Centered on Health 8-28-25 - When to seek medical advice to see if you are a candidate for knee replacement with Dr. Alex Sweet.
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Speaker 1 (00:01):
It's now time for Centered on Health with Baptists Help
on use Radio.
Speaker 2 (00:05):
Wait forty tell meny wit JS. Now, here's doctor Jeff Tubler.
Good evening, everyone, and welcome to tonight's episode of Centered
on Health with Baptists Health here on news Radio eight
forty WHS. I'm your host, doctor Jeff Tubblin, and we're
joined from the studio by mister Jim Fenn, who's ready
to take your calls to talk to our guest tonight.
(00:26):
Our phone number is five oh two five seven one
eight four eight four. Tonight, we're talking to doctor Alex Sweet,
who's an orthopedic surgeon with the Baptist Hospital affiliation and
who is talking to us tonight about knee replacements. There's
over seven hundred and ninety thousand new replacements done in
the United States every year. We've had doctor Sweet on
(00:47):
our show before, and he always is a wealth of
information about what to do and when to think about
having your knee replaced. We're going to start that conversation
with doctor Sweet right after this. It's a doctor Josh Poblin.
(01:25):
Welcome to tonight's episode of Centered on Health with Baptists
Health here on News Radio eight forty whas we're getting
a little bit a little bit of a late start. Tonight,
we have doctor Alex Sweet on with us tonight. He
has been with us before. He's an expert on how
to do this show, and he is one of our
most popular guests to have people call in. He is
(01:47):
going to talk to us tonight about knee replacements and
when we should be thinking about doing knee replacements. Over
seven hundred and fifty thousand are done in the United
States every year. Doctor Sweet is an orthopedic surgeon with
here in Louisville with affiliation with gott His Hospital. Doctor Sweet,
welcome back to our show.
Speaker 3 (02:04):
Thank you, it's good to be here.
Speaker 2 (02:07):
Sorry, we're getting a little bit of a late start
because you know, I have so much information to get
from you, like we always do, and you carry you carry.
I think the record for the most number of phone
calls that we've had during this show, so it's really
exciting to have you back. How are you doing tonight,
I'm done great.
Speaker 3 (02:23):
That's quite an honor. Good to hear.
Speaker 2 (02:25):
I'm glad people were interested. Yeah. I think one time
my friends all called in with some goofy questions, but
for real questions you definitely carry. You definitely carry the record.
So I want to start tonight with just a very
open ended question. I know that we're going to get
into some details, but since the name of our show
tonight is when to think about a knee replacement in general?
(02:46):
When is it time that someone should be thinking that
it's time to get a knee replacement?
Speaker 1 (02:52):
So I think it all boils down to three parts. One,
you have to have disease bad enough, and that means
you know, an extrayor and em just something going on
with your knee enough, arthritis or disease of whatever kind
it is that justifies undergoing a major surgery like knee replacement.
The second thing is you need to be healthy enough.
(03:12):
And that doesn't mean you know, you can't be eighty
years old and have a knee replacement. I mean, some
people are seventy and are just two unhealthy bad hearts
and can undergo surgery. And some people are eighty five
and are otherwise healthy. It might live twenty more years,
but you need to be healthy enough, and you know,
if there's questions, you can always see a cardiologist and
or you know your primary care and make sure.
Speaker 3 (03:33):
And the third thing.
Speaker 1 (03:34):
And what I tell people is the most important thing
is pain bad enough to justify it having failed the
conservative treatment that means rest ice, activity modification. You know,
anti inflammatory is like talent, all ibuprofen, you know, injections
that we'll kind of talk about tonight, maybe even some
simple exercises try to strengthen your quad. When you've undergone
(03:55):
that and it's affecting your quality of life enough and
you kind of come into the clinic waving the white
flag saying I can't do this anymore, that's when we
talk about the surgery.
Speaker 2 (04:05):
That's a great, great answer, and it really gives a
great framework of kind of things people may think about
and some things they may want to ask about, and
certainly things we're going to try and cover tonight. So
let's start with the knee itself. Tell us a little
bit about the anatomy of the knee, especially the parts
of it that you're going to be talking about when
(04:25):
it comes to replacing things, and the function of the
knee and how that matters with a knee replacement.
Speaker 1 (04:32):
Sure, so, a knee joint is where the tibia, which
is your shin bone, and the femur, which is your
five bone meat. Now there's also the fibula, which is
kind of the small bone on the outside of your ankle,
but at the knee. It's not a very big structure
and not really important for this conversation. And so in
addition to just those bones, what's capped on the ends
(04:55):
of the bones the cartilage, and that's the soft lining.
That's what makes us able to bend into trading in
it not crick and crackle and pop and grind, but
over time that cartilage wears out. Now, in addition to
the cartilage is also ligaments. Everyone's heard about your the
ACL and the MCL, and you know the less commonly
people hear about the PCL or the LCL. But there's
(05:17):
essentially four ligaments and they're very very important when you're
younger and playing higher level activities and in a knee replacement,
some of those you keep and some of them you don't.
Speaker 3 (05:28):
There's nerves and arteries and those are all.
Speaker 1 (05:31):
Kind of in the back and we stay well away
from them. And then there's your knee cap your patella,
and that's connected to your quatercep tendon going up your
thigh and your paateella tendon going down the leg and
that has to stay intact. And in a knee replacement,
it's really a terrible term for what we're doing. It's
a knee resurfacing. We're not really replace anything. We're just
(05:51):
shaving a few millimeters of bone and what may be
left cartilage and replacing.
Speaker 3 (05:57):
That with metal and plastic. So it's just it's like
a capping procedure.
Speaker 2 (06:02):
And the knee itself is you know, we ask a
lot of the knee, right, I mean we don't just
carry ourselves on our knees. I mean we bend, we
lift things like the knee is subjected to quite a
lot of pressure. And so is it normal over our
life should we expect that our knees are going to
(06:23):
get worn out or does that not necessarily have to happen.
Speaker 3 (06:28):
Everyone gets arthritis.
Speaker 1 (06:30):
It's just a matter of how bad the arthritis is
and how.
Speaker 3 (06:33):
Much it affects you. I've got some.
Speaker 1 (06:35):
Patients with knees You look at the X ray and
it's just hard to look at and it really doesn't
hurt them that much. They come in once a year
for a court zone shot and they get around just fine.
And other people their extray doesn't look that bad and
they're in the office, you know, just about begging me
for the next available appointment for a knee replacement. I mean,
it's incredibly variable how bad it gets, how quickly it gets,
(06:57):
and then on top of that, how much it affec
And most of it's genetic.
Speaker 3 (07:01):
It's not, Oh, you.
Speaker 2 (07:03):
Know, I was on my knees my whole life.
Speaker 3 (07:04):
You know, I was. I was a carpenter, you know,
I was on concrete.
Speaker 1 (07:08):
It's it's really not that it's more genetic than it
is anything else.
Speaker 2 (07:13):
And what are the I think I know the answer,
But what are the most What's the most common reason
somebody comes to you for any replaces? Is it pain?
Or is it that they need isn't functioning fly or
or what pain is.
Speaker 1 (07:27):
The most common? You know, that's probably for four out
of five, maybe even nine out of ten. Every once
in a while, someone comes to me for a knee
replacement because they just can't do things. It's not that
it hurts, they just you know, my family wants to
go to Disney World and I just I just can't walk.
My leg just it just gets tired. I can't do things,
(07:47):
and it's just an inability to tolerate activities of daily living.
Speaker 2 (07:53):
And we hear the term like bone on bone. I
mean people use that phrase. What does that mean? How
does it relate to what you do?
Speaker 1 (08:04):
So? Bone on bone means that the end of the
femur and the top of the tibia where the cartilage is,
has completely worn away. And when that completely wears the
bone actually rubs on the bone. So with an X ray,
all we see is the bone. If they're still cartilage
and you've got a healthy knee, it'll look on X
ray like the bones are not touching. They're separated by
(08:25):
about a cinemere and that's because of the cartilage. But
once you've lost all of that, you'll actually see the
bones touching each other and they'll actually start to erode
and you know, wear away the bone eventually. And when
that starts happening, it becomes more and more and more
painful and also noisy.
Speaker 2 (08:44):
People can hear it, So that's that's a real thing.
People can say, oh, I can hear my knee like
clicking or whatever. The description is that they use.
Speaker 1 (08:54):
The technical term is crevidence, but it's absolutely a real
phenomenon and people can can feel it and you can
hear it. Sometimes people come into clinic and they can
show you. I mean they straighten their knee and there's
this loud pop. I mean it can be impressive.
Speaker 2 (09:08):
Yeah, So we're talking about, you know, when it's time
to think about a knee replacement, and I think you
probably can appreciate this, you know as well, which is
what I see, like when people make the decision okay,
I want to have something done, like they're ready to
do it, and they're ready to do it right away.
But a lot of times when it comes to certain
surgical procedures, and I'd be interested about your perspective, people
(09:32):
are told, oh, you need to lose a certain amount
of weight before we can do that. So for somebody
who's struggling with me pain that might limit their ability
to exercise, do you have like a BMI cutoff? And
if so, like, how do you how do you help
people lose that weight before Dan can have surgery.
Speaker 1 (09:53):
Well, I think first of all, it's important not to
be judgmental. I mean, these are you know, people are
always self conscious when they come and they're worried that
you know, I'm going to say no about surgery, and
you know, they may even been turned down before, and
so if you're going to have this discussion, you want
to be frank and honest, but also you want to
make sure that you're you're not going to upset the patient.
(10:16):
So I don't have a particular cutoff. I've talked to
my patients about risks and benefits. You know, we know
that when your body mass index, which the relationship of
your height and weight, is over forty, you're an increased risk,
and when you get above fifty, that risk is is
even higher.
Speaker 3 (10:34):
But it's not just weight. It's also comobidities.
Speaker 1 (10:38):
You know how diabetes, heart disease, lung disease, kidney disease.
You know, it's also how your weight is distributed. You know,
if you're a male with a big belly and you
need a knee replacement, well your knee might not be
that big. But if you're a male with a big
belly and you want an anterior hip and that belly
is going to sit right over top of the incision
(10:59):
site and make it hard to do, maybe.
Speaker 3 (11:01):
It's not a good idea.
Speaker 1 (11:02):
So the distribution of fat is also important, and sometimes
that's part of the examination I'm doing. Even if I
don't talk to the patient about it. And that is
something I was going to ask you. What isn't a
what is an evaluation? Like in the office?
Speaker 2 (11:17):
What can you tell when you're examining the need that
if somebody doesn't realize they did, they're just coming to
you because they have me pain. What kind of tips
you off that you're like in the exam or or
what you're doing imaging wise that tells you, okay, I
should recommend a knee replacement here.
Speaker 3 (11:37):
So so what I'm sorry?
Speaker 2 (11:38):
What keeps me from one? Or what? What?
Speaker 1 (11:40):
What?
Speaker 2 (11:41):
What can you tell on an exam? Like what are
you looking for? And what kinds of things can you determine?
Like in the office when you're examining?
Speaker 1 (11:47):
Sure, you know so, I mean, obviously we have the
X ray that we can look at and see if
there's you know, disease. But then you tend to lose
motion as you develop ourthritis. Bone spurs start to form
and it instead of being able to, you know, take
your heel and put it on your butt, you can't
bend it very far. And as it gets even worse,
sometimes you can't straighten it out all the way and
(12:08):
you get what's called a flexion contractor or that the
knees kind of stuck in a bent position, and then
as you take it through motion sometimes they'll just grimace
and cause pain. And then you push on the joint line,
you push right where it may be bone on bone,
and people will WinCE. I mean you can see that
it's painful. And when that exam is painful, you know
(12:29):
that's what's causing their problem.
Speaker 2 (12:33):
Yeah, that's that's great. And we did have a question
that got sent into me while we were While we
were chatting about that, somebody wanted to know what a
baker's cyst was and what what it is, what causes it,
and how that's treated. Is that something that you see, Yeah, absolutely.
Speaker 1 (12:49):
So, a Baker's cyst or think of the knee.
Speaker 3 (12:51):
Like a balloon.
Speaker 1 (12:53):
It's supposed to have a certain amount of water in
it to lubricate it, right, like oil for the knee,
and that oil is called hyaluronic acid. It's a natural
lubricant that the knee forms to lubricate itself.
Speaker 2 (13:05):
Well.
Speaker 1 (13:06):
When the knee gets inflamed, when it gets the itis, right,
arthritis inflammation, the body is trying to put more oil
in it, trying to give it more lubricant, and so
it fills up with more fluid and as it does that,
the balloon starts getting stretched and that fluid has to
go somewhere, And the weak spot in the balloon is
in the back of the knee. So this out pouching
(13:27):
of the balloon, basically a second balloon forms and that's
what's called a Baker's cyst.
Speaker 3 (13:32):
So it's connected to the.
Speaker 1 (13:34):
Knee joint by a one way valve where the fluid
can go out into the cyst but can't go back in,
So it's actually a symptom of the disease.
Speaker 2 (13:45):
Is that drained or is that removed or how is
that usually treated?
Speaker 1 (13:51):
Sometimes if they're really palpable under the skin, you can
drain them. You can even send someone like a radiologist
have it drained under ultrasound.
Speaker 3 (13:59):
They tend to.
Speaker 1 (14:00):
Be near the big artery and nerves, so it's a
little dangerous just to drain those in clinic. What you
really want to do is treat the disease and the
Baker syst will go away over time.
Speaker 2 (14:13):
And can you explain to us, like do you think
patients are coming to you late? Like are people waiting
too long? Are they trying all these things. And I
know we're going to talk about some of these conservative
things and what you think about them. But are people
waiting too long to come to you? And if so,
(14:33):
does that make the surgery harder or is it just
they've lived with pain longer?
Speaker 1 (14:39):
You know, there are exceptions to this, but in general,
the surgery doesn't get harder. I mean, if your leg
gets really crooked or you lose too much of your motion,
your outcome can actually be affected by that waiting too long.
But that's very, very very rare with our society nowadays.
People are just very demanding in terms.
Speaker 3 (14:57):
Of the quality of life they want to live. I mean,
they want to be able.
Speaker 1 (15:00):
To play pick a ball, play golf, play tennis, you know,
take care of their grandkids. People are not accepting a
sedentary lifestyle and living in pain. So it's not as
common as it may be used to be.
Speaker 2 (15:13):
And how do you advise. I mean, obviously, by the
time they it to you, they've already done their excellent research.
But for people that are listening and are trying to
decide about seeing a surgeon, is there differences in sort
of training that people should look for in terms of
how to pick a surgeon for this. Are there different
ways of doing a knee surgery? I know we'll talk
(15:34):
about the surgery itself, but that are less invasive or
use different equipment that they should be thinking about when
they're picking a surgeon.
Speaker 1 (15:43):
Absolutely, you know, I think first of all, you need
to find a surgeon that you just you just trust, right,
I mean, it's a relationship. I have to trust that
the patient's going to do the right thing, and the
patient needs to trust and I'm going to do the
right thing. And that's the most important thing. Pick your surgeon.
Don't pick the surgeon because they use a particular implant
where you know someone that sells that implant. You know,
(16:04):
you pick the surgeon first, and then after that you understand, Yeah,
there's there's differences in training, and so if you need
a nee replacement, you want to go to a surgeon
who specifically trained for that, and that means they did
a fellowship, which means they did an extra year of
training to do that. If you want your ACL fix,
coming to me is a terrible idea. I'm not any
good at that surgery. I don't know how to do
(16:25):
it and I've never done it. In practice. But I've
got partners that do that all day long, and they
don't do knee replacements. So we all kind of have
our specialty niche. And you want to make sure you're
going to a total joint Arthur Placy, Fellowship trained surgeon.
Speaker 3 (16:41):
Oh, that's that's.
Speaker 2 (16:42):
Very helpful advice. And it's interesting how you know it's
sub specialized even within that specialty. I mean similar to
you know a lot of other medical specialties. So the
surgery itself, we hear the term total nee replacement. We
hear the term partial need replacement. Are those differential? Are
those really different? Is it two ways of saying the
(17:03):
same thing? Or what is a partial versus a total knee?
Speaker 1 (17:07):
So there are three compartments of the knee. There's the
kneecap compartment, There's the medial or the inside compartment where
the tibbian femur.
Speaker 3 (17:18):
Join.
Speaker 1 (17:18):
And then there's the lateral compartment or the outside compartment.
The most common area to get arthritis is on the
medial side of the knee, the inside of the knee.
That's where most people develop that arthritis and become bone
on bone, And if you have isolated disease in the
inside of the knee. You may be a candidate for
a partial knee. Sometimes people develop enough bone spurs on
(17:40):
the outside of the knee or underneath their kneecap that
a partial need may not be the right choice for them.
And so that's something you just have to discuss the
risks and benefits, you know, how long it's going to last,
how the rest of the knee may or may not
hold up, and decide what's best for you. And that's
the conversation that I have in the clinic with these clostations.
Speaker 2 (18:00):
Excellent and then so walk us through kind of what
the surgery day is like for a patient. How how
long does the surgery take, what where do they recover?
Are they in the hospital for a certain number of times?
Like what's the patient experience when they get to be replaced.
Speaker 3 (18:20):
Sure, so you know, there's two different ways to have
this done.
Speaker 1 (18:22):
You can have this done in a hospital setting and
have the ability to stay overnight and for some people
that may be emotionally comforting or medically necessary just to
monitor them. And there's also an option to do this
out patient where you go home the same day, like
from a from a surgery center. And and it's kind
of up to the patient and their medical status how
(18:43):
they want to do this, But you typically show up
to the surgery about maybe an hour and a half
before it's expected to start, so you can get changed,
get into the gown. The nurse can come in, make
sure they've got the appropriate history, start an ivy, give
you some medications. You know, the seizure provider will come
in talk to you. Typically you get a block help
(19:04):
numb up the leg. Depending on the type of vanta seizure,
that may even there may even be a spinal that's
that's given or a shot in the back that numbs
up both your legs. During the surgery. You may be
a candidate just for general landa szure where you go
to sleep. At some point before the surgery, I'll be
in you know, ask if there's any last questions. We
always take a marker and mark the operative leg. It's
(19:27):
just one more checkpoint to make sure that we can
never do a wrong site surgery. And then you wheel
back and go to sleep, and by the time you
wheel back you really don't know what's going on. You
wake up and everything's done, and you wouldn't know if
it was a twelve hour surgery or a twelve minute surgery.
But typically the surgery itself takes about fifty minutes, give
(19:50):
or take. But you got to go back, get to sleep,
get positioned, and the surgery itself a little less than
an hour. Afterwards you wake up, we're either getting you
up and having you walk with the nursing staff and
getting you home, or we get you up to your
room on the floor and then we get you up there.
(20:10):
Either way, we're getting you up right away. Once your
eyes open, it's time to get to work.
Speaker 2 (20:15):
Fantastic. Well, we're talking with doctor Alex Sweet tonight about
ME replacements and when it's time to consider them. This
is Senate on Health with Doctor's Health here on news
Radio eight forty whas. I'm your host, doctor Jeff Tublin.
We will be right back after the break. Welcome back
(20:43):
to Senate on Health with Dochor's Health here on news
radio eight forty whas. I'm your host, doctor Jeff Tublin.
We're talking tonight with doctor Alex Sweet, who's an orthopedic
surgeon with Bouchor's Hospital, and he is talking to us
tonight about ME replacements. So welcome back to the show,
doctor Sweet, and I wanted to start this section. I'm
(21:05):
trying to do some new parts on the show, and
one of the things I like to do is find
out things that people are doing or learning about out
in the community and using our experts to help us
sort through all this information dump that we get. And
so I like to call this section sort of the overhyped,
under hyped, or appropriately hype section. So I wanted to
(21:25):
start that with steroid injections and tell us a little
bit about your thoughts on steroid injections for knee pain.
Speaker 1 (21:35):
I think steroid injections are kind of the blue collar
worker of dealing with, you know, ne arthritis. It's a
hard working injection. It does pretty good for most people.
They're effective, they're safe most people. That's what they choose
to do on a regular basis. You can get them
every three months. You don't have to get them that often.
It is a essentially an anti inflammatory medication, just masks
(22:00):
the pain. It doesn't change the fact you have arthritis,
and it doesn't keep you getting worse.
Speaker 3 (22:05):
But it works pretty well.
Speaker 2 (22:07):
And does the response or the lack of response indicate
anything to you about their success that having any replacement,
or is that kind of two separate processes.
Speaker 1 (22:20):
That's two separate processes. As the shot tends to wear
off quicker, it means they're closer and closer to getting
ready for surgery.
Speaker 2 (22:29):
So it helps. But if they need it more often,
they're just sort of indicating, you know, this is something
that's not going.
Speaker 3 (22:35):
To go away.
Speaker 2 (22:36):
Yeah, and then what's off after four days? Yeah, you
gotta you can't get it every four days. And is
it done in the office or do you do these
in your office or do you send them to pay
management or who's doing these injections?
Speaker 3 (22:53):
We do them in the office routinely, every day.
Speaker 2 (22:56):
Perfect, all right, So that sounds like they are a
pro greatly hyped. What about We hear a lot about
platelet rich plasma, which is to tell us a little
bit about what that is and what you think about that.
Speaker 1 (23:12):
Yeah, So these platelet rich plasma or PRP injections, they're
essentially taking some of your blood, spinning it down to
get the platelets and the plasma out of it, and
then injecting that into areas of damage in the body.
Speaker 2 (23:28):
It has a lot of healing.
Speaker 1 (23:29):
Factors, so there's a theoreic uh, you know, possibility it
could help certain ailments. It has at this point been
studied extensively. Uh, it has essentially no role in osteoarthritis.
I mean it's been studied very very well. Did placebo
controlled trials. Means the patients don't know what they're getting.
(23:50):
The person giving the shot doesn't know what they're giving,
and they just compare the PRP versus the water shot
and there's no difference. There are some ailments where it
may make sense, some rotator cuff tears, you know, tennis elbow,
achilles tenon itis. There's some studies that show maybe it
does have a role, but not in not in new arthritis,
(24:11):
just not from my world.
Speaker 2 (24:14):
And is it covered, like is it something that's covered
by insurance or is it self pay and is it expensive?
Speaker 1 (24:21):
It is not covered by insurance again because it just
doesn't work, so insurance doesn't pay for it. It's for
just eight hundred dollars a pop depending on who you
go see for it, So it's it's a significant price tag.
Speaker 2 (24:38):
How does this get so popular? This is this something
that you know athletes are doing or famous? Like where
where did this sort of take off from?
Speaker 1 (24:48):
Well, I mean this came about, it was a great
theory that this. You know, these take the healing factors
from the blood, give you your own blood. So it seems
more natural than than you know, a steroid or some
sort of medication. And it's there's always a marketing hype
(25:09):
to things as well. I mean, people are making a
good deal of money off of this, and you know, providers,
some providers really like that aspect of it. I think
just as we've gained more knowledge about it, it just
doesn't seem to have a role in my world.
Speaker 3 (25:26):
So it's not something that I offer fair enough.
Speaker 2 (25:30):
Now, what about supplements. I know we see a lot
of ads for you know, conjoytan or this mineral or
this supplement, Like are do those health? Are they adjuncts
to other therapies? Do they work on their own? Are
they a waste of money? What are your thoughts about
some of those things?
Speaker 1 (25:49):
You know, conjoyitan is is kind of a waste of
your money, to be honest, that like taking medicines, it's
going to somehow make you create cartilage that just doesn't
have and you're born in your cartilage and when you
lose it, you lose it. Conjoydan is not going to
help some things like tumoric anti inflammatory is but kind
(26:09):
of a more natural way of reducing inflammation in your
body as opposed to taking like an ibuprofen. Those may
make sense. You know, some fish oils maybe can help
a little bit. I mean none of them work as
well as you know, an ibuprofen or a prescription strength
anti inflammatory, but they're probably safer, I mean, less risk
of GI you know, causing stomach leaves, less risk of
(26:32):
kidney kidney problems. So I have zero problem with patients
taking those. I think most people do.
Speaker 2 (26:39):
And what about some of these advertisements and and sort
of these popular trends people talking about, like nerve blocking,
like actually trying to adjust the way I guess the
nerve the knee receives the pain signals. Is that is
that something that's happening. Is that something that works? What
(27:00):
are your thoughts about nerve blocking or genicular nucleation or
things like that.
Speaker 3 (27:05):
Yeah, no, it's a it's a real thing.
Speaker 1 (27:07):
I mean our pain management team and our group they
do those regularly. They're also temporary, I mean, nerves grow back.
There can be side effects to them. Sometimes if you
try to burn a nerve, it can grow back a neuroma,
It can grow back abnormally and cause even increase pain.
So there's always a risk to anything you do, but
(27:30):
it can certainly help.
Speaker 2 (27:32):
It's just it.
Speaker 1 (27:32):
Doesn't eliminate all the pain. There's no way to block
all the pain and give you a pain free me.
You're still going to have problems.
Speaker 2 (27:42):
And what about things And I'm not sure if this
would fall under the category of things you would want
to be doing before you start to develop problems or
once you're having knee pain. But what what have you
seen in terms of things like yoga or tai chi?
Do you see people having success with kind of those
those types of things to kind of work out the
(28:03):
knee and things like that.
Speaker 1 (28:05):
There's no exercise that's gonna turn back the clock or
even prevent arthritis from getting worse. But maintaining a healthy
body is paramount to staying healthy. And so whatever working
out you can do, whatever exercise you can, you know,
you enjoy. If that's tai chi, if that's yoga, if
(28:26):
that's you know, swimming or biking, whatever it is. I mean,
it keeps your heart healthy, it keeps your weight down,
it keeps your your muscles around the knee, like your
quadri sep and hamstring strong, and that can actually make
the knee feel better even though the disease is gonna
get worse. If you stay lighter and thitter, the knee
will not hurt you as bad.
Speaker 2 (28:48):
And I guess just a couple more things I've seen
in terms of popularity, what about things like cannabis?
Speaker 3 (28:54):
Does that?
Speaker 2 (28:55):
Do you see people having success with that?
Speaker 1 (28:58):
So it's not that I have seen a lot of
So that's not something I can speak to. It's not
something that I was taught enough to feel comfortable prescribing,
but I certainly, I mean, my personal opinion is it's
safer than alcohol, and alcohol is legal, so I wouldn't
have a problem with someone doing that to try to
(29:19):
get some pain relief. I would refer them to our
our pain management team for that. Fair enough, we are
going to take a short break here. I want to
remind everybody.
Speaker 2 (29:29):
That you are listening to Centered on Health with Baptists
Health here on news radio eight forty wahas. Our guest
tonight is doctor Alex Sweet, orthopedic surgeon talking about me
replacement will be right that. Welcome back to Center on
(29:53):
Health with Baptists Health. Here on news radio eight forty
whas I'm your host, don't you, Jeff Tellin. We're talking
tonight doctor Alex Sweet, orthopedic surgeon about knee replacements. Remember
to download the iHeartRadio app and to re listen to
this show or any of our previous segments, and to
have access to all the other features the app has
to offer. So, Doctor Sweet, right before we went to break,
(30:15):
you were helping us understand some of the trends and
other options that are out there. But getting back to
what you do, which is the actual surgery, could you
tell us a little bit about after surgery. What is
the expectation that you set out with your patients in
terms of what they'll need to do afterwards in terms
of rehab. How long does it take for them to
(30:37):
kind of get back into things And do you set
expectations that they should feel totally normal at some point
or is there always sort of a little limitation after
a knee replacement. That was a long question that gives
you a lot to answer.
Speaker 1 (30:51):
Sure, Yeah, I mean I think the answer the last
part of that first, you know, do they feel normal?
It kind of depends on what normal is. I mean,
I tell them You don't do aknee replacement to make
you feel like you're twenty years old again. You do
a knee replacement so you can get back to doing
the things you enjoy doing. And if that's golf or
pickleball or just walking around the neighborhood or whatever it is,
(31:14):
those are the things you expect to get back to doing.
You know, if you are across country runner and your
knee hurts and you think you want to get anie
replacement to get back to that, it's probably not a
realistic expectation. So I think setting realistic expectations is a
huge part of having a successful surgery and a happy
patient in terms of what to do after surgery. You know,
(31:38):
I tell people, when your eyes open up, it's time
to get to work. You know. You start physical therapy
right away, and the first role is home physical therapy,
and I think they have an important role for that
first like week or two. After that you go to
out patient therapy. I also get a special exercise bike
(31:59):
to livered to my patient's houses, and the pedals kind
of barely move, and then they start moving more and
more and more as you start regaining that motion. It
was engineered by a bunch of orthopedic surgeons. Unfortunately I
was not on that design team.
Speaker 3 (32:13):
Uh, great equipment.
Speaker 2 (32:15):
I wish I was, which I was.
Speaker 1 (32:18):
Hard enough to have thought of it, but no, these
guys they designed a heck of a piece of equipment
for recovering knee replacements and you can do it up
to five times a day and it really gets the
knee going gets limber.
Speaker 2 (32:31):
So by about one, you know, a week.
Speaker 1 (32:34):
And a half two weeks after surgery, you start getting
the outpatient which is three times a week for an hour,
and if that's all you're doing, you're going to be failing.
You know, this is something where the first especially four
to six weeks through primary focus in life is rehabbing
this knee and you need to do it multiple times
a day for you know, several hours. Stretch it first
(32:54):
and then you'll you'll start the strengthening. So they'll give
you a lot of a lot of exercises to do
at home. When I tell people it's their homework and
if they do it, they'll recover well and they'll recover
quick and if they don't, they can have a longer recovery.
And pain control is probably the you know, the key
element to that by you know, three months, we call
people recovered.
Speaker 2 (33:15):
But that's what the caveat that.
Speaker 1 (33:16):
A knee replacement keeps getting better and better over the
course of a full year because it kind of feels
more natural, Swelling goes down, and you know, you really
get back to doing everything you want to do.
Speaker 2 (33:28):
You know, you have such a great way of putting
things into like a patient perspective, which is which is
really great. So I hope, I hope people are listening,
and I hope they're hearing what you say. How long
do you inform people that a knee replacement will last?
Speaker 1 (33:46):
So I tell people that the studies show that ninety
percent of people still have their knee replacement at twenty years.
So if you are sixty five years old, you expect
it to last the rest of your life. If you
are younger than that or at higher risk of needing
further surgery, and if you're older than sixty five, you
can kind of bet the ranch it should last the
(34:06):
rest of your life. I also tell people that's a
bell shaped curve, and you can get unlucky. You can
have a bad batch's cement. You know, God forbid, you
could get an infection in your knee.
Speaker 2 (34:17):
Something bad can happen.
Speaker 1 (34:18):
So there's always things that can go wrong, but in general,
the expectation of twenty years and.
Speaker 2 (34:24):
It's that second replacement harder on the patient or harder
for you as a surgeon than the first one.
Speaker 1 (34:34):
It's definitely harder on me as as a surgeon. It
takes a little bit longer to do. It used to
be a significant difference in terms of the recovery. But
as I've shifted my practice to a kind of enabling
technology and using robotics, I mean a I found that
the recovery from a primary knee replacement keeps getting better.
(34:54):
But the improvements we've made on revision knee replacements with
robotics is huge. I mean we're putting in needs that
are getting more results of like primary knee replacement. So
that's kind of an exciting time right now with the
robotics what we can do.
Speaker 2 (35:12):
You know, I was gonna that could be a whole
you know, another segment of the show, and I'm not
just the last couple of minutes, but tell us a
little bit about where things are going. I know that
you use some augmented reality in your constiest what is
life like in your o R, what are you doing
that you're excited about?
Speaker 3 (35:31):
I think just that.
Speaker 1 (35:32):
I think, I think the enabling technology. I think finding
ways to bring newer technologies to the o R to
make things safer and better and to keep improving outcomes.
You know, if you ever decide that you're just satisfied
with the practice of medicine, then it's time to retire.
You know. We should always be finding ways to improve,
(35:53):
and that's what I think we're all trying to do.
And so for me, robotics when I switched about four
years ago, going to huge change in my practice, and
now of the last year and a half, I've started
incorporating some augmented reality so I can have you know,
patients x rays, you know in the digital world, just
kind of in the corner of the room where I
(36:14):
can look at them, them up, bring them over the patient, look.
Speaker 2 (36:17):
At them, reference them.
Speaker 1 (36:18):
I can even on the MRI images just at the
tip of my finger, where it's not a sterility issue.
Speaker 3 (36:24):
It's right there.
Speaker 1 (36:25):
I can I can play it, scroll through it, I
can even interact with the robot. Using the augmented reality
helps me kind of plan the knee, visualize it, see
everything a little bit better and execute the knee more accurately.
Speaker 2 (36:40):
So when you just when you talk about that, are
you talking about like a heads up display that you
can manipulate or is it like a screen that you're manipulating.
Speaker 3 (36:49):
No, it's a heads up display.
Speaker 2 (36:50):
So I mean, I'm I'm, I mean, it's almost.
Speaker 1 (36:54):
Like you've seen the movie Minority Report. It's kind of
like that. I mean, you're just taking your hand and
moving stuff and swipe in and it's it's pretty.
Speaker 3 (37:03):
Cool what we're able to do.
Speaker 2 (37:04):
That's pretty cool. It's like Tony Stark's stuff. It's pretty cool.
You go to sweetnee and hip dot com.
Speaker 1 (37:11):
You can watch uh some videos utilizing it, and it's
it's fun to see.
Speaker 2 (37:18):
Say that site again, I was talking over you Sweet
knee and Hip dot Com. Sounds great. Yes, please, And
I'm going to be checking that out. And then in
just the last few seconds that we have. One of
the things that comes up a lot after knee surgery
is the need for antibiotics for procedures, like even for
me for a colonoscopy when I do it and stuff.
Is that something you ask your patients to have routinely
(37:40):
done when they have any replacement to get antibiotics.
Speaker 1 (37:44):
So the only thing that is controversial is dental work.
Everything else you either definitely do not need antibotics or
they're going to give it to you anyways. And on
dental work, we have absolutely no idea what should be
done there. There is really no consensus. Some people say
you should do it for life, some people say you
should do it for a year. Our office, to be honest,
(38:06):
out of a hatch, just kind of picked two years
and said for two years, we're going to give you
a dental profile access before any dental procedure or cleaning.
Speaker 3 (38:13):
And that's how we have practiced in our group.
Speaker 2 (38:16):
Fantastic love Doctus week. Thank you for like always giving
us such great practical information. Thank you for hanging in
there with some of our technical issues. Tonight, I want
to thank our listeners. I want to thank our producer
mister Jim Finn that's going to do it for tonight's
segment of Centered on Health with Baptist Health. I'm your host,
doctor Jeff Tomlin. Join us every week and I hope
everybody has a great weekend and has a great time
(38:40):
and a happy Labor Day. Thank very much.
Speaker 1 (38:49):
This program is for informational purposes only and should not
be relied upon as medical advice. The content of this
program is not intended to be a substitute for professional
medical advice, diagnosis, or treatment. This show is not designed
to replace the physician's medical assessment and medical judgment. Always
seek the advice of your physician with any questions or
concerns you may.
Speaker 2 (39:10):
Have related to your personal health or regarding specific medical conditions.
Speaker 1 (39:14):
To find a Baptist health provider, please visit Baptistealth dot com.
It's now time for Centered on Health with Baptists Help
on use Radio.
Speaker 2 (00:05):
Wait forty tell meny wit JS. Now, here's doctor Jeff Tubler.
Good evening, everyone, and welcome to tonight's episode of Centered
on Health with Baptists Health here on news Radio eight
forty WHS. I'm your host, doctor Jeff Tubblin, and we're
joined from the studio by mister Jim Fenn, who's ready
to take your calls to talk to our guest tonight.
(00:26):
Our phone number is five oh two five seven one
eight four eight four. Tonight, we're talking to doctor Alex Sweet,
who's an orthopedic surgeon with the Baptist Hospital affiliation and
who is talking to us tonight about knee replacements. There's
over seven hundred and ninety thousand new replacements done in
the United States every year. We've had doctor Sweet on
(00:47):
our show before, and he always is a wealth of
information about what to do and when to think about
having your knee replaced. We're going to start that conversation
with doctor Sweet right after this. It's a doctor Josh Poblin.
(01:25):
Welcome to tonight's episode of Centered on Health with Baptists
Health here on News Radio eight forty whas we're getting
a little bit a little bit of a late start. Tonight,
we have doctor Alex Sweet on with us tonight. He
has been with us before. He's an expert on how
to do this show, and he is one of our
most popular guests to have people call in. He is
(01:47):
going to talk to us tonight about knee replacements and
when we should be thinking about doing knee replacements. Over
seven hundred and fifty thousand are done in the United
States every year. Doctor Sweet is an orthopedic surgeon with
here in Louisville with affiliation with gott His Hospital. Doctor Sweet,
welcome back to our show.
Speaker 3 (02:04):
Thank you, it's good to be here.
Speaker 2 (02:07):
Sorry, we're getting a little bit of a late start
because you know, I have so much information to get
from you, like we always do, and you carry you carry.
I think the record for the most number of phone
calls that we've had during this show, so it's really
exciting to have you back. How are you doing tonight,
I'm done great.
Speaker 3 (02:23):
That's quite an honor. Good to hear.
Speaker 2 (02:25):
I'm glad people were interested. Yeah. I think one time
my friends all called in with some goofy questions, but
for real questions you definitely carry. You definitely carry the record.
So I want to start tonight with just a very
open ended question. I know that we're going to get
into some details, but since the name of our show
tonight is when to think about a knee replacement in general?
(02:46):
When is it time that someone should be thinking that
it's time to get a knee replacement?
Speaker 1 (02:52):
So I think it all boils down to three parts. One,
you have to have disease bad enough, and that means
you know, an extrayor and em just something going on
with your knee enough, arthritis or disease of whatever kind
it is that justifies undergoing a major surgery like knee replacement.
The second thing is you need to be healthy enough.
(03:12):
And that doesn't mean you know, you can't be eighty
years old and have a knee replacement. I mean, some
people are seventy and are just two unhealthy bad hearts
and can undergo surgery. And some people are eighty five
and are otherwise healthy. It might live twenty more years,
but you need to be healthy enough, and you know,
if there's questions, you can always see a cardiologist and
or you know your primary care and make sure.
Speaker 3 (03:33):
And the third thing.
Speaker 1 (03:34):
And what I tell people is the most important thing
is pain bad enough to justify it having failed the
conservative treatment that means rest ice, activity modification. You know,
anti inflammatory is like talent, all ibuprofen, you know, injections
that we'll kind of talk about tonight, maybe even some
simple exercises try to strengthen your quad. When you've undergone
(03:55):
that and it's affecting your quality of life enough and
you kind of come into the clinic waving the white
flag saying I can't do this anymore, that's when we
talk about the surgery.
Speaker 2 (04:05):
That's a great, great answer, and it really gives a
great framework of kind of things people may think about
and some things they may want to ask about, and
certainly things we're going to try and cover tonight. So
let's start with the knee itself. Tell us a little
bit about the anatomy of the knee, especially the parts
of it that you're going to be talking about when
(04:25):
it comes to replacing things, and the function of the
knee and how that matters with a knee replacement.
Speaker 1 (04:32):
Sure, so, a knee joint is where the tibia, which
is your shin bone, and the femur, which is your
five bone meat. Now there's also the fibula, which is
kind of the small bone on the outside of your ankle,
but at the knee. It's not a very big structure
and not really important for this conversation. And so in
addition to just those bones, what's capped on the ends
(04:55):
of the bones the cartilage, and that's the soft lining.
That's what makes us able to bend into trading in
it not crick and crackle and pop and grind, but
over time that cartilage wears out. Now, in addition to
the cartilage is also ligaments. Everyone's heard about your the
ACL and the MCL, and you know the less commonly
people hear about the PCL or the LCL. But there's
(05:17):
essentially four ligaments and they're very very important when you're
younger and playing higher level activities and in a knee replacement,
some of those you keep and some of them you don't.
Speaker 3 (05:28):
There's nerves and arteries and those are all.
Speaker 1 (05:31):
Kind of in the back and we stay well away
from them. And then there's your knee cap your patella,
and that's connected to your quatercep tendon going up your
thigh and your paateella tendon going down the leg and
that has to stay intact. And in a knee replacement,
it's really a terrible term for what we're doing. It's
a knee resurfacing. We're not really replace anything. We're just
(05:51):
shaving a few millimeters of bone and what may be
left cartilage and replacing.
Speaker 3 (05:57):
That with metal and plastic. So it's just it's like
a capping procedure.
Speaker 2 (06:02):
And the knee itself is you know, we ask a
lot of the knee, right, I mean we don't just
carry ourselves on our knees. I mean we bend, we
lift things like the knee is subjected to quite a
lot of pressure. And so is it normal over our
life should we expect that our knees are going to
(06:23):
get worn out or does that not necessarily have to happen.
Speaker 3 (06:28):
Everyone gets arthritis.
Speaker 1 (06:30):
It's just a matter of how bad the arthritis is
and how.
Speaker 3 (06:33):
Much it affects you. I've got some.
Speaker 1 (06:35):
Patients with knees You look at the X ray and
it's just hard to look at and it really doesn't
hurt them that much. They come in once a year
for a court zone shot and they get around just fine.
And other people their extray doesn't look that bad and
they're in the office, you know, just about begging me
for the next available appointment for a knee replacement. I mean,
it's incredibly variable how bad it gets, how quickly it gets,
(06:57):
and then on top of that, how much it affec
And most of it's genetic.
Speaker 3 (07:01):
It's not, Oh, you.
Speaker 2 (07:03):
Know, I was on my knees my whole life.
Speaker 3 (07:04):
You know, I was. I was a carpenter, you know,
I was on concrete.
Speaker 1 (07:08):
It's it's really not that it's more genetic than it
is anything else.
Speaker 2 (07:13):
And what are the I think I know the answer,
But what are the most What's the most common reason
somebody comes to you for any replaces? Is it pain?
Or is it that they need isn't functioning fly or
or what pain is.
Speaker 1 (07:27):
The most common? You know, that's probably for four out
of five, maybe even nine out of ten. Every once
in a while, someone comes to me for a knee
replacement because they just can't do things. It's not that
it hurts, they just you know, my family wants to
go to Disney World and I just I just can't walk.
My leg just it just gets tired. I can't do things,
(07:47):
and it's just an inability to tolerate activities of daily living.
Speaker 2 (07:53):
And we hear the term like bone on bone. I
mean people use that phrase. What does that mean? How
does it relate to what you do?
Speaker 1 (08:04):
So? Bone on bone means that the end of the
femur and the top of the tibia where the cartilage is,
has completely worn away. And when that completely wears the
bone actually rubs on the bone. So with an X ray,
all we see is the bone. If they're still cartilage
and you've got a healthy knee, it'll look on X
ray like the bones are not touching. They're separated by
(08:25):
about a cinemere and that's because of the cartilage. But
once you've lost all of that, you'll actually see the
bones touching each other and they'll actually start to erode
and you know, wear away the bone eventually. And when
that starts happening, it becomes more and more and more
painful and also noisy.
Speaker 2 (08:44):
People can hear it, So that's that's a real thing.
People can say, oh, I can hear my knee like
clicking or whatever. The description is that they use.
Speaker 1 (08:54):
The technical term is crevidence, but it's absolutely a real
phenomenon and people can can feel it and you can
hear it. Sometimes people come into clinic and they can
show you. I mean they straighten their knee and there's
this loud pop. I mean it can be impressive.
Speaker 2 (09:08):
Yeah, So we're talking about, you know, when it's time
to think about a knee replacement, and I think you
probably can appreciate this, you know as well, which is
what I see, like when people make the decision okay,
I want to have something done, like they're ready to
do it, and they're ready to do it right away.
But a lot of times when it comes to certain
surgical procedures, and I'd be interested about your perspective, people
(09:32):
are told, oh, you need to lose a certain amount
of weight before we can do that. So for somebody
who's struggling with me pain that might limit their ability
to exercise, do you have like a BMI cutoff? And
if so, like, how do you how do you help
people lose that weight before Dan can have surgery.
Speaker 1 (09:53):
Well, I think first of all, it's important not to
be judgmental. I mean, these are you know, people are
always self conscious when they come and they're worried that
you know, I'm going to say no about surgery, and
you know, they may even been turned down before, and
so if you're going to have this discussion, you want
to be frank and honest, but also you want to
make sure that you're you're not going to upset the patient.
(10:16):
So I don't have a particular cutoff. I've talked to
my patients about risks and benefits. You know, we know
that when your body mass index, which the relationship of
your height and weight, is over forty, you're an increased risk,
and when you get above fifty, that risk is is
even higher.
Speaker 3 (10:34):
But it's not just weight. It's also comobidities.
Speaker 1 (10:38):
You know how diabetes, heart disease, lung disease, kidney disease.
You know, it's also how your weight is distributed. You know,
if you're a male with a big belly and you
need a knee replacement, well your knee might not be
that big. But if you're a male with a big
belly and you want an anterior hip and that belly
is going to sit right over top of the incision
(10:59):
site and make it hard to do, maybe.
Speaker 3 (11:01):
It's not a good idea.
Speaker 1 (11:02):
So the distribution of fat is also important, and sometimes
that's part of the examination I'm doing. Even if I
don't talk to the patient about it. And that is
something I was going to ask you. What isn't a
what is an evaluation? Like in the office?
Speaker 2 (11:17):
What can you tell when you're examining the need that
if somebody doesn't realize they did, they're just coming to
you because they have me pain. What kind of tips
you off that you're like in the exam or or
what you're doing imaging wise that tells you, okay, I
should recommend a knee replacement here.
Speaker 3 (11:37):
So so what I'm sorry?
Speaker 2 (11:38):
What keeps me from one? Or what? What?
Speaker 1 (11:40):
What?
Speaker 2 (11:41):
What can you tell on an exam? Like what are
you looking for? And what kinds of things can you determine?
Like in the office when you're examining?
Speaker 1 (11:47):
Sure, you know so, I mean, obviously we have the
X ray that we can look at and see if
there's you know, disease. But then you tend to lose
motion as you develop ourthritis. Bone spurs start to form
and it instead of being able to, you know, take
your heel and put it on your butt, you can't
bend it very far. And as it gets even worse,
sometimes you can't straighten it out all the way and
(12:08):
you get what's called a flexion contractor or that the
knees kind of stuck in a bent position, and then
as you take it through motion sometimes they'll just grimace
and cause pain. And then you push on the joint line,
you push right where it may be bone on bone,
and people will WinCE. I mean you can see that
it's painful. And when that exam is painful, you know
(12:29):
that's what's causing their problem.
Speaker 2 (12:33):
Yeah, that's that's great. And we did have a question
that got sent into me while we were While we
were chatting about that, somebody wanted to know what a
baker's cyst was and what what it is, what causes it,
and how that's treated. Is that something that you see, Yeah, absolutely.
Speaker 1 (12:49):
So, a Baker's cyst or think of the knee.
Speaker 3 (12:51):
Like a balloon.
Speaker 1 (12:53):
It's supposed to have a certain amount of water in
it to lubricate it, right, like oil for the knee,
and that oil is called hyaluronic acid. It's a natural
lubricant that the knee forms to lubricate itself.
Speaker 2 (13:05):
Well.
Speaker 1 (13:06):
When the knee gets inflamed, when it gets the itis, right,
arthritis inflammation, the body is trying to put more oil
in it, trying to give it more lubricant, and so
it fills up with more fluid and as it does that,
the balloon starts getting stretched and that fluid has to
go somewhere, And the weak spot in the balloon is
in the back of the knee. So this out pouching
(13:27):
of the balloon, basically a second balloon forms and that's
what's called a Baker's cyst.
Speaker 3 (13:32):
So it's connected to the.
Speaker 1 (13:34):
Knee joint by a one way valve where the fluid
can go out into the cyst but can't go back in,
So it's actually a symptom of the disease.
Speaker 2 (13:45):
Is that drained or is that removed or how is
that usually treated?
Speaker 1 (13:51):
Sometimes if they're really palpable under the skin, you can
drain them. You can even send someone like a radiologist
have it drained under ultrasound.
Speaker 3 (13:59):
They tend to.
Speaker 1 (14:00):
Be near the big artery and nerves, so it's a
little dangerous just to drain those in clinic. What you
really want to do is treat the disease and the
Baker syst will go away over time.
Speaker 2 (14:13):
And can you explain to us, like do you think
patients are coming to you late? Like are people waiting
too long? Are they trying all these things. And I
know we're going to talk about some of these conservative
things and what you think about them. But are people
waiting too long to come to you? And if so,
(14:33):
does that make the surgery harder or is it just
they've lived with pain longer?
Speaker 1 (14:39):
You know, there are exceptions to this, but in general,
the surgery doesn't get harder. I mean, if your leg
gets really crooked or you lose too much of your motion,
your outcome can actually be affected by that waiting too long.
But that's very, very very rare with our society nowadays.
People are just very demanding in terms.
Speaker 3 (14:57):
Of the quality of life they want to live. I mean,
they want to be able.
Speaker 1 (15:00):
To play pick a ball, play golf, play tennis, you know,
take care of their grandkids. People are not accepting a
sedentary lifestyle and living in pain. So it's not as
common as it may be used to be.
Speaker 2 (15:13):
And how do you advise. I mean, obviously, by the
time they it to you, they've already done their excellent research.
But for people that are listening and are trying to
decide about seeing a surgeon, is there differences in sort
of training that people should look for in terms of
how to pick a surgeon for this. Are there different
ways of doing a knee surgery? I know we'll talk
(15:34):
about the surgery itself, but that are less invasive or
use different equipment that they should be thinking about when
they're picking a surgeon.
Speaker 1 (15:43):
Absolutely, you know, I think first of all, you need
to find a surgeon that you just you just trust, right,
I mean, it's a relationship. I have to trust that
the patient's going to do the right thing, and the
patient needs to trust and I'm going to do the
right thing. And that's the most important thing. Pick your surgeon.
Don't pick the surgeon because they use a particular implant
where you know someone that sells that implant. You know,
(16:04):
you pick the surgeon first, and then after that you understand, Yeah,
there's there's differences in training, and so if you need
a nee replacement, you want to go to a surgeon
who specifically trained for that, and that means they did
a fellowship, which means they did an extra year of
training to do that. If you want your ACL fix,
coming to me is a terrible idea. I'm not any
good at that surgery. I don't know how to do
(16:25):
it and I've never done it. In practice. But I've
got partners that do that all day long, and they
don't do knee replacements. So we all kind of have
our specialty niche. And you want to make sure you're
going to a total joint Arthur Placy, Fellowship trained surgeon.
Speaker 3 (16:41):
Oh, that's that's.
Speaker 2 (16:42):
Very helpful advice. And it's interesting how you know it's
sub specialized even within that specialty. I mean similar to
you know a lot of other medical specialties. So the
surgery itself, we hear the term total nee replacement. We
hear the term partial need replacement. Are those differential? Are
those really different? Is it two ways of saying the
(17:03):
same thing? Or what is a partial versus a total knee?
Speaker 1 (17:07):
So there are three compartments of the knee. There's the
kneecap compartment, There's the medial or the inside compartment where
the tibbian femur.
Speaker 3 (17:18):
Join.
Speaker 1 (17:18):
And then there's the lateral compartment or the outside compartment.
The most common area to get arthritis is on the
medial side of the knee, the inside of the knee.
That's where most people develop that arthritis and become bone
on bone, And if you have isolated disease in the
inside of the knee. You may be a candidate for
a partial knee. Sometimes people develop enough bone spurs on
(17:40):
the outside of the knee or underneath their kneecap that
a partial need may not be the right choice for them.
And so that's something you just have to discuss the
risks and benefits, you know, how long it's going to last,
how the rest of the knee may or may not
hold up, and decide what's best for you. And that's
the conversation that I have in the clinic with these clostations.
Speaker 2 (18:00):
Excellent and then so walk us through kind of what
the surgery day is like for a patient. How how
long does the surgery take, what where do they recover?
Are they in the hospital for a certain number of times?
Like what's the patient experience when they get to be replaced.
Speaker 3 (18:20):
Sure, so you know, there's two different ways to have
this done.
Speaker 1 (18:22):
You can have this done in a hospital setting and
have the ability to stay overnight and for some people
that may be emotionally comforting or medically necessary just to
monitor them. And there's also an option to do this
out patient where you go home the same day, like
from a from a surgery center. And and it's kind
of up to the patient and their medical status how
(18:43):
they want to do this, But you typically show up
to the surgery about maybe an hour and a half
before it's expected to start, so you can get changed,
get into the gown. The nurse can come in, make
sure they've got the appropriate history, start an ivy, give
you some medications. You know, the seizure provider will come
in talk to you. Typically you get a block help
(19:04):
numb up the leg. Depending on the type of vanta seizure,
that may even there may even be a spinal that's
that's given or a shot in the back that numbs
up both your legs. During the surgery. You may be
a candidate just for general landa szure where you go
to sleep. At some point before the surgery, I'll be
in you know, ask if there's any last questions. We
always take a marker and mark the operative leg. It's
(19:27):
just one more checkpoint to make sure that we can
never do a wrong site surgery. And then you wheel
back and go to sleep, and by the time you
wheel back you really don't know what's going on. You
wake up and everything's done, and you wouldn't know if
it was a twelve hour surgery or a twelve minute surgery.
But typically the surgery itself takes about fifty minutes, give
(19:50):
or take. But you got to go back, get to sleep,
get positioned, and the surgery itself a little less than
an hour. Afterwards you wake up, we're either getting you
up and having you walk with the nursing staff and
getting you home, or we get you up to your
room on the floor and then we get you up there.
(20:10):
Either way, we're getting you up right away. Once your
eyes open, it's time to get to work.
Speaker 2 (20:15):
Fantastic. Well, we're talking with doctor Alex Sweet tonight about
ME replacements and when it's time to consider them. This
is Senate on Health with Doctor's Health here on news
Radio eight forty whas. I'm your host, doctor Jeff Tublin.
We will be right back after the break. Welcome back
(20:43):
to Senate on Health with Dochor's Health here on news
radio eight forty whas. I'm your host, doctor Jeff Tublin.
We're talking tonight with doctor Alex Sweet, who's an orthopedic
surgeon with Bouchor's Hospital, and he is talking to us
tonight about ME replacements. So welcome back to the show,
doctor Sweet, and I wanted to start this section. I'm
(21:05):
trying to do some new parts on the show, and
one of the things I like to do is find
out things that people are doing or learning about out
in the community and using our experts to help us
sort through all this information dump that we get. And
so I like to call this section sort of the overhyped,
under hyped, or appropriately hype section. So I wanted to
(21:25):
start that with steroid injections and tell us a little
bit about your thoughts on steroid injections for knee pain.
Speaker 1 (21:35):
I think steroid injections are kind of the blue collar
worker of dealing with, you know, ne arthritis. It's a
hard working injection. It does pretty good for most people.
They're effective, they're safe most people. That's what they choose
to do on a regular basis. You can get them
every three months. You don't have to get them that often.
It is a essentially an anti inflammatory medication, just masks
(22:00):
the pain. It doesn't change the fact you have arthritis,
and it doesn't keep you getting worse.
Speaker 3 (22:05):
But it works pretty well.
Speaker 2 (22:07):
And does the response or the lack of response indicate
anything to you about their success that having any replacement,
or is that kind of two separate processes.
Speaker 1 (22:20):
That's two separate processes. As the shot tends to wear
off quicker, it means they're closer and closer to getting
ready for surgery.
Speaker 2 (22:29):
So it helps. But if they need it more often,
they're just sort of indicating, you know, this is something
that's not going.
Speaker 3 (22:35):
To go away.
Speaker 2 (22:36):
Yeah, and then what's off after four days? Yeah, you
gotta you can't get it every four days. And is
it done in the office or do you do these
in your office or do you send them to pay
management or who's doing these injections?
Speaker 3 (22:53):
We do them in the office routinely, every day.
Speaker 2 (22:56):
Perfect, all right, So that sounds like they are a
pro greatly hyped. What about We hear a lot about
platelet rich plasma, which is to tell us a little
bit about what that is and what you think about that.
Speaker 1 (23:12):
Yeah, So these platelet rich plasma or PRP injections, they're
essentially taking some of your blood, spinning it down to
get the platelets and the plasma out of it, and
then injecting that into areas of damage in the body.
Speaker 2 (23:28):
It has a lot of healing.
Speaker 1 (23:29):
Factors, so there's a theoreic uh, you know, possibility it
could help certain ailments. It has at this point been
studied extensively. Uh, it has essentially no role in osteoarthritis.
I mean it's been studied very very well. Did placebo
controlled trials. Means the patients don't know what they're getting.
(23:50):
The person giving the shot doesn't know what they're giving,
and they just compare the PRP versus the water shot
and there's no difference. There are some ailments where it
may make sense, some rotator cuff tears, you know, tennis elbow,
achilles tenon itis. There's some studies that show maybe it
does have a role, but not in not in new arthritis,
(24:11):
just not from my world.
Speaker 2 (24:14):
And is it covered, like is it something that's covered
by insurance or is it self pay and is it expensive?
Speaker 1 (24:21):
It is not covered by insurance again because it just
doesn't work, so insurance doesn't pay for it. It's for
just eight hundred dollars a pop depending on who you
go see for it, So it's it's a significant price tag.
Speaker 2 (24:38):
How does this get so popular? This is this something
that you know athletes are doing or famous? Like where
where did this sort of take off from?
Speaker 1 (24:48):
Well, I mean this came about, it was a great
theory that this. You know, these take the healing factors
from the blood, give you your own blood. So it seems
more natural than than you know, a steroid or some
sort of medication. And it's there's always a marketing hype
(25:09):
to things as well. I mean, people are making a
good deal of money off of this, and you know, providers,
some providers really like that aspect of it. I think
just as we've gained more knowledge about it, it just
doesn't seem to have a role in my world.
Speaker 3 (25:26):
So it's not something that I offer fair enough.
Speaker 2 (25:30):
Now, what about supplements. I know we see a lot
of ads for you know, conjoytan or this mineral or
this supplement, Like are do those health? Are they adjuncts
to other therapies? Do they work on their own? Are
they a waste of money? What are your thoughts about
some of those things?
Speaker 1 (25:49):
You know, conjoyitan is is kind of a waste of
your money, to be honest, that like taking medicines, it's
going to somehow make you create cartilage that just doesn't
have and you're born in your cartilage and when you
lose it, you lose it. Conjoydan is not going to
help some things like tumoric anti inflammatory is but kind
(26:09):
of a more natural way of reducing inflammation in your
body as opposed to taking like an ibuprofen. Those may
make sense. You know, some fish oils maybe can help
a little bit. I mean none of them work as
well as you know, an ibuprofen or a prescription strength
anti inflammatory, but they're probably safer, I mean, less risk
of GI you know, causing stomach leaves, less risk of
(26:32):
kidney kidney problems. So I have zero problem with patients
taking those. I think most people do.
Speaker 2 (26:39):
And what about some of these advertisements and and sort
of these popular trends people talking about, like nerve blocking,
like actually trying to adjust the way I guess the
nerve the knee receives the pain signals. Is that is
that something that's happening. Is that something that works? What
(27:00):
are your thoughts about nerve blocking or genicular nucleation or
things like that.
Speaker 3 (27:05):
Yeah, no, it's a it's a real thing.
Speaker 1 (27:07):
I mean our pain management team and our group they
do those regularly. They're also temporary, I mean, nerves grow back.
There can be side effects to them. Sometimes if you
try to burn a nerve, it can grow back a neuroma,
It can grow back abnormally and cause even increase pain.
So there's always a risk to anything you do, but
(27:30):
it can certainly help.
Speaker 2 (27:32):
It's just it.
Speaker 1 (27:32):
Doesn't eliminate all the pain. There's no way to block
all the pain and give you a pain free me.
You're still going to have problems.
Speaker 2 (27:42):
And what about things And I'm not sure if this
would fall under the category of things you would want
to be doing before you start to develop problems or
once you're having knee pain. But what what have you
seen in terms of things like yoga or tai chi?
Do you see people having success with kind of those
those types of things to kind of work out the
(28:03):
knee and things like that.
Speaker 1 (28:05):
There's no exercise that's gonna turn back the clock or
even prevent arthritis from getting worse. But maintaining a healthy
body is paramount to staying healthy. And so whatever working
out you can do, whatever exercise you can, you know,
you enjoy. If that's tai chi, if that's yoga, if
(28:26):
that's you know, swimming or biking, whatever it is. I mean,
it keeps your heart healthy, it keeps your weight down,
it keeps your your muscles around the knee, like your
quadri sep and hamstring strong, and that can actually make
the knee feel better even though the disease is gonna
get worse. If you stay lighter and thitter, the knee
will not hurt you as bad.
Speaker 2 (28:48):
And I guess just a couple more things I've seen
in terms of popularity, what about things like cannabis?
Speaker 3 (28:54):
Does that?
Speaker 2 (28:55):
Do you see people having success with that?
Speaker 1 (28:58):
So it's not that I have seen a lot of
So that's not something I can speak to. It's not
something that I was taught enough to feel comfortable prescribing,
but I certainly, I mean, my personal opinion is it's
safer than alcohol, and alcohol is legal, so I wouldn't
have a problem with someone doing that to try to
(29:19):
get some pain relief. I would refer them to our
our pain management team for that. Fair enough, we are
going to take a short break here. I want to
remind everybody.
Speaker 2 (29:29):
That you are listening to Centered on Health with Baptists
Health here on news radio eight forty wahas. Our guest
tonight is doctor Alex Sweet, orthopedic surgeon talking about me
replacement will be right that. Welcome back to Center on
(29:53):
Health with Baptists Health. Here on news radio eight forty
whas I'm your host, don't you, Jeff Tellin. We're talking
tonight doctor Alex Sweet, orthopedic surgeon about knee replacements. Remember
to download the iHeartRadio app and to re listen to
this show or any of our previous segments, and to
have access to all the other features the app has
to offer. So, Doctor Sweet, right before we went to break,
(30:15):
you were helping us understand some of the trends and
other options that are out there. But getting back to
what you do, which is the actual surgery, could you
tell us a little bit about after surgery. What is
the expectation that you set out with your patients in
terms of what they'll need to do afterwards in terms
of rehab. How long does it take for them to
(30:37):
kind of get back into things And do you set
expectations that they should feel totally normal at some point
or is there always sort of a little limitation after
a knee replacement. That was a long question that gives
you a lot to answer.
Speaker 1 (30:51):
Sure, Yeah, I mean I think the answer the last
part of that first, you know, do they feel normal?
It kind of depends on what normal is. I mean,
I tell them You don't do aknee replacement to make
you feel like you're twenty years old again. You do
a knee replacement so you can get back to doing
the things you enjoy doing. And if that's golf or
pickleball or just walking around the neighborhood or whatever it is,
(31:14):
those are the things you expect to get back to doing.
You know, if you are across country runner and your
knee hurts and you think you want to get anie
replacement to get back to that, it's probably not a
realistic expectation. So I think setting realistic expectations is a
huge part of having a successful surgery and a happy
patient in terms of what to do after surgery. You know,
(31:38):
I tell people, when your eyes open up, it's time
to get to work. You know. You start physical therapy
right away, and the first role is home physical therapy,
and I think they have an important role for that
first like week or two. After that you go to
out patient therapy. I also get a special exercise bike
(31:59):
to livered to my patient's houses, and the pedals kind
of barely move, and then they start moving more and
more and more as you start regaining that motion. It
was engineered by a bunch of orthopedic surgeons. Unfortunately I
was not on that design team.
Speaker 3 (32:13):
Uh, great equipment.
Speaker 2 (32:15):
I wish I was, which I was.
Speaker 1 (32:18):
Hard enough to have thought of it, but no, these
guys they designed a heck of a piece of equipment
for recovering knee replacements and you can do it up
to five times a day and it really gets the
knee going gets limber.
Speaker 2 (32:31):
So by about one, you know, a week.
Speaker 1 (32:34):
And a half two weeks after surgery, you start getting
the outpatient which is three times a week for an hour,
and if that's all you're doing, you're going to be failing.
You know, this is something where the first especially four
to six weeks through primary focus in life is rehabbing
this knee and you need to do it multiple times
a day for you know, several hours. Stretch it first
(32:54):
and then you'll you'll start the strengthening. So they'll give
you a lot of a lot of exercises to do
at home. When I tell people it's their homework and
if they do it, they'll recover well and they'll recover
quick and if they don't, they can have a longer recovery.
And pain control is probably the you know, the key
element to that by you know, three months, we call
people recovered.
Speaker 2 (33:15):
But that's what the caveat that.
Speaker 1 (33:16):
A knee replacement keeps getting better and better over the
course of a full year because it kind of feels
more natural, Swelling goes down, and you know, you really
get back to doing everything you want to do.
Speaker 2 (33:28):
You know, you have such a great way of putting
things into like a patient perspective, which is which is
really great. So I hope, I hope people are listening,
and I hope they're hearing what you say. How long
do you inform people that a knee replacement will last?
Speaker 1 (33:46):
So I tell people that the studies show that ninety
percent of people still have their knee replacement at twenty years.
So if you are sixty five years old, you expect
it to last the rest of your life. If you
are younger than that or at higher risk of needing
further surgery, and if you're older than sixty five, you
can kind of bet the ranch it should last the
(34:06):
rest of your life. I also tell people that's a
bell shaped curve, and you can get unlucky. You can
have a bad batch's cement. You know, God forbid, you
could get an infection in your knee.
Speaker 2 (34:17):
Something bad can happen.
Speaker 1 (34:18):
So there's always things that can go wrong, but in general,
the expectation of twenty years and.
Speaker 2 (34:24):
It's that second replacement harder on the patient or harder
for you as a surgeon than the first one.
Speaker 1 (34:34):
It's definitely harder on me as as a surgeon. It
takes a little bit longer to do. It used to
be a significant difference in terms of the recovery. But
as I've shifted my practice to a kind of enabling
technology and using robotics, I mean a I found that
the recovery from a primary knee replacement keeps getting better.
(34:54):
But the improvements we've made on revision knee replacements with
robotics is huge. I mean we're putting in needs that
are getting more results of like primary knee replacement. So
that's kind of an exciting time right now with the
robotics what we can do.
Speaker 2 (35:12):
You know, I was gonna that could be a whole
you know, another segment of the show, and I'm not
just the last couple of minutes, but tell us a
little bit about where things are going. I know that
you use some augmented reality in your constiest what is
life like in your o R, what are you doing
that you're excited about?
Speaker 3 (35:31):
I think just that.
Speaker 1 (35:32):
I think, I think the enabling technology. I think finding
ways to bring newer technologies to the o R to
make things safer and better and to keep improving outcomes.
You know, if you ever decide that you're just satisfied
with the practice of medicine, then it's time to retire.
You know. We should always be finding ways to improve,
(35:53):
and that's what I think we're all trying to do.
And so for me, robotics when I switched about four
years ago, going to huge change in my practice, and
now of the last year and a half, I've started
incorporating some augmented reality so I can have you know,
patients x rays, you know in the digital world, just
kind of in the corner of the room where I
(36:14):
can look at them, them up, bring them over the patient, look.
Speaker 2 (36:17):
At them, reference them.
Speaker 1 (36:18):
I can even on the MRI images just at the
tip of my finger, where it's not a sterility issue.
Speaker 3 (36:24):
It's right there.
Speaker 1 (36:25):
I can I can play it, scroll through it, I
can even interact with the robot. Using the augmented reality
helps me kind of plan the knee, visualize it, see
everything a little bit better and execute the knee more accurately.
Speaker 2 (36:40):
So when you just when you talk about that, are
you talking about like a heads up display that you
can manipulate or is it like a screen that you're manipulating.
Speaker 3 (36:49):
No, it's a heads up display.
Speaker 2 (36:50):
So I mean, I'm I'm, I mean, it's almost.
Speaker 1 (36:54):
Like you've seen the movie Minority Report. It's kind of
like that. I mean, you're just taking your hand and
moving stuff and swipe in and it's it's pretty.
Speaker 3 (37:03):
Cool what we're able to do.
Speaker 2 (37:04):
That's pretty cool. It's like Tony Stark's stuff. It's pretty cool.
You go to sweetnee and hip dot com.
Speaker 1 (37:11):
You can watch uh some videos utilizing it, and it's
it's fun to see.
Speaker 2 (37:18):
Say that site again, I was talking over you Sweet
knee and Hip dot Com. Sounds great. Yes, please, And
I'm going to be checking that out. And then in
just the last few seconds that we have. One of
the things that comes up a lot after knee surgery
is the need for antibiotics for procedures, like even for
me for a colonoscopy when I do it and stuff.
Is that something you ask your patients to have routinely
(37:40):
done when they have any replacement to get antibiotics.
Speaker 1 (37:44):
So the only thing that is controversial is dental work.
Everything else you either definitely do not need antibotics or
they're going to give it to you anyways. And on
dental work, we have absolutely no idea what should be
done there. There is really no consensus. Some people say
you should do it for life, some people say you
should do it for a year. Our office, to be honest,
(38:06):
out of a hatch, just kind of picked two years
and said for two years, we're going to give you
a dental profile access before any dental procedure or cleaning.
Speaker 3 (38:13):
And that's how we have practiced in our group.
Speaker 2 (38:16):
Fantastic love Doctus week. Thank you for like always giving
us such great practical information. Thank you for hanging in
there with some of our technical issues. Tonight, I want
to thank our listeners. I want to thank our producer
mister Jim Finn that's going to do it for tonight's
segment of Centered on Health with Baptist Health. I'm your host,
doctor Jeff Tomlin. Join us every week and I hope
everybody has a great weekend and has a great time
(38:40):
and a happy Labor Day. Thank very much.
Speaker 1 (38:49):
This program is for informational purposes only and should not
be relied upon as medical advice. The content of this
program is not intended to be a substitute for professional
medical advice, diagnosis, or treatment. This show is not designed
to replace the physician's medical assessment and medical judgment. Always
seek the advice of your physician with any questions or
concerns you may.
Speaker 2 (39:10):
Have related to your personal health or regarding specific medical conditions.
Speaker 1 (39:14):
To find a Baptist health provider, please visit Baptistealth dot com.
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