Dr. David Landy discusses everything you need to know about joint replacement.
Transcription:
Joey Wahler (Host): If you're suffering from knee or hip pain, there is a remedy. So, we're discussing joint replacement surgery. Our guest, Dr. David Landy. He's an orthopedic surgeon with UK HealthCare Orthopedic Surgery and Sports Medicine. This is UK HealthCast, a podcast presented by UK HealthCare. Thanks for listening. I'm Joey Wahler. Hi, Dr. Landy. Thanks for joining us.
David Landy, PhD: Hi. Thank you for having me.
Host: So first, what are the most common types of joint replacement?
David Landy, PhD: That's a great question. So every year in America, there's about a million patients who will have a knee replacement, and there are about a half a million hip replacements. There are other joints that can be replaced, such as the shoulder, elbow, ankle, but the most commonly replaced joints tend to be the knee and hip.
Host: When we talk about those huge numbers of people that are having this done, is that typically caused just by age, wear and tear, or can there be other factors as well?
David Landy, PhD: Yeah, that's a great question. The majority of patients who are going to be having hip or knee replacement are going to be having that for sort of just run-of-the-mill degenerative arthritis, also known as osteoarthritis. There can be other indications such as osteonecrosis where some of the bone in the joint dies. Additionally, sometimes for fracture management, they'll be a hip or knee replacement.
Host: Gotcha. And so, what are some of the typical symptoms indicating that joint replacement may in fact be needed?
David Landy, PhD: Yes, it's a very patient-specific decision-making, but has a lot to do with sort of how severe a patient's symptoms are and the extent to which they're sort of limiting someone's quality of life as well as the patient having failed other sort of less invasive or less aggressive options. So, you'd only want to proceed do a hip or knee replacement if sort of other less risky things weren't providing adequate quality of life. And some of those other options include physical therapy, maintaining a healthy weight, occasionally assist device use if that's reasonable to the patient, something like a cane or a walker. And then, sometimes injections can be considered as presurgical sort of intervention.
Host: And so, medication would be an option as well.
David Landy, PhD: Yes. Tylenol, acetaminophen or even non-steroidal anti-inflammatories, for some patients can be an option. Though all of these things, even though they're maybe non-operative, can carry their own risk as well.
Host: Sure. You kind of touched on this. When you advise a patient in this situation, what considerations do you go over with them that they should contemplate before deciding whether or not to get surgery?
David Landy, PhD: The first one is how much is this bothering you, right? Because just because somebody has severe radiographic changes, if their quality of life is still very good and they're not really bothered on a daily basis, they may not be at the point where they're ready for a hip or knee replacement. It's also important to consider the patient's risk profile. Some patients are going to be really low risk of a complication, others may be a little higher risk. And when you start to think about patients who may be higher risk of a complication, you really want to make sure that this makes sense for them from a benefit perspective. You know, a common question we'll get asked, "Oh, am I too old for a hip or knee replacement?" The answer to that's pretty easy, and the answer is no. You might be too sick for it or there might be other factors, but it's rare that there's just one thing that would make somebody a poor candidate for the surgery.
Host: And when you just mentioned that some are at a greater risk, is it typically those that have a pre-existing condition besides the joint pain that would be most at risk for getting this done?
David Landy, PhD: Yeah. The complication we worry sort of the most about with hip and knee replacement is an infection. And so, some of the risk factors that increase the patient's risk of infection are smoking, poorly controlled diabetes, severe obesity, needing to take medications that alter their immune system, which is sort of increasingly commonly seen for rheumatologic and other conditions and then, patients who are on dialysis or have really bad liver disease.
Host: Understood. So that being said, let's have you walk us through the process if surgery is needed. So at UK HealthCare, what can patients expect leading up to surgery once that's been determined?
David Landy, PhD: So before surgery, you would meet either virtually or in person with our anesthesia group to go over sort of what that's going to look like from an anesthesia perspective. There's a couple options, ranging from sort of neuroaxial anesthesia where patients get a spinal and some light sedation up to general anesthesia, and that's sort of a patient-specific decision with anesthesia what's going to be best for them. They'll also get some pre-operative labs to make sure there aren't any surprises and there's not anything we can do to optimize the patient before surgery to make them even lower risk of a complication. They'll meet with our nurse and nurse coordinator and scheduler to go over a packet of information about sort of what to expect the day of surgery and the few days after surgery.
Then, you know, once kind of all that's set up and they're optimized and they're ready and they've got a plan with anesthesia, they'll show up on the day of surgery. They'll get checked in, get to a pre-operative room. The nurse will help get an IV in them and start getting them ready for surgery. They'll see me or one of my partners, whoever's doing their surgery. They'll see the anesthesiologist again. And then, they'll head back to the OR, they'll have the surgery. Surgery usually takes about an hour and a half to two hours, and then they will get to the recovery room and they should expect to work with physical therapy later on that morning. And then, some patients will actually go home the same day. Other patients, especially patients who are older or have a little bit of medical comorbidity issues, we'll usually keep the night. And then, they'll work with therapy one more time the next day and often go home the day after surgery.
Host: Wow. So, they'll actually start working with physical therapy almost immediately.
David Landy, PhD: Almost immediately. Yeah. As soon as they're recovered from anesthesia, we want to get them up and get them moving. If you rewind 20, 30 years ago, that was not the case. And when we think about a lot of the advancements we've made with joint replacement, maybe a little bit of it has to do with the surgery or the implants, but actually probably the majority of it has to do with all of the optimization work and all of the care that surrounds the surgery in the perioperative period and being more organized about getting people up the same day and started with therapy and not letting them just sit around for two or three days and how we control pain and things like that.
Host: And then in terms of recovery, give us an idea, please, what's the timetable like and what does that involve? And also how does UK HealthCare help make that as smooth as possible, because that's going to take some work on the patient's part, right?
David Landy, PhD: Yeah, it does. Hip replacement patients usually recover a little quicker, a little more smoothly. It's largely about just sort of getting back to walking, maybe a little bit of physical therapy to work on some specific muscle strengthening and sort of getting rid of any kind of gait abnormalities they may have developed due to their arthritis over the years leading up to surgery, but that's usually a pretty smooth process. Usually, people are getting around and doing pretty well by two to four weeks and, by six to eight weeks, are pretty recovered.
Knee replacement, there's just tend to be a little bit more pain, a little bit more swelling, a little slower recovery, slightly less predictable. Really important that patients don't let the knee get too stiff. And so, they'll be working with physical therapy, usually outpatient physical therapy the week after surgery, already starting to work on making sure they maintain their range of motion and then, walking and things like that. But really, for the knee replacement, the recovery's more, you know, in the six-week to three-month range, especially for younger patients who are looking to get back to sort of a very high level of activity. Sometimes it's more like three months when they've really gotten their quadricep muscles strengthened, their thigh back, and are really starting to feel super comfortable on the knee.
Host: From your experience doing so many of these, for you and your team, what's the key at UK HealthCare in making that transition, that recovery as smooth as possible.
David Landy, PhD: I think the key is setting up the expectations preoperatively. Patient selection is very important and that's why it's such an individualized decision, right? There will be people who have bad-looking X-rays, but they're really not that bothered. And so if someone's doing really well before surgery, it's a little tougher to make that person a lot better. And then also, making sure people understand this isn't going to be a two-week recovery, right? You're going to need help, support, and things like that after surgery, and that you've really waited and made sure you've organized your life around this a little bit, so you can be focused on your recovery, especially in the first two to six weeks after a knee replacement
Host: Couple other things. In terms of the benefit afterwards, which of course is what this is all about for the patient, when we talk about quality of life, what are a few things they're able to get back to doing well that make this all worthwhile?
David Landy, PhD: So, the thing that is most predictable that almost everyone gets back to is painless walking. We kind of take it for granted if you don't have severe and sort of debilitating arthritis, but just the ability to go and walk around with your family and go do things and not be limited by pain after you've walked a hundred feet is super valuable to folks. Many patients will get back obviously to much more advanced activities, you know, doubles tennis, little bit of light hiking and things like that. But the biggest thing usually is just the pain relief with walking is a huge benefit to folks and not having sort of pain at night or pain if you do the wrong thing, trying to get out of a chair or something like that.
Host: Doc, I noticed he said doubles tennis. Singles, I take it would take a little bit longer to get back to, yes?
David Landy, PhD: It takes a little longer to get back to. Also, I mean, some of our patients certainly are a little bit on the younger side and are very active headed into surgery. But when you think about the people who are getting hip and knee replacements, some are going to play single tennis, but a lot of them were probably playing doubles tennis before.
Host: Gotcha. And of course, pickleball is now a big option for people, especially those in the older age range, right?
David Landy, PhD: It is. And yes, you can definitely get back to pickleball after a hip or knee replacement.
Host: Excellent. And so finally, to sum this all up for us, please, if joint replacement is needed, why would you say UK HealthCare Orthopedic Surgery and Sports Medicine is the best place to go? What do you really want to let people know? You guys do particularly well in this instance.
David Landy, PhD: I think we do a great job of taking care of somewhat complex patients and helping them make the right decision for them. I think we do a great job of if surgery's not the right decision for someone, helping them realize that and getting them directed to treatments that may be more appropriate. And then for patients where surgery is the right decision, helping sort of guide them through that process.
Host: Excellent. Well, folks, we trust you are now more familiar with joint replacement or, as the doctor mentioned, other possible options as well. Dr. David Landy, thanks so much again.
David Landy, PhD: Thank you.
Host: And for more information, please visit ukhealthcare.com. Again, that's ukhealthcare.com. Now, if you found this podcast helpful, please share it on your social media, and thanks again for listening to UK HealthCast, a podcast from UK HealthCare. Hoping your health is good health, I'm Joey Wahler.
Joey Wahler (Host): If you're suffering from knee or hip pain, there is a remedy. So, we're discussing joint replacement surgery. Our guest, Dr. David Landy. He's an orthopedic surgeon with UK HealthCare Orthopedic Surgery and Sports Medicine. This is UK HealthCast, a podcast presented by UK HealthCare. Thanks for listening. I'm Joey Wahler. Hi, Dr. Landy. Thanks for joining us.
David Landy, PhD: Hi. Thank you for having me.
Host: So first, what are the most common types of joint replacement?
David Landy, PhD: That's a great question. So every year in America, there's about a million patients who will have a knee replacement, and there are about a half a million hip replacements. There are other joints that can be replaced, such as the shoulder, elbow, ankle, but the most commonly replaced joints tend to be the knee and hip.
Host: When we talk about those huge numbers of people that are having this done, is that typically caused just by age, wear and tear, or can there be other factors as well?
David Landy, PhD: Yeah, that's a great question. The majority of patients who are going to be having hip or knee replacement are going to be having that for sort of just run-of-the-mill degenerative arthritis, also known as osteoarthritis. There can be other indications such as osteonecrosis where some of the bone in the joint dies. Additionally, sometimes for fracture management, they'll be a hip or knee replacement.
Host: Gotcha. And so, what are some of the typical symptoms indicating that joint replacement may in fact be needed?
David Landy, PhD: Yes, it's a very patient-specific decision-making, but has a lot to do with sort of how severe a patient's symptoms are and the extent to which they're sort of limiting someone's quality of life as well as the patient having failed other sort of less invasive or less aggressive options. So, you'd only want to proceed do a hip or knee replacement if sort of other less risky things weren't providing adequate quality of life. And some of those other options include physical therapy, maintaining a healthy weight, occasionally assist device use if that's reasonable to the patient, something like a cane or a walker. And then, sometimes injections can be considered as presurgical sort of intervention.
Host: And so, medication would be an option as well.
David Landy, PhD: Yes. Tylenol, acetaminophen or even non-steroidal anti-inflammatories, for some patients can be an option. Though all of these things, even though they're maybe non-operative, can carry their own risk as well.
Host: Sure. You kind of touched on this. When you advise a patient in this situation, what considerations do you go over with them that they should contemplate before deciding whether or not to get surgery?
David Landy, PhD: The first one is how much is this bothering you, right? Because just because somebody has severe radiographic changes, if their quality of life is still very good and they're not really bothered on a daily basis, they may not be at the point where they're ready for a hip or knee replacement. It's also important to consider the patient's risk profile. Some patients are going to be really low risk of a complication, others may be a little higher risk. And when you start to think about patients who may be higher risk of a complication, you really want to make sure that this makes sense for them from a benefit perspective. You know, a common question we'll get asked, "Oh, am I too old for a hip or knee replacement?" The answer to that's pretty easy, and the answer is no. You might be too sick for it or there might be other factors, but it's rare that there's just one thing that would make somebody a poor candidate for the surgery.
Host: And when you just mentioned that some are at a greater risk, is it typically those that have a pre-existing condition besides the joint pain that would be most at risk for getting this done?
David Landy, PhD: Yeah. The complication we worry sort of the most about with hip and knee replacement is an infection. And so, some of the risk factors that increase the patient's risk of infection are smoking, poorly controlled diabetes, severe obesity, needing to take medications that alter their immune system, which is sort of increasingly commonly seen for rheumatologic and other conditions and then, patients who are on dialysis or have really bad liver disease.
Host: Understood. So that being said, let's have you walk us through the process if surgery is needed. So at UK HealthCare, what can patients expect leading up to surgery once that's been determined?
David Landy, PhD: So before surgery, you would meet either virtually or in person with our anesthesia group to go over sort of what that's going to look like from an anesthesia perspective. There's a couple options, ranging from sort of neuroaxial anesthesia where patients get a spinal and some light sedation up to general anesthesia, and that's sort of a patient-specific decision with anesthesia what's going to be best for them. They'll also get some pre-operative labs to make sure there aren't any surprises and there's not anything we can do to optimize the patient before surgery to make them even lower risk of a complication. They'll meet with our nurse and nurse coordinator and scheduler to go over a packet of information about sort of what to expect the day of surgery and the few days after surgery.
Then, you know, once kind of all that's set up and they're optimized and they're ready and they've got a plan with anesthesia, they'll show up on the day of surgery. They'll get checked in, get to a pre-operative room. The nurse will help get an IV in them and start getting them ready for surgery. They'll see me or one of my partners, whoever's doing their surgery. They'll see the anesthesiologist again. And then, they'll head back to the OR, they'll have the surgery. Surgery usually takes about an hour and a half to two hours, and then they will get to the recovery room and they should expect to work with physical therapy later on that morning. And then, some patients will actually go home the same day. Other patients, especially patients who are older or have a little bit of medical comorbidity issues, we'll usually keep the night. And then, they'll work with therapy one more time the next day and often go home the day after surgery.
Host: Wow. So, they'll actually start working with physical therapy almost immediately.
David Landy, PhD: Almost immediately. Yeah. As soon as they're recovered from anesthesia, we want to get them up and get them moving. If you rewind 20, 30 years ago, that was not the case. And when we think about a lot of the advancements we've made with joint replacement, maybe a little bit of it has to do with the surgery or the implants, but actually probably the majority of it has to do with all of the optimization work and all of the care that surrounds the surgery in the perioperative period and being more organized about getting people up the same day and started with therapy and not letting them just sit around for two or three days and how we control pain and things like that.
Host: And then in terms of recovery, give us an idea, please, what's the timetable like and what does that involve? And also how does UK HealthCare help make that as smooth as possible, because that's going to take some work on the patient's part, right?
David Landy, PhD: Yeah, it does. Hip replacement patients usually recover a little quicker, a little more smoothly. It's largely about just sort of getting back to walking, maybe a little bit of physical therapy to work on some specific muscle strengthening and sort of getting rid of any kind of gait abnormalities they may have developed due to their arthritis over the years leading up to surgery, but that's usually a pretty smooth process. Usually, people are getting around and doing pretty well by two to four weeks and, by six to eight weeks, are pretty recovered.
Knee replacement, there's just tend to be a little bit more pain, a little bit more swelling, a little slower recovery, slightly less predictable. Really important that patients don't let the knee get too stiff. And so, they'll be working with physical therapy, usually outpatient physical therapy the week after surgery, already starting to work on making sure they maintain their range of motion and then, walking and things like that. But really, for the knee replacement, the recovery's more, you know, in the six-week to three-month range, especially for younger patients who are looking to get back to sort of a very high level of activity. Sometimes it's more like three months when they've really gotten their quadricep muscles strengthened, their thigh back, and are really starting to feel super comfortable on the knee.
Host: From your experience doing so many of these, for you and your team, what's the key at UK HealthCare in making that transition, that recovery as smooth as possible.
David Landy, PhD: I think the key is setting up the expectations preoperatively. Patient selection is very important and that's why it's such an individualized decision, right? There will be people who have bad-looking X-rays, but they're really not that bothered. And so if someone's doing really well before surgery, it's a little tougher to make that person a lot better. And then also, making sure people understand this isn't going to be a two-week recovery, right? You're going to need help, support, and things like that after surgery, and that you've really waited and made sure you've organized your life around this a little bit, so you can be focused on your recovery, especially in the first two to six weeks after a knee replacement
Host: Couple other things. In terms of the benefit afterwards, which of course is what this is all about for the patient, when we talk about quality of life, what are a few things they're able to get back to doing well that make this all worthwhile?
David Landy, PhD: So, the thing that is most predictable that almost everyone gets back to is painless walking. We kind of take it for granted if you don't have severe and sort of debilitating arthritis, but just the ability to go and walk around with your family and go do things and not be limited by pain after you've walked a hundred feet is super valuable to folks. Many patients will get back obviously to much more advanced activities, you know, doubles tennis, little bit of light hiking and things like that. But the biggest thing usually is just the pain relief with walking is a huge benefit to folks and not having sort of pain at night or pain if you do the wrong thing, trying to get out of a chair or something like that.
Host: Doc, I noticed he said doubles tennis. Singles, I take it would take a little bit longer to get back to, yes?
David Landy, PhD: It takes a little longer to get back to. Also, I mean, some of our patients certainly are a little bit on the younger side and are very active headed into surgery. But when you think about the people who are getting hip and knee replacements, some are going to play single tennis, but a lot of them were probably playing doubles tennis before.
Host: Gotcha. And of course, pickleball is now a big option for people, especially those in the older age range, right?
David Landy, PhD: It is. And yes, you can definitely get back to pickleball after a hip or knee replacement.
Host: Excellent. And so finally, to sum this all up for us, please, if joint replacement is needed, why would you say UK HealthCare Orthopedic Surgery and Sports Medicine is the best place to go? What do you really want to let people know? You guys do particularly well in this instance.
David Landy, PhD: I think we do a great job of taking care of somewhat complex patients and helping them make the right decision for them. I think we do a great job of if surgery's not the right decision for someone, helping them realize that and getting them directed to treatments that may be more appropriate. And then for patients where surgery is the right decision, helping sort of guide them through that process.
Host: Excellent. Well, folks, we trust you are now more familiar with joint replacement or, as the doctor mentioned, other possible options as well. Dr. David Landy, thanks so much again.
David Landy, PhD: Thank you.
Host: And for more information, please visit ukhealthcare.com. Again, that's ukhealthcare.com. Now, if you found this podcast helpful, please share it on your social media, and thanks again for listening to UK HealthCast, a podcast from UK HealthCare. Hoping your health is good health, I'm Joey Wahler.
