Gabby Cinnamon (Host): Welcome back to the Well Within Reach podcast. I'm your host, Gabby Cinnamon. And today, I'm very excited to be joined by Dr. Mohammed Ahmed, an Orthopedic Surgeon at Riverside to talk about advancements in joint replacement surgery. Thank you so much for coming on the podcast today, Dr. Ahmed.

Mohammed Ahmed, MD: Thank you for having me.

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Host: So this is your first episode with us, I believe. Can you tell us a little about yourself, your background, training, all that good stuff?

Mohammed Ahmed, MD: Yeah, so, I'm originally from the area, I grew up in the northern part of the Chicagoland area. I went to training out in St. Louis for orthopedic surgery, then did a one year fellowship in adult reconstruction or joint replacement in Cleveland, and then came back to the Chicagoland area to be with family.

Host: We're very excited to talk to you about this today. Can you kind of give an overview of joint replacement surgery and who is a candidate for this kind of procedure?

Mohammed Ahmed, MD: Yeah, so, joint replacement surgery is a very revolutionary surgery that's been around for now about 50, 60 years, and the actual surgery has not changed much, but the way we do these surgeries have improved quite a bit over the last decade or so. In terms of joint replacement surgery, what we're talking about are hip and knee replacements mostly, and then to a lesser extent, shoulder replacement surgery. And we do this for painful arthritic conditions of the hip and knee joint. And if patients develop these conditions, and they've tried everything conservative, and they fail, then they may be a candidate for joint replacement surgery.

So just, not everybody necessarily needs to have a joint replacement surgery. It's for people that have arthritic conditions that, really is affecting their quality of life and they've tried everything short of surgery, then we would say that they're a candidate for surgery.

Host: What are some of the most significant advancements in joint replacement surgery that you've seen in recent years?

Mohammed Ahmed, MD: So, there's multiple advancements. Um, the technology in terms of how to do the surgery has improved quite a bit. Traditionally we used to do joint replacements based on manual techniques. What that really means is we would put cutting jigs on the patient's knee, for example, and then make our cuts, balance the ligaments and then put the implants in.

Now we have a lot more information using CT scans and MRIs where we can have data before surgery, during surgery and after surgery. And one of the things that has sort of come about with this new technology is robotics. So what we do is we use a CT scan, generate a bone model of the patient's normal anatomy or the anatomy that they have, and then we can create a plan that's specific for that patient, have a robot come in and execute that plan for us. And the hope is that they have a better, quicker outcome and a better outcome longer term as well.

Host: Can you share with us the types of joint replacement surgeries that we perform here um, right, at Riverside?

Mohammed Ahmed, MD: Yeah, so, we do hip and knee replacements mostly. We also do shoulder replacements. Um, my practice is limited to hip and knee replacements, but my partners do shoulder replacements as well. And these are all offered at Riverside.

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 Now back to our episode with Dr. Ahmed. So can you talk a little bit more about robotics and how robots are used in joint replacement surgeries? I think sometimes people are a little bit apprehensive when they hear, Oh my gosh, a robot is going to be doing my surgery. Can you kind of put us at ease and explain how that works, how it benefits, not only patients, but also you as a surgeon.

Mohammed Ahmed, MD: Yeah, that's a good question. When we talk about robotic knee replacement or hip replacement, it doesn't necessarily mean we hit a button and then a robot comes in and actually does the entire procedure.

What it really does is we have a CT based model of the patient's anatomy and then we can generate a plan. What the robot helps us do is basically tell us whether or not we're in those target zones that we've sort of set and then certain, there's different types of robots, but certain robots can actually come and execute that for you.

The advantage of that is, that you have immediate feedback and it's objective, so I, you know, without a robot, you're basically making some of these estimates and where you're putting your cut guides or how you're balancing the ligaments can be a bit subjective and it's worked well in the past, but with the robot, you're actually having objective data and, you know, if you're hitting that objective data right away.

So there's advantage there. Also, some robots actually make the cuts for you. So the cuts can be much more precise than with a human hand versus a robotic arm, and so, we have better precision. The other thing the robots can also do is that they can limit how much exposure we necessarily need.

So, in traditional, for example, in traditional knee replacements, we have to expose the entire bone to be able to see where we're putting our implants, where we're making our cuts, and then also protecting vital tissue structures that we don't want to injure. With the robot, we sort of the robot can generate haptic boundary, which is basically an invisible boundary and it will not go beyond that boundary.

So if there's structures that are, for example, vital that we need to protect, the robot knows not to go there. It will, even if you try pushing the robot that way, it will automatically stop you. So there's a safety benefit there, but also because of that, we don't have to do as much exposure around the knee.

And what that really boils down to is much quicker recovery for the patient. So they're getting less tissue trauma during the surgery. The patients have less swelling after surgery and less bleeding during surgery. And that all leads to less pain, less narcotic use postoperatively and quicker recovery.

Host: Some, it's kind of crazy to hear, like, you know, just hearing like grandparents and older adults talk about how when people used to have hip or knee replacements, they used to have to stay in the hospital. And just the recovery was just so much worse. And now people, most people, would you say, go home that same day and then can start physical therapy and that kind of stuff in their recovery pretty early on.

Mohammed Ahmed, MD: Yeah, that's absolutely true. And a lot of it is from these advancements, but also from like the anesthesia protocols have gotten better. And we've realized that patients don't necessarily need to be in the hospital that long. And in fact, in certain circumstances, it's actually detrimental for the patient's recovery.

There's some good data out that says that. Patients that stay in the hospital longer are higher risk for developing infections and blood clots and things like that. What we do know is that it's safe to go home, provided that you have support and you have the right resources, which we do a good job of making sure that our patients do.

And then if all those criteria are met and the patient's medically stable, we will discharge them same day. And we've had excellent outcomes with that.

Host: Awesome. So is there a time when, you know, someone who needs a joint replacement surgery might not be a candidate for a robotic surgery and might need more traditional methods used?

Mohammed Ahmed, MD: Yeah, so in my opinion in terms of knee replacement, which is what I use the robot for here, there really isn't um, the only time that I don't use the robot now is for redo knee replacements. But for primary joint replacement surgeries, I will use the robot. The other small, very, very small percentage of patients that we don't do the robot for are people that have, like, metal allergies. So people that have metal allergies, we have to use specialized implants and those specialized implants are not compatible with the robotic program. So we will have to use a different implant.

Host: So can you, kind of going back to the recovery process a little bit, what might that look like for someone who's had a hip or knee replacement?

Mohammed Ahmed, MD: Yeah. So, like we alluded to earlier, most of these surgeries are done as an outpatient.

So you will either go home that same day within a few hours after surgery or worst case scenario within 24 hours after surgery. So people will go home. If it's a knee replacement, most people go to outpatient right away. Which means basically going to outpatient physical therapy two days after surgery. Most people are, walking within an hour or two after surgery. In terms of hip replacement, most people will go home the same day as well. They'll use a walker for, a week or so, a cane for a week or so. And then they're hopefully off of everything in about a couple of weeks. We don't do outpatient therapy for hips because we don't necessarily need it.

We usually just do home therapy to make sure that patients are sort of getting around okay, and their wounds are looking okay. And we have a therapist and a nurse to kind of help us with that. And then after two to three weeks of that, patients are pretty mobile and really don't need much more therapy after that.

Host: Yeah. It's kind of crazy that people, that you hear that have these surgeries and they bounce back so quickly. So that's, awesome news. Do you have like any examples of, you know, success stories of patients in recent years that you could share of how robotic surgery has helped them, you know, maybe in the past they wouldn't have had as great of an outcome in the past using traditional methods.

Mohammed Ahmed, MD: Yeah, so there, I can recall one patient that an individual who actually had a tibia fracture I want to say like 10 years ago.

And so the way they fixed the tibia was with a rod and the rod went basically just below the knee down to the level of the ankle to fix the tibia, which it did a great job of healing and, the patient did well, but then unfortunately the patient developed arthritis.

They tried non operative measures, it did not work, and the patient was ready for surgery. So at that time, we had to make a decision on whether or not we could do the surgery without having to remove the rod. And traditionally speaking, if we did not have a robot, we would have to take the rod out, which is a very morbid procedure. It takes a lot of time, there's a lot more surgery involved.

But because of the robot, we were able to kind of, number one, get the patient's bony anatomy with the rod in, and then make a plan where we would not have to take the rod out and we were able to do that. And then the robot was able to sort of execute that plan and we were able to get the patient's knee replacement done without having to take the tibial rod out.

The surgery went straightforward without any complications. The patient was doing very, very well. I just recently saw him for his one year post op and he's happier as can be. And we were able to save him from having a major, major surgery.

Host: That's amazing. So, you know, let's say someone listening has maybe, you know, been told that they need a joint replacement by their primary care provider um, or an orthopedic specialist. How do they schedule an appointment with you to get this surgery done?

Mohammed Ahmed, MD: Yeah, so they can just call the Riverside orthopedics hotline and then get in to see us. Or if they have an establishment with the primary care doctor, they can specifically ask their primary care doctor for a referral for a robotic surgeon and we can get them plugged into our system pretty easily.

Host: Awesome. I think that's a great place to end off on. Thank you so much, Dr. Ahmed, for coming on the podcast today.

Mohammed Ahmed, MD: Thank you.

 ankh T

Host: And thank you listeners for tuning into Well Within Reach brought to you by Riverside Healthcare. To learn more about joint replacement surgery and orthopedics at Riverside, visit riversidehealthcare.org.

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