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Prakash Chandran (Host): Since 1999, Syracuse Orthopedic Specialists has been the trusted provider for total orthopedic care in Central New York. Its locally-owned one-day surgery center provides operations that with the help of new technologies and more efficient procedures allow patients a quicker recovery from the comfort of their own home.

Host: Now, by partnering with the center, St. Joseph's Health offers its patients a safer, more convenient option for same-day joint surgery. Here with us to discuss this partnership is Dr. Max Greenky, an orthopedic surgeon from Syracuse Orthopedic Specialists. This is St. Joseph's Health MedCast, a podcast from St. Joseph's Health. My name is Prakash Chandran. So Dr. Greenky, thanks so much for joining us today. I really appreciate your time. I wanted to get started by asking what exactly should people consider joint replacement?

Dr. Max Greenky: Right. It's a great question. Joint replacements for most of the time is for severe arthritis of the knee and the hip. And the great thing about what I do is that you never need a joint replacement, right? But if you've got bad arthritis and you've failed all the conservative treatment and your joint pain is either preventing you from doing the things that you want to do or the things that you need to do, or making them miserable, that's really the time to start thinking about doing a joint replacement, assuming that you've tried everything else.

Host: Yeah, and I think that's why they generally refer to it as a quality of life operation. Because if it's impeding on the quality of your life, then you should consider getting it and removing that pain, right?

Dr. Max Greenky: Absolutely.

Host: Now, is there a certain demographic that you see more for joint replacement than others?

Dr. Max Greenky: Well, that's one of the other great things that I like about the specialty that I do, is that it's just people who generally are later in life. But for me, I don't really have an age cutoff. It's more, "Do you have the x-rays that show that you've got bad arthritis? Have you tried everything else conservative?" And then, is it affecting your quality of life? And if all the answers of that are yes, then in my mind it's okay to consider it whether you're young or you're old, as long as you can medically get through the operation.

Host: Okay. Now, one of the things that I do want to talk about today is that one-day or same-day surgery center. But before I do, I'd love to just understand traditionally, what is the typical recovery time when someone goes and gets a joint replacement?

Dr. Max Greenky: Right. Hips are totally different than knees. And so, for my knee replacement patients, I always tell them the first six weeks they may not like me that much. But after that, they'll start feeling better about life. But for example, if somebody does desk work for a living, then they're going to be out of work for probably four to six weeks. And if you do like construction work or something that's really labor-intensive, it's going to be more along two to three months that you should be out of work for. But generally, by the six-week mark, people are pretty happy they did the operation.

Host: And in terms of recovery time and getting the patient home, how long does that traditionally take?

Dr. Max Greenky: Yeah, traditionally, this has changed a lot in the last five to 10 years, I would say. But now, even my hospital patients are generally a 23-hour stay, so coming in the day before surgery, one night in the hospital and then going home the next day. Traditionally, people were in the hospital for two, three days. And actually, it used to be that the Medicare made you stay in the hospital for three days. But definitely, it's the way that things were going. And then, the pandemic sort of accelerated accelerated that exponentially I would say.

Host: Yeah, that makes a lot of sense. So, let's talk a little bit about the one-day surgery center that you're a part of. Talk to us about what it is and some of the recovery times that you see there.

Dr. Max Greenky: Right. And so, St. Joe's is now our partner here too. And it's basically, a surgery center, but we always joke that it's a mini-orthopedic hospital. Actually, I'm sitting here right now. Today, I did eight joint replacements here. And I always tell patients that if you're healthy enough to come here and they're comfortable with it, it's a nicer experience in the sense that everything here is streamlined and geared towards joint replacement. So from the minute you hit the door, there's a team working on you. We get you in and the surgery done. And then as soon as the anesthesia's worn off, we get you up and moving, get you on your road to recovery most of the time home or on your way home within six and seven hours after hitting the door.

Host: That is pretty incredible. You know, you said that traditionally people had spent 24 hours to a couple days waiting until they're discharged. And now in the surgery center, you're basically cutting that time down by a fourth and people can recover where they feel most comfortable, and that's at home right.

Dr. Max Greenky: Right, exactly. So I tell 'em if it's safe here to go home and you know you're gonna be recovering from operation, you might as well be in your own bed with your own food and with your own family.

Host: And what about the ongoing I guess help or treatment? Is there some sort of like outpatient physical therapy that patients are provided?

Dr. Max Greenky: Yeah, absolutely. Like I said, knee replacements is absolutely critical to the recovery. And so, as part of the surgery center, it's not just we see you in the office and you show up, there's a whole lot of work that goes in to make sure you're optimized for surgery, you know what you're getting into, that you know what we expect, that you know what to do afterwards. And so, before the operation, generally, We have you see your physical therapist once just to get you ready for the recovery. And then, we're generally having you see them within one or two days after the operation to get started on the recovery.

Host: So, it really sounds like this one-day surgery center and this partnership with St. Joe's has been an incredible boon for the community. I was wondering if you could share a little bit around how it actually got started.

Dr. Max Greenky: Right. St. Joe's has been our partner for a long time. It's just before it was exclusively at the hospital. And they've been extremely good to us. And I even still joke that the surgery center is probably all of our favorite place to operate, but St. Joe's is pretty darn close. And we've been partners in taking care of joint replacement patients for a long time. And now, moving forward, we're happy to have them on our team here. Just I think what they bring to the table is making sure that we have all the resources we need, especially given the post pandemic stuff with supply chains and manpower and high-level planning and things like that.

Host: So, can you tell us a little bit more about what the process of getting a joint replacement looks like? Like if someone is listening to this and they're thinking about it, can they just walk into the center and get seen by someone? Do they need to schedule an appointment? And are there a series of assessments that take place? Walk us through that.

Dr. Max Greenky: Yeah, absolutely. So, anybody who has arthritis in their hip and their knee, we'd be happy to see in the office. And it's the good thing about SOS is we've got six fellowship-trained joint replacement surgeons. That means that I'm an orthopedic surgeon who did a five-year residency, and I did one year where I just did hip and knee replacements, and there's six other people like that. And so, the point is that one of the great things about our practice, if you want to see one of us, we can generally get you in within a week. So, you come in for a consultation, we'll go over everything that you've done, what the possibilities are, both conservative and operative, and then go from there. And then, if you are a candidate for joint replacement surgery, we'll go over everything in the office. We'll start the process of from getting there to the finish line of surgery. So, that means seeing your primary care doctor to make sure that it's safe to do surgery, it's getting authorized with your insurance, getting in to see the physical therapist to make sure you're ready for the recovery. And then, all of us will see you back right before the operation, whether it's four weeks from then or whether it's four months, just because it's a lot of information to absorb in one visit. And the way that we all view this is as a partnership, and we really want you to understand what you're getting into and what the process is like.

Host: Yeah, absolutely. And is there any prep that the patient needs to do on their own before they come in for the replacement?

Dr. Max Greenky: So, there is a bunch of stuff you got to do, but we try to hold your hand through it. And so, there's our surgery schedulers who help, and then we have nurses called nurse navigators, which their only responsibility is, once we've signed up for a joint replacement, to work with each individual patients, identify their individual needs, and make sure that they're ready to go. And so, all that education that the patients have to do will happen. But it's not like we're going to sort of hold your hand through the entire process.

Host: Okay. Gotcha. So, you know, I know earlier we were talking about one benefit in coming into the one day surgery center is that they get to return home to recover, which obviously good for everyone. But can you talk a little bit more about the outcomes themselves? I know that there might be people listening to this that are just apprehensive about getting a joint replacement. So, maybe you can speak to that.

Dr. Max Greenky: Yes, it's a good question. And listen, any surgeon who tells you they don't have complications or stuff doesn't happen is either not doing enough surgery or they're not being truthful with you. But the hip replacement, the modern hip replacement is one of the most successful modern operations. It's just if everything goes right, people are thrilled with it. And the statistics sort of back that up. Knee replacement, also a wonderful operation. You know, what the study shows is about 90-95% of the patients are really happy that they did it in terms of their outcomes. But you know, of course, its surgery and surgery has risks involved with it. It's just a for better or worse in numbers game.

Host: Yeah. Now, you've obviously seen lots of different patients and have done a lot of different joint replacements. As we start to close, if there's one thing that you know to be true that you would like to leave our audience with, what would that be?

Dr. Max Greenky: Oh, gosh. That's a great question. You know, I would just say, wherever you end up, if you're considering it, you got to be comfortable with your care team. And so, I think that's one place that we excel at, is, like I said, I look at it as a partnership between us and the patients. And so wherever it is, whether it's me, whether it's somewhere else, whether it's one of my partners, like I said, you got to feel comfortable with them.

Host: I think that's the perfect place to end. Thank you so much, Dr. Greenky.

Dr. Max Greenky: Yeah, absolutely. Thanks so much for having me.

Prakash Chandran: That was Dr. Max Greenky, an orthopedic surgeon from Syracuse Orthopedic Specialists. For more information, you can visit sjhsyr.org and you can search for orthopedics. If you found this podcast to be 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 St. Joseph's Health MedCast from St. Joseph's Health. I'm Prakash Chandran. Thanks and be well.