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Melanie Cole (Host): If you have knee pain, you know how debilitating it can be, and you have probably tried many non-surgical treatment options but if they haven’t really provided you the relief that you have been looking for, your surgeon may recommend a knee replacement. My guest today is Dr. Matthew Gargulinski. He’s a board certified orthopedic surgeon and a member of the medical staff at Temecula Valley Hospital. Welcome to the show Dr. Gargulinski. So many people have arthritis, how do you know if your knee pain is caused by arthritis? How do you determine that?

Dr. Matthew Gargulinski, DO (Guest): Well there are several ways. There’s the symptoms you have and then there’s the diagnostic testing and physical examination that your doctor can perform. Some of the symptoms you have would be swelling, stiffness, grinding or popping, start up type pain when you are at rest for a while and then to help diagnose arthritis; your orthopedic surgeon or doctor is going to want to get an x-ray and that’s going to give us a lot of information and can tell quite a bit about whether you have a diagnosis of arthritis and what to do about it.

Melanie: So, if people have tried many of the first lines of defense which might be NSAIDs, or ice, physical therapy, any of these things Dr. when do you start the discussion that maybe they should look into surgical interventions?

Dr. Gargulinski: Well the foremost indication for a major surgery or a curative surgery for arthritis such as a knee replacement or hip replacement, would be pain. Now first of all, we want to establish the diagnosis and second of all, we want to make sure we tried all other nonsurgical treatments including injections as well and sometimes people are candidates for a much less invasive or a minor surgery such as a knee scope or and an arthroscopy but once you have failed these other treatments, and the pain has reached a level where it is significantly affecting your quality of life; then you really have to seriously have a discussion and consider a joint replacement surgery.

Melanie: They are getting so much more common these days and there as so many technological advancements in total knee replacement Dr. Gargulinski, tell us about some of those.

Dr. Gargulinski: Well, knee replacements specifically, have come a long way over the last 25 years or so. First of all, the materials they use have become much better and can expect to last decades as opposed to maybe ten or fifteen years where parts of the plastic or other parts of the implants would wear out. Also, the surgical technique has improved. The incisions 20-30 years ago were really very large and throughout the years, we have been able to have the same successful surgery with a much smaller, much less invasive incision and tissue damage from the surgery. The last and the foremost that we are working on right now or have been out for the last few years would be using different technologies like MRI, computer software and 3D printing to customize portions of the surgery.

Melanie: So, not everybody’s knee is the same size Dr. Gargulinski, so how do you determine replacements and how does that work for someone?

Dr. Gargulinski: Well traditionally, during the surgery, there is a number of different tools and measuring instruments that you can determine which size works best and the implants are sized both gender specific for female and male knees which differ, also with various different sizes. But now, we are using an MRI technology to actually measure everything ahead of time with a software program, so I can virtually do the surgery ahead of time and have all this information prepared and ready well before the surgery.

Melanie: That’s so cool. And what about natural knee motion? Is that pretty much maintained and what’s life like for a patient that uses one of these new pieces of technology?

Dr. Gargulinski: Well, this new piece of technology is meant to make sure that the surgery is done accurately, and all the parts are put in as precisely and well-aligned as possible. I use the analogy of getting a new set of tires on your car. Now, if someone just slaps a new set of tires on your car, they will work very well for two, three four years but if they are not aligned precisely, you will start to get a shake or a shimmy or start to wear out the tire on one side rather than the other and that’s the five, six-year timeline that things start to go wrong. It’s the same thing with a knee replacement. If things are off by two or three degrees, you may not notice it. Your knee may feel great just like every other knee replacement, but when it comes five, six years down the road; you might start having problems and that implant may fail early which would result in a revision surgery which is another major surgery and sometimes the outcomes aren’t as good.

Melanie: So, what’s the learning curve for you docs if you are learning this new technology and essentially in a way having the surgery preprepared, what do you need to do to learn all of this?

Dr. Gargulinski: Well, first of all, I have done hundreds of knees the standard, traditional, old-fashioned way so to speak where we have the instruments and we measure them during the surgery, so I was perfectly comfortable with that so this new technology, I first tried it in the lab and found it very easy to adapt. It makes everything much easier knowing ahead of time all the angles, all the amount of bone and tissue I am resecting, the sizes of the implants, just is a very easy transition to do with this new patient specific instrumentation technology.

Melanie: Is this considered minimally invasive?

Dr. Gargulinski: Yeah, that’s the same – the same approach can be made with standard instruments. We do call that minimally invasive if we are trying to minimize the amount of tissue altered or cut during the surgery and the length of the scar on the front of your knee.

Melanie: Would everybody be a candidate for this or who is not? Are there certain things that might preclude somebody from getting this type of knee replacement?

Dr. Gargulinski: Well the way the technology works is you first get an MRI of your leg and it makes a number of measurements of your ankle, knee and hip to get the angle of your knee and then some more precise measurements. So, if for some reason you are unable to get an MRI, we cannot use this type of technology. Now, a person with a pacemaker cannot usually get an MRI. A person with metal screws or prior implants in their leg will cause an altered signal and we won’t be able to get that precise data that we need to do this. So, that’s the first thing that we need to get and if you can’t get an MRI, we cannot use this technology. But all is not lost, we can still use the standard techniques that we have been using for years.

Melanie: What do you want people to ask you, Dr. Gargulinski, when you are discussing all of this with them and they are hearing the word new technology; what would you like to hear them ask?

Dr. Gargulinski: Well I love when my patients are educated. They do some homework on their own. And then I can help guide them to maybe the correct information because there is a lot of information there on the internet and hearsay from other people that may or may not be accurate. So, I want people to have researched somewhat on their own and to be familiar basically with what’s going on and then I can help direct them in the right direction and give them the information they need to make a decision. I want them to ask am I ready for a knee replacement. I want them to know the details of the new technology, so they can understand how this would be a better product for them that potentially it could be a quicker surgery, a more accurate surgery and possibly a faster recovery.

Melanie: And you mentioned a little bit before about long-term function, durability of the implants. So, what’s different now with these?

Dr. Gargulinski: Well, part of the – with this new technology we are talking about, I am focused on the precision of putting the implants in the proper alignment and not being off by a degree or two or not having the wrong sized implant. And that could certainly help with the longevity of the implant. It can change something that may wear out, fail or loosen within five years to something that may last 25-30 years. I think that’s an important distinction that the accuracy of putting these implants in can be aided with this technology. You know there are other factors as well, as far as how long the implants are going to last and a lot of the materials that technology has already been developed and the materials that we are using nowadays are very excellent.

Melanie: What a fascinating topic. How interesting what you are doing now. Why should listeners come to Temecula Valley Hospital for their care? Tell us about your team.

Dr. Gargulinski: Well, we are a Joint Center of Excellence which means we meet certain amount of national criteria that shows that our complication rates are exceptionally low, that our success rates and our patient satisfaction rates are exceptionally high. So, we have a general standard technique to make sure that we are using evidence-based medicine and all the most modern standard of care to take the best care of our patients. Now if you ask someone who has been a patient at Temecula Valley Hospital, I would say the vast majority 95% of them have very glowing remarks about the care that they had after their joint replacement and that makes me very proud to bring my patient there and to care for them appropriately.

Melanie: You’re listening to TVH Health Chat with Temecula Valley Hospital. For more information please visit www.temeculavalleyhospital.com that’s www.temculavalleyhospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. Individual results may vary. There are risks associated with any surgical procedure. Speak with your physician about these risks to find out if knee replacement surgery is right for you. This is Melanie Cole. Thanks so much for listening.