Transcription:
Precision Joint Replacement Means Smoother Recovery

Caitlin Whyte: (Host) Modern medicine is getting more advanced by the minute, and it can feel like a lot to catch up on. Well, Dr. Anthony Volare is an orthopedic surgeon and he's joining us today to share why someone would need joint replacement surgery. The new robotic arm assisted technology he's using in surgery and how it benefits the patients.

This is the inspire health podcast from Upland Hills health. I'm your host, Caitlin Whyte. So doctor joint replacement sounds like major surgery. So when does it make sense for a person to consider a joint replacement?

Dr. Anthony Volare:  Well, it is a major surgery. It's certainly something that we as orthopedists don't recommend that patients enter into lightly.

I mean, they should take it seriously. A joint replacement is something we do because the existing joint. Has worn out life happens to all of us. And I think there's a general understanding that our bodies are going to wear out and our joints are going to wear out how fast that occurs. Obviously depends on a lot of factors, what we did, when we were in high school, what we do now, what our profession is genetics.

There's a lot of factors how active we are, the, so there's a lot of factors that, will determine a joint wearing out. So when it does wear out. You're going to get some pain. You're going to get some swelling. At some point, patients are going to not feel that they want to tolerate that anymore, or it's going to interfere with their daily activities.

So that's when they come to see us. And, and there's a lot of other things that we can try before we, to, or before we resort to surgery to replace a joint because. Yeah, like we were saying earlier, this is, this is a major surgery we are taking out. We are exposing the joint. We're taking out all the arthritic bone and cartilage and we're replacing it.

We're capping it off with metal and plastic. And that imparts with it, a certain degree of responsibility, because you have to take care of that. You don't want it to break loose. You don't want to get infected, et cetera. So we try. As orthopedists and, and I think patients would agree with this. We don't want to jump to surgery right away.

We want to try the little things and patients come to us probably after they've tried. Most of those things, the, the Advil, the leave, the over-the-counter medicines and creams. And they've also tried to maybe, okay, I won't do so much of that because it, it aggravates my knee or my hip, some things they just avoid altogether.

There's a tipping point in someone's life though, when they realize that their daily activities, they're not doing them anymore because of this, painful knee or painful hip or something, you know? So they, they just sort of realized, yeah, I'm not doing all the things I enjoyed doing before their quality of life is getting closed into this little box in a corner.

And, at some point it frustrates a patient. What that tipping point is, is different in every patient, because we all have different function on a different level. We all have hobbies and things we enjoy that involve physical activity. And when a patient can't do that anymore, and also not only when they can't do it anymore, it's when those simple things don't work anymore.

I always talk with a patient when I see them. Let's go through that spectrum of. Of options we have, and it ranges all from first, maybe not doing that activity so hard as you did when, 10 years ago, when you were younger, maybe trying Advil, Aleve, the creams, we can also go to cortisone injections or lubricant injections, and maybe an occasional knee brace, anything to kind of help keep you functional and keep you doing that stuff.

Yeah. But when that doesn't work anymore, the patient has two options. They either have to say, well, okay, I guess I just won't do it anymore. And they deal with it.   but a lot of times the pain and the swelling doesn't let them just be, they, they decide. Okay. I think now is the time to have a joint replacement surgery.

And it's not like they do it as, as, some patients do it because they just feel, Oh, well, I guess I have to, they feel a little defeated with it. But other patients, a lot of patients, majority of patients, they feel they're almost angry. They're annoyed at that arthritis for not letting them do those activities.

Again, they're, they're angry. They're frustrated. They want to be. Doing more active things. And that's when that's when    it's time. And, and that's when I know as a surgeon that that's a good patient to have taken to surgery and replaced the joint because they're committed, they're determined they're in it, they’re in it to win it, you know?

So when they have the surgery, there's rehab, there's healing, there's rest, there's exercise. They've got to do all those things. If they want to optimize their outcome. And one way to know if they're that patient is how they present to you, their history of arthritis. And I always tell that to my patients.

 I don't tell them that they should have a knee replacement or a hip replacement. They already know. They know before coming in that door, they know they're determined to get back to a more active lifestyle. They want a joint replacement and they're coming to me to make it happen. So I understand that you are using some new technology in your surgeries.

Now, can you tell us about that? Yes. I joined with Upland Hills hospital about a year ago. And in the process of interviewing before I agreed to join, I actually joined them. They had asked me about what can they do as a hospital to sort of be on the forefront, to be on the cutting edge of technology.

What can we bring to our patients that is new? And I brought to them. The it's a Maaco robot assisted technology for joint replacements. It's by the Stryker company, which they've been doing joint replacements for decades. And probably about 15 years ago, they acquired the technology called Maaco and it's a robot assisted technology for joints and what it is.

It’s the cuts that we make. Cause remember I said earlier, we have to remove all that arthritic bone, all that extra bone and cartilage. Well, in order to do that in order to just make those skim cuts, we need to make. And so we don't remove too much bone that's where this. Technology comes in. I hate to say robot because people have this scifi image in their minds but it's hard to call it anything else, I guess, but it's not this autonomous, it's not this thing that just does the surgery for me. It's a tool and it's not just a physical tool. To help me do a better surgery, a better joint replacement for the patient. It's not just a physical tool. There's also just the technology part of it, which is a lot of information crunching.

When a patient comes in to see me and, we decided we want to do the surgery, whether it's hip or knee, we then get a CT scan. Of that joint. And we get a CT scan of the leg because we need to know the alignment of the leg. We want to make it straight. All that information gets sent over to the Maaco labs, where they kind of crunch that information in a computer and they generate a computer image of that joint replacement.

So even before we've done the surgery, I can sit there and look at the monitor, in my office, I can look at the monitor. And I can see what size that joint needs to be, the orientation, the flection, the extension, all that stuff that makes that knee. In in straight perfect alignment, like, like they were back, when they were young, so that's the technology.

It's, it's a great investment. It's I want to say it's cutting edge and I hate to say the, the phrase, like, the future is here, but it, it is, it's been around for a while. But computers have been around for a while too, but  you don't have the same computer you had 15 years ago, you have a new computer.

So this software technology has been evolving and getting better all the time with Stryker and the Maaco system. And they're even continuing it. Now I could go on and talk about all the different things. They're going to be adding into the software in the future to make it even better. So it's exciting as a surgeon, because when we go into surgery, there's steps that we take through the surgery in order to get to the outcome we want, which is the knee components that fit the patient.

And they're the right size. They're the right thickness. They're the right everything. So that, that knee is stable and we, we call it balanced. So it's not too loose, it's not too tight. So it feels like a natural need of the patient. And we now have the information to get us to that end point before we even take the patient into the operating room.

We have that information now and that machine is then connected to the computer, which is also in the operating room. And then that computer has an array of cameras so that it can see where that hip is, where that knee is in space. As we're doing the surgery. So, so if we were to rock the knee, swing, it sort of left.

And right during the surgery, the arm would also swing left and right with it because the computer and the camera eyes sees where that leg is in space. And it adjusts for it, which is an amazing thing, especially when you're doing a hip replacement, because the patient is on their side, everything is covered up and, we try to do our best to have them held in that position.

It's a rare occurrence, but you'll hear a story of where somebody kind of settles one way or the other. And if you didn't have the robot there to actually see that. With the camera array, the surgeon wouldn't know it and the components would be put in wrong, you know? So you just have to see it to really get an understanding of it. Because even, even the way I described it just doesn't do it justice. Let's say.

Host:  I mean, it sounds like incredible technology and it's great that you guys have this here at Upland Hills health, and obviously, having extra tools as the surgeon makes your performance better, but how does this make surgery better for the patients?

Dr. Anthony Volare: I think to, to kind of answer that you have to understand the way we traditionally did joint replacements. We expose the knee, we released soft tissue, sometimes ligaments and joint capsule in order to expose the knee in order to get to the areas we need to see in the bone remove and all that stuff. And then when we replace it, once we make those cuts, we, we put trial components in the knee.

And then we go to task at trying to do, as I was describing before balancing the knee, making sure the right size components, making sure the thickness of the plastic, it's all fits perfectly with this technology. Two things happen. Number one, I don't have to do as much. Soft tissue release or soft tissue stripping.

I don't have to release that ligament. I don't have to peel away that joint capsule. So that means less. That has to heal back later for a patient, because all that just equals some level of pain, the more you kind of strip away from the bone, the more painful it is. So we ha we have that to do it's less exposure even before we go and do that.

As I was saying before, we can go into the surgery. Knowing we have much greater information before we even have the patient on the operating room table before we even make any cuts. To remove the arthritic bone. We have the information to know exactly how much bone we need to remove. We won't have to go in and make a second cut.

We won't have to go and worry about the alignment because the more out of alignment things are, the more it could affect the patient's function and knee motion, the more soft tissue stripping we have to do, the more that has to heal back. So all that gets minimized almost on the front end of things.

Before we removed any bone. Any arthritic bone before we've done all that, we already know where we're going to go with it. We tweak it. Once we get them into the operating room, we can still have the option of adjusting and tweaking some of the information that the computer gives us. But for the most part, we don't have to do a lot.

And then once we lock it into the computer, it’s just a matter of making all that information, turning all that information into a physical reality for the patient. And we can do it, like I said, with less soft tissue and bone dissection or removal and all that. And that in the end equals less pain for the patient and less pain medicine that they'll need to take.

It helps them obviously if it's less painful, they can progress with physical therapy easier, and then they get back to their normal daily activities and they regained their quality of life faster. Because of this.

Host:  Well, thank you so much, doctor, for taking the time to tell us all about this innovative new technology to reach Dr. Volare call (608) 930-7115. And to learn even more, visit the Upland Hills health YouTube channel and search for robotic arm assisted technology for joint replacements. This is the inspire health podcast. I'm your host, Caitlin Whyte stay well.