I hello I'm Jennifer Blomquist.

>> Thanks so much for joining us tonight on HealthLine.

I had the privilege of hosting the program this evening and I'm so glad you joined us because it doesn't matter what topic or our focus of our show is each week you are guaranteed to learn something and get some free advice.

Nothing is really free today.

Why don't you take advantage of that?

We are delighted tonight to have a returning guest is an orthopedic surgeon and he brought a whole bunch of props of equipment and tools that he actually uses on patients.

And so I think you'll find that fascinating to actually see all the advancements in this field.

We're talking about joint replacement tonight.

So here's how it goes in case you're new to the program, we are live here in the studio and we are more than happy to take any questions you may have for our guests tonight.

So that's why we keep that phone number up throughout the program.

It's (969) 27 two zero if you're outside of Fort Wayne, it's still a free call because everythng on this show is free for our viewers it's 866- put it in front of that number and we'll get you through.

You can ask your question live on the air.

They do not just throw you on the air.

You will talk to a call screener, a very nice lady and she will talk to you and then you can ask the question live which I like because you can talk to the doctor.

You can go back and forth and maybe he needs more information from you to better answer your questions.

So that's a great option.

But I also appreciate as some people might not want to do it that way.

So just tell the call screener what you'd like to know and she will pass it along to us here in the studio and we'll get your question answered that way.

So without further ado, let's go ahead and introduce to our guest you may have seen him before Dr. William Berghof who is an orthopedic surgeon and I have the desk here is all of his all of his props that he brought with you.

>> Thank you so much for doing that.

It's my pleasure to come and I always bring my props because my patients always want to see what it is just inside their body.

It's a good way to get to know what we do and how we do and it's a pleasure to bring them in.

>> Yeah, and you wanted to talk?

Well, you know, that's the thing is this is something that you and other professions in you know, in this field deal with every day.

But for a lot of us it can be a little scary or daunting and thinking OK, what are you doing and what are you putting in there and what does it look like and how does it work?

>> Yeah, and we have this model of the knee in our office and patients still come in and ask and think we're going to shop here and here and then put new bone.

>> Oh goodness.

So it's good to always have the models and show everyone exactly what we do and I brought my notes today because I always forget to say things when I come to this show and it goes fast and we always get a lot of calls which we love that we're getting one coming in right now that we're going to go to in just a second.

But you were primarily wanted to focus on hips and knees hip tonight and we did a as a as a country last year we did about two point four million replacements primarily hip and knee replacements about one point three million of those were total knees.

Yeah.

And about eight hundred twenty five thousand were total hips and then you have a few hips and knees replaced for fractures and in other things so and interestingly about fifty eight percent are in women and the other remaining in men and so you know those are big numbers and it's growing.

Yeah we grew as a as an organization the American Joint Registry grew about 14 percent replaced it is it's gaining steam and it's getting very popular and we're seeing a lot more.

>> As I say, people are living longer and like I look at my parents are in their mid seventies and they don't look old to me.

My dad is still out of active.

He's still running in half marathons.

You know, my mom's still out doing her gardening and and my dad actually had some issues and had some surgery on it and he's good as new and back to doing what what he loves doing.

And so I think that's part of it.

Maybe it's just I don't I don't remember my grandparents living that kind of a life .

>> I think people today are more interested in their health .

You know, certainly shows like this to promote health , healthy bodies, healthy minds, they live longer and you know, look at the range of patients in my office.

I think the youngest I've ever operated on was a 22 year old, OK?

And she had rheumatoid arthritis and then the oldest you know, I've operated in the nineties.

Wow.

I two years ago I had a ten year recheck for a patient I put a total hip in when he was 94.

>> Oh my gosh.

So he came in at one hundred and he had kind of a big deal in the office but he was in great shape and if you're in great shape and you're you know minds good hearts good you know, joint replacement you can do it into the eighties and sometimes 90s age is just a number.

>> Right.

I just had a birthday yesterday .

That's why I'm in I'm in that frame of mind so I want to go ahead.

I don't want to miss this call Doctor because this person's waiting very patiently.

>> I think this is is it Patricia?

Is that correct?

Yes.

Hi.

Thank you so much for waiting.

Go ahead and ask your question.

Hi.

I was wondering can you run and jump when you have an artificial joint?

>> That's a great question and you know patients always ask what's going into it if they're going to have to give up anything if they do get an artificial joint prolong running jogging we kind of frown on it's just a cyclic manner that you load the plastic time and time again.

It doesn't do the joint very well.

You can jump occasionally but basketball probably not a good idea when we tell our patients long is it not a lot of twisting turning get back to sports.

You know I let him play doubles tennis.

That's kind of the upper thing in being a skier like myself.

>> I let them all ski.

I'm a little biased.

Yeah, but they can get back to a lot of activities.

There's new developments coming out where some of the are they're starting to look at him in shock absorbers or something built into them.

That's maybe a real frontier there and with that we could probably say we could let him do more.

But right now no high impact, repetitive high impact and you know, anything that's on and off is great.

>> All right, Patricia, good question.

It was a good question.

>> Did you want to ask anything else before we let you go?

No, that was it.

But thank you so much.

Oh, thanks for calling.

I appreciate it.

All right.

And if you want to do the same thing Patricia did, which is great again it was nice she could kind of interact back and forth of Dr. Berghof and get more information do it that way or you can call again, call that number at the bottom of your screen (969) 27 two zero.

Call that number and you can just relay your question to the call screener and they'll give i to us out here.

>> Either way you get your your questions answered so you know, you talk about those shock absorbers.

>> You know, I didn't think about that.

Is that something that new materials, you know, ten years away do you think or is it in the wild?

>> Yeah, we got they're still testing on that stuff.

>> But you know, if you would have told me we could have a custom made for an individual when I started my practice.

>> Yeah.

I mean we were just starting to make right and left knees when I started.

That's how far back to go.

Yeah.

And now we're into the field we're doing navigation, we're making custom.

The field is just expanded with technology and you know, hopefully someday we kind of get to that point where we can let people be a little bit more active.

>> I remember years ago I did have an ad she since passed away but she had rheumatoid arthritis and had surgery on her knee and it just looked agonizing.

I mean she was out of commission for like six months now this is going back 30 some years ago and now I meet people and they'll say well, you know, it was outpatient or you know, I was down for a little bit of physical therapy.

>> I'm amazed at how much the recovery time is cut down about 0 percent of the people go home back to their living environment.

You know, if it's safe if they have someone that can help.

Sure.

Yeah, And you know, maybe 10 percent need something like a nursing facility or rehab we encourage them to go back to home because you know, home's the place to be.

Yeah.

And you're encouraged to get up and walk more and and probably get a little bit better care.

So you know, last year we spent about 90 percent of them home and the other thing too is we really get them in the office.

We get them in therapy, we get them kind of tuned up before surgery, OK?

>> It used to be we would just do surgery and then they were in the hospital for three days an excruciating physical therapy and now we we get them up the same day some of the patients are discharged the same day that you've got hips like you're seeing in some of my knees I discharged discharged a few this week at the home the same day of surgery.

So and that's you know, anesthesia is really helped us a lot with the due to the spinal anesthetic and then they do regional blocs and with the newer techniques we really feel like we're making progress and getting people out of the hospital a bit earlier.

>> I think it's less scary when you hear about it that way like OK, my recovery's not I mean it's not going to be pain free but it's it's going to be different than maybe what we used to associate.

>> Absolutely.

And if you tell someone there's an option, you can go home the same day then you know, it kind of puts things in perspective.

>> It's really not going to be that bad.

Yeah.

Yeah.

Sounds like a big improvement.

We had another person call I want to ask you a question.

I believe this is Woody.

Go ahead, Woody.

Yes, this is Woody and yes I was I was calling I had a knee replacement and I'm trying to be active and everything I go to a lot of ball games, you know, like football and basketball and I I climb the stairs and everything.

Is it OK?

You know, how far should I push it that way or whatever and and the question to have you ever done a hip and a knee replacement at the same time?

>> That's interesting.

Wow.

Those are real good questions as far as getting back to activities I think you're right on when you say stair climbing I think stair climbing is the hardest to get back with the knees is it?

It's a quadriceps function.

All right.

And that can take up to six to eight weeks to get back but walking and walking the same day and then there's this progression in the last part of the progression is probably stair is what he hit on right there.

You must know is that it's difficult to get this there are climbing back and the other thing is a lot of elderly you don't have stairs.

>> That's true.

So they can practice what they're doing but they get around great without you know, much here at home on one level.

>> So is it OK to do that like if you had stairs and you had a knee replacement, is it OK to use them?

>> I mean should you use a minimally or is it OK to use it as much as you want as much as you want?

The other thing is most of the knees go to therapy.

Yeah.

And the physical therapist is the other half of this whole equation I'm sure you have to have good physical therapists to push the patient's right and then progress them as they progress and they usually have stairs in their offices and so yeah they have set up yeah.

>> And so once they accomplish the stairs and they say OK you can probably go up and down stairs without somebody assisting you OK and you know we always make sure they have a good banister and other things but the physical therapists are really the ones that kind of moderate that yeah they do a great job.

>> It's a team effort anymore.

I mean it's it's your it's your nurses, it's your doctor.

It's it's the physical therapist all working together.

Yeah.

And then as far as a knee and a hip I've done one.

Did you.

Yes I promised myself I'd never do it again.

>> Oh can I ask like relative to the age of the patient he was younger OK and they were kind of related together his bad hip played right and he really deformed hip that played into his knee and it was kind of coming up on insurance thing losing his insurance so he got on the better side of me.

Yeah.

Convinced me but I've done it once and it was successful but inside of the body was it there was same side and then you have to re drape and then we bring up other things that can go on with the draping and things like that.

>> So a prolonged anesthesia obviously.

Oh right sir again so thanks for that interesting point.

>> Yeah I guess so.

All right well thank you.

Those are great questions and again we just have Dr. Berghoff here for a short time just until about eight o'clock so call sooner rather than later we end up having that issue where people wait so call a call sooner.

Like I said there's (969) 27 two zero that's the number and we keep it up at the bottom of the screen throughout the program we did have someone who wanted me to ask the question for her.

So a woman named Sylvia, she said why can you not just replace knee cartilage when or I guess why can't you just replace knee cartilage when the knee is bone on bone?

Oh so what do you do when you're in that city your bone on bone it's more global OK and so that all these candles the entire knee is worn with our sports doctors do if you have a an injury to a certain area maybe a centimeter by centimeter in the in the cartilage OK they can go in and they can put a scaffolding of cartilage in there and it will grow but you have to have a surrounding cartilage around it that can support it and when your bone on bone it's the whole the whole knee is is shot.

The difference is between filling a pothole and resurfacing the whole street.

>> I see.

And and what she's asking is yeah OK. >> And the other thing interesting is when you get arthritis everyone thinks it's cartilage but there's some kind of bone that supports the the cartilage underneath.

You don't think of a mattress you mattress and box spring.

Right.

And as you get arthritis there's some kind of bone changes.

It becomes a lot stiffer.

So even if you were to put cartilage back on top of it, it wouldn't have the same support that normal bone would and it would be more apt to wear out the real the real cure on all this is probably treating the subcounty alone and the cartilage so they don't break down over the years.

>> Now that looks what you have in your model.

The knee replacement is that is that like a certain kind of plastic and is the metal part is that titanium steel?

>> This is one of our more custom knees and all of these are basically look like this the custom is just made for you, you know, looks like you getting a tailor made suit instead of one off the rack.

>> Right.

Just fits you better and this is you usually cobalt from polyethylene and this is usually a titanium statutory OK?

>> Yeah.

And so wear your bone on bone now we got a sandwich we got this plastic in between so the bones don't rub together and that's basically what a total knee is.

>> And if you look at the side here, you know we're only removing about five millimeters of bone you know, not chopping the whole knee here off.

Yeah, it's melting more than anything else and that's do you like how invasive is it now you talked about robotics playing a robotic surgery, playing a role.

>> Can you do a total knee replacement robot robotics with the way the general surgeons use the smaller incisions our surgeons use robotics and navigation to check their alignment and to make the cuts.

>> It's basically the same incision.

It's more a way that we can use to check our cuts and to make sure that the knees properly aligned.

Yeah, you know there's there's three things in the surgery.

You know, obviously you have to make the exposure and you have to make the right cuts and you have to put the implants in in the right alignment and then you have to balance these ligaments.

>> You know, that's the other thing you have to do some balancing so there's a lot going on.

Yeah.

And in the robotics is just one way that some of our surgeons use it to check their alignment.

Sure.

Very involved.

>> Gosh, the screen is just lighting up here so I don't want to get to answer some of these time in the past I kind of feel like I kind of half answer Jacob's question but go ahead, Jacob.

>> You were asking about custom knee replacements.

Yeah, go higher.

I was curious about the custom knee replacement one I guess how does that work?

How do you get a knee custom just for me and then the benefits of going to maybe a seasoned surgeon that wants to do a custom knee surgery or maybe a newer younger surgeon that maybe he wanted to try it for the first.

>> Hmm.

Well, the custom is the easiest way to think of it if you can see this if I put a caliper in surgery and I measure this is a size four, then I get a size four in this direction automatically there are two Tueller married together.

OK, and your question Jacob is a custom made if I could say this is a size nineteen I can put a size eight or nine or ten or whatever I want in this direction so it addresses this side and that side and realistically get that same knee you had before you got the arthritis in it and that to thinking there is it feels more natural and you know some people say that knee doesn't feel right or clunks or is I think your chances of getting it just right is the same as if you go to a tailor and get a suit made just perfectly for you and you sort of off the shelf.

>> It's it's a personal preference and you can get both knees twenty years and a fantastic results.

Yeah, but the thinking is just maybe one just feels a little more natural and and that's that's a benefit and I did bring two to custom here and I want to see OK this may be the Jennifer custom OK just so people understand and then this is awfully heavy.

>> It is and that's what I wanted you to pick that.

>> Oh my goodness.

Wow.

And this would be like like a paperweight.

This is the doctor Berghoff of course my size to me.

>> Yeah.

And they all come in different sizes.

>> Camera three I think the big thing is when the patients do pick those up I'm shocked.

Yeah, well it has to has to undergo millions of cycles through your lifetime.

Sure.

And it has to hold up to all the activities you know like your caller called in jumping and running are still OK. >> It'll hold up it's you know it's the plastic the metal hold up it's the plastic that kind of wears out over time.

>> We had mentioned twenty year life expectancy for the hardware.

Is that kind of a uniform if you drive it right you're going to get twenty years OK if you go out and start jogging you might not get twenty years but OK I have people in the office you know I see twenty plus years that are taking care of their joints and done what I told them not to do obviously they've done really well.

>> Gosh yeah I wish everybody at home kind of feel this.

I am really shocked.

I mean it really is it's like is if you picked up one of those you know those big circle glass paperweights you could have on your desk at the office I mean that's what I like comparable weight wise.

>> So I'm going to go ahead to another phone call if you don't mind and I please apologize.

I'm not sure if I am pronouncing this right.

>> Is it Teege or Teej eg Teege?

OK, I'm so sorry.

>> Go ahead with your question.

Yes I have friends that have had knee replacements and we've had discussions like with those named Monte and one's Matt Tom and Jason and with all the different available companies and different implants that are available to you, how do you make a decision with computer assisted custom?

What are some factors that go in and choosing what implants you would use for a patient?

>> Good question.

First of all, is patient activity OK?

You know, maybe younger and more active people, higher erformance people more demanding need a more demanding implant and for that, you know, we we we make that choice for someone less demanding they might not need the benefits of necessarily custom but the needs we put in give them exactly what they want pain relief, restorative function.

>> They can do the stuff they want to do, you know, visit the grandkids, play golf and do all that stuff.

>> But maybe they don't want to go out and climb a mountain or ski, you know, so we try to match the patient implants with the patients and what we're running into a lot of times now the insurance companies are pushing back on what we can and can't do and you know, we try to fight for the patient as much as we can and give them the best product that they can.

But it's it's like anything else in life , you know, it's a constant battle.

>> Yeah.

Yeah, that's interesting.

I mean at least I guess you do have choices that's one thing.

>> Absolutely.

Well there are a number of products out there so yeah.

Teege did you want to ask anything else.

>> Nope that's it.

OK great question you for your time.

Oh thank you so have a good night.

Thank you.

We also had somebody wanted to ask you a question.

It was Wesley and wanted me to ask for him so he said can someone with a joint replacement get an MRI?

>> Oh I wonder because I know with braces like when our kids have braces they said they couldn't have an MRI.

>> Yeah, So they can get an MRI usually it's more with the hips.

>> The hips are mostly titanium ,the knees are cobalt chrome and so they're a little bit ferromagnetic OK and so you get scatter if we want to look at a total knee or anything around the total knee they can get a CT scan.

>> That's a better clearer picture.

It's not magnetic and it's not interfered with by the metals so both of them can do imaging studies the hips more of the MRI and the knees with the cobalt chrome which you picked up pretty heavy just get distorted with the MRI so they get the CT scans.

>> Yeah, good.

Yeah that's a great question because I I've always heard that if you have anything metal that if you get a you know Wesley if you want to get an MRI of a different part of your body other than where the joint is you can do that.

It's not like there's ever enough magnet to pull or disrupt it like a pacemaker obviously you can't for some of the pacemakers but with the joints you can because you're not going to go anywhere.

>> They're in their rock solid oak and they're not going to be moved by the magnet either way or another.

OK, that was a great question.

>> See, I'm going to try and quickly get this one and Barb a knee replacement and how long- is the recovery we kind of touched on a little bit earlier about how you can be discharged the same days your surgery.

>> You know, it all comes down to two teams.

You know, my nurse Katie and.- her team and they get the patients ready and then we have patient educators at Parkview that make sure your lab work's all done in that situation half hour.

>> Oh yeah.

And then we Mindy's our educator.

She sits down with the patients and gets them all ready for surgery and then behind all this you got physical therapy getting them ready for surgery.

>> Yeah.

And then when you get them to the hospital you got preop postop anesthesia.

>> I mean and then if they do stay up on the floor it's you know, everyone knows me as a joint doctor but I got to tell you I got the greatest team.

>> Yeah.

Around supporting what I do and it makes it easy for me to do this.

I hear that all the time from patients whether they have cancer or they're having something orthopedic done is they'll say like I had a great team, you know, and when I was growing up that wasn't it.

You know, if you needed it if you had a problem, your family doctor might send you to another doctor and they might send you somewhere else for physical therapy and then you might do you something else with another another office and you know, the communication is hard to communicate.

>> You're split up like that and I have a it's been with me twenty two years and a great first assistant.

>> I swear if I drop they finish I many of your colleagues have said that you have a so I I don't think we have time to take John's question but John I hope you're listening.

He wanted to know his joint replacement help if you have one leg that shorter than the other.

>> Good question.

You can correct the leg length more easily with a hip than you can with a knee the knee we can well for your boat and we straighten you out.

You're going to be obviously longer but we can correct leg links with the hips by far a lot easier than we can with the knees all just question wonderful questions.

>> Just a wonderful night.

I'm glad everyone's staying inside and watching us and not out in this terrible cold so well you Dr. William Berghof, thank you so much.

A pleasure as always.

>> My pleasure.

Thanks for having me back.

Come back with all the accessories again is extremely helpful.

We love having that so thank you.

Thank you and again thank you to all of our viewers for watching and for your great questions tonight.

Hey, I want to remind all of you that they're putting clips of the show on YouTube now.

So if you like to look at some highlights of this show or any ther health lines, you can do that.

We just started that about a week ago.

So take advantage that I'm Jennifer Blomquist.

ave a great night and again be safe.

Stay warm and we'll see you next Tuesday.

Mark Evans will be hosting the show.

Take care.

Bye bye