.

Hello and welcome to HealthLine this Tuesday evening.

I'm Jennifer Blomquist.

I have the privilege of hosting the show.

I know I have a lot of regular viewers out there.

So thank you so much to all of you for tuning in again.

We always appreciate that and maybe you're a newbie to our show and if you are, I just want to run through how this works.

If you're one of our regulars, I apologize you well you probably already know all this stuff but still a good reminder that we are live here in the program or here in the studio a live program and we welcome any questions that you may have.

We have an orthopedic surgeon with us tonight and we're going to be talking about joint replacement surgeries, maybe some things you didn't know about it.

Maybe you have an issue.

Maybe somebody you care about has an issue that you would like to ask a question about that so here are some options for getting those questions answered best way my favorite way is just call we keep the phone number at the bottom of the screen throughout the program it's (969) 27 two zero .

If you're outside of Fort Wayne it's still a toll free call as long as you dial 866- in front of it, call and you talk to a very nice call screener they will not throw you on the air.

I promise that they will talk to you and give you a couple of options.

>> You can ask your question live.

That's what I prefer if you feel comfortable doing that because our guest might need some more information from you and you guys can talk back and forth and that's a really great way to get your question answered.

You are welcome though just to relay your question to the call screener.

They'll let us know and then we'll get it answered for you and then of course just this past winter we started the texting line.

So that's a little different number (969) 27 three zero.

>> If you feel comfortable, put your name and where you're calling from or where you're texting from and I want to assure you that your phone number does remain private.

No one's going to see your phone number.

It does not come up on the screen.

So without further ado, I'm going to introduce you to our guest tonight.

He has never done a show with us so I'm excited to have him.

Dr.

Roy Small and you are an orthopedic surgeon so thank you so much for coming on.

Absolutely excited to be here.

Appreciate it.

>> People, we've we've had many of colleagues in your profession come before and I always like to preface it with just because you go to see an orthopedic surgeon doesn't mean they're going to do surgery.

I know the you know, the desire is to start as conservatively as possible with treatment.

So I don't know if you want somebody who's got issues are there other things you can exhaust before resorting to surgery when it comes to joint replacement?

>> Yeah, absolutely.

I mean we talk about this with every patient that comes to see me.

We always start with imaging to see sort of where the baseline is at, how bad is the arthritis, how bad is the joint for me particularly I focus on hip and knee replacements only so the majority of my patients I'm seeing do have hip or knee complaints.

So we often start with imaging .

It's usually if it's if it's bad arthritis it's quite obvious an x ray but if we need more imaging we'll then get an MRI and always we begin with conservative treatment options so start with activity modification sort of modifying how you're using your joint or the things you're doing to be active so it's less painful for you.

Antiinflammatory medications, weight loss of course steroid injections.

We also do hyaluronic acid injections so a whole slew of non-operative treatments that are fairly easy to do either at home or in our office.

>> And do you find that I mean does it we always I think associate arthritis and joint pain with an older individual if you see any commercial on TV for different products, you know, whether it's like one of these ointments, it's usually an older person.

But I feel like people are so active especially like my kids.

I feel like are much more their athlete.

They're they're athletic programs and things were so much more demanding and there year round.

>> So I'm wondering if you're seeing younger people, you know, with these issues.

Absolutely we do.

And you know, arthritis we know has a genetic component to it.

It often tends to run in families.

So we do see it in younger patients all the time.

Just routine osteoarthritis.

There's also a lot of other reasons we perform joint replacement so for other conditions, sometimes developmental conditions that people are born with that can require doing either a hip or knee replacement at a much younger age.

>> Now if you exhaust all the conservative values and surgery is looking like your best option, I was surprised I didn't realize that especially when it comes to the knees which I know that's one of your specialties that you can do a partial knee replacement I thought it was you just the whole thing.

>> So is this a new newer concept or it is personne replacement has actually been around for a long time.

Robotic assisted personnel replacements which I perform has not been around quite as long perhaps the last fifteen years or so and has really become mainstream over the last ten.

>> But it does allow really the knee joint is made up of three separate compartments.

You have the medial the inside compartment of the knee, the lateral or the outside and then the patella federal the kneecap joint as well and actually any one of those three joints can be replaced individually.

So some patients, for example, the most common is the inside compartment of the knee which is the most common place to develop arthritis.

>> We can actually just resurface the inside part of the knee which is done all robotically.

It's much less invasive than a full knee replacement.

You get to keep a lot of the ligaments and the inside of the knee the ACL stays which is normally removed for a full knee replacement.

So it's a faster recovery .

The motion is a little bit more natural and normal after that type of a surgery and you get back much quicker.

It's it's really around a six week recovery versus versus three months.

>> I was going to say the I've only personally know one person who had knee replacement and it's a it's a tough it is to recover from I mean that it was you know as an older gentleman but granted but still I mean it was he said he would never do it again after he was going to have his other one died.

>> He had some other health issues to which may have exacerbated it but yeah, that's something that you had to I would think kind of mentally prepare for .

>> Absolutely.

>> Now when you talk to the three different parts of the knee, is it possible that you know, you replace one and then maybe another section needs attention down the line or is that is that unusual?

>> It is possible and that's why it's picking the right candidate for partial knee replacement is very important because I tend to reserve those for patients that have very little to no arthritis and the other compartments if you have two compartments that are showing arthritis and it's often best to do a total knee do so the other thing you touched upon the robotic surgery and I wanted to talk about that I remember years ago doing a program with an OBGYN surgeon and there was definitely some hesitancy on his part about embracing the robotics.

I mean this is going back fifteen fifteen years ago probably.

But now it's you're hearing a lot more about it, you know and I feel like it's here in Fort Wayne .

So it's not you don't have to go to a bigger city to have it done.

But some people might be a little scared and think I don't what is this robotic surgery and how much control do you have as the surgeon over what happens?

>> Yeah, it's a great question and it's often a misconception to yeah.

>> So with the robotic platform or the type of robot that I use it really helps throughout the phase of care so so preoperatively I get CT scan of the hip knee and ankle when I'm doing a knee replacement surgery it allows me to create a three dimensional model of the knee that we can then plan out the surgery prior to the patient ever hitting the operating room then during surgery the robot as we call it it really is a guided saw tool that allows us to make very accurate, very precise bone cuts but it's all being performed manually.

>> So it's really all the robot does for us.

>> This helps us with the planning and then the execution of the actual bony resection and then in the case of the partial knees, it's actually a burr tool that that just kind of carves out the very specific area that fits perfectly with the implant but it does it with sub one millimeter accuracy which it's obviously hard to be that accurate any other way.

>> Yeah, I mean years ago I remember it was wasn't it just like if you had a knee replacement total knee replacement it was a scar all across.

Yeah.

So now it sounds like I mean is there even any stitching it's it's still it's still a fairly large incision on the front side of the knee for multiple reasons but a lot of times you know, especially with the Parshall's the work on the inside is a lot smaller but still at the totals it's it's still a big procedure, still an open procedure with the enhanced accuracy and objective measurements you can get from the actual platform, the robotic platform.

>> All right.

We're going to talk more about knee replacements and all kinds of joint replacement surgeries.

But I did want to remind you to call or text in a question again, it's (969) to seven to zero is the phone number.

If you want to call us or you can text which somebody did it's (969) 27 three zero.

We got a text from a guy named John from Fort Wayne .

>> So thank you, John.

Kind of you touched on this a little bit, Dr.

Small.

He's asking about you know, how long does it take to recover from total knee replacement surgery?

I don't know if you want to talk you said up to three months but you're not just sitting around for three months.

That's why they let you sit anymore.

No, no, no.

Is it is it you know, I guess I didn't think about this is it even outpatient?

>> It is.

It is OK, I don't know if you had to stay overnight or not for yeah no that's an excellent question.

So overall my my answer I give to that is it's around a three month recovery period.

That being said the majority of our surgeries are performed same day now so you come in, you have surgery, you go home the same day you're up walking right away after surgery.

>> It's hard to believe it is.

>> We begin physical therapy crutches though you start on a walker.

Oh, and then usually patients will progress from a walker to a cane within the first week or two depending on their comfort level and we start physical therapy between days three and five.

So that's when you're kind of getting started moving the knee again, getting the motion back a lot.

You know arthritis and stiffness often go hand in hand so the knees are tight stiff prior to surgery.

So we try our best to get that motion back relatively quickly.

The first two weeks I usually tell patients it's really all about rest.

You're resting the knee, icing the knee, keeping it elevated, keeping the swelling down weeks two through six are about getting that motion back and mobility back.

Getting back up on your feet the dynamics of your limb tend to change so for your brain to get used to that takes a little bit of time and then week six to eight through twelve we really focus on strengthening getting that quad strength back.

>> So most patients are really through the recovery period by three months and then really I say from three to six months is we kind of go above and beyond.

You get your knee back to being strong again, back to your normal gait cycle, back to your normal activity levels so that the full recovery the real answer would be honestly up to six months.

>> But I think in general you're doing most things by that 12 year mark and I you know, I've heard this another thing I've heard from some of your colleagues is people will come and say to the physician or surgeon they'll say so do I need the knee replacement and and the doctors usually saying you tell me you know, if it's I mean I guess if you have like a horrible injury or something that'll be a different story.

But you know, another one of your colleagues had said something like, you know, if you're to a point where it's, you know, hindering your everyday activities or you feel like you're missing out, that's kind of you know, the guideline he gives to patients.

But some people will tolerate the pain you they'll put it off.

>> It's they're all there anyway.

Is there any danger to putting it out?

There is so there it's all all great points and I say the same exact thing.

I mean a joint replacement procedure is an elective procedure and I say to every one of my patients a surgeon a surgeon should never tell you you need a joint replacement.

>> There are a few caveats to that cases where you're starting to get bone loss or the arthritis is so bad not only have you worn through the cartilage but now the bone is starting to change those cases.

>> I say maybe we start to think about it sooner rather than later.

The other case is if the knee is getting very stiff.

So if you're starting to not be able to straighten your knee really with it maybe a twenty or so degree lack of full extension then maybe we start thinking OK, might be time to consider a joint replacement.

>> But in general absolutely we try all the conservative nonsurgical measures first until those have failed then we consider joint replacement.

>> And can you talk about the kind hardware that would go in a person's knee?

I picked up one we had a doctor on this past year that brought some of the hardware.

>> Holy cow.

I mean it was like some heavy duty stuff.

Yeah, I was surprised by the weight but also I mean it's solid so I mean in general can you expect to just need that kind of surgery once even if you're a younger person?

Could that last forever or maybe for your lifetime?

>> I guess right.

So in general it's different for the hip or the knee but in thirty years our data tells us that the survivorship is excellent.

>> It's more than 90 percent for hip and knee replacements.

So for the vast, vast majority of people you have one joint replacement procedure and it's it you're done for life as far as the implants go.

They are they are they have some weight to them.

They're no doubt it's a metallic implant.

We have we have much we have newer materials now newer implants and press fit implants that don't utilize cement.

They're actually sort of weg fit or press fit into the bone and then your own bone can go on to them.

>> Those are actually quite a bit lighter as most of them are made of titanium alloy but in general there is some weight to the implants.

>> Yeah yeah.

So yeah you feel like you have to go on a diet after surgery but but you know like you kind of touched on that too.

There are things I have also met people that probably would have were on the road to needing knee replacement but they just that was kind of like being in pain and uncomfortable.

That was kind of what they needed to push them into losing weight and getting more active.

>> And it's amazing some of the just how much better you feel and how much it can help you physically.

So I don't know have you ever met any patients that have been successful in avoiding surgery just absolutely.

>> Yeah, absolutely.

I have I mean especially if you're kind of in that category where it's moderate to severe and it's still somewhat tolerable.

>> It's not exactly reversible but you can slow the progression.

Yeah, these these activity modifications, weight loss, physical therapy injections I mean I've had patients five years down the road and still with their native parts which I think is always the best way if you can.

>> Sure.

And this is a you know, this is a great time of year to go on a diet really there's so much good I mean there's fruit and vegetable stands around and produces so much better and I and the weather you know I mean you can get out walk around and not freeze to death so you know, it's a good time a good time of year to start an exercise program.

>> Maybe I will even do that.

So you know, can we talk about a hip replacement too?

>> Because we've we've done some programs on that.

I cannot believe that because hip replacement seems like a big deal to me and I'm shocked that those patients are out of bed at like that that day.

>> Is that ever done outpatient or is that still at least a one night hospital?

No.

90 especially with the entire approach hip replacements 90 percent of my patients are out same day of walking the same day in general the recovery is a little bit easier after a hip replacement than any replacement.

>> There's a few reasons for that.

But similarly the same day procedure you said anterior which means the front so did they used to go in in the back posterior.

>> Exactly.

So so really multiple ways to get into the hip.

The two most common in the United States today are the anti approach which is through the front part of the thigh and then the posture approach which is more from the side.

It's been somewhat of a paradigm shift in orthopedic surgery over the past ten or so years to our last poll at the hip and knee replacement annual meeting.

The last poll showed that more than 50 percent of the audience was performing the surgery from the front so and that's the first time that that's ever been it started around 10 years ago is only about 10 percent of the hip replacement surgeries.

>> So it really has been a drastic shift.

Yeah, and that is something you can do the robotic surgery with as well very similarly to different types of technology in the hip side robotics and navigation which is getting into the weeds a little bit.

But the main difference would be that the robotics uses big arm that I was talking about to help perform the bony resections navigation which is the technology that I utilize currently is more x ray based.

So the whole surgery is done under fluoroscopy or during surgery x ray and it gives us sort of exact measurements of where the components are going, the leg length, the offset different numbers we look at that are very important for hip stability all done via x ray.

So it's all sort of multiple screens and an x ray machine and then the rest of the hip replacement is done free hand.

>> So for those patients, you know, how many months would they expect to be doing physical therapy and recover?

I mean what did you say with a knee replacement?

Is it day three through five?

You start physical therapy exactly with hip replacements, especially the direct anterior approach.

>> I actually routinely do not use therapy after hip replacement surgery.

>> I know that it's usually not necessary the first couple of weeks sort of similar to the knee I say just rest not a ton of walking.

>> I keep getting up and moving to get the blood flowing but really weeks two through six you're kind of recovering on your own and then after week six I in general hip replacement is about a six week recovery .

So usually after week six I get some rays in the office, make sure the implants are looking OK and then I know no restrictions whatever whatever's comfortable for you to do and well you're welcome to do it.

>> That's that's amazing because that I and I realize the knee is a pretty big deal but hip as well.

I mean it's holding on to a lot of weight bearing area of the body for sure.

>> So do we have listen I know we're down to probably about five minutes left in the show but that is more than enough time to take questions.

Please give us a call (969) to seven to zero also you could text we just got another text and somebody can get to that question two nine six nine two seven three zero.

So I have never heard of this doctor small but somebody and from Anna from Fort Wayne is asking have you ever heard of is it Jiffy is that OK?

I couldn't see them a word a jiffy knee replacement.

>> I have never heard of that but I have and that's an excellent question.

We actually get a lot of questions on this one.

The knee replacement they've done an excellent job with marketing.

It's so a lot of patients have heard about it.

>> It really is a very similar knee replacement in terms of how the knee implant goes in the type of knee implants that are utilized, the recovery protocol recovery period all very, very similar really what's unique about the sort of gifty knee replacement is the approach that's utilized so they promote a quad sparing approach to the knee which can be performed in any knee replacement.

They routinely perform the quad sparing approach and I also with my partial knee replacements all get the quad very approach.

>> So in general the when we look at the literature it seems like about a four to five a faster recovery which can be beneficial in some cases but there can be some drawbacks to that as well.

Is that something I guess they would just have to consult with their with a surgeon I would you say is becoming commonplace ?

>> It is it is becoming common.

I get that question a couple of times a day.

Oh yeah.

I must have missed that infomercial or something.

>> You'll see that along the way.

So all right.

We did get another text question I please I apologize if I'm not pronouncing that correctly.

I think it was baize from Fort Wayne .

Can can you go back to sports after having a knee replacement?

I'm curious to hear that question.

>> The first question really that I got the answer is absolutely yes.

You can get back to sports after knee replacement.

I encourage it actually I think we do knee replacements for a reason to get people back to doing what they like to do.

So if you have something you enjoy doing, whether it's pickleball or downhill skiing, downhill skiing, water ski that are very active in the gym so absolute you can particularly after the partial knees as well.

I mean after personne replacement's I don't even really talk about restrictions so you can do whatever you want on a partial knee replacement.

>> Wow.

that is amazing.

We have a few more questions a few more minutes left I should say.

So if you have another question ,feel free to call or text in real quickly.

But I did want to ask you especially one thing I've talked to some of your colleagues is about being a parent of six children sports is not just you know, it's not just at the local park district like I did for six weeks.

You play softball, you know, and they don't play softball until next spring.

It's if you want to do a sport and you want to play at a high school level, you've got to do it year round and it is it's hard especially when you get to the high school level being a multisport athlete is nearly impossible.

There are some kids who pull it off but I just have to think that when I see these kids are constantly I mean they're working out hard.

They're at their practices.

It concerns me as a parent from an orthopedic standpoint and if they get arthritis and joints like when they get to college, the college age, are they not going to feel good?

>> I don't know if you share that concern.

If you see a lot of cases like is true the majority of the times where sports or physical activity would lead to arthritis is often after an injury.

I mean our bodies are very resilient.

The ligaments are set up and created to sort of protect the knee and and to have the motion be a certain way and to protect the cartilage.

But when that goes awry is often after an injury.

So they haven't shown you know, there's been some studies looking at single sport athletes that maybe have a slightly higher increased risk of injury secondary to repetitive motions that they're going through.

But in general I always encourage physical activity.

I always encourage sports participation.

>> I think it's really it's protective for your joints if anything.

OK, good to know.

>> Maybe I should worry less.

I'm going to try and squeeze in one more quick question.

So John from Fort Wayne I don't know if it is the same job but if it is hey again he's wanting to know is stem cell therapy a good alternative to hip replacement?

>> Another great question that I get these are tonight.

Yeah, STEM cell therapy.

>> Unfortunately there is not good literature to support stem cells.

There is a lot of financial money and studies going on in this field but nothing that we have now that can replace cartilage and I think that's the most important thing once the cartilage is lost we don't have any way to really put it back on or regrow it pre pre arthritic disease potentially there's some new things coming out that that could help slow the progression of arthritis or or reduce the inflammation within the joint that can help pain.

But unfortunately with the stem cells we're not there yet.

>> Yeah, but hopefully someday we've had it we've had a lot of people and all different specialties.

We'll call in and ask about stem cells.

I mean like you said, there is a lot of research going on and it's amazing to see that in five to ten years how things can change.

>> So stay tuned.

Come back sooner than five or ten years.

I would love to have you back on.

So again, this is Dr.

Roy Small.

Thank you so much for joining us this evening.

Really appreciate it so and so many thanks to all of you.

We have such great viewers.

You guys come up with great questions.

I really appreciate that.

So take care.

We are going to have another HealthLine here next week.

I don't know the topic yet but I will find out it'll be it'll be a great show.

We have wonderful guests so take care.

Enjoy the rest of this week and I'll see you back here next Tuesday night.

Bye