Transcription:
Rapid Recovery Following Joint Replacement Surgery

Host: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. And today, we'll be talking about rapid recovery following joint replacement surgery with Dr. Sumon Nandi, Chief of Adult Reconstruction, Department of Orthopaedics at the University of Maryland Medical Center. I'm Bill Klaproth. Dr. Nandi, thank you so much for your time. It is great to talk with you and such an interesting topic. So let's start here. Can you explain to us what is rapid recovery?

Dr. Sumon Nandi: Well, first and foremost, thank you so much for the opportunity to speak to you today. Rapid recovery after a total joint replacement is when patients have surgery and they're able to go home. The same day or, at the latest, the following morning after surgery.

Host: So that is rapid recovery. So it seems like we would all choose to recover at home if possible. But can you share with us the top three reasons someone would choose rapid recovery?

Dr. Sumon Nandi: Even before the COVID pandemic, patients really found the ability to go home the same day very appealing. They're able to recover in the comfort of their own home. They're able to have their own family take care of them and who takes better care of you than family, right?

Now during the COVID pandemic, patients have an added sense of comfort being able to minimize the amount of time that they spend in the hospital. The University of Maryland has done a wonderful job performing elective surgery as safely as possible during the COVID era, but patients still feel comfortable being able to get up, walk and leave the hospital shortly after the surgery.

Let's take a look at the data, when you're talking about patient's health and their wellbeing, you really got to rely on the data when making decisions about something as important as patient's health. So what does the data show about rapid recovery? So the data shows that if you get up and walk the same day of surgery after joint replacement, it improves the speed and quality of patients' recovery, which is of course critically important. On top of that, if you spend no longer than overnight in the hospital, the studies have also shown that you minimize the likelihood of getting a blood clot in your legs that can go to your lungs and cause problems. And finally, if you leave the same day of surgery, which a lot of folks find really appealing, there are no increased risks associated with that in the literature when you compare that to patients leaving the following morning. So there're really many, many advantages to rapid recovery after total joint replacements. And it's really an exciting program that we're able to offer patients.

Host: And I'm sure this is very, very popular and the benefits are clear, as you were saying, for people that choose rapid recovery. One, it increases the speed and quality of the recovery. Two, it minimizes potential blood clots. And three, man, it feels good to be at home, right? That comfort certainly adds in the recovery. So you were talking a lot about the data, talk to us about this. How much faster do patients recover with rapid recovery?

Dr. Sumon Nandi: Just the act of getting up and walking the same day of surgery has been shown to improve the speed and quality of patient's recovery. The act of being in one's home, being around family really improves the state of wellbeing that patients have. There's an overall feeling of being well, as opposed to being sick, that accompanies patients when they're in the hospital. So that's a very beneficial aspect of being able to go home. When you talk about the average recovery after either a hip or a knee replacement, well, they differ in some regards, but the end result is a pain-free hip after a hip replacement and a pain-free knee after a knee replacement.

So after a hip replacement, again, patients get up and walk the same day. For patients who are interested and who are medically suitable, they're able to go home the same day. And really after a hip replacement, all you do is you walk around and six weeks later, you're pain-free and walking normally. So hip replacements are pretty easy to recover from.

Knee replacements, again, you are going to have a pain-free knee once you recover from the knee replacement. The difference between hip replacements and knee replacements are knee replacements do require more work on the part of the patient. So patients really have to work on straightening the knee, bending the knee and walking. So the range of motion after a knee replacement or regaining range of motion after a knee replacement is critical to success after surgery.

So if patients are really working hard on that range of motion, then they will have an outstanding outcome after knee replacement. And once they recover, they will have a pain-free knee that they love. The only difference between hip and knee replacements is that knee replacements require a little bit more work on the part of the patient, but at the end of the day, they have a wonderful pain-free knee that's in sharp contrast to the very painful debilitating joint pain that they had prior to surgery.

Host: Right. So you do have to do work at home, but if you put the work in, if you do the work, you're going to get those good results. You were mentioning someone can opt for rapid recovery if they're interested and medically suitable. So who is not a good candidate for rapid recovery?

Dr. Sumon Nandi: The vast majority of patients are able to go home the same day. The patients who are not as suitable are those patients who have one or more organs that are failing. So if you have one or more organs that are failing, you really need to be monitored, at least overnight in the hospital. Rapid recovery is never, ever performed at the expense of safety. The whole reason why it's performed is because the data shows that there are no added risks in the appropriate patient and it improves the speed and quality of patient's recovery. But again, it is never performed at the expense of patient safety.

So for patients who have medical problems that don't make them suitable to leave the hospital the same day. We of course keep them overnight, make sure they're doing well and make sure that their experience is as safe as possible and that we assure them an outstanding outcome.

Host: So you said just about everybody is suitable for rapid recovery. So that is really good news. So then can you explain to us what the recovery process will look like and how quickly patients are able to return to daily activities?

Dr. Sumon Nandi: Absolutely. So as far as daily activities go, walking around, going to the restroom, patients are able to do that the same day of surgery. And in fact, they do that before they leave the hospital. So patients will walk around with a physical therapist shortly after the surgery. If patients have stairs in their home, the physical therapist will teach them how to safely do stairs in the hospital the same day of surgery before they go home. So that degree of activities of daily living patients were able to do the same day. And each day patients notice an improvement in their pain and the degree to which they're able to become active. They're able to walk farther, to do more. And really by six weeks, patients are doing absolutely beautifully. So after a hip replacement, again no exercises, just walking around, within six weeks, you're pain-free and walking normally.

After a knee replacement. once you go home, you start those exercises right away to really regain that range of motion. Within two weeks, you're pretty comfortable walking indoors without any cane, crutches, walker. And within six weeks, you're pretty comfortable walking anywhere, even outdoors or uneven terrain.

Host: Wow. That is totally amazing. And you said there is some time in the hospital you will have to do some form of walking or is it minor physical therapy before you released, even though it is same day?

Dr. Sumon Nandi: Yeah. So the physical therapists at the University of Maryland are outstanding and they see all of our patients prior to discharge. And help us ensure that the patients feel comfortable going home, that they know exactly how to navigate. All of the situations that they're going to run into at home, whether it be getting in the car, going to the restroom, walking from room to room. Patients really have a great sense of security before they go home. That's due to the preparation that we give them, the education that we give them before surgery in conversation form and written form.

And then again, after the surgery, we have the physical therapists work with them and give them hands on experience on how to navigate their day-to-day activities and feel comfortable. So, yes, just as you said, the same day of surgery, patients within just a few hours will work with physical therapy and walk around, do stairs if they have stairs in the house and then be discharged home.

Host: So rapid recovery sounds great. I'm sure everyone is interested in this and it's easy to see the benefits of it. So you mentioned generally after six weeks, a patient is pain-free. So the next question someone might be asking as well, "This is great. Now, how long can I expect my new joint to last?"  

Dr. Sumon Nandi: In the late '60s, early '70s, when hip and knee replacements first came out, there was an 80% likelihood that they'd last 20 years. Now about 15 years ago, there was a huge advance in the piece of plastic we use in hip and knee replacements. And that 15-year data is extraordinarily good. It shows just trace amounts of wear. So, with modern implants, the expectation is that joint replacements will last far longer than 20 years.

Host: So again, good news on that front. And Dr. Nandi, does that mean that someone of a younger age might opt for a knee replacement earlier instead of letting it go all the way to where that person is in debilitating pain or really affects the quality of their life? How does someone know when they are ready for a total joint replacement?

Dr. Sumon Nandi: You need three things really. One, you need to have bone-on-bone arthritis. And what does that mean? So arthritis is a process. It's not a thing. It's a process by which the cushion in your joint wears away and then your bones grind against one another, and that causes pain. And on an x-ray, if I can see that all the cushion is gone, then that's what we refer to as bone-on-bone arthritis. No cushion left. The bones are just grinding against one another. So that's one of the things you need.

The second thing you need is you need to have tried everything short of surgery. So when patients come to see us at the University of Maryland, we don't just drag them kicking and screaming into the operating room. We make sure that folks have tried everything short of surgery first. So even if patients come to see the surgeon, we will still make sure that patients have tried everything short of surgery first. Again, one, you have to have bone on bone arthritis. Two, you have to have tried everything short of surgery. And three, you have to say, "You know what? I've tried everything short of surgery and now, I still can't live the way I want to live. I can't do this anymore." If all three things are true, then you're a candidate for a hip or knee replacement.

Getting back to your original question about hips and knees, so with knee replacements, we've got some good data that shows that if you do a knee replacement in patients less than 50, there's a higher likelihood of infection and we really don't know why, but there is a higher likelihood of infection according to the data. And there's a higher rate of the pieces and parts getting loose sooner than they otherwise would, and that would of course require another surgery, which of course we want to avoid. We want to perform one surgery and have the patient be good for the rest of their life. So that's why knee replacements in patients less than 50 are not ideal.

However, there is no such data in patients who have hip replacements. So there are patients who have conditions involving the hip, that really destroyed their joint at a relatively young age, you know, in their twenties. And those patients may still have a hip replacement and do very well. So in that regard this is yet another way in which hip and knee replacements differ. But as long as you fit those three criteria, bone on bone arthritis, you've tried everything short of surgery, and then, three, you can't live the way you want to live anymore, then you're a candidate.

Host: So that's really how to assess it. So that's really interesting. I was thinking since the joint replacements do last longer, someone might be like, "Put it in now, doc. I'm not waiting another 10 years," but the way you explain it, bone on bone, all non-surgical interventions have been tried, and then," I just can't live like this anymore," those are the criteria that you look for before considering total joint replacement.

Dr. Sumon Nandi: Yes, exactly. And you know what? I think you're absolutely correct. I think what you're getting at is, you know, way back in the late '60s and early '70s, when hip and knee replacements first came out, patients would wait until they were in a wheelchair before they decided to have a hip or knee replacement. But over time, life expectancy has increased. Patient's expectations in terms of what they want to be able to do on a day-to-day basis have changed.

So now patients won't wait until they're in a wheelchair and they're right, they don't need to. When they feel that, "You know what, I really can't be active to the extent that I want to. I can't walk around on vacation anymore. I can't play with my grandkids. I can't be active in my recreational activities to the extent that I would like," then patients decide, "You know what? It's time."

Host: Right. So that's exactly the point I was making. I did have people in my family way back when where the knee was so debilitating to them, like they were basically in a wheelchair. Their quality of life was shot before even thinking about total joint replacement. And then it was, "Oh my God, this is such a crazy surgery. Oh my God." Well, now it seems like we do this, we get you up and walking the same day and we'll have you home the same day. And if you do all the exercises correctly, if you do the work that the physical therapist and you prescribe, hey, within six weeks, generally, you're going to be pain-free and you're going to be back to mainly your daily activities. So, yeah, that's kinda what I was going for.

And then to know this joint replacement is going to last and it's basically same day surgery, just really amazing and interesting how the technology has increased to this point and how you're able to give people's lives back sooner, quicker, and easier than say 10, 15 or 20 years ago.

Dr. Sumon Nandi: Absolutely. You know, we've learned so much over time and I certainly feel privileged to have the opportunity to perform hip and knee replacements. I love being able to be a part of the patient journey from having debilitating pain that doesn't allow them to do what they want to do to the point where, after surgery, they're now able to do all the things that they want to do. It's just very rewarding and it's wonderful to see. There's been such an evolution. There's been so much research done in the field. And again, rapid recovery is based on the data. There's been a lot of research. It's been proven in study after study after study. The pioneers in rapid recovery have been doing this for about 10 years. So it's not experimental. It's not just being tried out, "Let's see what happens." Patients should really feel comfortable with rapid recovery after joint replacements. It's really a wonderful thing that can be offered to patients in horrible pain.

Host: Well, follow the data, follow the science and I imagine that this is very rewarding. Like you say, you're giving people's lives back. What a dramatic difference you can make in someone's life, who can't lift their leg up to drive or can't play with their grandkids or their children, and now they can. So I imagine that would be a really special feeling.

Well, Dr. Nandi, thank you so much for your time. This has really been informative. We really appreciate it. Thanks again.

Dr. Sumon Nandi: Thank you for your time. I really enjoyed our conversation. Thank you.

Host: That's Dr. Sumon Nandi. And for more information, please visit UMMS.org/podcast. And thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. And we look forward to you joining us again.