in those cases. And so, those are all things that can need surgery. Casting or bracing for fractures that are in the right alignment and not displaced, that's when we can usually cast or splint something

Host: Yeah, and many older adults worry that a fall will inevitably lead to a hip fracture. So, what practical evidence-based steps can patients and families take to reduce the risk of falls and fractures both at home and also in the community?

Dr. Thomas J. Bramwell: So, the biggest thing is, as we already mentioned, being active. That's great for bone health. So, just getting out a little bit every day, doing a walk, doing biking, running if you can, are all very good for your joints. In Wisconsin and a lot of America, vitamin D and calcium is very important to supplement with that. Especially if you're over 50 or 60 years old, that always is more likely—and in females—to have osteoporosis. And so, those are all things that can mitigate some of that issue.

Host: Yeah, and talking a little bit more about that. So, how do you approach a bone health and osteoporosis screening in an orthopedic practice? And what do you wish every patient over 50 understood about bone density, osteoporosis, and fracture prevention?

Dr. Thomas J. Bramwell: Yeah. A lot of times osteoporosis treatment in regards to scans and things done to get an initial assessment are often initiated by their primary care provider. And so, a thing called a DEXA scan will actually help to get information regarding that, kind of the level of osteoporosis if you do have it. When we see some of these fractures, like a hip fracture or a wrist fracture in an older patient, we will often send them to their primary for treatment or to get an initial assessment if they haven't had that.

Host: Yeah. And for families and caregivers of patients recovering from major orthopedic surgery or significant fractures, what are the most important things that they can do at home to support safe mobility, prevent complications, and help the patient return to normal function?

Dr. Thomas J. Bramwell: I often preach in my office really taking your time. A lot of times when we see these injuries, whether it's in the emergency department or in our office, it's just a simple accident, people not leaving enough time, they trip and fall. And then, unfortunately, you have a big injury. So, I often start with that, leaving more time to get places, especially as we get older, and taking your time can help.

But also, you know, after surgery, if you have had one of these injuries, often people will be using a walker. That can help avoid falls in the early time. Removing rugs, elevated toilet seats, these are all simple adjustments that can be made to help avoid these things.

Host: And we kind of talked a little bit about it, but before we talk more about knee replacement, what lifestyle changes, exercise programs, or injury prevention strategies can help people with early knee arthritis manage their symptoms and potentially delay the need for surgery?

Dr. Thomas J. Bramwell: I often say be active. You can see that's kind of our mantra in orthopedics, as best as you can. And it's easier for some than others. But being active is a real key to your joint health and staying mobile, having less stiffness and soreness on a regular basis, and then avoiding things that cause significant pain.

So, if there is something that really hurts you for days after, then we say, you know, those are things to avoid. As we get older, running is certainly one of those. And so, alternating things like walking, doing hikes, biking or cycling like we talked about, those are all things you can do instead. Those again help your bone health and bone quality and allow you to have less pain.

Host: Yeah. So, let's turn to robotic-assisted knee replacement, which is available at Mile Bluff Medical Center in Mauston. What exactly is robotic knee surgery, and how does robotic-assisted total knee replacement differ from the traditional knee replacement performed by a surgeon using the standard instruments?

Dr. Thomas J. Bramwell: Yeah, that's a great question. There's a lot of misconceptions about it. The biggest thing robotic surgery does now in the current environment is provide more data for the surgeon. Robots are not doing the surgery, making bone cuts, doing things on their own. They are providing data guided by the surgeon to allow us to be more precise, more accurate, for every patient's surgery.

So, the biggest difference is that we get this data. And then, we can utilize it to make more precise bone cuts, allowing less soft tissue disruption that we feel can lead to a lot less pain, both early on and in months and days to come. So, those are the biggest advantages.

Host: Yeah. And for which knee conditions is robotic-assisted total knee replacement most commonly used today? And how do factors such as age, body weight, activity level, and other medical conditions such as diabetes or heart disease influence whether someone is an appropriate candidate?

Dr. Thomas J. Bramwell: The indications for robotic knee replacement are not different than if you were doing it with several other techniques or ways to do it. The same factors apply. It's really what the surgeon's comfort is and how they do the surgery, and robotics can help as we talked about. The candidates are still the same, but it's important to be active, be a healthy weight.

Avoiding smoking. Nicotine can be a major contraindication to surgery. Diabetes being under control is another one. So, having all those things in balance before you do surgery is most important.

Host: Yeah. And you kind of touched on some of it already, but what potential benefits can robotic assistance offer patients undergoing total knee replacement? For example, can it affect pain, function, alignment, walking ability, or the speed of recovery and return to work or sports?

Dr. Thomas J. Bramwell: Yeah, almost all those things. We really look for decreased pain right after surgery, because there's less soft tissue work that often leads to less pain, less swelling after the procedure. That allows you to get moving with therapy quicker. It also allows you to get that strength in a quicker timeframe because you're active with your physical therapy. That is always still important, whether you have a robotic knee replacement or not, is you still do outpatient physical therapy. That's really someone that helps guide you through the recovery process, making sure you're hitting all the appropriate landmarks or goals that you have after surgery.

Host: Yeah. And when patients are deciding between a traditional knee replacement and a robotic-assisted procedure, what questions should they and their families ask their surgeons?

Dr. Thomas J. Bramwell: Yeah. It's most of the same questions. There's not a ton of difference when you talk about what the patient needs to know. There are a few differences, like sometimes there are additional incision sites with a robotic knee replacement. So, that's something to know about. But otherwise, from a question standpoint and what they want to know, those are going to be the same between both regular and robotic-assisted knee replacement.

Host: Yeah. And again, we kind of talked about it a little bit earlier, but talking about the misconceptions that patients may have about robotic-assisted knee replacement. For example, the idea that the robot replaces the surgeon or guarantees a perfect outcome. How do you explain the technology, and what positive feedback have you received already from patients who have had the surgery?

Dr. Thomas J. Bramwell: Yeah. The patients often have less pain. They're able to get moving quicker with therapy, especially once they've had surgery, been discharged from the hospital, getting home and being able to get home the same day. Sometimes we're even able to do that now where you have the surgery, come into the hospital, have your procedure, and go home the same day. So, that's been a real advantage here at Mile Bluff.

Host: Yeah. And as we wrap up this episode, what's one thing you want listeners to take away from this conversation?

Dr. Thomas J. Bramwell: Well, I'm excited to join the orthopedic team here at Mile Bluff. Excited to bring robotic total knee replacement to the facility and organization. We treat a lot of different conditions here in the area, from fractures to hip and knee replacement, which is a real passion of mine. And we want to get patients better as quick as possible and with less pain.

Host: And that wraps up this episode of Mile Bluff Unscripted. We appreciate you spending time with us, and we appreciate Dr. Bramwell for sharing his expertise. If you would like to make an appointment with him, please call 608-847-5000. New patients are always welcome. To explore more topics and connect with our providers, visit milebluff.com. Take care, and we'll see you next time.