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Prakash Chandran (Host): Have you been told you need joint surgery but hoped you could put it off just a little longer? Well, you’re not alone. Many patients want relief from pain but are not ready to proceed with a major surgery even though there are things they may want to consider. I’m Prakash Chandran and in this episode of Healthy Takeout, we’ll be discussing total joint care and the risk of delaying surgery. I’m pleased to welcome Dr. Young-Ho Oh, an orthopedic surgeon at Harrington Healthcare. Dr. Oh, thanks so much for educating us today.

Young-Ho Oh, MD (Guest): Hi. It’s a pleasure to be here. Thank you for having me.

Host: Of course. Of course. So, I want to start at square one actually. Why is joint health so important in the first place?

Dr. Oh: That’s how we live our lives. Joints let us move, let us ambulate, they let us use our extremities to participate in activities of daily living.

Host: Yeah, that makes a lot of sense. So, my question is as we age and we play sports and these things, sometimes we may sustain an injury and I’m curious about when a patient is advised to have joint surgery; what leads up to that point? When is it that severe when surgery is needed?

Dr. Oh: Well joints wear down over time like anything else and we develop osteoarthritis. Certainly, people that had injuries to their joints are more susceptible to it but one of the biggest risk factors is family history and with arthritis; unfortunately, comes pain and with the pain it prevents us from doing the activities that we enjoy, and it can be something as simple as just walking pain-free which we as humans need to do. And with arthritis, our joints down and the bones starts rubbing on the bone instead of the smooth surface of the joints and we develop pain and ultimately, in order to relieve this pain; a joint replacement is recommended.

Host: So, that’s really interesting. You are saying that regardless of whether I’m playing sports or not or being rough on the joints; most of the pain that we see today actually comes from family history?

Dr. Oh: That is the biggest risk factor for having osteoarthritis. But anyone that’s had a joint injury to their knees or hip, or shoulders are more susceptible to osteoarthritis. It results unfortunately in the same diagnosis of having arthritis which is treated very similarly.

Host: Okay, so let’s say it gets to the point where a patient has that osteoarthritis, or you advise a joint replacement is necessary; I’m curious why is it vital to have the operation sooner than later?

Dr. Oh: Most people will know when they need the surgery and it’s predicated by how much pain they are in and it’s a major surgery and there’s recovery involved. The danger of waiting is our health. If it comes to the point where we are too unhealthy to have it; then it becomes not advisable to have such a major surgery. So, it can be better to do it when you are more healthy. However, it all depends on how much pain we are having and whether we can live with it or not.

Host: So, you mentioned something whether we can live with it or not and like I said just at the top of the episode; so many people just kind of – you are kind of amazed at the amount of pain that they can take. They are like you know what, I don’t need surgery. That pain in my knee I’m feeling, I’ll just kind of get used to it. And sometimes I see my friends and I’m like how are you surviving like this? what do you normally say to the patients? Is there a scale like between a one and a ten where you are saying you should – this will improve your quality of life?

Dr. Oh: Yeah, well in those cases, if they are at a ten out of ten pain; it’s probably advisable for them to have the surgery. But again, surgery is not risk free. So, it comes down to benefits and risks and at a point where it is that severe, sure the benefits of surgery would probably outweigh the risks at that time. It really is a patient preference of undergoing such a surgery. Some people will say they don’t have time for it. Some people can’t take the time off of work. Some people have had other friends or family members who have had a bad experience with it. So, this all plays into the decision making of delaying surgery.

Host: So, you talked a little bit about the time that it takes to go through surgery. What are the most common surgeries that you do and how long is the recovery process?

Dr. Oh: Well, total knee replacements are probably the most common joint replacements that we do. The second is total hip replacements and the third are total should replacements. The recovery time can be up to about six weeks of just laying low, staying at home and taking it easy. But it can take up to one full year for a full recovery and with that being the best you are going to be after such a surgery will be at one year.

Host: And that includes physical therapy and being proactive about speeding up the recovery. Is that right?

Dr. Oh: That’s correct. Physical therapy is a very essential part of the recovery from any type of joint replacement and if individuals are not attuned to that; it can really affect their outcome. So, just by doing the surgery itself, it’s not enough. In fact, the surgery itself actually can take about an hour and for a skilled orthopedic surgeon; it’s pretty common, pretty easy for us and actually very fun to tell you the truth. However, for the patient, it’s the amount of effort and time and energy they put into their rehab that really affects their outcome and how they are going to do.

Host: Yeah, I think that’s like one of the most important things that you’ve highlighted so far that it’s not just you get surgery and the problem goes away. It’s you get surgery and you are proactive with physical therapy and being mindful of everything that you are supposed to do to speed up that recovery. So, in addition to physical therapy, is there anything else that you recommend patients do to help speed it up?

Dr. Oh: Well, obviously, decreasing any risk factors you can. Being severely overweight can affect your outcome. Being a smoker can affect your outcome. Having just underlying medical issues which haven’t been addressed need to be optimized prior to surgical management. Being diabetic and not having your sugars under control can be a risk factor. And just having a positive attitude. I found that that works better than anything else that we can do for the patient.

Host: You’re saying that having a positive attitude will help increase your recovery time?

Dr. Oh: Absolutely. Without a doubt.

Host: That is so amazing. And so, one of the things that you just highlighted in addition to having a positive attitude is that diet and exercise and I know that diet and exercise or monitoring those can be tools to reverse many diseases and conditions. So, you are saying that this actually works the same when it comes to our joints. Is that correct?

Dr. Oh: Oh exactly. Even before you go through a joint replacement, the recommendation, 90% of what we can offer patients is something that they can do on their own and that’s diet and exercise. The right type of diet, the right types of foods and maintaining good weight and the right types of exercise depending on the joint that’s involved. Our joints were made to move and if you do focus on range of motion of the joints and nonimpact strengthening exercises, you will keep your joints healthy and feeling better and that’s also true after surgery as well. And then also, maintaining your nutrition, just having good nutrition especially having enough protein which is the building block of our body will help you heal much quicker after surgery as well.

Host: Yeah, so a couple of the things that you said here today that are important are that first of all, after you get surgery; you need to be proactive in getting that physical therapy and maintaining a positive attitude and then that diet and exercise which is something that you don’t really think about but our body is a system and like you said, proteins are the building blocks for our body and they help with joint recovery and is it also fair to say joint maintenance as well?

Dr. Oh: Oh yeah sure, absolutely. Exercise, our joints were made to move and if you don’t move your joints, you are going to lose them. That’s how I tell that to people. And people that have just mild osteoarthritis and have a little bit of pain; I tell them the most important thing to do is actually exercise their joints. Motion is good.

Host: And when you say exercise and movement; we are talking about on a daily basis, on a weekly basis? What do you primarily tell your patients?

Dr. Oh: I’m talking on a daily basis. Absolutely. Just focus on range of motion of any joint or the affected joint especially. Mobilization is key. It’s good for your back, it’s good for your lower joints, your upper extremities, your hands. It’s all your joints. Joints were made to move and if you don’t move them, you literally will lose them.

Host: Yes. Well Dr. Oh, thank you so much for helping us understand how important our joints are to our overall health. And it really sounds like the risk of delaying getting surgery when you need it, it just becomes harder over time is what I’m hearing from you so the best thing to do, try to maintain that diet and exercise, be proactive about your joint health and if something happens due to your family history or an injury, then go do something about it because with the advancements today, I’m sure that joint replacement like you said, someone skilled can do it in an hour and then it’s up to you to proactively heal. Is there anything else Dr. Oh, that you would like our audience to know before we wrap up?

Dr. Oh: I would say get your physician involved. Speak to your medical doctor first and if necessary, you can speak to a musculoskeletal specialist such as an orthopedic surgeon or a physical medicine and rehab doctor or a rheumatologist, anybody that specializes in joint care and it’s a ream approach and I think with that and the medical advances we can certainly what we see, keep you in the game and keep you moving and get you better.

Host: I love it. I love it. so, everyone for more information please visit www.harringtonhospital.org. Our guest today has been Dr. Young-Ho Oh. This is Healthy Takeout from Harrington Healthcare. I’m Prakash Chandran. Thank you so much for listening.