Selected Podcast
Joint Replacement Surgery
Worn-out joints can be unbearable but joint replacement may improve quality of life. Dr. Dimitri Delagrammaticas, orthopedic surgeon, discusses joint replacement.
Featuring:
Dr. Delagrammaticas sees patients in our San Luis Obispo and Pismo Beach offices. He performs surgeries at French and Sierra Vista Hospitals and the Coastal Surgical Institute in Pismo Beach
Dimitri Delagrammaticas, MD
Dimitri Delagrammaticas graduated from Cal Poly, San Luis Obispo, where he completed the blended degree program, receiving dual conferment of Bachelor’s and Master’s Degrees in Biomedical Engineering. After college, he worked as an engineer in the medical device industry before attending medical school at Georgetown University School of Medicine in Washington, D.C. Dr. Delagrammaticas completed his orthopedic residency at Northwestern University in Chicago, Illinois, where, in his final year, he was chosen to be Administrative Chief Resident. During his time at Northwestern, he additionally participated in international work with the AO foundation as well as Operation Walk. After residency, he completed an additional fellowship year in Adult Reconstruction at The Steadman Clinic in Vail, CO. While there he focused on hip and knee replacement as well as hip preservation including the anterior approach to hip replacement, revision and outpatient total joint replacement, and non-arthritic surgical preservation of the hip joint. His practice interests focus on primary and revision hip and knee joint replacement and hip preservation. He has published original research and review articles on clinical and radiographic assessment as well as rapid recovery and narcotic reduction after total joint replacement. Dr. Delagrammaticas’ interests outside of medicine include cycling, surfing, auto racing, and skiing. He and his wife, Kristin, and their three children are very excited to be back in the Central Coast and take advantage of all the area has to offer.Dr. Delagrammaticas sees patients in our San Luis Obispo and Pismo Beach offices. He performs surgeries at French and Sierra Vista Hospitals and the Coastal Surgical Institute in Pismo Beach
Transcription:
Prakash Chandran (Host): Worn out joints are no laughing matter. And pain can be unbearable. But the good news is, that replacing joints can reduce pain and help you move and feel better. We’re going to talk about it today with Dr. Dimitri Delagrammaticas, an Orthopedic Surgeon at Tenet Health Central Coast. This is Healthy Conversations, the podcast from Tenet Health Central Coast. I’m Prakash Chandran. So, first of all, Dr. Delagrammaticas, when we’re talking about joint replacement, which are the most common joints that are replaced?
Dimitri Delagrammaticas, MD (Guest): In my practice, I’d say the most common joints that I see are hip and knee by far the most common joints that suffer from arthritis and that tend to wear out over time. Especially for our active community here in the Central Coast.
Host: And what are the types of injuries that necessitate a joint replacement like you are talking about?
Dr. Delagrammaticas: So, there’s probably a couple different ways that a patient may present to me with hip or knee pain that would ultimately need a hip or knee replacement. There are the sort of the run of the mill wear and tear that occurs with time just sort of analogous to when you wear the tires out on your car, you can wear out the cartilage in either your hip or your knee joint with normal wear and tear over time. There’s probably a component of genetics that plays into it. so, if you have family members in your family that have joints replaced. Oftentimes I see in common as well. But other injuries such as fractures or injuries to the joints can result in arthritis to the knee and to the hip. Some other conditions where there might be malalignment or ligament injuries that can predispose patients to hip or knee arthritis. By far the most common is just run of the mill wear and tear over time.
Host: Yeah, you know, like many people listening, I’m a weekend warrior. On Sundays, I play pick up basketball with my friends and sometimes I will sustain a knee injury and through that rest, ice and compression method; I’m able to nurse it back to health within a couple of weeks at most a couple of months. But I’m wondering when should a person consider going in for a replacement of the joint? Is it when the injury becomes more frequent or when the pain persists and doesn’t go away? Maybe talk a little bit about that.
Dr. Delagrammaticas: It’s always important to kind of listen to your body. If you are having persistent pain, pain that doesn’t go away, it’s important to get that checked out and make sure there’s nothing more serious going on. Oftentimes, like you just said, the most important thing to do is start with the simple things ice, rest, oral anti-inflammatories. Those are always the mainstay of treatment for joint pain in general but especially with arthritic hips and knees.
You know we find that we get patients pretty comfortable and get good relief and back to those activities that they enjoy with some of those simple things. If those aren’t working, oftentimes, we may recommend things like injections or some physical therapy to again, try to get as much life out of those hips and knees as possible before having to consider surgery.
Obviously, surgery is always, you don’t want it to be the last option, but for patients who have been suffering a long time with hip and knee pain; it can be a very reliable and to get them back to doing those things they enjoy.
Host: When we are talking about this knee or hip replacement, I’m sure people listening are wondering what type of life they are going to have after the replacement. So, they might be playing sports now, they might be running and even though the knee or hip hurts them a little bit; it’s something they can deal with. But maybe talk a little bit about what the quality of life will be like after the replacement is done.
Dr. Delagrammaticas: I always joke with my patients that the whole reason we are doing these surgeries is to get them back to doing what they love doing. A lot of times, patients who are really limited, unable to play tennis or go hiking or ride substantial distances on their bikes because of the knee pain or the hip pain that they are experiencing and so, the whole reason that we do this is to get them back to doing those things. Arthritis in and of itself is not a dangerous condition. It’s not life threatening or limb threatening. It’s really more about quality of life and so that’s the number one thing.
Host: That’s really interesting. I think that so many people believe that if a replacement is needed that you are somehow diminished or handicapped in your abilities afterwards. But what I’m hearing from you is that afterwards, you can actually go back to pretty much what you were doing at 100% almost. Is that correct to say?
Dr. Delagrammaticas: Yeah, I’d say so. At the same time, you have to remember that these are mechanical devices. They are still metal and plastic and ceramic pieces and so it’s not always exactly the way that you had it when you were in your 20s but for the most part, we don’t have many restrictions as far as patients going back to doing the activities that they like. Obviously, low impact exercise like swimming, biking, hiking is better than things like running and jumping. And high impact exercise can always potentially put a little bit more wear on these prosthetic device themselves. But at the same time, if there’s an activity that brings you meaning to your life and you are able to do so through a joint replacement; I tend not to put too many limitations on my patients for that reason.
Host: Let’s talk about the procedures themselves. I imagine that knee and hip replacement procedures are quite different from one another. But maybe talk about what goes into each one and what the recovery time is like.
Dr. Delagrammaticas: Let’s start with knee replacement. Probably a bit more common than the hip replacement just because of how many patients are affected by knee arthritis. But when the patients come to see me, oftentimes, they think of a knee replacement as sort of cutting out the entirety of the knee and putting in a block of a knee replacement into that space. But I like to think of it more as a resurfacing in which we are cutting off the surface or shaving away the surface of the – both the femur or the thigh bone as well as the surface of the tibia or the shin bone and recapping those with metal and plastic pieces to sort of give you some more tread back onto your knee.
The procedure itself takes about an hour to an hour and a half and oftentimes, patients are up walking the same day and I have had patients even leave the hospital that same day after surgery. But most patients, they are in the hospital a night or so but usually going back to their home after that procedure and be getting physical therapy right away to build up muscle strength and maintain range of motion but to get back to sort of daily activities.
It's about at the six week mark where most patients are doing light recreational activities and about 12 weeks before they are sort of released to full activity. The hip replacements are very similar. The procedure is about an hour to hour and a half in duration. A lot of patients are up moving around that same day. Some are going home the same day or if not then the next morning.
I have actually changed my practice over time. I find that a lot of patients after hip replacement don’t necessarily need even physical therapy. My preferred approach is an anterior approach replacement. I find that patients do pretty well pretty quickly and are able to get back to their normal life pretty quick and so for that reason, I don’t tend to send a lot of patients to physical therapy unless they need it initially. But sort of make that assessment after they start getting back to their normal routines. And the same way with the knees. I find about six weeks; most patients are back to light recreation. So, I always use golf as an example, chipping and putting maybe by six weeks and then twelve weeks swinging the full driver. And twelve weeks is that mark where you are released to full activity and back to a full speed normal life.
Host: It’s actually pretty impressive how fast they can go back to their kind of everyday life and normal activities. I’m kind of curious about prevention itself. Like people that are listening to this obviously want to do everything they can to avoid a replacement if possible. So, maybe talk a little bit about your recommendations around leading a certain lifestyle or potentially taking care of themselves in such a way to minimize the need for joint replacement in the future.
Dr. Delagrammaticas: Really, I think the most important thing is to live an active, healthy lifestyle, diet and exercise can’t be understated enough. I think there’s certainly maintaining a healthy weight, a healthy diet and then being active, getting out an enjoying what the Central Coast has to offer, hiking, biking. I would definitely prefer you choose lower impact exercises if I had the choice but if running and jogging is something that gets you up in the morning and keeps your mind sharp and healthy, then that’s what you should do too. But in my mind, things like swimming, biking, elliptical where there’s a little bit less impact on the joints I think probably in the long term can maybe have a little bit of a benefit to minimize the forces on those joint surfaces themselves.
And part of it is staying active over the course of a lifetime. I think there’s definitely something to be said for that for keeping your muscles and your mind sharp as you get older.
Host: That makes sense. It’s one of these things where we often hear people talking about if you don’t use it you lose it and I imagine that it’s the same way with joints. As long as you are not doing anything too high impact, it’s actually really good to really get out moving around because it really will increase the longevity of that joint. Is that correct?
Dr. Delagrammaticas: Not to get too deep into the science of it but there’s some good evidence to say or some basic science evidence to show that the cartilage really does respond to physical activity. Some mechanical stresses, the bones themselves definitely respond to mechanical stresses and so, when you think about other conditions like osteoporosis or thinning of the bone, it’s important to do weight bearing activities and be active because the body’s response to moving your joints and walking and putting weight on your bones is to sort of reinforce and rebuild and renew. So, it’s a balance. You don’t want to be too hard on yourself but at the same time, you do, like you said, you want to keep moving so you don’t lose it over time.
Host: Just in wrapping up here, I’m curious as to if you have any advice for people listening who might be challenged by the decision to have that knee or hip surgery.
Dr. Delagrammaticas: Yeah, I always tell patients it’s an elective procedure by all means so, your knee or your hip will definitely tell you when it’s time. Again, my philosophy is always try to maximize the nonsurgical treatment options but at a certain time, your joint will tell you, it will be waving a white flag and tell you when enough is enough. And at that point, it’s your decision to make to proceed to surgery. But it’s never really – it’s never a medical emergency. It’s really about when the quality of life and when your life is impacted to the point where you decide that a joint replacement is the treatment for you.
Host: All right, well I truly appreciate your time today. that’s Dr. Dimitri Delagrammaticas, an Orthopedic Surgeon at Tenet Health Central Coast. For more information visit www.tenethealthcentralcoast.com/services/orthopedics. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Healthy Conversations, the podcast from Tenet Health Central Coast. Thanks and we’ll talk next time.
Prakash Chandran (Host): Worn out joints are no laughing matter. And pain can be unbearable. But the good news is, that replacing joints can reduce pain and help you move and feel better. We’re going to talk about it today with Dr. Dimitri Delagrammaticas, an Orthopedic Surgeon at Tenet Health Central Coast. This is Healthy Conversations, the podcast from Tenet Health Central Coast. I’m Prakash Chandran. So, first of all, Dr. Delagrammaticas, when we’re talking about joint replacement, which are the most common joints that are replaced?
Dimitri Delagrammaticas, MD (Guest): In my practice, I’d say the most common joints that I see are hip and knee by far the most common joints that suffer from arthritis and that tend to wear out over time. Especially for our active community here in the Central Coast.
Host: And what are the types of injuries that necessitate a joint replacement like you are talking about?
Dr. Delagrammaticas: So, there’s probably a couple different ways that a patient may present to me with hip or knee pain that would ultimately need a hip or knee replacement. There are the sort of the run of the mill wear and tear that occurs with time just sort of analogous to when you wear the tires out on your car, you can wear out the cartilage in either your hip or your knee joint with normal wear and tear over time. There’s probably a component of genetics that plays into it. so, if you have family members in your family that have joints replaced. Oftentimes I see in common as well. But other injuries such as fractures or injuries to the joints can result in arthritis to the knee and to the hip. Some other conditions where there might be malalignment or ligament injuries that can predispose patients to hip or knee arthritis. By far the most common is just run of the mill wear and tear over time.
Host: Yeah, you know, like many people listening, I’m a weekend warrior. On Sundays, I play pick up basketball with my friends and sometimes I will sustain a knee injury and through that rest, ice and compression method; I’m able to nurse it back to health within a couple of weeks at most a couple of months. But I’m wondering when should a person consider going in for a replacement of the joint? Is it when the injury becomes more frequent or when the pain persists and doesn’t go away? Maybe talk a little bit about that.
Dr. Delagrammaticas: It’s always important to kind of listen to your body. If you are having persistent pain, pain that doesn’t go away, it’s important to get that checked out and make sure there’s nothing more serious going on. Oftentimes, like you just said, the most important thing to do is start with the simple things ice, rest, oral anti-inflammatories. Those are always the mainstay of treatment for joint pain in general but especially with arthritic hips and knees.
You know we find that we get patients pretty comfortable and get good relief and back to those activities that they enjoy with some of those simple things. If those aren’t working, oftentimes, we may recommend things like injections or some physical therapy to again, try to get as much life out of those hips and knees as possible before having to consider surgery.
Obviously, surgery is always, you don’t want it to be the last option, but for patients who have been suffering a long time with hip and knee pain; it can be a very reliable and to get them back to doing those things they enjoy.
Host: When we are talking about this knee or hip replacement, I’m sure people listening are wondering what type of life they are going to have after the replacement. So, they might be playing sports now, they might be running and even though the knee or hip hurts them a little bit; it’s something they can deal with. But maybe talk a little bit about what the quality of life will be like after the replacement is done.
Dr. Delagrammaticas: I always joke with my patients that the whole reason we are doing these surgeries is to get them back to doing what they love doing. A lot of times, patients who are really limited, unable to play tennis or go hiking or ride substantial distances on their bikes because of the knee pain or the hip pain that they are experiencing and so, the whole reason that we do this is to get them back to doing those things. Arthritis in and of itself is not a dangerous condition. It’s not life threatening or limb threatening. It’s really more about quality of life and so that’s the number one thing.
Host: That’s really interesting. I think that so many people believe that if a replacement is needed that you are somehow diminished or handicapped in your abilities afterwards. But what I’m hearing from you is that afterwards, you can actually go back to pretty much what you were doing at 100% almost. Is that correct to say?
Dr. Delagrammaticas: Yeah, I’d say so. At the same time, you have to remember that these are mechanical devices. They are still metal and plastic and ceramic pieces and so it’s not always exactly the way that you had it when you were in your 20s but for the most part, we don’t have many restrictions as far as patients going back to doing the activities that they like. Obviously, low impact exercise like swimming, biking, hiking is better than things like running and jumping. And high impact exercise can always potentially put a little bit more wear on these prosthetic device themselves. But at the same time, if there’s an activity that brings you meaning to your life and you are able to do so through a joint replacement; I tend not to put too many limitations on my patients for that reason.
Host: Let’s talk about the procedures themselves. I imagine that knee and hip replacement procedures are quite different from one another. But maybe talk about what goes into each one and what the recovery time is like.
Dr. Delagrammaticas: Let’s start with knee replacement. Probably a bit more common than the hip replacement just because of how many patients are affected by knee arthritis. But when the patients come to see me, oftentimes, they think of a knee replacement as sort of cutting out the entirety of the knee and putting in a block of a knee replacement into that space. But I like to think of it more as a resurfacing in which we are cutting off the surface or shaving away the surface of the – both the femur or the thigh bone as well as the surface of the tibia or the shin bone and recapping those with metal and plastic pieces to sort of give you some more tread back onto your knee.
The procedure itself takes about an hour to an hour and a half and oftentimes, patients are up walking the same day and I have had patients even leave the hospital that same day after surgery. But most patients, they are in the hospital a night or so but usually going back to their home after that procedure and be getting physical therapy right away to build up muscle strength and maintain range of motion but to get back to sort of daily activities.
It's about at the six week mark where most patients are doing light recreational activities and about 12 weeks before they are sort of released to full activity. The hip replacements are very similar. The procedure is about an hour to hour and a half in duration. A lot of patients are up moving around that same day. Some are going home the same day or if not then the next morning.
I have actually changed my practice over time. I find that a lot of patients after hip replacement don’t necessarily need even physical therapy. My preferred approach is an anterior approach replacement. I find that patients do pretty well pretty quickly and are able to get back to their normal life pretty quick and so for that reason, I don’t tend to send a lot of patients to physical therapy unless they need it initially. But sort of make that assessment after they start getting back to their normal routines. And the same way with the knees. I find about six weeks; most patients are back to light recreation. So, I always use golf as an example, chipping and putting maybe by six weeks and then twelve weeks swinging the full driver. And twelve weeks is that mark where you are released to full activity and back to a full speed normal life.
Host: It’s actually pretty impressive how fast they can go back to their kind of everyday life and normal activities. I’m kind of curious about prevention itself. Like people that are listening to this obviously want to do everything they can to avoid a replacement if possible. So, maybe talk a little bit about your recommendations around leading a certain lifestyle or potentially taking care of themselves in such a way to minimize the need for joint replacement in the future.
Dr. Delagrammaticas: Really, I think the most important thing is to live an active, healthy lifestyle, diet and exercise can’t be understated enough. I think there’s certainly maintaining a healthy weight, a healthy diet and then being active, getting out an enjoying what the Central Coast has to offer, hiking, biking. I would definitely prefer you choose lower impact exercises if I had the choice but if running and jogging is something that gets you up in the morning and keeps your mind sharp and healthy, then that’s what you should do too. But in my mind, things like swimming, biking, elliptical where there’s a little bit less impact on the joints I think probably in the long term can maybe have a little bit of a benefit to minimize the forces on those joint surfaces themselves.
And part of it is staying active over the course of a lifetime. I think there’s definitely something to be said for that for keeping your muscles and your mind sharp as you get older.
Host: That makes sense. It’s one of these things where we often hear people talking about if you don’t use it you lose it and I imagine that it’s the same way with joints. As long as you are not doing anything too high impact, it’s actually really good to really get out moving around because it really will increase the longevity of that joint. Is that correct?
Dr. Delagrammaticas: Not to get too deep into the science of it but there’s some good evidence to say or some basic science evidence to show that the cartilage really does respond to physical activity. Some mechanical stresses, the bones themselves definitely respond to mechanical stresses and so, when you think about other conditions like osteoporosis or thinning of the bone, it’s important to do weight bearing activities and be active because the body’s response to moving your joints and walking and putting weight on your bones is to sort of reinforce and rebuild and renew. So, it’s a balance. You don’t want to be too hard on yourself but at the same time, you do, like you said, you want to keep moving so you don’t lose it over time.
Host: Just in wrapping up here, I’m curious as to if you have any advice for people listening who might be challenged by the decision to have that knee or hip surgery.
Dr. Delagrammaticas: Yeah, I always tell patients it’s an elective procedure by all means so, your knee or your hip will definitely tell you when it’s time. Again, my philosophy is always try to maximize the nonsurgical treatment options but at a certain time, your joint will tell you, it will be waving a white flag and tell you when enough is enough. And at that point, it’s your decision to make to proceed to surgery. But it’s never really – it’s never a medical emergency. It’s really about when the quality of life and when your life is impacted to the point where you decide that a joint replacement is the treatment for you.
Host: All right, well I truly appreciate your time today. that’s Dr. Dimitri Delagrammaticas, an Orthopedic Surgeon at Tenet Health Central Coast. For more information visit www.tenethealthcentralcoast.com/services/orthopedics. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Healthy Conversations, the podcast from Tenet Health Central Coast. Thanks and we’ll talk next time.