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Is it Time for a Hip or Knee Replacement? · Flourish- A Prisma Health Podcast

• 0:03
  Sam Greenberg (Host): Welcome to Flourish, a Prisma Health Podcast.
• 0:06
  I'm Sam Greenberg, and joining me today is Dr.
• 0:08
  Corey Hamilton, joint replacement surgeon at Prisma Health, as we
• 0:12
  discuss knee and hip replacements, when is the appropriate time to get
• 0:15
  one, and what can patients expect.
• 0:17
  Dr.
• 0:18
  Hamilton, thank you so much for joining me
• 0:20
  Corey Hamilton, MD: Absolutely.
• 0:21
  Thank you, Sam, for this opportunity.
• 0:23
  I look forward to our conversation
• 0:24
  Sam Greenberg (Host): Of course, as do I.
• 0:26
  So let's start big picture.
• 0:27
  What are the signs that someone may need a hip or knee replacement, and
• 0:31
  how do things like pain, stiffness, and difficulty with everyday activities
• 0:35
  factor into that big decision?
• 0:38
  Corey Hamilton, MD: it seems like a simple question, but honestly, one
• 0:41
  of the biggest questions I get in the office is, " Well, doctor, is it time?
• 0:44
  What do you think?"
• 0:45
  And I always tell all my patients the same thing.
• 0:48
  When you have hip or knee pain, when it becomes progressively worse, it's
• 0:52
  constantly there, despite being on different medicines or trying therapies,
• 0:57
  maybe you've gone to your primary doctor and they've talked to you about getting
• 1:01
  injections, those things, but nothing's working, and you're still getting pain
• 1:05
  that interferes with exercise, travel, daily activities such as just taking
• 1:10
  care of the house, playing with your kids or grandkids, that's a great
• 1:13
  time to start talking to your surgeon
• 1:16
  Sam Greenberg (Host): What are some of those treatments that
• 1:17
  maybe people should try before considering a joint replacement?
• 1:21
  And again, how do you determine when those are no longer enough?
• 1:25
  Corey Hamilton, MD: The easiest thing to do in the, in the first line is the
• 1:27
  strong nonsteroidal anti-inflammatories.
• 1:30
  So what's that?
• 1:31
  That's just as simple as ibuprofen or, Advil, your
• 1:34
  Aleves, those types of medicines.
• 1:37
  Tylenol is another medication that you can add with those that can be very
• 1:40
  great for early to moderate arthritis, and it does a good job to help people
• 1:44
  kinda stay active and, and push through getting through that bit of knee pain.
• 1:48
  Now, when those medicines, you're taking them on a regular basis, and
• 1:52
  you're not really getting the pain relief that you need to keep moving
• 1:55
  forward, that's when I tell people, "You know, you should get it looked at.
• 1:58
  You should at least have the conversation, get some X-rays with your doctor."
• 2:02
  Sam Greenberg (Host): can't really hurt to open the conversation, right?
• 2:04
  I mean, when you are hurting, then maybe open that dialogue with the doctor
• 2:09
  Corey Hamilton, MD: Absolutely.
• 2:09
  I think knowledge is king, right?
• 2:11
  So you wanna be able to know what's going on.
• 2:14
  , A large time, when patients come in, it's not necessarily that they're
• 2:17
  looking to talk about surgery.
• 2:18
  Sometimes they just wanna know where are they at in the process,
• 2:21
  where's the condition of my knee or hip right now, and, and what's my
• 2:24
  kind of outlook on how long do you think I can keep going like this?
• 2:29
  Sam Greenberg (Host): Doctor, is there an ideal age for something
• 2:31
  like a knee or hip replacement?
• 2:33
  And can someone wait simply too long to have the procedure?
• 2:36
  Corey Hamilton, MD: another great question, because I think where we're
• 2:39
  at today in joint replacement is vastly different than where it was 30 years ago.
• 2:44
  And most of us kinda think of, well, that was my elderly grandparents
• 2:48
  got hip and knee replacements.
• 2:49
  The age average for hip and knee replacements has dropped drastically.
• 2:53
  I take care of a lot of patients that are middle-aged or even
• 2:56
  younger for these issues.
• 2:58
  And so I tell everybody, arthritis isn't an age issue.
• 3:01
  It's actually kind of the way God and genetics made us.
• 3:04
  And so you never know.
• 3:05
  Just because of your age, it doesn't mean that you can't have arthritis.
• 3:08
  So if you're having the hip or knee pain, it's worth getting it
• 3:11
  looked at by one of your doctors
• 3:13
  Sam Greenberg (Host): So with that age dropping, how long do these modern
• 3:17
  hip and knee replacements really last?
• 3:19
  And what things can affect the lifespan of those joints?
• 3:23
  Corey Hamilton, MD: The technology is advancing almost, you know, every couple
• 3:26
  of years we're seeing things change.
• 3:29
  The hip replacements that, were being put in back when my mentors
• 3:33
  were in training notoriously failed in the 10 to 15-year range.
• 3:37
  Now these things are lasting us 30-plus years.
• 3:40
  So it won't be uncommon that I'll have somebody in their 30s get a
• 3:43
  hip replacement, and I tell them they're gonna be much older and
• 3:46
  maybe never happen when that fails.
• 3:49
  Knee replacements are not quite up to that same standard.
• 3:52
  They're just a little bit, less of a longevity, but we have great studies
• 3:56
  and data that show at 20 years, 90% of knee replacements are still functioning.
• 4:01
  So still you get a good long time with these hip and knee replacements
• 4:04
  now compared to 25, 30 years ago.
• 4:06
  the second part of your question was kind of what factors can lead to
• 4:09
  wear and tear these, these implants.
• 4:11
  So, well, you know, the analogy I tell my patients, it, it's like having a nice car.
• 4:16
  You, you wanna take care of it.
• 4:17
  You wanna, for your body, stay as healthy and active as you can, maintain healthy
• 4:22
  weight, exercise, those types of things.
• 4:24
  If you take care of your body, it's taking care of the implant naturally
• 4:28
  Sam Greenberg (Host): These advancements have been amazing.
• 4:30
  The fact that you said that you may never need to have that looked at again is
• 4:35
  simply stunning and probably unheard of as little as maybe five, 10, 15 years ago
• 4:41
  Corey Hamilton, MD: it's kind of interesting when you talk to patients and,
• 4:44
  they'll get their knee replaced, and they say, "Well, how long do you think I have
• 4:47
  before I'm gonna have to get this done?"
• 4:48
  And you tell them, "Well, I'm gonna have you see me every five years now to take
• 4:52
  a, X-ray and to see how you're doing.
• 4:54
  But realistically, you and I probably will never have to do anything again."
• 4:58
  And, and the look on their face, it's, it's kinda priceless.
• 5:00
  You know?
• 5:00
  It makes you feel good that you've done something to help that patient for life.
• 5:04
  Sam Greenberg (Host): It's one of those I'll see you later,
• 5:05
  but I kind of hope that I don't
• 5:07
  Corey Hamilton, MD: Right, exactly.
• 5:08
  In a good way.
• 5:09
  I tell them, "Graduation day is a good day.
• 5:10
  I hope we see each other somewhere not at work because you're doing great."
• 5:14
  Sam Greenberg (Host): All right.
• 5:14
  So, Dr.
• 5:14
  Hamilton, someone has made that major decision to get the joint replacement.
• 5:18
  What activities can someone safely enjoy after that procedure?
• 5:23
  And are there certain exercises or maybe high-impact activities that
• 5:27
  they should avoid to even increase the longevity of those joints even more?
• 5:32
  Corey Hamilton, MD: the classic training was that, you know, if you get a knee
• 5:35
  or hip, you're never running again.
• 5:37
  Your exercises are gonna be kind of s- minimal to simple.
• 5:40
  And, and just like with the changes in technology have increased the
• 5:44
  lifespan and longevity, so too have we seen an increase in the abilities and
• 5:48
  activities that patients get back to.
• 5:50
  You know, anecdotally, I have one of my patients I've done, bilateral total
• 5:54
  knees on several years ago, and, just this past year, he sent me a video of him
• 5:58
  competing in a power lifting competition.
• 6:00
  Now, I, I did message him back and say, "Gosh, I love to see
• 6:03
  that, but please don't get hurt."
• 6:06
  But, you know, they're, they're able to get back to some pretty high-end things.
• 6:09
  realistically, agility, pickup games of basketball on total knees maybe
• 6:14
  aren't the most comfortable, but the functional abilities of the replacements
• 6:18
  are very capable of handling it.
• 6:20
  Hip replacements, especially these days, can handle just about anything.
• 6:24
  I have a lot of high-end runners and, cyclists that love to get
• 6:28
  back to those activities after they recover from hip replacements.
• 6:31
  Sam Greenberg (Host): So what I'm hearing is go see Dr.
• 6:33
  Hamilton, you become a powerlifter.
• 6:35
  Is that right?
• 6:36
  Corey Hamilton, MD: Yeah, that's, that's what I'm gonna put as my
• 6:37
  advertisement, but I, I don't know if I'll be as successful.
• 6:42
  Sam Greenberg (Host): Doctor, we've talked about the advances in the joints
• 6:45
  themselves, but what are some of the advances in the surgical techniques that
• 6:49
  have improved outcomes for patients?
• 6:53
  Corey Hamilton, MD: In the surgical techniques, we're getting
• 6:54
  smarter, we're getting better.
• 6:56
  You know, we, we learn a lot from our mentors and, and the mistakes
• 6:59
  that were made in the years past.
• 7:01
  And what we know now is the more we can respect the tissues the
• 7:05
  better the patient's gonna do.
• 7:06
  The body is a, a very well-tuned machine, and so most of our techniques are now
• 7:11
  in the minimally invasive category.
• 7:13
  A- And minimally invasive doesn't necessarily just mean the skin incision,
• 7:16
  but once I get inside the hip or knee, respecting the tendons, the ligaments,
• 7:20
  trying to keep all the structures how they are, and just restoring the
• 7:24
  joint to this new implant so that it can function within the existing body.
• 7:28
  That allows people to have less pain, faster recoveries, and functionally feel
• 7:33
  more like this joint is part of them
• 7:35
  Sam Greenberg (Host): Doctor, what should patients know about
• 7:37
  the recovery and rehabilitation timelines after a joint replacement?
• 7:42
  And what sort of improvements in pain, mobility, and quality of
• 7:45
  life can realistically be expected?
• 7:48
  I'm sure there are different stages that it goes through
• 7:51
  Corey Hamilton, MD: Absolutely.
• 7:52
  Different stages is the, is the best way to describe it.
• 7:55
  You know, hips and knees recover slightly different than each other,
• 7:58
  but I tell all my patients the orthopedic magic number is, is about
• 8:02
  three months of, global recovery.
• 8:05
  first stage of that recovery is really the first two to three weeks.
• 8:09
  That's the after surgery soreness, high level of inflammation and
• 8:13
  swelling, where you expect to kind of feel like you've had a big surgery.
• 8:17
  The advancements in kind of the protocols from multiple different types of medicines
• 8:23
  to help with that inflammation, the soreness, obviously some pain medicines,
• 8:26
  but also different, icing and compression modalities that we use, and guided
• 8:31
  therapy that starts at home and then transitions into the outpatient setting,
• 8:35
  all really is aimed at this rapid recovery protocol that we employ today.
• 8:39
  So by six weeks, I tell my knees and my hips, at that point, you can expect to
• 8:43
  get back into a lot of the activities that you have been putting off before.
• 8:48
  Not full capacity, maybe not full strength, but you're at least
• 8:51
  engaging back into it and building up.
• 8:53
  So that way by about three months, we should have you back doing what you
• 8:57
  wanna do, and we're giving each other a hug saying, "It's time to graduate."
• 9:01
  Sam Greenberg (Host): You love to hear it.
• 9:02
  And that graduation day is a huge thing.
• 9:04
  And doctor, as we wrap up, someone is maybe on the fence about
• 9:08
  getting a joint replacement.
• 9:09
  What are some things that you would tell them to get them to come on in, and what
• 9:13
  can they expect from an initial visit?
• 9:16
  Corey Hamilton, MD: I think the mentality that patients need to approach their hip
• 9:19
  or knee pain with when they know they've had arthritis, they've had the visits or
• 9:24
  they've maybe even just been told that they have the symptoms, they need to
• 9:27
  think, well, and the quality of life that I'm having, if my hip or my knee wasn't
• 9:31
  the problem, would I be much happier?
• 9:33
  Would I be more engaged in my life with my family, my friends?
• 9:36
  If the answer is yes, then there's no sense in waiting.
• 9:39
  Go have a consultation, see what options are available
• 9:43
  Sam Greenberg (Host): All right.
• 9:43
  I think I'm gonna give my dad your card and not that he wants
• 9:46
  to be a weightlifter, but I think he needs some new knees
• 9:50
  Corey Hamilton, MD: Perfect.
• 9:51
  I don't know if I can promise he's gonna deadlift 1,000
• 9:53
  pounds, but we'll see what we get
• 9:55
  Sam Greenberg (Host): All right, Dr.
• 9:55
  Hamilton, I know this information will help a ton of people.
• 9:58
  It's been awesome.
• 9:59
  I appreciate your expertise.
• 10:01
  Thank you again for your time today
• 10:03
  Corey Hamilton, MD: Absolutely.
• 10:04
  I loved talking with you, Sam, and I appreciate your time
• 10:07
  Sam Greenberg (Host): Of course.
• 10:08
  For more information and to listen to our full podcast library, please
• 10:12
  visit prismahealth.org/podcast.
• 10:14
  And as always, if you found this information helpful, please
• 10:17
  share it on your social channels.
• 10:19
  This is Flourish, a Prisma Health podcast