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Liz Unruh (Host): Hello listeners, and thanks for tuning into the Well Within Reach podcast, brought to you by Riverside Healthcare. I'm your host, Liz Unruh, and joining me today is Dr. Didi Omiyi, who is an orthopedic surgeon with Riverside Orthopedic Specialists. Thanks for joining us today, doctor.

Didi Omiyi, MD: Thanks for having me, Liz. I'm glad to be here.

Host: Yeah. So before we jump into our topic of total joint replacement, we're going to get a quick message about MyChart.

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Host: And we're back. So can you tell us a little bit about yourself and your role here as you joined the Riverside team?

Didi Omiyi, MD: Yeah. I'm an orthopedic surgeon. I've been in practice for about 11 years. My specialty is in total joint replacement, so specifically hip and knee replacement surgery, revisions of hip and knee replacements, complex joint replacement surgeries, and also partial knee replacements as well. But as an orthopedic surgeon, I'm trained in, you know, all aspects of orthopedics and will see and be treating patients with all sorts of injuries.

But, my focus is total joint replacement. I've been in practice 11 years here in Illinois and, my family were relocated up north from central Illinois. And, that's what brought me to Riverside and excited to be here.

Host: Yeah, we're excited to have you and for having you join our orthopedic team. For someone who may not have been following orthopedic surgery super closely, can you tell us a little bit about how the knee and hip replacement has changed in recent years?

Didi Omiyi, MD: You know, I think that we've definitely made a lot of great advances in the implants that we're using. So the materials that we are using now to design our implants, we're seeing those last longer and longer.

We're getting great longevity and good outcomes with those implants. And, because of that, we're seeing already successful surgeries just be more successful. We're seeing less revisions are some of the problems that we used to have with older materials. We are seeing more revisions as a whole because, more patient's are getting these surgeries, which is a good thing.

The surgeries that are allowing patients to live active lives and be out of pain much longer than they used to be. And so because of that, we're getting good results from that. But at the same time, you know, these are artificial devices with complications that can happen. And so we're seeing more revision surgeries. But the materials have been great, great improvements with that. And then, I think we're just, our protocols for rehab and recovery have really improved. And so we're seeing patients get back to their everyday lives a lot sooner. And, those are real advantages for patients who are undergoing these procedures.

Host: I mean, definitely how people can maintain or get back to their level of activity is huge.

Didi Omiyi, MD: A lot of concerns for a lot of patients, a lot of people trying to find time to say, well, how can I take time off to have surgery? I've gotta take care of a family member. I have to work, I have children to take care of.

So, seeing those advancements in getting people back to their daily lives quicker and sooner, really take some of that apprehension out of having these surgeries done.

Host: Yeah, for sure. I could definitely see that being a huge positive. So in your opinion, what's the biggest misconception that people still have about joint replacement surgery?

Didi Omiyi, MD: I tell patients this, even family members who've had surgeries, I tell them when you have a total joint surgery, you're not sick. We think about going to the hospital and we think about going to have surgery, and it's a huge deal, for sure. But the whole goal of this is to restore function, take away pain and get you up and moving right away and get back to your regular everyday lives. So I tell patients, you're not laid up. I don't want you to be in bed. I don't want you to think about, Hey, I've got this long recovery ahead of me. I want you to think about once we fixed your hip, we fixed your knee, we've given you a joint that doesn't have the same pain you had before.

A joint that's going to function well, you need to get it back into shape. But that, you really can start getting back to everyday life, you know, as soon as you are able to do that. And, without fear of damaging something that we did in surgery as long as you follow the precautions and things like that.

So I think that's one of the big misconceptions when I talk to patients. They a lot of them are surprised by when I tell them, Hey, we'll get you walking the day of surgery. You will go up and down stairs the day of surgery. And, I think that just kinds helps to frame that okay you know what, this is a procedure that's going to get you back to doing what you want to do soon or quickly.

Host: Yeah. I think that's the wildest concept to me every time is they're like, yeah, I just had a hip replacement and I'm walking up and down stairs in the same-day.

Didi Omiyi, MD: Yeah.

Host: Blows my mind.

Didi Omiyi, MD: And when we first started doing these surgeries, we were so cautious. We would keep patient's in the hospital sometimes for two weeks.

We'd keep them in bed for seven days, just waiting for something to heal before we get them up. But we've just realized, again, with the newer materials we're using, our protocols, you don't need to do that. And actually moving sooner is better.

Host: Yeah. And I'm sure part of that comes from we're going to talk about this, but the less invasive the surgery is. So, you know, I hear surgery and I'm like, oh my gosh, they're making a huge incision. But that's not necessarily the case anymore. Right. So like what does it mean when we talk about a less invasive joint surgery?

Didi Omiyi, MD: Yeah, no, absolutely. When we use the terms less invasive, a lot of people can use it to describe different things. What I think is important is to understand that surgery is trauma to the body. It's controlled trauma, but it is trauma. It is injury, and so how can we minimize the injury we're doing to the body in order to replace the joint? So we do that absolutely by the length of the incision, but that even doesn't quite capture what we're really talking about. We're talking about less muscle damage. We're talking about less stress on the skin or the tissue in order to get to the parts of the joint that we need to, to do the procedure. So can we do a hip replacement without cutting any of the muscles? So, you know, I prefer to do what we call a direct anterior approach to the hip.

It's a technique that's been around for a while and we've modified it in recent times. It's become really popular, but we don't have to cut any muscles when we do the procedure. We go in between the muscles, less pain, quicker recovery, less damage to the muscle tissue. So that is a less invasive way of doing a hip replacement surgery.

Even if some people do a different approach, maybe they're a couple different tendons that they no longer cut than they used to cut. They're able to go in between those. With different equipment, we can get better exposure to see what we need to do. And that allows us to do the procedure in a less invasive way.

Same thing with knee replacement surgery, going through a small incision, going through the side of the knee, not cutting through the tendon. All those things, allow us to minimize the trauma that surgery causes and helps with quicker recovery.

Host: Yeah, for sure. I'm sure the less number of stitches or repairs you have to do to muscle just helps the patient heal faster.

Didi Omiyi, MD: Absolutely. You know, you've kept more of what you had originally and so, there's less that has to get back to its previous level of function.

Host: Yeah, for sure. So we touched on this a little bit, but implant materials and designs have improved and changed over the years and you know, you said it definitely has allowed that these implants to last longer. Can you talk a little bit about those materials that are used now?

Didi Omiyi, MD: Yeah. So I think that for hip replacements and knee replacements, I think we, over the past, probably about 20 years or so, we've kind of settled on the materials and the way we process those materials that allow them to have longevity.

So we've gone, for instance, in knee replacements, we've developed, coatings on the replacements whereby we can use less and less bone cement to fix the knee replacement to the bone. Now, a majority of my knee replacements actually we don't use bone cement anymore. This material the bone grows into this material and that's one less point of failure.

Because sometimes cement may have a certain shelf life. And you know, might have to be redone if it loosens. So once we have bone- to- implant healing, we see that as a implant that's going to last longer. It saves us time in surgery, so surgery's more efficient because we're not waiting for that cement to set up.

And, again, it allows us to get, get the patients up quicker and moving quicker. So that's one example of some of the materials that we're using in knee replacements. Hip replacements, we've been doing no cement for a while now, and are less an advance in terms of the bonding to the bone, but.

The design of hip replacements, now we have more options that are more representative of the different body types that you have out there. So not everybody's hip is the same. So we have more implants that can match a patient's anatomy more closely, we think that allows us to reproduce their natural biomechanics.

And the closer we can reproduce your biomechanics, the more comfortable the joint feels, the more natural it feels. And we think that that also allows patient's to recover quickly and also improves their satisfaction with their joints.

Host: Yeah, I think that's huge. I had recently learned that there's different varieties of hip replacements, and I think it definitely would help you feel more, I would say like level, if you're only getting one side done that it's less.

Didi Omiyi, MD: Exactly like basically what we able to do is that if we can match and we spend time studying x-rays before surgery, after surgery. So we say, okay, this is what a patient comes in rather than trying to get their hip to fit what I have, I can get what I have to fit their hip better.

They feel more comfortable where, you know, they'll get up and they're like, okay, you know what, this the length. How far my hip sticks out, the rotation. This is more what I'm used to. And so that helps with recovery.

Host: Yeah, for sure. So that's one way of technology is advanced. But you also mentioned earlier using like technology in surgery. So are there certain types of modern technology that helps improve outcomes and your precision during surgery?

Didi Omiyi, MD: Yeah, no, absolutely. I mean, there's a lot of technology out there. I mean in our modern world today, you know, technology is a huge part of everything that we do, and surgery is no exception.

So, we have robotic surgery and I do a lot of my knee replacements robotically. Kind of the same thing we're talking about just now with the hips. With robotic surgery, I can cut the bone more accurately when I'm trying to get the arthritis out to replace a knee, for example. With that level of accuracy, I can now match a patient's anatomy a little bit better.

I can then say, you know what? This patient needs a little bit more of what we call, they're naturally bow-legged, and so rather than me cutting their knee and getting them a knee that's completely straight, I can now cut it a little bit accurately to match that bow that they have naturally, they wake up and they feel a little bit more comfortable with that.

And we see patients having high level of satisfaction with something like that. So robotic technology allows us to match a patient's pre-existing anatomy better. And we can do it more accurately than we could do when we were just doing what we call a manual jig, where we just kind of line things up and moving things manually.

We digitally plan the surgery before we even walk into the operating room, and we have a robotic arm that helps us to execute that plan more accurately. We're using AI in hip replacement surgeries to help us position our implants in ways that, again, are more accurate, more precise, allows us to match patient's anatomy a little bit better, leading to more successful surgeries.

And so technology has really made a difference in being able to personalize the surgeries a little bit more, customize it for each patient instead of one-size-fits-all. And all those things just help with recovery and help with longevity. And also just as a surgeon, it allows us to now have the tools to do some of the things that we always wanted to do, but we couldn't do because now we can execute those plans with more confidence.

Host: Yeah. That's all great information.

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All right. And to kind of shift a little bit, so these advances that you have had in orthopedic surgery, how have they changed the recovery experience compared to, I don't know, say 10 to 20 years ago?

Didi Omiyi, MD: So we've talked a little bit about how we're able to match a patient's anatomy a lot more closely. Allows their hip or their knee to feel more like what they're used to. Because of that, there's less of an adjustment period in the recovery time, in the recovery period whereby they're able to get back to their previous level of functioning better, they have less discomfort, because the joint just feels more natural, and that's what we're trying to achieve.

There's going to be pain after all surgery, but when you are trying to recover and you are dealing with a joint that feels off, your alignment feels off. It doesn't feel like, well, you're used to and it hurts. It takes a lot longer for those people to recover and get used to it. So if we are able to eliminate that part of that adjustment, it feels more natural.

Then they're just dealing with the pain and just pushing through that. In terms of pain, we've developed a lot better techniques in terms of controlling the pain after surgery. So part of the reason why patient's used to have to stay in bed is because it hurt so much and they didn't want to move their joints.

Now we have different injections that we use, different types of medication, and we talk about what we call multimodal pain control, whereby we're using all different types of medicines, anti-inflammatories, non-opioid medications, steroids, all different things that help to control pain in different pathways. That allows patient's to hurt less and you hurt less, you move quicker, you rehab quicker, you get back to everyday life quicker.

So when we combine our techniques in terms of accuracy, being able to reproduce anatomy more closely, when we combine that with pain control protocols and being able to improve that, all those things we're seeing really is making a difference in patients recoveries. And why we're able to get patients out of the hospital pretty quickly, I mean, essentially if a patient is healthy and otherwise in good shape, these surgeries are really outpatient procedures where the standards or the expectation is that you'll go home the same-day.

Host: Wow. That's crazy. Yeah. I know a lot of people assume that they have to travel pretty far to have this type of precision and accuracy and all the pain management type things that you were talking about. But what would you say about our patients ability to receive this level of care here at our community hospital?

Didi Omiyi, MD: Yeah, I'll tell them that it's right here. You know, I think that all the advances, the technology, the tools, the robotics, the AI powered customization, the pain control protocols. I mean, everything that you'll get at a big academic set or a big tertiary center, we have right here at Riverside at the community hospital. We have a hospital that's committed to having the best technology.

Everything that I have been used to using in terms of being able to get give patients, that topnotch care, we have it at our fingertips. And so, I will tell patient's that there's no need to travel an hour, two hours into the city to get access to all that care, that we really have it right here in our community.

And it's a great thing to have. But you know, it's also something that I want patients in our community to expect. You know, I want them to expect that their community hospital is doing everything it can to have everything that they need for them and to care for them in the best way possible and provide that high quality of care.

Host: Yeah. What kind of benefits are there for patients and their families having these surgeries close to home for the recovery process?

Didi Omiyi, MD: It makes all the difference in the world. Part of the reason why patients are doing well with going home the same-day, for instance, is because you recover better the sooner you get back to doing the things that you normally would want to do.

So rather than sitting in a hospital bed for three days not getting up to prepare your own meals, not going up and down your own stairs, not going to the bathroom. You go back home, you're going to jump back into your normal routine and getting back to your normal routine with your new joint will allow you to get used to using that new joint sooner. If you have to travel two, three hours to get your care; then you're considering do you have to spend a night or two in that city just to make sure that there are no problems or complications before you start traveling back home. So that's another few days where you're not getting back to your normal routine, three days before you say, how do I navigate my own stairs?

How do I get up in the middle of the night to go to my own bathroom? Able to have surgery right here at home. You get back to doing that that same-day. You get to recover that quickly. Of course, the biggest thing too is just your support system, your family, your friends, your usual routine. It makes a really big difference in your recovery when you have that support system in place versus having to travel elsewhere, for that care and not having that support system in place.

And we talked a little bit about patients trying to find time to just take off for their surgery. So when you build travel into that, that adds more time than you have to take off and find for the procedure. So there are huge advantages of being able to get the care that you're looking for close to home for many reasons.

Host: I think that's really huge. And you brought a lot of great points, having that support system in place. So I have one final question for you. If someone has been putting off knee or hip replacement surgery because they're worried about the surgery, what's one thing you would want them to know about today's options?

Didi Omiyi, MD: I'll tell most patients, if you've got to the point where your knee pain, your hip pain, or any of your joint pain is affecting your quality of life, then it's time to come in and let's have a conversation. Majority of the time, if not 90 something percent of the time, we are going to be able to have a solution for you that's going to take away your pain.

That's going to get back to doing some of the things that this is limiting you from doing and give you that quality of life that you may be missing and our job as a team is to find ways to help them achieve their goals. Some patients, surgery may not be an option, but majority of the time when it's got to the point where it's end-stage, surgery's a great solution to get them where they need to be.

And it's a highly successful procedures. The patients are doing really well in the right candidates and we can help you to achieve your goals of pain-free. Improve quality of life and function.

Host: Yeah. Well thank you so much for all this great information today.

Didi Omiyi, MD: Thanks Liz. I'm glad to be here and thanks for having me.

Host: Yeah, no problem. And thank you for tuning into the Well Within Reach podcast with Dr. Omiyi from Riverside Orthopedic Specialists. To learn more about the full range of services offered at Riverside, visit riversidehealthcare.org.