hello.

Welcome to HealthLine this Tuesday evening.

I'm Jennifer Bloomquist.

Thanks so much for tuning in.

This is a live program.

We're here in the studio right now and it's a great opportunity to get some free medical advice because we all know there's almost nothing free today but this really is free.

Even the phone call won't cost you any money you can call in any time during the show.

We do have a physician with us tonight, an orthopedic surgeon actually and he will answer any questions you may have orthopedic related.

We'll keep the phone number at the bottom of the screen so that you have handy to look at.

It's (969) 27 two zero if you're here in Fort Wayne outside of Fort Wayne it is still a free call if you put an 866- in front of there and again the phone lines are open now they'll be open until just before eight o'clock.

So I always advise people especially when we have an orthopedic doctor with us to call sooner rather than later because we do end up getting a lot of calls.

So I want to make sure you reminded of that and also you have two options when you call in you can either ask the question live during the program or if you'd rather relay your question to the call screener they will give it to me and I can ask Dr. Lynch the question for you.

So let's go ahead meet our guest.

He's been with us a few times before.

This is Dr. Jonathan Lynch who is an orthopedic surgeon.

So we appreciate him coming back.

>> Thank you for thank you for having me back.

Sure.

It's good to know we didn't scare you off in the past so but he specializes in orthopedic surgery and we're going to talk about joint replacement surgery.

But like I said at the beginning of the show, if there's something else orthopedic related that maybe you just want to get a sense of direction from Dr. Lynch about maybe how to address it or what options you might have, please feel free to call in any time.

>> So you you do a lot of joint replacement.

But I know from talking to you in the past you don't just jump into surgery.

I mean I know that you try conservative methods first to sometimes take care of these problems, right?

>> Absolutely.

So you know the nice thing about joint replacement surgery that I tell all my patients and what I do is basically for the most part every procedure we do is elective in nature, especially when it comes to especially doing a joint for the first time.

So you know, kind of getting back into the basics.

Arthritis is kind of in stage nature of the joint when you lose the cartilage in your bone on bone and that tends to be the time when patients are at home seeing us and a lot of times they will have seen their doctor first who a lot of times we'll start with conservative measures like anti inflammatories, maybe physical therapy, sometimes even injections.

But those tend to be kind of the mainstay of conservative measures.

We try first before delving into any sort of surgical discussion and again when when it comes to surgery, you know, it's it's ultimately and always the patient's decision at that point whether they want to proceed.

But but we certainly always always start by trying conservative measures and and then I you know, basically say that I feel they're a good surgical candidate and their bone on bone and you know, they're indicated for the surgery.

>> I think they could get a good outcome then and then it's up to them whether they they want to proceed down that route.

So would you expect if you're talking about somebody who's got bone on bone, will they experience immediate relief following surgery or what kind of what's the recovery ?

>> So that's a really good question and good point because I think, you know, a lot of patients that come and see us, you know, you get a broad range of patients so you have some patients who come to a surgeon who want nothing to do with the surgery which is obviously very understandable.

And then you have a lot of patients who are in miserable pain and they're at the point where they where they want or want or need something done.

And so really the response to surgery kind of depends on that starting point.

So there's been studies that really have shown that the patients that have bone on bone ,complete loss of joint those tend to be the patients that get the best response from surgery.

And so you know, those are the patients that right out of the gates tend to tend tend to do the best.

So I think it's really important when you for patients that that is potentially seeing a surgeon or considering surgery.

>> I think it's important in the patient should know what is my expected outcome based off, you know, the x rays that that you see in clinic a lot of times it's nice because I can review the X-rays with the patients and show them exactly what's going on and you know, if you have bone on bone with no loss of joint space, you tend to be the one that does the best out of the gates.

But the first couple of weeks tend to you're not going to be pain free by any means and knee replacements always tend to be a little bit tougher to recover from the replacements really, really just difficult and it sounds like it's it sounds like you have a lot of stuff you do after work physical therapy.

Yeah.

Follow up appointments.

>> Right.

Right.

So yeah.

What about as far as doing a surgery maybe do replacing the what do you is there even like a general guide as far as how long they could expect that replacement to help or does it depend on your active what was your lifestyle.

>> Yeah I think a lot of things and that's one thing I think as we know as modern medicine evolves and continues to evolve, the thing that's improved more than anything, especially knee replacement is probably the implants themselves.

So you know, 20, 30 years ago the polyethylene or the plastic was manufactured in a way that it wore out a lot quicker and when it wore out there'd be a lot of bone loss around the knee knee implants.

>> And so we're still doing a lot of revision work today which is like the redesign screws from those old ones and some of those are thirty years old and like I've had patients that were all the way through the plastic they're like metal on metal with the newer implants manufactured better we expect the plastic to not be as much of a problem.

So we won't know how long they'll last.

But barring a complication like infection or wound healing problems and the implant coming loose, then we expect them to you know, I you know, we hope twenty or thirty years I think is reasonable if all goes well but it's hard to know for sure because so many factors play a role in that as you kind of alluded to that yeah.

>> You're even just body you know, body mass and if it's a heavy person maybe or if they're really active, those are those are factors in an interesting point this past year at our annual meeting for the hip and knee surgeons, they pulled the audience to ask if they put restrictions on patients and about half of surgeons don't.

So I don't I don't like the formal restrictions on my patients but I do like operating post-operative Lubeck what can I I can't do and half the surgeons don't restrict patients which I think shows the confidence in the newer implants that but I'm not you I'm not quite there.

Yeah like I tend to say like maybe avoid high impact high low you know high school those the join just for the longevity of the joint but just even long term not just for long term that's that's kind of getting that but but now it sounds like it's a commitment because you you do this surgery and then afterward you have to be committed to the physical therapy and the monitoring is right.

Right.

>> Especially on the knee replacement side on the hip we a lot of times give exercises or recommend to a lot of walking and not formal therapy but for the knee it's very important to get therapy to get it moving because if you don't get your motion back early you can get stiffness that can be potentially long term.

So physical therapy for about six to eight weeks after knee replacement is probably what most surgeons are doing.

So now I do know of some people that have had two knee replacements.

I know they don't do them simultaneously.

So if that was a somebody in that situation, how much time do you usually have to wait for , you know, the other.

>> Yeah, you're right.

So in the most in some circumstances some surgeons will do them at the same time I was the type that they wouldn't.

>> Yeah, because there's been a lot and you're right there's been a lot even more recently more evidence to kind of support doing them separately if possible.

Some people want to get them done because they're concerned if some say well if I get one I don't want to get the other done down the road and so some people like that they go through the knee replacement and it is a big recovery and so some people like to wait maybe a year between them just just to kind of fully recover between this and then I've also had a lot of patients who wait six weeks because they're very happy with the one.

So I think it's very patient dependent and it kind of highlights the importance of mindset going into it.

I think there's a lot of power to mindset and you know where you're mental and more and more information coming out on mental health and recovery because it plays a vital role, you know, like controlling your baseline mental health and anxiety and depression plays a vital factor kind of how patients do after joint replacement.

>> It's just you see that because we had it was a kind of a distant friend of our of a family of our family and she became horribly depressed during the recovery because it was painful and I think she was expecting and you said everyone's different, you know, and I think she was just expecting it to be easier right.

And I felt terrible for her and she was supposed to have the other knee replaced it as far as I know she never did because it was it was so traumatic for her.

But you don't think about the you look like yeah.

Yeah that's right.

So you know, that's what I think again getting to the patients I like really being an informed patient, knowing because some patients come in they say just want fixed and wow some things you can't fix or if you try to fix you can make them worse.

And so you know, making sure you're properly indicated for surgery, making sure your bone on bone if you're ever in doubt you you're doing it you're committing to big surgery, getting a second opinion is merited, you know those sort of things.

But but then it goes into that certainly some people just recover better than others and there's so many factors at play and so you get to it can be hard as a surgeon to outline the expectations for everyone and make an umbrella expectation.

I tend to try and set the bar low in terms of I expect the worst and then hopefully, you know, get them to hope for the best.

>> But but you know, in the worst case scenario typically it's those first couple of weeks you're in a lot of pain but after after that you tend to make the turn and start to feel better and most people fortunate six weeks are extremely happy and done and when they generally want to get it done again.

But and that's why I think a lot of people are getting their joints replaced nowadays because they do get good outcomes better more so than years ago and in the big picture of life I guess six weeks is too bad you think about that at that time of year.

Yeah, like a lot but right.

I just want to remind everybody we have we've not received any calls and I don't want you to miss out on getting some free advice or at least some help or if nothing at all maybe just be led into a certain direction if you have some concerns about yourself or maybe someone in your family or friend.

Dr. Lynch is only with us until just about eight o'clock.

So it's (969) 27 two zero again if you're outside of Fort Wayne it's still a toll free call.

Just put an 866- in front of there and again we're talking about joint replacement surgery.

But if you have something else you want to ask Dr. Lynch about, he said that would be fine too.

So orthopedic related.

So you know, I'm always amazed at the stories you hear about these people getting hip replacement, how quickly they get out of bed like they're walking that night.

>> Yeah, that was just unheard of years ago.

Yeah.

You know, like if you're like my you know, if you somebody's a grandparent do that you thought they'd be in the hospital for a week and right.

So what's that is it continues to be the trend is just getting people up and going that's the thing I think we've we've learned the importance of rapid recovery is getting people up on their feet quicker is a huge part in the healing process and getting the best outcome possible.

So when hip replacement was originally done they the approach was more invasive in the sense that a lot of times and the first ones they had to in the hip joint then a lot of times those patients were bedridden while they allowed that like you know, fracture to heal.

So these patients are bedridden, not a big blood thinner.

They got a lot more blood clots for that reason.

So we've learned the sooner you get up and it's going to get moving, you decrease the risk of blood clots.

You tend to get the strength back quicker.

Pain's better controlled and again the surgical technique implants have improved but so has pain control around the time of surgery.

Yeah.

So getting multiple medications on board and avoiding we really I mean just like any other I think profession of medicine right now we know the importance of minimizing narcotics due to their addictive potential but it's you know, it's needed you and I have fortunately a lot of patients nowadays are very conscientious of that because you have some patients say I'm not going to take any and it's well, you know, I don't want you to do that.

We want you to take what you need.

But but there's a lot of other medications to kind of help minimize the need for narcotics.

So you know, I think all those things have led to more rapid recovery in patients getting out of bed quicker, doing better.

A lot of joints nowadays, especially post covid era are being done in an outpatient setting where they're going on these days by that too.

So you know, now even some insurance companies are starting to want to move that way because I think the profession as a whole has started to prove that we can we can do it safely for the right patient.

So because there's really there's a lot times there's not much we do in the hospital that can't be done at home.

So if you're not needing I.V.

pain medicine, you know you're taking on all medications and you have appropriate Dimitriades AIDS and help at home and you know, good setup at home and we sometimes even try to send patients on the same day if possible.

>> So yeah.

Well I guess if you've got a good support network and people I'm sure yeah.

>> Well Dr. Lynch we do have someone who wants to ask a question.

>> So Daniel are you still on the line.

Yeah.

How's it going.

Hi it's we're doing OK. >> How are you doing?

What's your question?

Well I think my comment slash question kind of fits right in with the end of what the doctor was saying and the starters I used to play a lot of basketball and after I would get done I had this since it was kind of connected to the gym who would give me a decent massage and I did the whirlpool and I pretty much walked out feeling free press I mean each day when he passed away and I just kept doing the massage at home on the bed twenty minutes in the morning and before that and it really helped keep my knees mobile but one time I was working building a compressor station out of town and I was staying in a hotel with a blanket was so heavy that I just even twitched my ankle to the left and it's through my nearest socket.

I'm done with what I'm saying but I tried different joint suppliments.

I finally found one that I just take three of the pills each night and it's got some type of proprietary BLENKIN connective tissue agent in it that really holds my knee together.

So I'll just let you go with the fact of and this isn't drug enhanced but that yeah.

Stretching and outpatient stuff may not need a doctor.

A lot of these people if they know the techniques and things don't have a blessed night.

>> Thanks.

Yeah sure.

I do see a lot of things that I have learned are not FDA regulated.

There are a lot of holistic I'll see commercials or holistic things and say hey if you have joint pain or yeah I would be personally scared to do any of that before consulting with at least your family doctor.

>> Yeah, I think so.

I mean and I'm I'm totally with a holistic approach.

I mean I think yeah.

You know we got to we got to balance you know what is our lifestyle and diet versus you know, medications and surgeries and injections.

Those those the latter should be second hand really you know but I mean a lot of times when patients are CNS you know when you're bone on bone arthritis no matter what supplement you take, you're not going you know you're going to have is going to it's going to be there.

So you know, the caller called in and he may be at a state that he's at a point where he's not quite bone on bone and you know, certainly can take things and I'm there certainly are unfortunate there's no supplement that's been proven to help prevent cartilage degradation which is devastating but there's several that can help joints feel better which obviously you know, he felt one that helped him personally.

So point well point well taken .

This is you know, the surgery should be kind of the last ten stage option for people who fell.

And the one thing I will say that I get question a lot is stem cells because that's a hard topic to I would be very wary of stem cells.

There's a reason that patients have to pay out of pocket for it is because insurance companies don't cover because there's no proof that if you inject a stem cell by itself that cell to become a cartilage cell like your knee had you know when you're developing and grow into healthy knee it's got to have the right growth factors in the right environment to become a cartilage cell.

So putting a stem cell on your knee and expecting it to turn into cartilage is right now we're not there but I've had some patients who maybe you know, they they when paid to cash at a third party and they get really, really KDDI.

>> So yeah.

You know, so I'd definitely be wary of that to say patients maybe get some pain relief but there's no scientific proof that that that that has a long term effect.

>> I mean there's nothing wrong with exploring your options like for sure.

You know I mean some of these things it's just like electric vehicles.

>> You know, we're just in the initial stages exactly what they are looking into exactly.

I think some days out in the sports side of things there's definitely in the long term I think that's the biologics in the future.

I think it's the future lies there and maybe down the road.

But for currently for patients with end stage arthritis I'd be a little leery of that approach.

>> OK, yeah try not to manage too much on your own.

It's to run a pasture at least your life at least a family doctor.

>> Yeah, someone you know.

Yeah we have another caller.

So Deborah , are you still there?

Oh hi Deborah .

Go ahead with your question.

I was wondering for as far as the patients concerned which is the worst to recover from a shoulder replacement hip replacement knee replacement.

>> Yeah.

So I'll I'll probably comment more on the hip and knee.

I don't personally shoulders but I'd say out of the three the knee, the knees probably the hardest to recover from and I think part of the reason is because out of the both the hip and shoulder their ball and socket means they're a little more as far as the motion of restoring motion of those joints are a little easier to store from that aspect whereas the knee there's the dynamic motion of the knee is much more difficult to recreate and it makes I think the recovery process more difficult and there's less kind of soft tissue and muscle around the knee to which I think the swelling post-operative form and he makes a little bit more difficult to recover from so so out of those three I'd say the knee is probably the toughest the hip probably the easiest.

But but I think a lot of my shoulder shoulder colleagues would would about to see the shoulders kind of right up there with the hip and I think patients probably indicated great outcomes with all three.

But if I have a patient who needs both the hip and knee and they want to start with the are when I definitely lean towards going to the hip first.

>> So yeah.

>> All right.

Deborah , did you want to ask anything else?

Yeah.

I also wondered about pain.

You can't hardly get any pain medication from doctors anymore .

>> I mean what's a patient supposed to do?

Yeah no it's it's a good question and unfortunately you know we're we're at as physicians it can be difficult for us.

So you know, we basically nowadays the people that prescribe the most pain medications are typically either primary care physicians or pain specialists.

So every physician's tracked in terms of the narcotics we prescribe patients and there's every provider will in the appropriate circumstances you know, treat pain if narcotics are merited.

But when it comes to chronic pain that a lot of times we're seeing patients for a doctor or a specialist you see for maybe a one time visit is probably not going to be the one to prescribe that.

So and part of the reason is to get narcotics patients are sometimes required to have a contract with a single physician that stating that they're only going to get their their pain medications from that doctor.

So if it's a patient that we're seeing that is not a surgical catheter, they don't need surgery.

They have pain for the reasons that are more chronic in nature than a lot of times we will refer them to a pain management specialist or back to the PCP or they're for their their narcotic needs.

>> It's a it's a tough situation.

I mean there's such a it's so sad, you know, the narcotic and opioid epidemic and I totally understand that.

But then I understand everything sometimes you in really bad pain and it's not somebody wanting to abuse the narcotics but hopefully as time goes by we can come up with something that will work.

But it's yeah it is it's a difficult situation to be in for both parties patient and it is so good question though Deborah .

Thank you.

Dr. Lynch.

Somebody called wanted me to ask a question for her.

So Elaine said she had a total knee replacement and then she had been told and I've heard this before too that she before having a dental visit she needed to take an antibiotic.

Is that what is still recommended for people?

>> So typically our protocol and I personally is for two years after surgery so during that first two year period there's increased blood flow around your surgical site.

So when the dentist the hygienist cleans your teeth, a little bit of bacteria from your mouth can theoretically get in your bloodstream and go and sit at a joint.

So since there's more blood flow there, the bacteria can kind of tend to want to stop there and start an infection.

>> So like a like a seven day regimen of antibiotics, it's just the right before the procedure.

>> So they're usually taking four pills like within an hour of their dental.

It's not like you know before it's like if you had an ear infection and you do it exactly.

So it's just a one time right before they get their teeth cleaned.

So that way if they do get bacteria in the blood it's kind of it's stuff they're ideally not you know, and that's still being investigated.

But I think the benefits of doing that outweigh the risk of getting a parasitic joint infection.

Yeah, that sounds so I say two years and then after that I leave it up to the patient because you know, if I had a joint replacement I'd maybe always want to do that but OK, being stewards of antibiotic and knowing the antibiotic resistance and patterns that can evolve in society if you prescribe them unnecessarily there's that risk too.

>> So that's why we say two years.

OK, yeah good.

Yeah yeah.

All right.

How we another person who wanted me to ask for them so this was Jake and Jake had had both knees replaced he said with half joints but now needs whole replacements and then how how much more depth is that.

>> So I guess I hadn't heard it.

Yeah you can do a half.

Yeah.

So no that's that's a very good question.

And the good news is a lot of patients have had a partial knee replacement down the road typically will need a total knee and that's part of that is generally it's just like having a total knee the first time.

So there's been you know, there's been studies that show actually that the outcomes are very similar to a patient who had a total knee the first time.

Usually the very nice part and that's why a lot of times when I'm trying to coax patients towards considering a partial knee replacement, I always say that and they say well why not just do the whole thing if we you if we have to come back and do it, Tony?

Well, the truth is usually fixed where you have to because if only part of your knee is bad you should only replace that because hopefully as partial knees have lasted long and even if they've lasted 10 years that's ten good years that he's functioned with them and then going back to total knees they it's basically like having a total knee where would be the first time we usually don't have to use special revision parts which is what we have to do for revising a total knee for the second time.

So I generally generally tell them to expect it to be like a total knee overall the recoveries you know, similar to partially just a little more it's a little more involved obviously because there's there's little more work done inside the joint the second time around.

But for the most part the bone stack and everything everything there is generally good when going from a partial to total just like you're having a total for the first time.

>> Yeah, I've never met anyone has had a partial so I didn't know if they you know I didn't if that was even really being done much anymore.

>> Yeah but it still is I'd say it's probably for most surgeons probably less than 10 percent of the time and knees and and for some even less than that but but no they're definitely for the properly indicated patient person.

>> These are great thing and we have less than a minute left.

So unfortunately probably not enough time to take another question.

But I'm just wondering is there you know, a lot of like you say a lot of these surgeries are elective.

It kind of is you know, when the patient's ready to do it.

Do you recommend seasonally I mean I'm just wondering is it dangerous to do something elective in the winter months you could slip on the ice or I don't know if you what your recommendation would be if somebody is toying with when to do it?

>> Yeah, it's a good question I think because I see both sides of it.

I think the more elderly patients we have tend to want to stay away from winter for that reason because if they're already using any military aid or Walker a baseline and they're worried about balance issues, then the weather can throw another wrench into the factor.

But for a lot of patients who don't have those concerns and they probably want to do it in the wintertime because they're not going to be active in a boot.

So yeah.

So I think that yeah, So I think we tend to have kind of a steady business throughout the year because you get patients on both sides of that.

But yeah, it's definitely a patient preference and I see both sides so sure.

>> Wow.

And sadly the show is over I'm sorry I the time goes by quickly.

I so appreciate everyone who called in the questions tonight and of course thank you very much Doctor.

>> Thanks for having me back.

It's always a pleasure.

Always a pleasure to have you.

Thank you so much.

>> Take care and have a good night and we'll see you back here next Tuesday for another HealthLine.

Bye bye