Joey Wahler (Host): When it comes to having a joint replaced, hips and knees are the most common while ankles, shoulders, elbows and wrists are also sometimes replaced. So what's involved in joint replacement?

This is Be Well with Skagit Regional Health. I'm Joey Wahler. Our guest, Dr. Christopher Sheu, Orthopedic Surgeon at Skagit Regional. Dr. Sheu. Thanks so much for joining us.

Dr. Christopher Sheu: Hi, Joey. Thanks for having me.

Joey Wahler (Host): So let's start with the basics. In a nutshell, how do joints work actually?

Dr. Christopher Sheu: So these joints are a little bit different. Typically, the most common joints that we do here at Skagit are the shoulder, hip and knee. Typically, most joints are either a ball and socket or a hinge joint, where there are two bones that connect and are kept together by ligaments, tendons and soft tissue.

Joey Wahler (Host): When someone needs a replacement, is it usually because of wear and tear over the course of a lifetime? Is it something acute? What's the most common cause?

Dr. Christopher Sheu: Yeah, it depends on the patient population. Typically, joint replacements are performed in the older population and is usually after years of wear and tear from activity. It can be from trauma and less commonly from unknown reasons, sometimes genetic and familial issues.

Joey Wahler (Host): How about the symptoms that your patients typically experience before they come to see you?

Dr. Christopher Sheu: Typically, for all joints, usually the main complaint is pain, decreased function, decreased motion and sometimes weakness. And depending on the joint, you may also have patients that experience instability, locking, catching, stuff like that.

Joey Wahler (Host): And you mentioned the most common replacements that your practice does are knee, hip and shoulder, right? We don't hear as much about shoulder replacement as the other two. Tell us a little about that.

Dr. Christopher Sheu: Yeah. So the shoulder replacement, the shoulder joint is similar to the hip joint where it is a ball and socket, but the shoulder joint is a little bit more complex because the socket isn't really shaped and conformed to the shape of the ball. So the shoulder is a little bit more unstable, if you will, based on the morphology of the bone. But typically, what a shoulder replacement involves is removing the worn cartilage surfaces and replacing that with metal and plastic.

Joey Wahler (Host): So I was just going to ask you, what does joint surgery like for a hip or knee or a shoulder or something else, what does that basically involve?

Dr. Christopher Sheu: Typically, depending on the patient, most of these procedures are performed in an outpatient setting where you walk into surgery and you walk out of surgery the same day. Typically, there's a minimally invasive or small incision along the joint and we take care to preserve the soft tissues upon our dissection down to the joint itself and we ended up, you know, removing the diseased portions, replacing that with a prosthetic joint. Typically, the patients wake up the same day. They go home the same day with the precautions. And usually depending on the joint, physical therapy works with them afterward to regain their motion, their strength and help them get back to their full capacity.

Joey Wahler (Host): Now, I know someone that recently had a partial hip replacement. So sometimes the whole joint doesn't need replacing, right?

Dr. Christopher Sheu: That's correct. So typically, in a younger patient who perhaps may have had a traumatic event or has advanced disease of just the ball aspect of the bone, a partial replacement is a good option in order to preserve the native socket bone in hopes that down the line, if they do need a full replacement, that they've basically bought some time if you will.

In the older population, typically those who don't walk very much or have lower functionality, a partial hip replacement is typically indicated in those patients in order to just get them back on their feet and back to their normal activities.

Joey Wahler (Host): Now, you alluded a moment ago to rehab afterward. So after joint replacement surgery, is there such a thing as a typical recovery regimen and timetable for most people?

Dr. Christopher Sheu: Yeah, absolutely. For my shoulder patients, usually the first two weeks, they're not doing too much. You wake up in a sling, you're working on elbow, wrist and hand motion, but the shoulder’s not moving too much. You start some early motion around a week. And then therapy typically ensues at the two-week mark for motion, strengthening around six weeks and your release about 12 weeks.

For the hip, usually, most patients don't need physical therapy. It's a matter of just walking and getting up immediately after surgery. But for those who are a little bit slower and may need extra help, typically we start therapy around the six-week mark. For total knee replacements, typically you start physical therapy within a few days after surgery because the knee is a joint that typically gets stiff and it's important to get full motion as fast as possible. So therapy typically is started around three to five days after surgery.

Joey Wahler (Host): Gotcha. Now, how about recent advancements in joint replacement surgery, like something known as an interior hip replacement?

Dr. Christopher Sheu: Yeah. Great question. So traditionally, hip replacements are done in a lateral or a posterior approach. And what that means is there's different intervals of the muscles and soft tissues around the hip, where we dissect down in order to get to the joint. And the most utilitarian and most common approach is the posterior approach through the back of the hip. Now, typically that is an entry point that has a lot more soft tissue and involves a larger dissection, sometimes muscle detachment and results in a longer hospital stay possibly, increased recovery time and different post-surgical precautions.

Now, with the advent of the anterior hip replacement over the last few decades, this is more of a minimally invasive approach through the front of your hip, which as you can imagine is through a lot less tissue, allows for direct access to the joint itself. But typically, it's a procedure that has less precautions after surgery. It usually has less pain and quicker recovery compared to the poster approach. And a decreased risk of a hip dislocation, which is not uncommon, but still exists as a possible risk after joint replacement.

Joey Wahler (Host): How long do joint replacements usually last?

Dr. Christopher Sheu: Great question. So it depends. Each joint typically has a medical-grade plastic liner that acts to dissipate the forces and decrease wear, but usually 20 to 30 years as a rule of thumb based on the current technology. That probably will get better as advancements in medical manufacturing and implants progress. But it really depends on how much you use it. The more you use it obviously, the faster it will wear out and vice versa.

Joey Wahler (Host): One thing I'm curious about as well is how often people that have a joint replaced on one side need it done on the other, if not at the same time or around the same time, then maybe sometime down the road?

Dr. Christopher Sheu: Typically, for the lower extremities, it's a little bit more common where soon after the initial surgery, they want to work on getting the other side performed. The shoulder, I think is a little bit different. Typically, people have a dominant side. And so I think the shoulder is a lot less common, but it definitely still exists. But quite a few patients usually present with bilateral or both-sided pain and advancement in arthritis and it's not uncommon to have both joints replaced.

Joey Wahler (Host): So, especially with the more common replacements we've talked about, hip, knee, shoulder, that you do, what are some of the positive benefits your patients express? It must be rewarding to know that you're making such a difference in their lives.

Dr. Christopher Sheu: Yeah, that's the great thing about orthopedics is the immediate gratification of the feedback you get from your patients. You know, I think the most common thing we hear is why did I not do this earlier? And so, typically most surgeons run their patients through conservative treatment first with perhaps physical therapy, medication, sometimes injections, assistive devices. And usually, if those things fail, then we talk about surgery as a last resort. But, most patients typically remark upon their increased motion, decreased pain, and being able to get back to the activities that they love to do.

Joey Wahler (Host): Well, let's close by following up on something you just mentioned there. You said many patients say, "I wish I'd done this earlier." Why do you think they don't do it sooner? Is it that maybe they think there's more involved? They're a little bit freaked out unnecessarily because maybe they don't know some of the things we've just talked about.

Dr. Christopher Sheu: That's exactly right. That's why I think things like this are very important, Joey. I think keeping people informed with regards to what the surgery entails and the advancements in medical technology. I think patients are recovering faster. They're doing better, they're becoming more functional. And so all of those things, I think, we just all need to be a little bit better informed.

Joey Wahler (Host): Well, indeed, doc. Hopefully, we've contributed in our own way to that cause. So folks, we hope you now have a better understanding of joint replacement surgery. Dr. Christopher Sheu, thanks so much again.

Dr. Christopher Sheu: Thank you, Joey. I appreciate the time.

Joey Wahler (Host): Same here. And for more information, please visit SkagitRegionalHealth.org. That's SkagitRegionalHealth.org. If you found this podcast helpful, please do share it on your social media. And thanks for listening to Be Well with Skagit Regional Health. Hoping your health is good Health, I'm Joey Wahler.