Scott Webb (Host): Hip and knee joint replacements are remarkably common these days, and most patients are up and about the same day as their surgeries. And here today to tell us more about himself and these replacements is Dr. Andy Padmanabha. He's a Harvard Fellowship-trained orthopedic surgeon specializing in hip and knee replacement surgery with Solution Health.

This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of Solution Health. I'm Scott Webb.

Doctor, thanks so much for your time today. We're going to talk about joint replacements and what that means. And, you know, who's a good candidate for joint replacement and all that good stuff. Before we get there, tell listeners a little bit about yourself. Who are you? What do you do? And maybe what do you love about what you do?

Dr. Anand (Andy) Padmanabha: my name is Dr. Andy Padmanabha. I'm a specialist in hip and knee replacement surgery. I did my specialty training in hip and knee surgery at the Harvard University Adult Reconstruction Program in Boston, Massachusetts. As a dedicated hip and knee surgeon, I perform approximately 300 hip and knee replacements annually.

Host: You know, and for you, that may not seem like a lot, but for me, that seems like a lot. You know, I'm just like, I've got two knees and two hips and I'm, you know... I've certainly known folks who've had these joint replacements, but it's great to have your expertise today and talk through some of this stuff.

So when we say joint replacement, I'm never sure, do they replace the whole joint? Is it everything? Is it just parts of the joint? So generally speaking, the major ones that you do, what does that mean? What is a joint replacement?

Dr. Anand (Andy) Padmanabha: Sure. So, you know, typically, a joint replacement is what we call a total knee or a total hip replacement, which involves replacing the entire aspect of the joint where the two bones meet. In rare circumstances, it could be a partial knee replacement in which we replace only the affected part of the knee replacement, although that's typically about 10% of knee or hip replacements.

A joint replacement in general is a procedure that is designed to improve a person's quality of life due to debilitating and painful knee or hip pain. The procedure involves removing the painful arthritis in the joint and replacing the worn down joints with metal and high-grade plastic that we call polyethylene. Those materials provide the patient a smooth and stable platform to walk on so that the arthritis isn't a concern anymore.

Host: Yeah. I was going to ask you, of course, there are acute knee injuries that maybe is a different conversation, a different podcast, but generally, it's sort of in your world, in your realm, the folks you're meeting with in the office and talking over hip or knee replacement with, is that generally it? Is it usually arthritis? Is it usually osteoarthritis that gets folks in the office?

Dr. Anand (Andy) Padmanabha: Yeah, I would say so. About 80,-5% of patients are patients who are dealing with debilitating osteoarthritis of either the hip or the knee. In rare circumstances, it could be sequela of a prior injury or trauma that they had in childhood. It could even be what we call hip dysplasia, where the ball or the socket is misshaped or malformed. But typically, it is arthritis, where the bones are starting to wear away, the cartilage is worn away, and now the bone is rubbing against the bone.

Host: Sure. And that could be family history, genetics, behavior, lifestyle. So, you know, multitude of things that could lead to that. I guess my question for you is when is it time for someone to come see you? When is it time for someone to consider a replacement?

Dr. Anand (Andy) Padmanabha: Everybody has a different level of activity and what they hope to get out of their activities of daily living. I typically recommend that a patient consider a joint replacement if they're having significant pain in the knee or the hip, if they feel stiffness in the knee and the hip that's affecting their normal activities of daily living, whether it be going up and down stairs, getting their shoes and socks on, even going out to play some pickleball, which happens to be, you know, all the rage these days, right?

Host: It sure does. Yeah.

Dr. Anand (Andy) Padmanabha: So, yeah, that's when I typically say you should probably have a consultation with a hip or a knee surgeon.

Scott Webb: Let's assume then that someone had a partial, but probably a total knee or hip replacement. Let's talk about the recovery. I think, for a lot of folks, maybe that's what kind of scares them off or has them dragging their feet a little bit as they hear about the PT or whatever it might be afterwards and maybe that kind of holds them up.

Dr. Anand (Andy) Padmanabha: Right. You know, in my practice, I try to use a minimally invasive surgical technique, which is commonly employed in sort of modern total joint replacements, as well as a standardized pain medication regimen to quicken the recovery and functional outcome of the patient. So, most patients, I would say 70% to 80% of patients typically go home the same day after the surgery. For the first two weeks after the procedure, the patient will walk with the use of an assistive device, whether it be a cane or a walker. It depends if it's their right knee or their left knee, they can typically drive at around the two-week mark if it's their left knee, maybe around the three week mark if it's their right knee. But physical therapy is a very vital component of the process. It aids the patient to get stronger after the surgery. And I typically say that physical therapy should last about 10 weeks after the surgery. Most patients turn the corner at around the six to eight-week mark.

Host: Not that I'm interviewing you here for the job, so to speak, doctor, but when it comes to patients trying to find the right surgeon, you know, what's entailed? What do you recommend? What kind of questions should they ask?

Dr. Anand (Andy) Padmanabha: Yeah. You know, plain and simple. I think the patient should always choose a surgeon that they trust. Ideally, that surgeon is someone who has specialized training in hip and knee surgery and routinely performs hip and knee replacements. So whenever a patient's coming in for a consultation for a hip and knee replacement, I think standardized questions such as," What is your postoperative pain regimen? What is a typical physical therapy protocol? And how many of these surgeries do you typically perform on a weekly or a yearly basis?" are all important questions to ask.

Host: Yeah, sounds right to me. You know, I'm sure folks have questions. And when you think about knee and hip replacement, we want these things to last, right? And that kind of leads me to my next question is, you know, how long do they last? Is there an expiration date on some of these things or does it really depend on when you get the knee or hip, right? So if you get it in your 30s, you may need another one. But if you get it in your 60s, you're probably good to go. Maybe you could take us through that. Like how long do these things last?

Dr. Anand (Andy) Padmanabha: Yeah, that's a common question and a very good question as well. You know, I would say that most of the literature now on modern knee and hip replacements suggest that if you have the joint replacement under the age of 50, the lifetime risk of needing another surgery to address a problem with that initial replacement is higher than the chances of you passing away with that implant. So, if you're younger than 50, I would say the revision chances are upwards of 50%. Now, if you're in the average age of 65 and, you know, assuming , nothing catastrophic happens to the implant, such as a major trauma, that implant should last you the rest of your life.

Host: Interesting, yeah. I was going to ask you, once someone has a hip or knee replacement, how often do they need the other hip or the other knee done? Is that just sort of implied that, listen, if this knee is bad enough, the arthritis is bad enough in this knee, chances are likely that other knee is going to catch up to it eventually. Is that how that goes? If you get one, you probably need the other. And I won't ask you if you have a buy one, get one sort of arrangement.

Dr. Anand (Andy) Padmanabha: Well, yeah, I mean, I would say a lot of patients after they have their first one done will ask me, "How does my other knee look?" And, you know, honestly, I would say it's a 50/50 chance that they have arthritis on that other knee or hip, believe it or not. It's usually on one side in most patients. But, you know, certainly genetics plays a role into arthritis and patients who have hip arthritis are going to have higher likelihood of having knee arthritis, whether that be in the same leg or the other leg.

Host: Yeah, there's just no way for us to outrun our family history and genetics and all that, especially on bad knees, right? This has been really educational and fun today, doctor. Just give you a chance here at the end, you know, final thoughts, takeaways, words of encouragement for folks whose lives are suffering, the quality of their lives is suffering because of bad hips, bad knees, maybe all of the above. How do we get them in the office?

Dr. Anand (Andy) Padmanabha: Right, absolutely. You know, at our program at Solution Health, I personally work with Foundation Orthopedics, located in Nashua, New Hampshire, and we have an excellent program with Southern New Hampshire Medical Center, where we perform same-day total joints and enhanced recovery systems to allow patients to get back to their activities of daily living. So if you're a patient that is affected on a daily basis with stiffness and pain, and you're just not getting back to the activity that you were once doing at one point in your lifetime, I would say reach out to our office for a consultation at the very least to discuss some sort of treatment plan.

Scott Webb: Yeah, treatment plan, figure out what your options are. In many cases, surgery is a last resort after you've tried, you know, meds and injections and physical therapy and all of that. But once you get there, as you say, many folks, once they have those new hips and new knees, they're like, "While I'm here, what do you think of the other one?" So, this is really great today. I really appreciate your time, your expertise, your compassion. Thanks so much. You stay well.

Dr. Anand (Andy) Padmanabha: Of course. Thank you, Scott. It's been a pleasure.

Host: And for more information, go to snhhealth.org/ortho. And if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of Solution Health. I'm Scott Webb. Stay well, and we'll talk again next time.