hello welcome to HealthLine.

>> I'm Jennifer Blomqvist.

I'll be hosting the program this evening.

I really appreciate you tuning in.

As I always tell everybody every time we do this program you will learn something.

It's a great show.

Get some free advice.

We do have a familiar face with us tonight.

We have an orthopedic surgeon who's been on a number of times in the past.

He was kind enough to join us again tonight and as usual he is here to answer your questions.

He's here to help you.

That's why we keep the phone number up at the bottom of the screen.

It's (969) 27 two zero if you're outside Fort Wayne , there's still a toll free call available if you want to do it that way 866- and then the rest of the number we'll put you through.

You have two choices when you call in the I like the first choice the best but you do what you are comfortable with.

You can call in and you can stay on the line and then you can talk to Dr. Lynch and have a conversation with him and that is nice because he might need to ask you questions to give you the best advice possible or if you prefer to have me ask the question for you that's another great option.

So just tell the call screener what your preferences and they will help you out there.

So let's go ahead and introduce you again to those of you who have maybe not seen him though he's been on a number of times.

>> Dr. Jonathan Lynch, an orthopedic surgeon.

Great to have you back.

It's great to be back.

Thanks for having me.

>> I appreciate you coming on.

So Lord knows they have very busy schedules.

So in the orthopedic world we are going to be talking specifically about hip and knee replacement which is his specialty.

>> But if you have something else that's orthopedic related, I would go ahead and call I mean nothing else you can kind of point him in the right direction did my best because if so many people who are specializing in different areas and he could maybe point you in in the right direction there so feel free to call any time.

Like I said, the phone lines are open now but we only have them here till about eight o'clock so call sooner rather than later.

I it's funny when I got the topic about hip and knee replacement I had just talked to somebody whose mom had had a knee replacement and was telling me how horrible it was and she was taking care of her mom and I thought Oh that sounds terrible but it sounds like it's just something that you have to really be mentally and physically prepared for .

>> I don't want to talk about that.

>> I mean there's been so many advancements but it's still a big commitment.

It's still a big commitment.

I think it's something I counsel every patient on with knee replacement, especially people that have had a hip down or shoulder down knee.

It has to be a tougher joint even to recover than hip and hips and shoulders.

And I think a big part is you around the knee there's not quite as much soft tissue and muscle so the swelling plays a big part there.

So keeping swelling down certainly helps.

It's just known to be tough those first two weeks I always set that expectation you kind of set the bar almost, you know, a little bit low in some areas and expect them to really have struggling to have pain and then a lot of people do do better.

>> But it's usually for two weeks that I typically say you're going to be more pain than you were going into the surgery and after about two to three weeks you start to make the turn.

I've had a lot of patients not experienced that.

I mean I think you know, a lot of people who go in with a really arthritic or deformed knee, those patients tend to get a very good response early on.

So your starting point certainly dictates the course postoperatively but there's no way around some pain.

>> There's just no way around.

>> Well, and I know we've talked about this in the past that you know, it's somewhat of an elective procedure because a lot of times you've said, you know, the patients will say well, you know, when when do I need to get this replaced?

And you usually ask them you tell me when you want to do it now for sure.

>> I mean I think like that's a nice part of my job when it comes to a clinic like a lot of times, you know, when when the patient is healthy enough and I know we'll talk about this in greater detail when people are healthy enough to have it done, it really comes down to do you do you truly have bone on bone arthritis?

Are you at a point where there's no other option short of this and if the x ray shows that then the choices the patients and so my my job is really to say hey your knees bad enough to need it.

You tell me when you want it and a lot of times when there that our office you know, that's ten times a point because they've tried everything short of that.

But it's definitely an elective surgery from the perspective of the patient.

Now that being said, a lot of people ask well just because it's elective does insurance cover you know, insurance does still cover the procedure but it's elective in the sense that, you know, it's not an emergent cardiac catheterization to save your life or something like that.

It's elective in terms of lifestyle modification.

That's why a lot of people get it done because people get good outcomes.

It improves quality of life and make sure, you know, certainly a very rewarding aspect to our career.

But it is elective.

>> Yeah.

And it's so I'm always impressed by how quickly you know, that used to be a long hospital stay years ago.

>> So what what do you what is it outpatient or is it so that becomes a very confusing point for both providers and patients but almost every placement now is considered outpatient.

But that doesn't mean you're going to go home the same day.

It simply means that you know by CMS or center or Medicare or Medicaid consider it outpatient but they you know, their pay covers, you know, would include a potential night stay in the hospital.

So that being said, we learn during the time of covid that a lot of people do really well going home the same day around the time of covid we had to do them outpatient truly where they went home and there's been several studies done to show that people are safe to do as an outpatient whether you go home, the E.R.

readmissions, things like that don't go up by going home and we know more than anything that the sooner people get up the sooner demobilize the better coverage, the quicker recovery and the less likely you are to have a complication.

>> So while while the joint replacement is considered outpatient for all, it doesn't mean you may not stay a night in the hospital.

But if patients are healthy enough, you know, a lot of times we encourage them to consider going home because there's not a lot we do in the hospital that they can't do at home.

You know, we give them so we kind of ask what is improved to make it better we have gotten better at knowing what medications help.

So all those medications that we'd be giving in the hospital, they can take they go home with we give blocks around the time of surgery.

pSo a lot of times our anesthesiologist will give a regional bloc to help with pain that first 24 hours.

So that's been very effective and then certainly the techniques have in some ways advanced to allow for less pain in terms of implants and surgical techniques to help as well.

But we've we've learned that early mobilization is critical to outcome and I think that's led to these being done as more and more outpatient cases.

>> Yeah, and even the hip replacement I know you've said people typically do go home that day.

That day.

Yeah.

So they're even standing like two hours later and again, you know, it's very true and I think it's like again it's not one size fits all for whether it be joint replacement or who goes home and who stays.

I mean there are so many things that we take into consideration but certainly the age and the health of the patient or the two biggest thing so younger healthier patients good to go home or elderly especially female patients probably better stay a night in the hospital, make sure something doesn't happen and there's risk stratification scores to help guide us in that you know, so considering everyone is a true outpatient and sending them home, I think I think there's there's some concern to that.

So certainly having a hospital fall back on to to be able to watch and monitor patients I think is very important and but that doesn't mean that you should have to utilize it for everyone.

>> So I think we should utilize our resources appropriately and we're you know, we're trying to do that in our profession so.

>> All right.

Well, we are talking about hip and knee replacement.

But like I said, you know, if you have a different orthopedic related question, feel free to call that in and Dr. Lynch can help you out again.

There's a phone number at the bottom of the screen (969) to seven to zero.

Looks like somebody is calling in and wanting me to ask you a question so and get to that in just a second.

This was Bonnie and Bonnie said she oh is she is she is she on the phone line?

Are you there Bonnie my name is about oh OK. >> Go ahead.

I'm sorry what it tell me your I had the wrong name I'm sorry.

>> Oh gosh my name is Valerie.

Oh go ahead Valerie I'm sorry.

Go ahead with your question OK it's about a total knee replacement the the me was injured when I was much younger and they would not replace it because of my age but now I'm just about sixty and it needs to be totally replaced but I'm having a problem with the weight issue.

They said that I need to lose fifty pounds.

I lost fifty pounds but you have lots of pounds to make it still kind of push them out so it's frustrating to me.

Are there any doctors that will because I care about my weight but they got to understand my weight came on because of the mobility so it could be is fixed that is going to resolve the weight issues because I used to be very healthy.

I used to be active when the knee went bad.

You know the mobility stop, you know.

So is there any doctors that would take a look at me and and come up with a plan because I want to get it done.

>> I've been to physical therapy.

I home you know, weight loss is impressive now that's very good.

And I you know, I appreciate your question, Valerie.

And you know, it's something I see very frequently in clinic and it can be a very tough issue for the doctor and patient both like you said because as we know weight you know two things battle weight one is exercise.

One is diet.

And really when it comes down to when you're being overweight trying to get down to the healthy weight, that's really the only thing you have to employ and it sounds like you've been doing that and kudos to you for doing that.

and get your weight down to a healthy level is because we know BMI is a risk factor for complications and having an infection is by far probably one of the worst complications that can happen in joint replacement.

So it's really a preventative measure to get you there now you know, I don't want to speak for everyone but you know, I myself and I believe most my partners would see just about anyone at any weight.

That doesn't mean we necessarily do surgery on you.

But but we we certainly it's just one factor we look into we generally set a goal weight and there's not a hard line for anyone and for me I find most often if people are trying and at least trying to get there then that's that's enough for me to be encouraged to try and help them.

We just don't want you to have a poor outcome and weights just one factor.

We look and we we've seen studies that show that weight while it's a factor for problems, it's not as high as say smoking or poorly controlled diabetes.

So there's been more push in our society recently to start doing patients that are even morbidly obese or BMI over forty or one time I thought that it was very poor practice to do that.

I think there's actually more data now to support offering surgery to patients with BMI over 40 so you know, I believe I know myself or any of my partners would be happy to see it and see what we can do to help you.

>> I guess it never hurts to get a second opinion.

No, I never sure.

You know and actually I was reading a book by a surgeon who he then became CEO of Kaiser Permanete and he said which I agree with is that if you're going to have a big surgery, it's it's a lot of times appropriate to get two opinions like you know I mean you're sure you're signing up for something major if you have a you know, if you're trying to get somewhere and one doctor tells you now it doesn't hurt to get another opinion to see what options are available.

>> Yeah, well, we bought a car ecently and we sure you shop around you know, it's just kind of the same thing you might want to just kind of wait your options anyway so.

Well, Valerie, we wish you all the best but it sounds like maybe you know, if you want to go talk to maybe another doctor too and see see what what they have to say.

So now we do have somebody named Bonnie who called earlier.

>> She also has a name that she says needs to be replaced.

But apparently there's a cyst behind it and she wants to know what can be done about that.

>> Is that common?

Very common.

So I was reading her question while Barbara was asking and so it's a baker cyst is what we call it in the back side of the knee and basically the Baker Sisters is fluid inside the knee.

There's nowhere in the front for it to escape because of the quadriceps Meccan the quadriceps mechanism there.

So the path of least resistance is out the back between two muscles.

So almost everyone with arthritis has abacuses because of swelling within the knee.

We don't go and directly remove it because the main artery and nerve that innervate the leg is back there.

But by doing the knee replacement the cyst shrinks over time and a lot of times what we're doing the surgery will actually go ahead and erupt while we're exposing the news a lot of time brain drain we don't like Hensleigh do but it generally will kind of erupt on its own while we're naturally doing the surgery.

But you know, I've never had a patient come back and express it as being a problem down the road.

So usually it regresses by treating the underlying arthritis in the knee.

>> So that would not cause an issue like to have the knee replaced.

>> They would still they would do it with that.

Yeah, exactly.

All right.

All right.

Great questions coming in tonight.

I have one more from Mike that we're going to get you in a second.

But if you're watching it and you have a question you'd like to ask Dr. Lynch, feel free to do so right now (969) to seven to zero again if you're outside of Fort Wayne it's still toll free if you put an 866- in front of those numbers let's see Mike wanted to know what the risks are getting a knee replacement when you previously had a blood clot in it?

>> Yeah, that's a very good question.

You know, certainly a big concern that we always have is blood clots.

That's one reason we've moved towards doing these surgeries more outpatient military-becausp and walk the less likely to develop a blood clot.

One of the biggest risk factors for having blood clot is a previous history of it, especially in the recent history as opposed to the remote history.

So patients who have a history of blood clot generally what we'll do is we'll put them on a little stronger blood thinner like a little stronger one.

So for a lot of people with issues like a baby aspirin or an antiplatelet medication which doesn't have as much bleeding risk but for people who have had a history of placebo, we'll put them on a stronger blood thinner or there's something called an ABC filter where a filter can be placed in your vena cava which is the large vein that drains from both of your legs and that could catch a blood clot from the leg that goes to the one we rarely do that but patients who are the highest risk that can be placed prior to surgery to help because the complication f a blood clot that we all worry about is a fatal P or pulmonary embolus that occurs at an extremely, extremely low rate fortunately.

>> But for those patients high risk that too is an option.

>> So it never generally if you had a history of blood clot we would not do the knee replacement.

We just take those things into consideration.

>> Yeah, that is always worrisome here and that impacts so many other parts of your physiology having that risk.

>> Yeah, there was a gentleman who really studied it extensively now he had a patient early on die of a blood clot and actually he was a surgeon out in Maryland and was originally a hand surgeon.

I did a lot of training placement but he spent his whole career studying anticoagulants and blood management.

We still don't have a perfect answer to it but we've learned that using aspirin has less of a bleeding risk but it tends to be as effective as the stronger anticoagulants that cause bleeding.

So for low risk patients we just like something like a baby aspirin.

>> Yeah, all right.

Yeah, it's amazing all the things that you know you're talking about now these advancements and even just 20 years ago you didn't hear about people having the positive outcomes they have today a lot of advances have been made again, feel free to call and ask us questions.

Don't ask me I won't be able to help but Dr. Lynch can help you out.

It's (969) 27 two zero.

We're going to keep talking about knee and hip replacement .

I know from doing shows with you and many of your colleagues in the past the trend is always to start conservatively.

>> You know, if somebody is having an issue you guys might do an injection or physical therapy.

>> So surgery's almost always is what you've said is the last resort but who is a candidate for joint replacement?

I mean is it do you can you tell right away if if they're going to be a good candidate or do you have to do a lot of testing or weight or a certain amount of time?

>> I can tell right away.

I mean these are these are this is that I mean, you know, a lot of times we will sign them up for surgery the first visit and they will have gone through a lot of those things if the big and if the patient wants to.

But you know, if patients come into your office and they have true.

But again the key word for me is bone on bone arthritis.

There's no cartilage left in the joint space that is the number one indicator prior to anything else to be a candidate.

So we know that if you're short of full bone on bone arthritis that it's probably more appropriate to start with those conservative things.

So to me that's I think the key the key word is is kind of bone on bone and then beyond that it's really taken into consideration your general health .

So there's certainly there's many things in your general health that we take into consideration.

You know, so you people live a healthy active lifestyle are probably going to be slightly better candidates than patients that may have comorbidities that put them at risk that we've talked about previously.

>> But you know, the primary indication is ambulatory patient who has bone on bone arthritis that is debilitating and feel like they can't live the rest or life like that really that's what it comes down to.

>> Yeah, I've talked to people have had situations like that and it's just just a miserable way to really live.

So I mean I could see why they'd want to just jump in and do the surgery at that point.

>> So that's what's beautiful.

But I mean it's pretty amazing to think that six weeks after doing this they come to your office and they they feel like they've gotten their life back a lot of times.

So it's again it depends on their starting point.

But fortunately we're very fortunate to be in a place where we can really help people significantly.

>> Oh yeah.

And it can be life changing.

It's just like we were talking about earlier in the show.

It's a process and the recovery is a recovery for hips faster than for knees it generally is.

>> Yeah, I think they don't go that first two tends to not be as as painful and so it just tends to make it the process a little quicker in general.

But I usually tell patients to expect a six recovery for both but for knees or about eighty percent at six weeks for hips you're about ninety percent recovered and that's of kind of full recovery from the surgery.

>> So Hips is a little bit quicker.

Well what does it involve after the surgery?

You know like how do they come back and see you and then when could they even start putting some weight on those parts of their body?

>> There's a really good question.

So generally speaking most of the time is for weight bearing after the surgery and really severe cases where you have a lot of bone loss or you're doing something special beyond a standard reconstruction you may have to do toe touch weight bearing for six to 12 weeks because a lot of the implants we use require the bone to grow to the surface of them so that those implants aren't fully stable until that happens.

So with bone loss sometimes there may be restricted weight bearing.

They're generally coming back at two weeks for an incision check.

So obviously sooner if there's concerns.

Yeah, we usually check their incision at six weeks and then we usually take an x ray that I'm sorry check the incision at two weeks, take an x at six weeks and then if there's still any concern at that point then they come back at twelve weeks and then again at a year out from surgery so well and because it is such a big investment in time and resources I think people want to know is this it like well I just will this fix it for good.

>> I think the the hardware is a titanium steel for the most part so yeah it's on the hips they're made of a titanium alloy on the knees part of it's a cobalt chrome or is part of its titanium but those are the main materials.

>> Yeah yeah.

I mean the question of whether the hip replacement or knee replacement is going to fix it is really comes down again.

What is that extra in some cases an MRI show?

Yeah because a lot of people come in and they think oh my knee hurts I just want it replaced and that's not always the answer.

In fact I can lead to really poor outcomes.

If you were just you just gave a knee replacement and had knee pain, sure there'd be issues so it's got to be the right indications.

But but yeah if if they're true bone on bone and again come down to being a candidate I mean it's amazing it generally fixed the problem for people like what's life expectancy of the hardware that you use.

>> So there's been retrieval studies on hips that show up to eighty five percent survival at twenty five years even so it's pretty high knees I think is a little bit less than that.

You know I usually say expected to last beyond a decade and I mean I've seen a lot of knees that are you know twenty to thirty years and I was materials a long time ago so the materials are made a little better.

I think we're putting them in better in terms of how we cement them.

A lot of times we cement knees and there's even newer implants said they'd do it without cementing how which would even increase the longevity.

So so I you know, I generally say expect 15 to 20 years with the best outcome but we've seen them last longer so that's nice.

>> Yeah.

Nobody wants to have to do it twice I'm sure so but if you're really young yeah probably well so yeah one thing we're seeing is a lot of patients we're being more confident to do them on younger younger patients you know used to be taught kind of wait till you're at least 50.

That was when the implants were not you know, quite as good.

We're doing them on younger people but we always tell them that's what the risk of knowing is there's going to be this isn't the last we have to go into that joint problem.

>> Right.

Understandable.

Well, we are two people who called in wanted me to ask the question so I'll get to those quickly.

Lisa once said she had two partial knee replacements in the past.

>> Now she needs to get a full out.

Now she needs to get full knee replacements.

So for both of them, what can I expect recovery wise?

>> Yeah, really good question, Lisa.

In general the nice part of having had a partial knee replaced um when we go on to do the fall it's generally like pretty close to doing a full knee replacement when we take the partial off there's generally not a lot of bone loss which is what we see in revision surgery.

>> So although it's similar I mean it technically is a revision when you make a partial to a total from that sense it's really the bone stack is like a primary knee.

So I would expect your recovery to be like anybod who's had a primary knee expect it to be a little more painful than what your partial knee was is there's more work being done just as we know partial knees tend to recover a little quicker for that reason.

But I would expect that to be very similar to anyone who has a total knee replacement for the first time.

>> All right, great.

And we've got just a couple of minutes left.

But Bill wanted to know what is the best type of knee for a knee replacement?

Is it something the patient has a say in?

>> Yeah, I mean, you know, typically not I mean you know, this is you know, obviously we we all have different reasons why we do what we do.

But I you know, for me, I you know, I choose to not have any ties to industry for this reason because I try to make the decision I would implant we use based off what is going to be best for the patient.

So you know, when I choose a new plan for the patient it's simply because I feel like it's going to be the best implant for their anatomy if they tell me they have a favorite or they prefer one then I will take that into consideration if I'm comfortable with that implant.

But a lot of times I give them my reasoning as to why I want to use a particular implant general it comes down to their anatomy or their deformity and what I'm comfortable with as a surgeon.

So I you know, I I think that's typically what I run into a lot of times I get asked what's the difference between a custom knee or robotic knee and a manual knee?

The answer is the data shows absolutely no difference in any of those.

So I think again it comes down to whatever surgeons comfortable with and whatever their outcomes and results are with that particular implant and with with their you know, in their hands is what's most important and what they're good at doing.

You should stick with letting them do it that way probably would be my it would be kind of the way I view that.

But certainly if there's other outlying reasons I'm always open to listening to it so all right.

>> Well we have like maybe one minute left that I want to just try and squeeze this in because we're getting into cold weather .

People can fall and hurt themselves.

A woman wanted to know if she fell and broke her hip.

Is she going to be the candidate for a hip replacement?

>> Is that what you normally would do for a broken it depends so young active patients I break their hip we would do potentially a total hip replacement if they're less active we'll do what we call a partial hip replacement is more stable.

OK, so it depends on the activity level of the patient.

Yeah that happens and among other factors but I don't know if this is true that I had heard that if you have a broken hip you only have a a small window of time during which you could do a replacement.

>> It's true.

It's just that you want to do it sooner or later because the more you lay in bed the complications go up.

So generally we want to get to within forty eight hours of the hip fracture.

But you want the patient optimized for surgery to optimizations key so if there's anemia, low sodium or things like that then you correct it's best to do that before the surgery.

>> OK well we don't want anyone to fall just yeah I don't even like to think about the cold weather but it's coming in so you just you know especially you might want to if it's an older person your family maybe help them out puts himself on your sidewalk before the winter definitely sets and works pretty good too.

>> It's messier but it does work.

So unfortunately the show is just about over.

Dr. Lynch, it's always great to have you on its back.

I insist that he comes back.

He has two little ones and then of course this crazy job.

So we certainly appreciate you given your time to us.

All right.

Thank you.

Thanks to everyone who called in tonight.

Great questions.

>> I'm Jennifer Blomquist.

Take care.

We'll see you on HealthLine again next week.

Have a good week