Scott Webb (Host): Welcome to Health Dose, your go-to source for quick and reliable health and wellness news. I'm your host, Scott Webb. And today, we're discussing joint replacement surgery with Dr. Robert Barry. He's a board-certified orthopedic surgeon with MyMichigan Health who specializes in general orthopedics for adults and children. Doctor, Welcome to the podcast.

Robert Barry, MD: Hi, Scott. It's nice to be here.

Host: It's nice to have you here. And I was just mentioning to you that I'm 57, I have osteoarthritis, my knees hurt, and I wonder when is it time for me? So, let's talk about some of the most common signs and symptoms indicating that it might be time to consider joint replacement surgery.

Robert Barry, MD: Sure. People come in and, usually, they come to the office and they're having pain, pain at night, pain with activities. It's starting to limit their ability to do the things that they enjoy or it starts to interfere with their ability to go to work comfortably, and whether it's in the knees or hips or shoulders or whatever, but they start to develop more and more symptoms. And oftentimes, people will try aspirin or Motrin at home or they'll see their primary care physician and they'll offer some suggestions. And when they're having symptoms that don't respond to those simple things, then they usually give me a call or an orthopedic surgeon a call and come and see us.

Host: Yeah, that sounds about right, that checks out for me, try the OTC things, of course. Maybe a little yoga. Try to avoid things that are really stressful on my knees, like pickleball. So then, Doctor, let's talk about the typical process and timeline for diagnosis to undergoing joint replacement surgery. How does that usually work for folks?

Robert Barry, MD: It's going to change a lot based on each individual. So, some people will respond very well to just the simple, easy things. Some people will end up, you know, like you said the over-the-counter medications, they'll try those . And maybe they don't do well and we'll give them a prescription medication that might keep them comfortable for years where they never even have to come back to the office. And it does vary quite a bit.

Now, some patients, you try treating them with an arthritis pill and they have persistent problems and maybe we can offer them an injection. There are different types of injections that we can do that have varying good results with people. Some do better than others. Those are things that we can try. But when we have a patient that doesn't respond to all the conservative methods, therapy and shots and pills, then when we go to about getting them scheduled for surgery, it usually takes about a couple of months to get all the process organized to get them from the office through all the required steps to get them ready for surgery to actually getting them in the hospital.

Host: So, Doctor, let's talk about the non-surgical or conservative options that you were mentioning there. I'm picturing myself and maybe I'm transferring too much onto me or projecting so much from me, but I feel like folks maybe want to leave surgery as a last resort. They want to try everything possible before they get to surgery. What's been your experience with patients or prospective patients?

Robert Barry, MD: Typically, people will come in and you start with the simple things, the arthritis pills, the Motrins and Aleves, and the Advils, and there's prescription versions of those medications that are a stronger dose, and that can be very helpful for people. And then, you go through the injections. If they don't respond well to the medications, some patients are going to be happy to try . Other people are going to be not willing, they don't want to have a shot, they don't want to try those things.

And then, it varies quite a bit from patient to patient. Some will want to rush to surgery. They don't want to try some of those other things. But really, it's important to try those things because they may have some success with them. And we don't have to get to surgery. Surgery's always the last resort. That's the process for conservative treatment.

Host: I feel like surgeons are, in a way, Doctor, kind of like mechanics. So if you're having a noise in your engine, they don't just start by replacing the engine, they start by changing your oil and doing some of the more conservative things before you get to replacing the whole engine. It makes me wonder, Doctor, though, like what are some of the potential risks and complications that might be associated with joint replacement surgery that might be on the minds of folks in your office?

Robert Barry, MD: Yeah. All surgeries have risks, from the smallest ones that we do, the joint replacements, which is one of the larger surgeries that we do. The risk of surgery always includes infection, healing problems, continued pain and stiffness despite surgery. And those are real, whether it's a small surgery or a large surgery.

So, infections are a very small percentage, but they do happen. And it's important to do everything we can to prevent the risk of infection and complications of continued pain, stiffness. That's a real thing. And some patients are going to struggle with stiffness. The biggest predictor for postoperative range of motion is what preoperative range of motion is. So, those patients that are very stiff to start with, they're going to struggle getting their range of motion back. Some people will have pain, but they're pretty flexible. Those patients don't tend to struggle as much getting the range of motion back. So, it depends on patient to patient and what their bigger risks are.

Host: Yeah. My mom, I was telling you, she's got a new knee, she's got a new hip, and the physical therapy for the knee was pretty grueling. It took her a little bit longer her with the knee, but her knee wasn't great, as you're saying before the surgery and the hip went a little bit smoother because her hip was in better shape.

So, Doctor, I love talking about robots. I love talking about AI. I love talking about all the advancements in medicine. So of course, when I speak with a surgeon, I'm picturing you with a giant scalpel in your hand, right? My memory maybe goes back to the '60s, '70s, '80s. But today, like what are some of the latest advances? Are you using robots and things like that?

Robert Barry, MD: So, robot technology is evolving in the field of orthopedics. And it's not universal. It's not the standard of care. But it is a technology that is available and some surgeons are grasping it more than others wanting to pursue it. The studies are still inconclusive. We're gaining more and more information on whether that's really what needs to be done for all of the patients. The gold standard is still not robot-assisted. But that is evolving technology. And maybe within a few years, that may be the new standard of care.

Host: That's, as you say, the gold standard still today. Are you finding that that's helping more folks to heal faster, have smaller scars, you know, recover faster back on their feet faster. Is that like some of the advancements, is that's what's helping to get folks back on their feet?

Robert Barry, MD: Oh, sure. If you look at the last 20 and 30 years of joint replacement surgery, when I was a young doctor, patients stayed in the hospital for three, four or five nights. Now, most joint replacements nationwide are done as outpatient procedures. So, it's varied quite a bit.

Host: Doctor, I want to talk about expiration dates, if you will. Like, joint replacements, will they last a lifetime? I'm guessing it depends on exactly when we get the joint replacement, but is it possible that folks may need a revision surgery along the way?

Robert Barry, MD: It is possible. They're a good product. And we know that people will have 80% good to excellent results at 12 to 15 years. That's a pretty good duration. And I know personally that I have some knee replacements and hip replacements that are more than 20 years old. But they don't last forever. They are pieces of machinery. And any piece of machinery will start to wear out. So, depending on how old a patient is when they start, it will impact how long it'll last. And we also know that they last the longest in skinny, older women. And they last the shortest in big, young men, which really makes sense. It's a mechanical issue. The more load you put on it, the more quickly it's going to wear out.

Host: I like to do a little myth-busting, Doctor, from time to time. I don't if you're prepared for that, but what are some of the misconceptions about joint replacement procedures that practitioners would really like to address?

Robert Barry, MD: I think the biggest myth is people may not have a realistic expectation on what happens after a joint replacement. It's unrealistic to think that there's going to be zero pain. Some people may have, you know, virtually no pain at all and feel very natural with it. But realistically, we know that patients are still likely to going to have some discomfort, still likely to have some issues, not as strong, not as flexible. It's hard to replace what nature gave us with an artificial piece of equipment. So, what we're really hoping for is that people have less pain, better function, but we can't make them 40 again. That's not realistic. But, you know, we're trying to keep people active doing the things they want to do, and that's kind of our goal with these big major operations.

Host: Yeah. For me personally, Doctor, I'd like to be able to walk from the family room to the kitchen and not be in pain. I don't necessarily need to play on the pro tour, right?

Robert Barry, MD: Right. It's about having realistic expectations. If you want to see a disappointed patient, give them unrealistic expectations. You know, people need to know what's going to happen. And that's the biggest misconception, I think.

Host: For sure. Well, I appreciate your time today. I like to bust myths. I like to educate. These podcasts are great for me. Free medical advice from experts like yourself. So, thank you so much.

Robert Barry, MD: Thanks for having me. It's been a pleasure talking to you.

Host: Great having you here. And for those who would like information about MyMichigan Health's comprehensive musculoskeletal care, you can visit mymichigan.org/msk. And if you enjoyed this podcast, please share it on your social channels and explore our podcast library for more health-related topics. This is Health Dose. Thanks for watching and listening.