South County Health Orthopedics Center is the worldwide leader in Mako robotic arm assisted surgeries and the Center performs just over 1/3 of joint replacement procedures in the state of Rhode Island.
Dr. Michael P. Bradley, Chief of Orthopedic Surgery and President of Ortho RI, discusses orthopedic surgery at South County Health.
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Orthopedic Surgery
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Learn more about Michael P. Bradley MD
Michael P. Bradley MD, MBA, MS
Michael P. Bradley MD focuses his practice on sports medicine, orthopedic trauma, and knee/shoulder/hip replacements. He is board-certified and holds an advanced Certificate of Added Qualification in Sports Medicine. As a URI official athletic department physician, he cares for URI athletes, where coincidentally his father coached soccer for nearly 20 years.Learn more about Michael P. Bradley MD
Transcription:
Bill Klaproth (Host): Over the years, millions of Americans have undergone orthopedic surgery to repair and replace issues with shoulders, knees, hips, and more. Here to talk with us about orthopedic surgery is Dr. Michael Bradley, Chief of Orthopedic Surgery with the South County Health Orthopedics Center. Dr. Bradley, thanks for your time. So what are some of the most common issues that lead to someone needing orthopedic surgery?
Dr. Michael Bradley (Guest): Thanks for having me Bill. The growing population health issues and orthopedic surgery really stem around degeneration of the body. So whether that’s hip, knee, shoulder, some sort of degeneration, we link that to arthritis oftentimes, osteoarthritis is probably the major condition that we’re all facing nowadays. In the shoulder, that ends up being degeneration of the tendons or rotator cuff tendon disease, but again it follows a very similar path of linking to age and degeneration.
Bill: So it sounds like it’s mostly because of normal aging?
Dr. Bradley: Yeah, so that’s a great question, and yes there are some expected worsening with age, but I’ll be honest, the real true crux and the real effort that we need to place from a medical standpoint is into why are these things happening from other factors. We know age is one. We know obesity is one, especially in the United States, but there are other factors like genetics that don’t really tell us why one generation is getting arthritis much earlier than the previous generation. So I think some of it’s untold. We’re certainly providing some of the solutions, but it would be really nice to figure out why these things seem to be happening earlier and earlier.
Bill: That is a really good question. I was just wondering, are there people that have a higher risk for orthopedic issues?
Dr. Bradley: Yeah, just like markers that people are developing for different medical conditions, cancer, diabetes that we’re finding on genes, we’re actually finding markers on genes for osteoarthritis and the greatest illusion is to see their grandmother had arthritis of their hip or knee in their 90s, but then all the sudden the next generation it’s in their 80s, the next generation it’s in their 70s, and so there’s definitely a link to genetic component that we have not figured out yet, but we’ll be studying.
Bill: And that would be really good to understand, I would imagine, for preventative measures. So what is the most common surgery you perform?
Dr. Bradley: Yeah, so those three joints are the most common, so knee, hip, and shoulder, and probably in that order, and joint replacement surgery for the knee or the hip are very common procedures. I’ll give you some idea, but there’s about 700,000 total knee replacements done a year right now. That number will grow to 3.5 million by 2030, which is a short time away, so these are becoming more and more common procedures. They don’t look like they’re slowing down. Part of it, what we just mentioned, that people are getting arthritis earlier; part of it are the conditions are getting better, the procedures are getting better, so the willingness for someone to do that is changing, but also the population health statistics really are emerging. The crux of this is the age of surgery continues to slightly move down.
Bill: That’s interesting, and I imagine those three body areas, knee, hip, shoulder, those are the main big joints that we’re moving all the time, so is that why those are more susceptible to injury and degenerative aging?
Dr. Bradley: Yes, absolutely. The activity level on those three joints surpasses most of the other areas. Obviously the shoulder has the greatest range of motion. It doesn’t have the weightbearing characteristics of the knee or hip, but being the only joint that can move 180 degrees, there’s a lot of expectation.
Bill: And you were just talking about joint replacement. How have joint replacement procedures changed over the years, and specifically, can you tell us about the Mako robotic arm assisted surgeries you perform?
Dr. Bradley: Of course, I would say the actual materials that we use to replace joints has been pretty consistent since they started 60-70 years ago, but the refining of the actual shapes of the design, how they’re put in, and whether they use either a cement technique or not a cement technique is probably one of the major issues, and then the approach or the surgery to perform those, even though the materials have not changed, the surgery to perform those has changed a lot, so that’s the surgical approach, and then what we’re getting to is the precision with where the implants go, which is part of the computer navigation and the Mako robot assisted computer navigation system. The elements of putting these things in the exact right place for each subsequent person allows for, what we call, the longevity of the implant, meaning this will stay in somebody and work many years down the road in addition to being good right after surgery.
Bill: So because of that precision, I imagine the recovery process has got to be better than regular open surgery.
Dr. Bradley: Yeah, so this is a great question, and there’s no doubt that with the precision technology, you can perform at slightly more minimally invasive. We caution people. At the end of the day, we still have to get these implants into your body, so it’s not through microscopic incisions, but those incisions can be planned better, the procedure can take shorter amount of time, the blood loss is less, so there’s a lot of things that go into the surgical procedure that can benefit from having some element of precision technology.
Bill: And for someone considering surgery, what do they need to know?
Dr. Bradley: Yeah, so although we love to do this, and this is what we do all the time, to be honest the crux of our job, although performing it is a skill set that we work hard on, it’s actually choosing the right person. So most of the time we try nonoperative things because it’s the patients that really have tried everything else that still realize that they’re not going to be able to do what they want to do in life, and that’s different in every person that come to us and say, “I’m ready now.” And that part of saying I’m ready now buys them into the procedure, allows them to really research it wholeheartedly. If they think there are a lot of options and we are too often pushing surgery on people, that’s not a recipe for success. So believe or not, if somebody thinks they’re ready for surgery, I think coming to listen to all the options, whether they’re surgical or nonsurgical, and then trying some things that often times can get temporary relief or at least some relief and some of it is exercise related, some of it’s modifying activities and losing weight and things like that, and ultimately, I think we’re fairly honest with people. If there are no other options, there are no other nonsurgical options, these are things that are very common procedures, and if we do them well, and do them consistently, I think people will have great outcomes and that’s what we care most about.
Bill: Well, that makes sense, and with the opioid crisis, last question Dr. Bradley, can you talk about cofounding the opioid sparing pathway at South County Health?
Dr. Bradley: Yeah absolutely, and this goes along the lines of when somebody’s in pain, they come in to see you, you’ve got to have options for people, so I think thinking of narcotic pain medicine as a solution is not probably what we need to be doing nowadays, so the opioid sparing pathway stems from the idea that there are other medicines out there that can help calm the pain pathways prior to surgery, so we actually give people medicines that are not narcotic prior to their surgery. We actually perform the operation with techniques that lower their narcotic needs, and in one year, we’ve been able to reduce the amount of narcotics that our total joint patients get 60%, so that’s pretty significant. We’re decreasing their need for it, and they still have great pain control. So now we’re applying that to other injuries, people that fall and break their shoulder, or their elbow, or their wrist, and really approaching pain differently, and to honest the real crux of it is educating patients about the pathway rather than having a quick fix narcotic, so there’s such a need. It’s a huge population health issue right now, and I think we’re proud to be trying to be at the forefront.
Bill: That is absolutely true, and we do need solutions for the opioid crisis and your results are amazing. Dr. Bradley, thank you so much for your time today. For more information, please visit southcountyhealth.org, that’s southcountyhealth.org. This is South County Health Talks from South County Health, I’m Bill Klaproth, thanks for listening.
Bill Klaproth (Host): Over the years, millions of Americans have undergone orthopedic surgery to repair and replace issues with shoulders, knees, hips, and more. Here to talk with us about orthopedic surgery is Dr. Michael Bradley, Chief of Orthopedic Surgery with the South County Health Orthopedics Center. Dr. Bradley, thanks for your time. So what are some of the most common issues that lead to someone needing orthopedic surgery?
Dr. Michael Bradley (Guest): Thanks for having me Bill. The growing population health issues and orthopedic surgery really stem around degeneration of the body. So whether that’s hip, knee, shoulder, some sort of degeneration, we link that to arthritis oftentimes, osteoarthritis is probably the major condition that we’re all facing nowadays. In the shoulder, that ends up being degeneration of the tendons or rotator cuff tendon disease, but again it follows a very similar path of linking to age and degeneration.
Bill: So it sounds like it’s mostly because of normal aging?
Dr. Bradley: Yeah, so that’s a great question, and yes there are some expected worsening with age, but I’ll be honest, the real true crux and the real effort that we need to place from a medical standpoint is into why are these things happening from other factors. We know age is one. We know obesity is one, especially in the United States, but there are other factors like genetics that don’t really tell us why one generation is getting arthritis much earlier than the previous generation. So I think some of it’s untold. We’re certainly providing some of the solutions, but it would be really nice to figure out why these things seem to be happening earlier and earlier.
Bill: That is a really good question. I was just wondering, are there people that have a higher risk for orthopedic issues?
Dr. Bradley: Yeah, just like markers that people are developing for different medical conditions, cancer, diabetes that we’re finding on genes, we’re actually finding markers on genes for osteoarthritis and the greatest illusion is to see their grandmother had arthritis of their hip or knee in their 90s, but then all the sudden the next generation it’s in their 80s, the next generation it’s in their 70s, and so there’s definitely a link to genetic component that we have not figured out yet, but we’ll be studying.
Bill: And that would be really good to understand, I would imagine, for preventative measures. So what is the most common surgery you perform?
Dr. Bradley: Yeah, so those three joints are the most common, so knee, hip, and shoulder, and probably in that order, and joint replacement surgery for the knee or the hip are very common procedures. I’ll give you some idea, but there’s about 700,000 total knee replacements done a year right now. That number will grow to 3.5 million by 2030, which is a short time away, so these are becoming more and more common procedures. They don’t look like they’re slowing down. Part of it, what we just mentioned, that people are getting arthritis earlier; part of it are the conditions are getting better, the procedures are getting better, so the willingness for someone to do that is changing, but also the population health statistics really are emerging. The crux of this is the age of surgery continues to slightly move down.
Bill: That’s interesting, and I imagine those three body areas, knee, hip, shoulder, those are the main big joints that we’re moving all the time, so is that why those are more susceptible to injury and degenerative aging?
Dr. Bradley: Yes, absolutely. The activity level on those three joints surpasses most of the other areas. Obviously the shoulder has the greatest range of motion. It doesn’t have the weightbearing characteristics of the knee or hip, but being the only joint that can move 180 degrees, there’s a lot of expectation.
Bill: And you were just talking about joint replacement. How have joint replacement procedures changed over the years, and specifically, can you tell us about the Mako robotic arm assisted surgeries you perform?
Dr. Bradley: Of course, I would say the actual materials that we use to replace joints has been pretty consistent since they started 60-70 years ago, but the refining of the actual shapes of the design, how they’re put in, and whether they use either a cement technique or not a cement technique is probably one of the major issues, and then the approach or the surgery to perform those, even though the materials have not changed, the surgery to perform those has changed a lot, so that’s the surgical approach, and then what we’re getting to is the precision with where the implants go, which is part of the computer navigation and the Mako robot assisted computer navigation system. The elements of putting these things in the exact right place for each subsequent person allows for, what we call, the longevity of the implant, meaning this will stay in somebody and work many years down the road in addition to being good right after surgery.
Bill: So because of that precision, I imagine the recovery process has got to be better than regular open surgery.
Dr. Bradley: Yeah, so this is a great question, and there’s no doubt that with the precision technology, you can perform at slightly more minimally invasive. We caution people. At the end of the day, we still have to get these implants into your body, so it’s not through microscopic incisions, but those incisions can be planned better, the procedure can take shorter amount of time, the blood loss is less, so there’s a lot of things that go into the surgical procedure that can benefit from having some element of precision technology.
Bill: And for someone considering surgery, what do they need to know?
Dr. Bradley: Yeah, so although we love to do this, and this is what we do all the time, to be honest the crux of our job, although performing it is a skill set that we work hard on, it’s actually choosing the right person. So most of the time we try nonoperative things because it’s the patients that really have tried everything else that still realize that they’re not going to be able to do what they want to do in life, and that’s different in every person that come to us and say, “I’m ready now.” And that part of saying I’m ready now buys them into the procedure, allows them to really research it wholeheartedly. If they think there are a lot of options and we are too often pushing surgery on people, that’s not a recipe for success. So believe or not, if somebody thinks they’re ready for surgery, I think coming to listen to all the options, whether they’re surgical or nonsurgical, and then trying some things that often times can get temporary relief or at least some relief and some of it is exercise related, some of it’s modifying activities and losing weight and things like that, and ultimately, I think we’re fairly honest with people. If there are no other options, there are no other nonsurgical options, these are things that are very common procedures, and if we do them well, and do them consistently, I think people will have great outcomes and that’s what we care most about.
Bill: Well, that makes sense, and with the opioid crisis, last question Dr. Bradley, can you talk about cofounding the opioid sparing pathway at South County Health?
Dr. Bradley: Yeah absolutely, and this goes along the lines of when somebody’s in pain, they come in to see you, you’ve got to have options for people, so I think thinking of narcotic pain medicine as a solution is not probably what we need to be doing nowadays, so the opioid sparing pathway stems from the idea that there are other medicines out there that can help calm the pain pathways prior to surgery, so we actually give people medicines that are not narcotic prior to their surgery. We actually perform the operation with techniques that lower their narcotic needs, and in one year, we’ve been able to reduce the amount of narcotics that our total joint patients get 60%, so that’s pretty significant. We’re decreasing their need for it, and they still have great pain control. So now we’re applying that to other injuries, people that fall and break their shoulder, or their elbow, or their wrist, and really approaching pain differently, and to honest the real crux of it is educating patients about the pathway rather than having a quick fix narcotic, so there’s such a need. It’s a huge population health issue right now, and I think we’re proud to be trying to be at the forefront.
Bill: That is absolutely true, and we do need solutions for the opioid crisis and your results are amazing. Dr. Bradley, thank you so much for your time today. For more information, please visit southcountyhealth.org, that’s southcountyhealth.org. This is South County Health Talks from South County Health, I’m Bill Klaproth, thanks for listening.