Benefits of same-day joint replacement [Music playing] [Text on screen: Ohio State Health & Discovery Health Talks] Gail Hogan: Thank you for joining us for Health Talks. I'm Gail Hogan, and Dr. Nicholas Greco is here to share how same-day joint replacement with no overnight stay is now possible, thanks to the experts at Ohio State. [Text on screen: Gail Hogan Host Health Talks] Gail Hogan: Dr. Greco, first can I ask you, what do you term, how do you explain joint replacement? [Text on screen: Nicholas Greco, MD Orthopedic Surgeon Ohio State Wexner Medical Center] [Music fades] Nicholas Greco, MD: So joint replacement is a procedure in which we resurface the end of the bones that are arthritic and causing pain, and we also realign the joints so that we straighten the weight-bearing forces through the center axis of the body, and re-tension up muscles and ligaments to allow patients to ambulate and perform functions that they like again. Gail Hogan: So what kind of joint replacement are we talking about when we talk about this type, where you could go home on the same-day? Nicholas Greco, MD: So we're primarily talking about knee and hip replacement surgery. Gail Hogan: That sounds hard to believe, actually. It really is possible? Nicholas Greco, MD: It is, yes, yeah. So still, they're big surgeries, so we don't take it lightly, but with the new technologies, we now allow patients to recover quickly enough that they can actually get home the day of surgery, and hopefully be on the road to recovery within a few weeks after the procedure. Gail Hogan: Are certain patients eligible, others not? [Text on screen: Nicholas Greco, MD Orthopedic Surgeon Ohio State Wexner Medical Center] Nicholas Greco, MD: I think that the ambulatory surgery is really best suited for patients that have an active lifestyle before surgery, that enjoy hiking, cycling, jogging, weight lifting. But it really can also be applied to even patients that maybe don't have the healthiest lifestyle, but are interesting in partaking in a new path after developing a plan with their surgeon. Gail Hogan: You mentioned arthritis, but what about an injury? Would you be able to do this same type of procedure for those people? [Text on screen: Nicholas Greco, MD Orthopedic Surgeon Ohio State Wexner Medical Center] Nicholas Greco, MD: Yes, we could. And a lot of arthritis now we think is maybe related to a post-traumatic origin, as we would term it, so someone that maybe had an accident or injury earlier in their life, and that has accelerated the arthritis and the loss of cartilage, causing the bone-on-bone defects that lead to the pain. Gail Hogan: What kind of sports injuries would you usually see that this would pertain to? Nicholas Greco, MD: Yeah, we're seeing it in patients that maybe played football, basketball, different pivoting or twisting injuries of the knee or the hip earlier in their life, that now have been sidelined, not able to partake in those recreational activities, and are hoping to maybe try to get back into those activities through this type of surgery. Gail Hogan: Is most of this arthritis, you said sports-based sometimes, but even those who have developed arthritis because of a sports injury, is it familial, is there a family history of arthritis and that's what these folks develop? [Text on screen: Nicholas Greco, MD Orthopedic Surgeon Ohio State Wexner Medical Center] Nicholas Greco, MD: Yeah, I think that's a great point. We typically term the osteoarthritis as idiopathic in maybe 90% of cases. So even though we think that some of it might be post-traumatic and related to an injury, really, most of it is probably genetic in origin, and patients have family members that have developed the arthritis, passed the genes, unfortunately, down to them, and that's probably the source of most of the arthritis. Gail Hogan: How do you personalize a treatment then for each patient? Because we've talked about different types of injuries and how they develop. [Text on screen: Nicholas Greco, MD Orthopedic Surgeon Ohio State Wexner Medical Center] Nicholas Greco, MD: Yeah, no, that's a great point as well. I think it really stems from multiple factors, not only the physical condition but also the medical. So for each patient, we really get them in before surgery to our medical specialists to try to have all their medical problems examined and make sure that they won't deter from the recovery from surgery. And then, from a physical standpoint, with our orthopedic team, we try to learn what activities are important to the patient, try to use preoperative X-rays and computer software to try to size up their bones, realign their axis of weight-bearing forces through their joints, and really determine what the best type of surgery, what the best type of implant and technology might be for their specific case to return to their activities. Gail Hogan: So it sounds like there's a group of medical clinicians who really work with the patient even before their surgery. [Text on screen: Nicholas Greco, MD Orthopedic Surgeon Ohio State Wexner Medical Center] Nicholas Greco, MD: That's right, yeah. It's a multidisciplinary team here in Ohio State between the medical and surgical departments to try to optimize patients and get you in the best position for surgery so that you can have a successful result. Gail Hogan: And that was my next question, how does that benefit the patient, knowing that there's all these other folks who are tied to their treatment? Nicholas Greco, MD: So it benefits them in terms of making them the best candidate for the surgery, so trying to be preventative. So first off, trying to prevent maybe complications, which are rare, but still can occur. Infection is one of them that we really try to prevent, and then as far as blood clots and other medical complications as well, so we try to be preventative. But then, if things were to come up during the recovery period, now we still have opened up those access lines to medical providers beforehand, so we can easily touch base with them, and even touch base with physical therapists as they're recovering to have that open line of communication and adapt our plan. Because we know that there are standards of care out there for most patients that we try to follow, but every patient is a little bit different, and because we have such a multidisciplinary approach, we can make adjustments before, during, and after the surgery to best suit the patient's recovery. Gail Hogan: Is that why communication is so important with these patients as they go through the process? [Text on screen: Nicholas Greco, MD Orthopedic Surgeon Ohio State Wexner Medical Center] Nicholas Greco, MD: Yeah, I think that's the key, because again, everybody is a little bit different, everybody needs a little different type of treatment to get them to the end result that they're trying to achieve. So the benefit of being here is just having that open line of communication with the primary care provider, the medical subspecialties, for patients that have cardiac or pulmonary disease, ahead of time to communicate with them. And then, during surgery, having the communication with the anesthesia team to personalize the anesthesia to best treat the patient. And then, post-operatively, the patients have open communication with their physical therapists, and particularly if they stay in the Ohio State system, that allows myself and the other surgeons to easily communicate with therapists, develop treatment plans on the spot or on the go. And then also, the patients have open lines of communication to our surgical team, via not only the phone call, but now updated technologies, through the MyChart application on the phone, on the computer, ability to do telemedicine if patients can't make it and have long drives. And so, we have so many modes of communication now to try to benefit the patient. Gail Hogan: Can you get some of these patients back to 100%? [Text on screen: Nicholas Greco, MD Orthopedic Surgeon Ohio State Wexner Medical Center] Nicholas Greco, MD: I believe that we can get them pretty close. I think in most cases, they're always going to know that that joint is artificial. But in most patients that recover well, report that, yeah, they're 90%, 95% better than they were, and feeling like they're almost normal to the point of where they were before the arthritis. And that really allows them to participate in those activities that we mentioned, the patients that like to do hiking, long bicycling journeys, travel across the country, we're able to get them back to most of those activities without too much issue. [Text on screen: Gail Hogan Host Health Talks] Gail Hogan: So what does the patient have to do to make sure that they can get back to almost 100%? Nicholas Greco, MD: So I think that preoperatively, we really focus on the physical therapy, I think that's the one- Gail Hogan: Before surgery? [Text on screen: Nicholas Greco, MD Orthopedic Surgeon Ohio State Wexner Medical Center] Nicholas Greco, MD: Before surgery, yeah. So not only is it important after, but I really believe that it is important before surgery as well. Some studies have spoken to that, developing the muscle memory, learning the exercises ahead of time, that really takes stress off the joint, and really makes the post-operative recovery easier, because after the surgery, all patients are going to be a little bit limited, and if they already have that muscle memory developed ahead of time, know what exercises they're going to have to do, that just is one less burden that they have to worry about after. So having that degree of physical activity and physical therapy beforehand really benefits their recovery after the surgery. Gail Hogan: Then on their own, exercise, I don't know if diet plays any role in this? [Text on screen: Nicholas Greco, MD Orthopedic Surgeon Ohio State Wexner Medical Center] Nicholas Greco, MD: Yeah, diet does play a role as well. We really focus on weight loss before surgery, because the more stress or weight that you have on a joint, the tougher it makes for the recovery, and then potentially even decreases the longevity of the joint replacement. So we really harp on the weight loss beforehand, but not only the absolute number of weight loss, but also what types of foods you're putting into your body. And that's what's great about Ohio State, again, is that we have access to our nutrition department here, so they can really focus on a specific weight loss plan for the patient that not only will decrease that absolute number of the weight, but also making choices to get food that maybe doesn't cause inflammation in the body or other stresses that can benefit you after surgery as well. Gail Hogan: Most of the time, can you give me a timeframe as to how long it takes a patient to recover? And I don't know if we're talking just hips or knees or both. [Text on screen: Nicholas Greco, MD Orthopedic Surgeon Ohio State Wexner Medical Center] Nicholas Greco, MD: Yeah, I think it is different between the hips and the knees. The hips typically will take about a week or two to get over the post-surgical pain, soreness, and stiffness. And then, with our muscle-sparing approaches at Ohio State, in some cases, within two weeks, patients can be off the cane, starting to walk in their neighborhood with some ease, and by four to six weeks, feel like they're almost fully recovered from a hip replacement surgery. Gail Hogan: Now, does age have anything to do with that? I would think the younger the patient, the easier it would be to get back into life again. [Text on screen: Nicholas Greco, MD Orthopedic Surgeon Ohio State Wexner Medical Center] Nicholas Greco, MD: That's a great question, because it is a mixed bag. I think that most younger patients tend to have healthier lifestyles and be more physical, which may have, in some sense, led to certain types of arthritis. But that does benefit the recovery in the sense that they usually have more muscle tone, more muscle memory, to benefit the recovery after and the physical therapy, so that can help younger patients. But we still find that in older patients, they can do well, just like these younger patients, if they partake in maybe some physical therapy and structure beforehand. Gail Hogan: What about robotics, what's that technology doing for what you do? Nicholas Greco, MD: Yeah. So robotics is really growing in orthopedics over the last five to 10 years. So we're fortunate to have some specialists here that really prefer to use the robotics, and the robotics really can help to personalize the treatment, and as I discussed previously, size up implants, align the axis of the forces, and then tension up ligaments to maybe a degree that a surgeon can't do manually. So that's something that we're really interested in at Ohio State and we have robotics here, and we're trying to partner with some companies to develop robotic platforms in the future. Gail Hogan: Robotic, minimally invasive, all these things, does that mean it's less painful usually for the patient and an easier recovery? Nicholas Greco, MD: That's what we think, particularly with the approaches to the knee and the hip, trying to be muscle preserving in those approaches and the types of equipment that allow us to do that, but also the surgical technique, is really important to allowing the patient to recover quickly. Gail Hogan: What are you doing as far as research? You just mentioned robotics is coming up, but what else is out there on the horizon? [Text on screen: Nicholas Greco, MD Orthopedic Surgeon Ohio State Wexner Medical Center] Nicholas Greco, MD: Yeah. So robotics, as you mentioned, is really big. Artificial intelligence and trying to figure out which patients benefit most from the surgery based off of their physical medical background, like we talked about, and predicting those recoveries. So just like you asked about how quickly it takes a patient to recover, the benefit of different artificial intelligence and computer programs is trying to group patients into rough categories so that they know, what can I expect? How soon can I recover after? What activities can I get back to, and how will that happen? So that's one really big area in orthopedics right now is the artificial intelligence. The robotics, the computer software that is involved with robotics, but also can be used independently of robotics too, to help prepare for a patient's surgery. So those are the things that are really at the forefront, and that Ohio State is trying to get involved with currently. Gail Hogan: And so, why would you suggest that a patient come to see you and go to Ohio State if they need a joint replacement? [Text on screen: Nicholas Greco, MD Orthopedic Surgeon Ohio State Wexner Medical Center] Nicholas Greco, MD: I think the benefit of coming to Ohio State to have your joint replacement surgery is that we're always thinking about new approaches that could benefit the patient, but we're really particular about investigating those approaches through research to prove benefit before making them a standard of care for all patients. [Music playing] So currently, we're looking at different approaches, not only surgically, but with medication, anesthesia that we administer during the surgery, to try to expedite those recoveries, and we're trying to prove this through statistical methods and science to show benefit to a patient before making it a standard of care for everyone. So those are really the key points that make Ohio State a great place to have your joint replacement performed. Gail Hogan: Thank you, Dr. Greco, and thank you for joining us for Health Talks. [Text on screen: Ohio State Health & Discovery Health Talks health.osu.edu] [Music fades]