Joey Wahler (Host): It's among the most common bone and joint operations in the United States. So, we're discussing knee replacement surgery. Our guest is Dr. Alex Athey. He's an orthopedic surgeon. This is Wellness in Reach, a Mount Carmel podcast. Thanks so much for joining us. I'm Joey Wahler. Hi there, Doctor. Welcome.

Alexander Athey, MD: Thanks, Joey. Thanks for having me.

Host: Great to have you aboard. We appreciate the time. So first, just how common is knee replacement surgery these days?

Alexander Athey, MD: Yes, it's incredibly common. It's one of the most common procedures performed nationwide and worldwide. So, you know, tens of thousands, if not hundreds of thousands, are going to be performed every year.

Host: And while the procedure is usually thought of as being primarily for older patients, sometimes younger people need it too, right?

Alexander Athey, MD: Yeah, that's true. The indications certainly are expanding a little bit into younger and younger ages as the technologies, the techniques, the implant designs, all of these, you know, are continuously being updated. And, you know, in 2026, it's certainly not uncommon to see some patients potentially even seeking out total knee replacement even in their mid to early 40s.

Host: Speaking of the technology and the advancements in recent years, we hear, of course, so much about robotic surgery in just about every walk of medicine these days. So when it comes to knee replacement, how has the robotic world changed the way you and yours approach the procedure?

Alexander Athey, MD: Yeah, I mean, I think it's really important to talk about, you know, before we kind of even get to the robot, I think it's probably important to set the stage a little bit and kind of think about what's changed in how surgeons kind of think about knee replacement. You know, traditional knee replacement's been really incredibly successful, but we also know that there really is still some room to improve. A meaningful group of patients really can have residual pain, some stiffness or simply, you know, feel that their replaced knee never quite feels natural.

And one of the things we've, you know, come to appreciate much more now is just how different one person's knee can really be from another's. So, we know that not every knee is really kind of built the same. Some people naturally have a little bit more bow to their leg. The orientation of their joint line can differ. So really, the relationship between the femur and the tibia is different amongst, you know, every patient, and those variations really can be completely normal for that individual.

So historically, even though everybody's knee is a little bit different, knee replacement was much more standardized. We often worked towards a very similar, something called mechanical alignment. It's a target where we put nearly every knee straight, as straight as we could. So put simply, you know, we could start with many different shaped knees but work towards making them much more similar when we were finished.

You can kind of think about it almost like a one-size-fits-all approach. That has led us to ask, you know, really important questions. instead of making every knee fit the same target, can we safely personalize knee reconstruction, to the way that might actually benefit the patient ultimately?

And so, that's really kind of setting the stage of the excitement about the robot. And I think, you know, a dovetail, I don't want to jump the gun here, but kind of what you were referring to is, you know, where does that robotic technology kind of fit? You know, what can you do with a robot that's different with traditional knee replacement? I'm happy to keep going. If you want me to move in a different direction, I can kind of speak to that or go somewhere else.

Host: Well, being that you mentioned personalized knee replacement surgery. So for the layperson, before we get to how the robot fits into making that happen, what do we mean by that?

Alexander Athey, MD: The goal is to restore the knee closer to its own native pre-arthritic anatomy and balance really, you know, with the ligament tension when it's safe and appropriate to do so. So basically, you can kind of think about it like knee arthritis sets in, how can we personalize the knee to basically put it back to what the knee was like before?

So, personalized or kinematically informed, these are kind of phrases that are out there right now. These alignment strategies kind of allow us to think more carefully about the individual patient's anatomy, soft tissue balance, all of it. Sometimes we can create a really well-balanced knee by making thoughtful adjustments to implant position, rather than really forcing everybody's knee into exactly the same alignment, and then releasing the ligaments or soft tissues to make that predetermined position work. So, it's a really important distinction. So, you know, trying to minimize the amount of soft tissue disruption

And I would really just, you know, touch on saying, like, the emerging research is encouraging. These personalized alignment strategies can definitely reduce the need for some unnecessary soft tissue releases. And some studies have demonstrated some improvements in early aspects of, you know, pain, function, and just how natural the knee feels at ultimate recovery. But at the same time, I think, you know, we really need to be honest that it remains an evolving field. Not every study has shown better overall outcomes. And I would certainly never promise a patient that robotics or a particular alignment philosophy guarantees a faster recovery or a better knee.

But what I can say with confidence is that this technology allows me to be much more thoughtful about recreating the individual knee in front of me instead of really applying, you know, a one-size-fits-all or the same approach to everyone. While I would never guarantee a faster recovery anecdotally in my own practice, I've really been impressed by how quickly many of these patients are bouncing back. That clinical experience is one of the reasons why I've really become so enthusiastic about this approach.

Host: All right. I'm sure our audience appreciates your candor and thoroughness that you just described. So, one other thing before we get to more specifics about the robot. You mentioned, Doctor, a term earlier when you were talking about every knee not being created equal, so to speak. You mentioned a term, I believe you said not everyone's bow of the knee is the same. What do you mean by that?

Alexander Athey, MD: Maybe next time you're walking down the street, you can kind of look and see. You know, everybody's knee anatomy is different. So, you know, the way that I kind of explain it to patients is bow-leggedness, right? So, bow-leggedness, straight legs, or knock-kneed, right? Some people are just built differently, and there's a lot of different subclassifications within each one of those. However, that's probably the easiest bucket to kind of think of it, whether you have really bowed legs, really straight legs, or really kind of knock-kneed appearances.

Host: Hence, the term bowlegged in some cases, right?

Alexander Athey, MD: Exactly right. Yep

Host: Gotcha. So now, drum roll please. We'll get to the robot a bit. And so, robotic technology, as we mentioned, is becoming so prevalent and so preferred in many cases. How does it help to bring about the kinds of improvements that you've discussed?

Alexander Athey, MD: Right. So, you know, this is where robotics, I think, really does become exciting. The robot is not really performing the operation for me. What it gives me is much more Information and control while I perform the operation. So, I can really assess an individual patient's knee anatomy, evaluate how the knee moves, how the soft tissues are balanced, make very small adjustments to a surgical plan, and then see the consequences of all those adjustments really before I even commit to making the final cuts or shape the bone to accept the final implant.

So then, the robotic system helps me execute essentially that individualized plan very precisely. So when patients ask me, you know, in clinic, you know, why I use robotics, my answer is not simply because a robot can make an accurate cut. The more important point is that the robot gives me information and precision to design and execute a knee replacement around that patient's, you know, individual anatomy, rather than asking the patient to fit a predetermined plan.

Host: That gives you as the surgeon a better picture of what you're dealing with, right? And it gives the patient, as you alluded to earlier, a better chance at post-surgery having their knee be closer to, if not exactly where it was when it was healthy, yes?

Exactly right. Exactly right. You know, and I think, you know, post-operatively is a nice dovetail because obviously patients care, you know, a lot about their own recovery. And robotics has changed honestly a part of that operation, but I think that's not the only thing that's changed the post-op recovery, you know?

So, I don't think recovery really comes down to any single piece of technology. For me, robotics is really part of a broader philosophy of respecting the patient's anatomy and their soft tissue. For example, you know, I routinely use a subvastus approach for the knee. So instead of cutting through the quadriceps muscle or the tendon, I'm able to just sort of work on the side of it, keep the muscle and the tendon intact.

So, I think about the operation in kind of two complementary ways. On the inside, I can sort of reconstruct the knee in a way that respects how the particular patient's knee is built. And on the way in, can I really minimize unnecessary disruption of the muscles or tendons? So, it's really, you know, a one-two punch of trying to minimize the amount of unnecessary soft tissue disruption during a relatively, you know, large surgery.

So, that combination is kind of what excites me about modern knee replacement. It's not really adding, you know, just the technology. It's about using technology and surgical technique together, to make the operation more personalized and as soft tissue-friendly as we possibly can.

Understood. Great point you made there about how it's part of a bigger picture of advancements, not just the robotic equipment. So, that being said, Doctor, as you touched on a moment ago, patients naturally care a lot about recovery and the time it takes. So, what's the basic compare or contrast between doing it the new way versus the traditional way in terms of post-op experience?

Alexander Athey, MD: Yeah. So, a lot of the times what I'm seeing is, you know, let's say classic total knee replacement. You know, when I see patients in my own clinic, I'll tell them these advancements, you know, it's some of the, you know, most advanced technologically advanced ways that you can do this knee replacement in 2026.

The reality is, for the first three weeks after surgery, I tell every single one of my patients they're not going to like me very much. It's a tough recovery. It's tough to get through. You take the pain meds, you go to therapy, but really the only way out is through. But usually by about three weeks, you're through the worst of it. Often patients are coming back at three weeks. They're not really taking much narcotic medicines anymore. They're off their gait aids. That is a stark contrast to how patients used to be at three weeks with these sort of more traditional approaches. It was very much a coaching session, say it'll get better, see them back at two months.

They're still kind of struggling a little bit. So really, it's shortening that interval of getting patients back to doing the things that they want to do, getting them off their gait aids, getting them off their narcotic medications or other pain medications. Anecdotally, I've seen it's been a massive shift in my practice.

Host: Couple other questions for you. First, with all of the above advances in place, how does someone typically know or when should they know when it's actually time to have replacement? Where's that line, if you will?

Alexander Athey, MD: Yeah, this is probably the most important part of this conversation, honestly, because technology does not change the indication for surgery, right? Someone can have terrible-looking X-rays, or arthritis on X-ray and still be functioning extremely well. That person probably does not need a knee replacement.

And so, I tell patients all the time that we are really treating them, right, not their X-ray. We should use reasonable non-surgical treatments while those treatments are allowing them to live the life that they want. When their quality of life is good enough, then we keep doing that. So really, you know, it kind of ties into a philosophy of my own, which is, you know, presenting the right surgery, but at the right time, and with no pressure.

So, the ball is always in the patient's court. We have a very frank conversation, meet them where they are in their disease process, what they've tried, what they haven't tried. And then, you know, when the arthritis begins consistently taking away the things that matter to someone, whether that's walking, exercising, playing golf, traveling, sleeping comfortably, I mean, working, the list goes on and on, right?

When these things start piling up, and they're just always constantly thinking about their knee, then it might be time to have a conversation about knee replacement. And when that time does come, that's where I think the advances we've been discussing become really exciting.

Host: Being you mentioned arthritis, let me ask you this. How often in your experience does someone need knee replacement because of the fact that they're overweight or for whatever other reason the knees have been really overworked over the years? Might have to do their job. It could be from athletics, obviously. How often is it one of those things, Doctor, as opposed to you're living a "normal life," you've avoided all that stuff, and yet arthritis sets in and all of a sudden, maybe at a relatively young age even, you need it anyway? What's the balance there?

Alexander Athey, MD: Yeah, the balance is certainly there are risk factors that increase the risk of, you know, arthritis setting in. The most common arthritis that we see these days is osteoarthritis or just, you know, run-of-the-mill wear and tear, natural wearing down of the cartilage, and then eventually, you know, becomes bone-on-bone arthritis.

Probably the second most common that I see in my own clinic is post-traumatic arthritis, meaning usually someone had some kind of an injury, sports injury when they were younger, had an ACL reconstruction, changed tthe mechanics of their knee, and it just puts them at a higher risk of having arthritis earlier in life.

You know, we used to see a lot of rheumatoid arthritis, but with a lot of the advances in the biologics that are out there right now, the medications to really change the disease course, that's actually kind of falling down on the amount of times that we see that in clinic.

Now, there are certainly modifiable risk factors that you could do. I mean, there's lots of biomechanical studies showing that every pound that you lose is five pounds off your knee. So, you can do the math, you lose 20 pounds, that's 100 pounds of force that your knee's not seeing anymore. So, you know, those repetitions add up for sure. And so, anytime that, you know, I'm meeting a patient for the first time, if there are things that we could potentially optimize, you know, prior to talking about surgery for sure, then we definitely should. And a lot of that goes into those, you know, non-operative, non-surgical management things that we're talking about. So, optimizing the patient, getting them into weight loss if it's appropriate, making sure their nutrition's okay, have them done any physical therapy, those kinds of things.

And there's a lot about osteoarthritis that we still don't know even in 2026. There certainly seems to be a genetic component, although we're not really 100% sure, you know, how that ties into the whole relationship, of the overall disease process. So yes, there are definitely, you know, modifiable or risk factors in general. But in my mind, you know, osteoarthritis has a heavy genetic component that sometimes people are just predisposed to getting it, whether they have the risk factors or not.

Host: And then, in summary here, Doctor, for those joining us that are considering knee replacement, you've done such a great job of comprehensively breaking down all the details. Job one, what's the most important thing you want people to understand about this procedure?

Alexander Athey, MD: To leave you with, I'd want them to know that the knee replacement, it really does continue to evolve. We understand much more about the differences between individual knees than we have in the past. You know, we have a technology that allows us to really measure those differences, plan around them, execute that plan with remarkable precision, sub-millimeter precision. But, you know, we have surgical techniques designed to minimize unnecessary disruption of soft tissues around the knee. But none of that, you know, makes knee replacement a small operation, and none of it guarantees a perfect result.

But when someone truly needs a knee replacement, I think we can now approach the operation in a much more individualized way. So, that's really what excites me about the modern knee replacement. The goal really is no longer to simply replace a knee. The goal is to replace your knee in a way that respects how your body was built.

Host: The way you're describing that, I'm sure those joining us are comforted and feel a lot better about the procedure if they happen to be considering it. Well, folks, we trust you're now more familiar with modern knee replacement as the doctor has pointed out. Valuable information indeed. Thanks so much again.

Alexander Athey, MD: Absolutely. Thank you for having me. Really appreciate it.

Host: Same here. And to learn more about orthopedic care at Mount Carmel, please visit mountcarmelhealth.com/services/orthopedics. If you found this podcast helpful, please do share it on your social media. And thanks so much again for being part of Wellness in Reach, a Mount Carmel podcast.