(upbeat music) - Hello and welcome to The Journal.

I'm Steve Kendall.

Every year more than 3 million people have knee replacement services done.

Increasingly, this surgery is done using robotics.

It's evolved over time.

Joining us from the Wood County Hospital to talk about this procedure and especially the new evolution in robotics is Dr. Carlos Gomez.

Dr. Gomez, welcome to The Journal.

Thank you for being here to talk about this.

Kind of talk us through how knee replacement surgery has evolved since it first began, because obviously done a lot differently 15, 20, 30 years ago, but it's even changed a lot just in the past couple of years.

So talk about that evolution a little bit.

- Absolutely.

Thank you for having me today.

- [Steve] Sure.

- Steve, we have been doing total joint replacement for about 30 years, and through the years, we've been noticing improvement on the technology.

Initially, we were able to use just some tools that were able to be used for every single patient.

And I have a little sample that you can see how we initially used big rods to put inside the bones to cause, to try to get the alignment that we need for those patients while we were doing the procedure.

[Steve] Right.

- So I've been here in Wood County Hospital about 15 years.

In the past 12, we tried to brought the latest technology in joint replacement.

So initially we were doing MRIs or CT scans to make a patient a specific type of total knee replacement.

[Steve] Ah, okay.

- So, and the first, as I said, we made this jigs with the studies, with the MRI and with the CT scan and make this jigs that were used.

One for the femur, one for the tibia.

And we were able to make the perfect cuts to get that patient an specific need.

You know, all the bones are different.

[Steve] Sure.

- And so we need to make sure they were a specific for that patient.

[Steve] Right.

- Through the years that changed and last year we started at Wood County Hospital, bringing robotics.

Robotics in orthopedic have been around 20 years.

[Steve] Okay.

- And with the first generation up to the fourth generation is what we were able to acquire here in northwest Ohio.

The first hospital they had it, in this area.

And me, the one that did the first robotic fourth generation type of knee.

[Steve] I see.

- It's been very exciting.

[Steve] Right.

- The changes that we've seen through the years is, as I said before, making this jigs, this process takes about six weeks.

- [Steve] Wow.

- With the latest technology, we have a robot that we can do in four minutes.

What it takes six weeks to.

[Steve] Used to take six weeks.

- Absolutely.

[Steve] Oh my gosh.

- Our, the advantage of it is we don't have to do any extra tests, no MRIs, no CT scans, so we don't have to expose the patients to other type of studies and the robot will do it in real time.

[Steve] Wow.

- So in four minutes, we can arrange, using this arrays that we put in the patient as well as we have to document all our information through a camera that is five times faster than a hummingbird.

[Steve] Yeah.

- Wing.

It's very fast.

So it takes a thousand pictures per second and we can document our knee into the system and in those four minutes, we see the alignment that the patient presents with and we can program that to make sure we get the alignment that the patient needs.

- Yes.

Because as you said, this really personally, because everybody, you know, we all have knees, but everybody's knee is a little bit different.

You said alignment, those sort of things.

[Dr. Gomez] Absolutely.

- And I guess from the patient's perspective, that shaves so much more time off that they get their knee replaced or their joint replaced and get rid of the reason why they're doing it, the pain, everything can go away faster, they can get to physical therapy faster, all those sort of things.

So it really shortens that timeframe not only for you but for the patient as well.

[Dr. Gomez] Absolutely.

- Yeah.

[Dr. Gomez] They don't have to wait six weeks, but back then.

[Steve] Yeah.

- When they needed to wait six weeks, we have those patients in rehab so they could get stronger.

Probably get a little bit better motion.

[Steve] Yeah.

- And those patients definitely bounce back a lot faster.

[Steve] Ah.

- But definitely with this new technology, we are able to be more accurate.

We can decrease at the time of staying in the hospital.

[Steve] Right.

- And we can have smaller incisions and also a faster recovery.

- Yeah.

So yeah, a lot less invasive and a lot, just a lot better all the way around from every aspect of it.

When you talked about, you know, the initial, the way we used to do it, the older style thing, that replacement, how long, would that be a permanent replacement or would that be something that would last 15 years, 20 years.

What was the life expectancy of an old style replacement?

- So.

We, at that point, FDA is the one who rules that and.

- [Steve] Okay.

All right.

- Says you know, usually it's about 10 to 15 years.

[Steve] Ah, okay.

- But not only the techniques have evolved, but also the quality of the implants.

[Steve] Sure.

- So for instance, with this prosthesis, the company has put a lot of effort and money into develop new techniques and also materials.

So when we have a knee replacement, we have metal in the femur, metal in the tibia, and a piece of plastic in the middle.

- [Steve] Okay.

- Back in the day, that was a plastic that we started to wear off.

So the release of freed radicals is what it makes that plastic to wear off.

- [Steve] Ah, okay.

- Nowadays, the addition of vitamin D into the poly, the plastic has helped and decreased wear and tear 50% compared to the old type of material that we use.

[Steve] Wow!

So the longevity of this product is gonna be a lot better.

[Steve] Yeah.

- And those knees are gonna be better.

We have good studies right now that show that the longevity can be, that patient can be good for forever with that knee.

Again, it depends on use and abuse.

[Steve] Sure.

- But we have good results so far and and with the literature that we have.

- Yeah.

Now has there been a change?

Because I know that at least from the layman's perspective, they used to say, well let's hold off on doing a joint replacement because we want this to last the rest of your life, which means let's wait until you are 60, 65, whatever it would be.

[Dr. Gomez] Right.

[Steve] That's not the case now because if you could replace my knee at age 40, theoretically you're saying that might last me the rest of my life given the new materials and the techniques and everything that are now available.

- Steve, great point.

[Steve] Yeah.

- Because that was the problem before we were thinking that this materials were gonna last and we've learned through the studies that they do last, having the latest technology obviously is gonna make the longevity a little longer.

Age at this point is not an issue.

- [Steve] Ah.

Great.

- It's all about quality of life.

[Steve] Yeah.

- And I always tell my patients, if we have done everything, you've done therapy, you've had injections, you have lost some weight, and you're still having pain, but your quality of life is not there, it's time to make a change.

So for instance, I've done a total knee replacement in a 40 year old.

- [Steve] Ah, okay.

- I've done a total knee replacement in a 94 year old.

[Steve] Yeah.

- And they do well.

And so age at this point is not, I think the main thing for our patients is quality of life.

And I think we achieve that with that.

- Yeah.

And so it's a good point too because the other aspect is as you get older, surgery becomes somewhat more problematic.

This removes that if invasive too, it makes it easier for someone is on that end of the scale versus maybe the younger end of the scale for this.

So it works all the way around for everybody.

That's incredible.

[Dr. Gomez] Absolutely, absolutely.

[Steve] Incredible.

[Dr. Gomez] Through the process we've been doing other things that have helped on the patient with pain, which you touched earlier.

- [Steve] Sure.

- So on those patients, we do a block, a nerve block of the leg and they do or general or spinal, we prefer spinal because the patients are more awake with less nausea after the procedure.

And then at the end we have a product that I'm the only one using in Northwest Ohio.

It's a combination of a medication is an anti-inflammatory.

- [Steve] Okay.

- With a long lasting anesthetic that we pour in the back of the knee.

- [Steve] Oh.

- And it stays there for 72 hours.

It makes that transition very smooth for our patients.

When the nerve blocks go away, they still have that pain medication inside the knee before we close them.

And we have noticed from our pharmacy department that we use less narcotics in those patients as well.

- [Steve] And that's always a benefit too.

- It's a huge benefit nowadays.

Absolutely.

[Steve] Okay, good.

Well, we'll talk more in just a minute.

Back in just a moment with Dr. Carlos Gomez from Wood County Hospital.

We're talking joint replacement surgery, the new robotic techniques and focusing on knee replacement.

Back in just a moment here on The Journal.

Thank you for staying with us on The Journal.

We're joined in a segment by Eric Avers, a Physical Therapist at Wood County Hospital, and also Dr. Carlos Gomez, Orthopedic Surgeon there.

Dr. Gomez, we left that last segment you were talking about the fact where we've gone through the procedure, the patient's been getting an anti-inflammatories, pain medication before you've complete the procedure finished.

So talk about what happens as you get everything in place.

You've got the patient now ready to turn over.

So what happens as you complete that process?

And then we'll talk with Eric about, he picks it up then as physical therapy thought.

So what are the final stages of your role in this as we talk about the procedure?

[Dr. Gomez] Right, Steve.

It's an effort of team work and I round my patients right after surgery, make sure that everything is fine, talk to the families, give it a little, you know, talk about what the to expect.

But definitely they will go back to the floor and because of the blogs, we don't recommend them to be up.

So they stay in bed and the next morning, the first thing they do is when they have breakfast, the pain pill and for dessert they'll have therapy.

[Steve] Ah.

- So therapy is important for them, which they do in the morning and they work with their team, physical therapist.

And at noon, they'll come back so they can do steps.

After that the patient goes home about 3PM.

The next step.

[Steve] Wow.

So you're in and out of there really within a real short period of time.

Okay.

- We make sure that there are also arrange for a follow up so they can see Eric in rehab.

- Yeah.

Yeah.

So literally the day that they, that next morning they're up and starting to move around a little bit on this new replacement joint.

[Dr. Gomez] Yeah.

They're big cities where they say, "Well, we wanna send them the same day."

I think that is a great idea, but I want to do everything in my power to make sure that we can decrease complications with them.

I wanna make sure we give them three doses of antibiotics.

I wanna make sure the pain is under control and I wanna make sure they start therapy the next morning.

- Yeah, yeah, yeah.

So we've gotten through the procedure and you've released them and now of course, when sometimes when people say physical therapy, people could get a little shaky because obviously it means there's gonna be some work ahead.

So talk a little about this process because obviously since the surgery procedure has been a lot less invasive and much more customized, the individual patient, hopefully that makes your job a little bit easier.

- Absolutely.

So it's, we try to make it as streamlined as we can from when they leave the hospital within another couple days we get 'em into outpatient.

We've found, since we've kind of incorporated some of these newer procedures, things are a lot easier for us.

They're a lot easier on the patient.

There's less pain.

We're able to get the outcomes that we need a lot easier and a lot quicker without having to burn up as much insurance coverage so that first week that we've had surgery, we get 'em in, we take some initial measurements of their surgical leg compared to their non-surgical leg, kind of set some goals with the patient, send them home that first day with a few more exercises that they need to be working on at home, get 'em scheduled then for four to six weeks and kind of hopefully get them back to where they need to be within that time range, generally for the most part.

- Yeah.

Now you mentioned some, so when you measure both legs, is there an expectation that it will be slightly different or what's the purpose of that.

- Typically, no.

[Steve] Okay.

- We get some.

[Steve] That's good to know.

That's a good thing.

- Yeah, yeah.

[Steve] It's a good thing.

- We get some people who, they're, the right leg's the bad one, but the left one's also bad and I'm gonna get the right one done first and I gotta have, so you don't want to compare to an already bad leg, but we kind of have a general idea.

We want to be able to get the knee all the way straight and we want to be able to get roughly 115, 120 degrees of bending out of the knee so that person can descends stairs properly, can get up and down off of a low toilet, a low couch, those kind of things.

That's kind of a general range of motion that you need to function without any issues.

So that's-- - That's the goal.

And hopefully now, you can obviously, can you go beyond that and get a larger range of motion, but that-- [Eric] Yeah.

- That's what you really need to just to do.

To do all the normal things that we're-- [Eric] Yes.

- We're used to doing.

- Yep.

Yep.

That's kind of the bare minimum.

And we are seeing younger and younger people that are having these surgeries now and they have some higher level goals that require more range of motion and if that's the case, no problem.

- Well, and that reason is your point because, you know, we talked about the fact that you can do them now earlier, you can do them later.

[Eric] Correct.

- How does that, if when you deal with a, say, a 40 year old, you can, you sort of just touched on that.

Is the plan obviously different for a 40 year old than, say, a 65 year old?

[Eric] Absolutely.

- Okay.

- We try to individualize the goals.

We talk about that with every patient.

What are you trying to get out of this?

Are you trying to just get back to recreational exercise or are you trying to do something higher level?

Are you chasing grandkids around?

We have that conversation the first day and then kind of set goals based on that.

- Yeah.

And obviously you provide feedback to Dr. Gomez and then you look at what's coming out of physical therapy and work with Eric or his counterparts to say, we need to do a little more or we should be seeing a different result or we're hoping for a different result than maybe what we're seeing.

But most times it probably goes well I'm assuming.

[Dr. Gomez] Yeah, yeah.

- Definitely.

We do work together very well because if they seem to find something that they're not happy with, they communicate with me immediately and we can address whatever needs to be addressed in that patient.

We like to get that motion as Eric said, 0 to 120 with a minimum of maybe one 110 so they can be functional.

[Steve] Sure.

- But if with time they're not able to get to that point, then we have to directly the program another way, just to make sure we achieve and get to what need to achieve on those patients.

Yes.

- Yeah.

Now do you ever encounter, I know because obviously someone who's had this surgery, is there ever reluctance on their part to, like, test the joint?

Like, "Well, do I really wanna move it because, you know, I'm not sure."

I mean there there's probably some a little concern like, well, I maybe does it safe to move it, do I wanna move it?

I mean how do you deal with that from a psychological point of he was like, "Well it feels okay, but I don't wanna break it right out of the box."

So.

[Eric] I can tell you Dr. Gomez is already on top of that before the patient ever even gets to us.

He explains everything went well.

We made sure the knee could go all the way straight, it could bend and everything's nice and stable.

So we basically just have to explain that a little bit of pain is okay.

It generally goes away within a week or two for the most part.

[Steve] Right.

- But it's okay.

The alternative if we don't get this motion back is, you know, we're not gonna have the outcome that we want to have.

So that is a pretty good motivational tool for people to kind of push themselves a little bit.

- Yeah.

Because that's good to know because obviously, it's like anything new the first time you want try it, it's like, "Well, do I really wanna see if I can push it to that limit?"

And obviously as you said, there's gonna, you know, with any kind of rehabilitation or any kind of physical therapy, there's gonna be some pain because you're doing some new things with a new device so that is something to take into consideration.

But it's good to know that, yeah, you've prepped them enough that they go, it's okay to do what Eric is asking them to do.

[Dr. Gomez] The expectations are said before.

So we talked to them before surgery, throughout surgery and after surgery.

So we work as a team to make sure we achieve that goal.

And it's definitely important to show them that motivation is important.

It's not about what the surgeon does, it's about a whole team effort where we have the surgeon, we have the patient, we have physical therapy, and we will work together to get to the goal that we set from the get-go.

- Yeah.

And that's a good point because your thing is to make sure when they leave they have the functionality that they need if and if not more so.

So that's a good thing.

[Eric] Yep.

We try to make sure that everybody, when they're done with physical therapy, they've got a home program.

It's not done after that month, two months of physical therapy, you've got some things that you need to continue to work on to get your strength all the way back where you want it to be.

And we try to make sure that everybody's got pictures and they've got videos and they've got bands and weights and everything else that they need to be able to continue to work on it.

[Steve] So it's, yeah, it's pretty comprehensive.

Yeah.

[Dr. Gomez] And one of the things that I like to do right after surgery is to take a picture of that knee completely straight and completely bend so we can show the patients that they can do that.

And even though they say, "Well, I was asleep there or, you know, I was under whatever," still they can do that.

[Steve] They know they can do that.

[Dr. Gomez] And they keep that that picture so they can look at it and say, "I have a goal, we need to keep going on it."

[Steve] And it's doable and I'm not gonna hurt myself doing it.

[Dr.Gomez] Absolutely.

- Okay.

We're gonna be joined by one of your patients here in the next segment.

So back in just a moment here on The Journal with Dr. Carlos Gomez, a Physical Therapist, Eric Avers and a patient who's gone through this procedure.

who'll talk with us about that, Helen Frobase back in just a moment here on The Journal.

Thank you for staying with us here on The Journal.

We're talking about knee replacement, Wood County Hospital with a new robotic situation, generation four knee replacement robot.

And we're joined in this segment by a person who has just gone through this procedure, Helen Frobase, and we want to thank you for being here.

[Helen] My pleasure.

- Talk a little about how you found out about this, how you got through it and then we can talk about, you know, how it's worked out and that sort of thing.

So how did this all start with you to approach Dr. Gomez to talk about getting this procedure done?

[Helen] Well, it started, my older brother, who's 16 years older than I am, had his knee replaced and just was going on and on, raving about Dr. Gomez, you know, so I thought, well, I'll go in and get a baseline.

I'm 16 years younger and I probably need partial, but I'd been dealing with a lot of pain and swelling for years and I needed a total knee.

So I went ahead and had that done.

And that was in December of 19 and then, just almost a year ago, I had the other side done.

So I have the original way and then I also have the robotic knee as well.

[Steve] So you can kind of give us a comparison of the two firsthand.

[Helen] Sure.

[Steve] Wow.

Okay.

[Helen] I know he mentioned the picture that we all get at the end and that was, seeing that picture with my knee bent, you know, like when I was 10 years old, it was my goal, you know, to reach that in physical therapy.

So.

- Yeah.

Now you talked about the fact you got one done and then the other.

How, I mean, how much difference was there in the two procedures?

Can you tell a definite difference between the original one and what you had to go through to get it back to where you wanted to be and then doing it with the new procedure?

- I think the second one with the robotics, I think that was, it was less hospital time and I think the recuperation was quicker.

And the rehab and everything, I think it was quicker and I ended up with a better degree of bend.

[Steve] Ah, okay.

- Than with the first one.

- Yeah.

Yeah.

And Eric from your perspective, when you were, you know, dealing with the ways we've done this over time versus now, that's obviously changed the way you approached the physical therapy part of it and the plan as well.

Right?

[Eric] Yeah.

It's made things considerably easier for us.

We don't have to be as mean.

Sometimes we get a reputation from people physical.

- [Steve] I wasn't gonna mention that but you did.

Okay.

Alright.

- Yeah.

Yeah.

So we, I don't think we have to be as mean anymore.

We can be a little more gentle and things just kind of come along a little bit easier than they have in the past.

- [Steve] And that makes it better for you too.

- Absolutely.

- Nobody wants to be the meme guy or-- [Eric] Absolutely.

Yeah.

- Whatever.

So that's a good thing.

Dr. Gomez, when you talk with people who are considering this, you know, you've talked about the advantage, but talk again about the main points, why this is a much easier procedure and something that people maybe shouldn't put off because they're worried about, well, this is gonna be really invasive and the rehabilitation's gonna be a long time and the PTs gonna be tough and Eric's gonna be mean to me and that kind of thing.

So talk a little about how when someone comes in and says, "I'm thinking about this, I've heard horror stories."

[Dr. Gomez] Yeah.

- How do you talk them them through that and explain to them that what they've heard isn't exactly what's, isn't anything close to what's about to happen.

- Unfortunately, yes.

We have patients that come with very horrific stories about total knee replacement and our job is to show them what they have and what we can do for them.

I think that using the latest technology has helped us out to be more accurate, to have less time on the patients in the hospital with less pain and a faster recovery.

So that is something they want, we don't push them into anything they don't want.

We are there to explain to them and they make up their mind.

Again, as I said before, they want a change on their quality of life and we can provide that with the latest technology.

- And Helen, when you, you know, obviously, you've had the experience of of doing both knees because you hear stories where people say, "Well, after I got one done, I'm not gonna do the other one."

But in your case, the first one was successful.

[Helen] Right.

- And it was full scale, everything worked out fine, but that encouraged you probably to do the second one.

[Helen] Right.

- It turns out with the newer techniques, the robotic techniques made it even made it even easier.

- Yeah.

And it was like, you know, I mean, you hear people say this all the time, but it's true.

Why didn't I do this sooner?

- [Steve] Ah.

- Honestly.

And afterwards, I know a lot of people may not believe it, but when I went home, I had no pain.

[Steve] Wow.

- I had no pain.

[Steve] Yeah.

And that's quite a change from-- - Right.

- From the, yeah.

- Right.

And I think it's important.

I mean, it takes two to do this whole thing.

It takes, you know, the patient and the doctor as well.

But with the patient, I mean, it's best I think.

Do you notice, Eric, if you have patients come in that have maybe done a little work ahead of time?

[Eric] Absolutely.

It makes a huge difference.

[Helen] Yeah.

Because with my first one, I didn't do much, but with the second one, I prepared.

[Steve] Yeah.

And what would be the kind of things that people, if they're looking at this, you would recommend that they do as preparation for the process to make the end of it, the other side of it go better.

[Eric] It doesn't need to be anything intense.

I'll tell people to get on a stationary bike, keep the seat nice and high, avoid creating pain, but just get some range of motion in the knee as much as you can.

Do some walking, do some, just gentle leg lifts, trying to get your muscles a little bit stronger.

It's gonna make things a lot easier afterwards if you have that leg in a little bit better shape.

- And then probably even the cardio part of it too to help with all of that as well.

Now question real quick.

If I've had, let's say, a knee replacement some time ago and I'm now, you know, with the older technology and I'm due for now, that one has to be replaced.

My original model is now is obsolete, out of date, it's not functioning.

I want it to, is this process work the same way with something like that?

And that isn't-- [Dr. Gomez] No.

- As applicable.

Okay.

All right.

[Dr. Gomez] This is for-- [Steve] For a fresh, for a new.

Natural.

Okay.

Gotcha.

Okay.

Yeah.

Yeah.

What would, now, just for the sake of what would be, if I came in and said, "Look, I've had both knees replaced 20 years ago, what would you recommend I do then at that point?

Is there something I can do or not?

- So, you know, we examine the patient, see where the problem is.

Sometimes we see the patients are still weak and they just need a little bit of therapy.

[Steve] Ah, okay.

- Or we take an x-ray and make sure that if there's no loosening of the components that would've been cemented there or that can be changed.

So their options, but definitely, the robotic knee at this point is only used for a new.

[Steve] In first initial replacements.

- Yeah.

Absolutely.

- Yeah.

Now, if someone wants to find out more about this, what's the easiest way for them to get in touch with your office and say, "Hey, I'm interested in talking with you about that."

- [Dr. Gomez] Sure.

- What's the simplest way to do.

- Sure.

We're gonna give you our number.

[Steve] Okay.

All right.

Okay.

- And we are always are telling our community, we do a seminar every other month.

- [Steve] Ah, okay.

- In the hospital, in the hospital meeting rooms.

And we educate our community.

We got patients from Ohio, from Michigan, from Indiana, from all over the place and they want to get educated about it.

Again, as I said, we're the first ones with this technology, so we gotta tell the people out there that we have it and we're able to provide the best care they can get.

- Yeah.

And and you mentioned that in the first segment, that people would say, "Gee, you know, they wouldn't immediately think of Bowling Green, Ohio as having this kind of technology.

But you said you were among the first and are still among the very few that do it and there is nobody else, really.

You mentioned that, you know, larger institutions like Ohio State Medical or UM Medical, they're not at this level yet with this Generation Four robotics.

- Yeah, I think the studies are gonna start showing that we are able to be, do and in very a good way are totally replacements with being consistent in what we do and with good results.

So they'll be able to, in the near future, to be on board as well.

- [Steve] Okay.

So what number should they call?

- 419-435-3072.

- Okay.

And they can get in touch with you and then, and have the outcomes like you've had, which are, yeah, really, really good.

That's good to know.

And it's good to know that in our own community locally, we have the ability to, you know, go in and have this done and not have to travel someplace because sometimes people trot off too because they have to travel a hundred miles, 75, several hours away to do it.

[Dr. Gomez] Yeah.

- And that can make people reluctant.

So it's good to know it's right here.

Really.

Right in the neighborhood.

That's good to know.

So Dr. Carlos Gomez, thank you so much.

Eric Avers, Physical Therapist.

Thank you.

And Helen Frobase, thank you for coming on, talking to about us and Helen, we're glad everything's going well for you.

And.

Yeah.

And it will continue to.

Thank you so much.

[Helen] Thanks.

[Dr. Gomez] Thank you, Steve.

- Thank you.

You can check us out at wbgu.org.

Of course, You can watch us each week on WBGU-PBS.

We will see you again next time.

Goodnight and good luck.

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