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New Approaches to Hip and Knee Replacements

Learn about the latest advances in hip and knee replacements. Topics include why replacements are necessary, benefits of new techniques, recovery, the ability to resume an active lifestyle, and more. In this episode, you will hear from Matthew Sloan, MD, an orthopedic surgeon with Orthopedic Affiliates in Concord, MA. Dr. Sloan specializes in using the latest techniques for hip and knee replacement surgeries.
New Approaches to Hip and Knee Replacements
Featured Speaker:
Matthew Sloan, MD
Matthew Sloan, MD is an Orthopedic Surgeon. 

Learn more about Matthew Sloan, MD
Transcription:

Scott Webb (Host): Hip and knee replacements are much more common today than they used to be. And between minimally invasive procedures, faster recovery times and improved quality of life for patients; joint replacement surgery has a lot of upsides. And joining me today to tell us all about these surgeries and the benefits to patients is Dr. Matthew Sloan. He's an Orthopedic Surgeon with Emerson and a budding Tik Tok star. This is the Health Works Here, podcast from Emerson Hospital. I'm Scott Webb. So, Dr. Sloan, so great to have your time today. We're going to talk about hip and knee replacements, very common procedures these days, but a lot that folks may want to know, lots of questions they may have, and it's great to have an expert on, so as we get rolling here, why would someone need a hip or knee replacement?

Matthew Sloan, MD (Guest): The most common reason for hip and knee replacement is what we call primary osteoarthritis or wear and tear of the cartilage in the hip or knee joint. And we often don't know why this process happens for some people and not for others or why some people get mild arthritis that doesn't progress and others get arthritis that rapidly progresses from mild to severe over a short period of time, like a few months.

And then other people require these procedures for systemic conditions, things called rheumatoid arthritis or other inflammatory conditions. And other people have a history of trauma around the joint and may have had prior surgery that progresses to what we call post-traumatic arthritis.

But, having arthritis, which we diagnose with an x-ray is only half the story. The more important part are the symptoms that the patient experiences. So, for example, you could have grade four or what people call bone on bone arthritis on an x-ray, but if it's not causing you pain or limiting your activities, you don't need a joint replacement.

And you may never need one, but if you have advanced arthritis, you're a candidate for joint replacement, and then if you have symptoms that limit your quality of life, despite treatment with medications, therapy, weight loss, injections, or other non-surgical treatments, then joint replacement is the definitive way to cure arthritis.

Host: Yeah, it sure seems like it is. And I know that things have changed a lot over the years. I remember, working with a guy when I was younger and he had a hip replacement and this scar from his hip replacement, I swear Doctor went from like, just under his armpit all the way down practically to his knee. It was, I mean, grotesque maybe is the word that I want to use. And I know it's so much better, so much more, minimally invasive. The scarring is better. The recovery is better. So when I have you go through, like, what are some of the new approaches to hip and knee replacement?

Matthew Sloan, MD (Guest): For hip replacement, one of the approaches that has come into increasing use over the past couple of decades is something called the anterior hip replacement. This is a type of hip replacement where the incision for the surgery is made more over the front or the anterior part of the thigh rather than the side, which is known as the lateral part or the back part known as the posterior part of the thigh.

There are several benefits of this approach for the patient and the surgeon. So for the patient, there's a very low rate of hip dislocation after surgery, which is a rare, but very problematic complication of a hip replacement. And in addition, there are several studies that have demonstrated faster recovery times after an anterior hip replacement, lower rates of reported pain with less use of narcotic pain medications after surgery and less muscle damage.

This is likely due to the fact that the approach uses something called an inter muscular plane, meaning instead of spreading through a muscle, the access to the hip joint, two different muscles are simply spread apart. For the surgeon, the benefits of being able to use a special table that positions the leg for us and easy use of x-ray during the procedure to confirm that all the implants are the optimal size and in the appropriate position before the case is finished.

And so those are the reasons I prefer anterior hip approach for my non-complex hip replacement patients. However, there's benefits and drawbacks to all hip approaches. And if there was one perfect approach, all surgeons would use that approach. And then, on the knee replacement side, there's a number of things we're doing as well.

So for knee replacement, some of the new approaches include partial knee replacement, where a patient with arthritis in one part of the knee can have only part of the knee replaced, allowing for maintenance of all the ligamentous structures of the knee, including the ACL and the PCL, which gets removed during some total knee replacements. This allows for a more natural feeling knee than total knee replacement and higher patient satisfaction. And then there's a lot of modern technology in knee replacement, such as things called cementless knees, which don't require the use of bone cement to be fixed in place, custom knees, which are built to match a patient's anatomy based on the CT scan and robotic assisted joint replacement, which uses robotic guidance to assist with the cuts and confirm ligamentous tensioning when placing a knee replacement.

Host: Yeah, it sounds like a lot of great benefits, both for the surgeons, patients and so on. And I think one of the things that scares people off a little bit, or has them sort of allowing their quality of life to suffer if you will, and not seeing a specialist, not considering replacements is the recovery, that they've heard horror stories about the recovery. The PT can be grueling and so on. I want to have you take folks through that. What is the general recovery time? When can folks get back to living their lives, doing things they were doing before, and just generally assure them that it's not as bad, maybe as they've heard.

Dr. Sloan: Yeah, this is what patients ask me the most about when we're talking about joint replacement, but, the short answer is recovery varies for everyone. The biggest factor for recovery is the patient's functional level prior to surgery. For folks who are managing their arthritis without an assistive device, like a cane, crutch or a walker before surgery, and they're otherwise in good physical shape, they may only need a cane or a crutch for a few days after surgery.

For folks who have severe deformity and have been on a walker or even a wheelchair for years, they should expect to have a longer recovery just due to muscle atrophy or wasting away from not using it for so long. But no matter how soon you get off the assistive device, you should expect pain relief once the arthritic joint is replaced.

So there's no physical restrictions after these surgeries. And many of my patients go home the same day. You're able to walk and put full weight on the leg as tolerated from day one. And with anterior hip you can bend. And, the only real limitation that we use is no deep bridging, which most folks don't do unless they're doing some forms of yoga.

So, in day-to-day living, most people don't get in those sorts of positions. But as far as length of recovery, many of my patients are back to driving within two to four weeks, which is a big thing for independence. We did have one patient tell us that she went dancing about three weeks after hip surgery. Although I'd say that's probably not typical.

Host: Yeah, my mom had a knee replacement surgery and I was just sort of shocked, you know, even though I host these, that she was up and walking around, she called me from the hospital. She was like, yeah, I got my new knee. I'm walking around, going home soon. So really amazing. And as you discussed earlier, some of the new approaches and new technology is kind of mind blowing really. I want to ask you though what's the life expectancy, when we think about the knees that you're doing, hips that you're doing. Are folks going to need another one of those? Do they tend to hold up for a lifetime? Will they be facing surgery again? You know, that sort of thing.

Dr. Sloan: This is one of the main reasons that we don't jump to joint replacement in younger folks who have early arthritis or not severe symptoms, because these implants do have a finite lifespan. But, we do believe that the majority of total hip and knee surgeries should last more than 30 years, if there's no complications.

One of the main drawbacks I discussed with patients who are considering partial knee replacement, is that on average, they're not expected to last as long as total knee replacements. So we're over 90% of total knee replacements are still in place at 20 years. The most recent studies show that about 80% of partial knee replacements are still in place at 20 years. However, we know that advances in modern designs and materials continue to increase the life expectancy of these implants. So it should only get better over time.

Host: It seems that it will. And I think you answered this question earlier, but maybe we'll just go over this again. Maybe just talk to folks a little bit about know, what their lives will be like afterwards, less pain, back to normal, maybe doing some things they weren't even able to do, you know, before the surgeries, and so on.

Dr. Sloan: This is exactly the reason why people have joint replacement surgery, because they're trying to get back to something that they've given up due to their hip or knee pain. So, the surgeries are primarily a pain relief procedure. So, if you like to go for walks and hike or bike for exercise, but are limited by joint pain from doing these activities, then be able to resume them after surgery. You shouldn't expect that you're going to feel like a teenager again after surgery, but you should expect pain relief with regular activities. So, some patients do get back to high impact activities such as running and jumping sports. However, they have to understand, that the more force you put through these replacements, the shorter their survival will be. So you may be looking at 15 to 20 years of high use activities before they wear out instead of 30. However, we tell our patients that they can reasonably expect unlimited low impact activities, such as walking, cycling, and swimming.

Host: And in doing some research for this and as we wrap up here, Doctor, I know that you're big into a Tik Toks and Insta, Instagram, you know, and I wanted to just step aside a little bit and just have you tell us about yourself? Like, why did you become an orthopedic surgeon? What do you love most about what you do.

Dr. Sloan: I originally went to medical school, thinking that I was going to be a cardiologist, but I fell in love with surgery. During medical school, we rotate through all different specialties. And after I did my general surgery rotation and became enamored with the operating room, I rotated on orthopedic surgery and I couldn't believe the things they were doing and the way we were returning quality of life to patients. And I just love how it's one of the rare fields in medicine, where you can meet a patient with a debilitating problem and fix it in a short period. I like the mechanical nature of the work and taking a discrete problem and solving it. But mostly I love the appreciation that our patients have for getting back to the things they miss doing.

Host: I'm sure. I'm sure that that's big part of it, you know, as you say, you were drawn to surgery and just, you know, seeing sort of the frowns when they come in and the smiles on their faces when they're done, I'm sure that's very gratifiying.

Dr. Sloan: Yeah, absolutely.

Host: So, tell us just a little bit about for those who aren't familiar, I'm familiar because I have a 14 year old daughter, but, you know, for those who aren't familiar with Tik-Toks and Instagram, like, what are you doing there? And what's the response been like.

Dr. Sloan: I always loved in residency and fellowship in my training, teaching younger students, what we're doing, and getting to share what I love about joint replacement and orthopedics in general. Some people use it to show off their dance skills and what they cook, but I use it mostly for teaching. So most of the folks that follow me are either patients who are interested in learning more about joint replacement surgery. But the majority of folks I interact with are medical students and orthopedic trainees. And I present just interesting cases in the joint replacement and orthopedic surgery world and go through the thought process of how we come to solving some of the problems that we see on a day-to-day basis.

Host: That is so cool. And it has been great today to learn more about hip and knee replacements, the latest technology and more about you and how you're using social media to teach. Really awesome, thanks so much for your time and you stay well.

Dr. Sloan: Yeah. Thanks so much.

Host: And check out Dr. Sloan's Tik Toks on his Instagram page, that's @Hip and Knee Relief and call 978-369-5391. Or visit orthoaffil.com. That's orthoaffil.com to make an appointment with Dr. Sloan or another orthopedic surgeon with Emerson. And thanks for listening to Emerson's Health Works Here podcast. I'm Scott Webb. And make sure to catch the next episode by subscribing to the Health Works Here podcast on Apple, Google, Spotify, or wherever podcasts can be heard.