CredentialsPositions
Board Certifications
Education and Training
- Professor, Department of Orthopedic Surgery at NYU Grossman Long Island School of Medicine
- Surgical Director, Perioperative Surgical, Department of Orthopedic Surgery, NYU Langone Hospital- Long Island
- Chair, Department of Orthopedic Surgery at NYU Grossman Long Island School of Medicine
Board Certifications
- American Board of Orthopedic Surgery - Orthopedic Surgery, 1989
Education and Training
- Fellowship, New England Baptist Hospital (Boston, MA), Adult Reconstructive Orthopedic Surgery, 1987
- Residency, Mount Sinai Medical Center, 1986
- MD from Icahn SOM at Mount Sinai, 1981
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
The following is a paid podcast.iHeartRadio's hosting of this podcast constitutes neither an
endorsement of the products offered or theideas expressed. The following program is brought
to you by NYU Land Going Health. It's Katz's Corner with doctor Aaron Katz.
You're trusted expert in men's health,providing straight talk on a wide range
(00:21):
of men's health topics and advice onhow to live your healthiest life. Now
on seven ten woor. It's theChairman of Urology at NYU Land Gone Hospital,
Long Island. Here is doctor AaronKatz. Good morning everybody, and
welcome again to Kats's Corner here onwr iHeartRadio. So glad you could join
(00:42):
us this morning. We have awonderful show for you today, not just
for men, but for everyone,mostly adults, I would say, but
this particular topic, we'll be talkingabout what is new in knee replacement surgery
and how to evaluate, you know, if you have problems with your knee
as well as if we have timehip surgery, because these are very common
(01:03):
orthopedic procedures that we do here atthe NYU Land Going Health System out on
Long Island. And to help uswith this discussion, I've asked a dear
friend, a wonderful colleague I've knownhere since I've been chair of the Urology
Department for the past twelve years,Doctor James Caposi. Jim is the chairman
in the Department of Orthopedic Surgery andprofessor at NYU Grossman Long Island School of
(01:25):
Medicine, and he's also the SurgicalDirector of Perioperative Surgical Services here. He's
been the chair of the Operating RoomCommittee and has done a tremendous job and
quality and efficiency of improvements over thepast a few years and making sure all
our time starts promptly at seven o'clockin the morning. And we were just
(01:48):
together yesterday for a wonderful celebration ofthe third commencement of our medical school.
And I know doctor CARPOSEI and Iare super proud of the Dean and actually
the found Dean was also there,Doctor Sheloff yesterday, and a wonderful day.
Yesterday wasn't a gym And thanks forcoming on to the show this morning.
Thank you, Aaron, thanks forhaving me. It was a great
day. It was really it wasa nice day that the students were excited.
(02:12):
The parents were more excited. Andit's always like, you know,
young students starting their career in medicine. Yeah, it really is wonderful.
And it's only three year medical schoolprogram. I believe in the country that's
truly dedicated three years and you know, for people young people that want to
go into primary care medicine. Butwe certainly have a lot of interest in
(02:35):
other areas as well. And Iknow you've been extraordinarily busy and you're building
up your wonderful orthopedic department here atNYU and Long Island and super busy with
procedures in the hospital for patients thatrequire knee replacement hip operations. We're going
to get into all of that.Maybe you can just start out by telling
(02:58):
us. You know, I'm sureyou see is quite a bit or hear
this. You know, someone callsyou, they call the office. You
know, I have been my kneehurts. You know, I'm not so
sure. Should I go to thedoctor, Should I wait a few days?
Advil, rest ice heat? Idon't know what do I call?
When? When? Should people getconcerned and see someone like yourself an orthopedic,
(03:19):
a specialist. Sure, well,thanks for the question, Aaron,
and also just before we get started, want to you know, congratulate your
department is absolutely awesome. I knowwe started close to the same time in
our positions. Yes, him,and it's been fun to watch both our
departments grow together, to watch theresidency programs grow. So yes, you
know, it's exciting stuff. Thankyou. I appreciate that, Jim,
(03:40):
thank you, Oh anytime. Yeah, So, you know, people often
have joined symptoms, especially as weget older. You know, it's like
if you don't wake up in themorning with something hurting, you want to
be really alive. As we getolder, so something's always hurting, you
know. I think it's not unusualto treat these things symptomatic at first.
(04:00):
If you see some swelling of thelice on it, you know, if
you've been doing a lot of gardeningthe day before, or you're you know,
tried to play football or hockey withyour kids or grandkids and things are
aching, that's not unusual. Ifyou can take some addible or some motrin
or some talent all put some iceon it. If it's swollen, then
you know, give it a littlebit of time, give it a day
or two or three see if thething's quiet down, if you see that
(04:24):
things are not getting better, orit's persistent swelling, or especially if there's
redness or something that's concerning, thenyou really should get yourself either you know,
to your interns to take a quicklook at it, or if not,
to an orthopedic surgeon so we canreally evaluate it and make sure it's
not something more serious. Yeah,and not necessarily need to go to an
urgent care or emergency room for somethinglike that and knee pain. Again,
(04:46):
you don't typically have to for somethingthat seems relatively minor and seems sort of
an ache and pain. I mean, obviously, if you're playing something vigorous
and you had a collision or somethingdoesn't seem right, or something seems a
skew, well not quite the positionit was in before, yeah, you
may want to head over to anurgent care or to an emergency room just
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to get an X ray make sureyou didn't break something or pop something out
of a joint. But usually thoseare much much more painful than your typical
aches and pains that we all getfrom, you know, being a little
over vigorous. Yeah, I mean, I know, you know it must
be difficult to get into. Youknow, your practice, you're extraordinarily busy
if someone has pain. I mean, do you have you extended hours or
(05:29):
do you see patients on the weekend. I mean that you personally, but
your practice or somewhere where patients canyou know, get easier access to to
your guys. Yeah, we have. Actually, you know, that was
a big complaint is that all ofus have specialties and so it becomes very
hard to see a specialist and weall had several weeks waiting time, things
like that. So several years ago, we're probably going on maybe four or
(05:54):
five years now, we started inorthopedic urgic care after hours where people can
just walk in anytime between four andeight pm. They don't need an appointment,
and if they're having an orthopedic complaintor an injury, you know,
they can see one of the orthopedicPA's, they can get an X ray
right there, they can get treatmentright there, and if it's something more
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serious, we can get them pluggedinto the system, get them an appointment
with one of the pond is,get them set up for an MRI if
they need it, or things likethat. It's kind of a nice clinic
it's busy, and it's funny whenwhen I'm leaving the office, usually somewhere
in the you know, six sixthirty range for seeing patients all day,
I'll see the waiting room typically filledwith high school kids in gym shorts who
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are at a practice or tryout orsomething, and they're usually sitting in there
with mom with a bag of icearound their knee or the ankle of their
wrist. So it's been nice insteadof having to wait in an emergency room
for a long time exactly. Yeah, be able to pop over and see
somebody with orthopedic training. That's wonderful. You can get the treatment going,
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yeah, and is wonderful. I'mgonna just take a pause there and give
people a phone number that you hadgiven me before the show, just to
let people know that that is available. It's five one six seven four seven
eighty nine hundred five one six sevenfour seven eight nine hundred and that is
in Minneola, Jim, that thatwe here. That's the Goden City Office,
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Garden City officeteen hundred, Franklin.They're having us the Garden City Office.
It's right between the police headquarters andwhat used to be Lord and Taylor
is in the building right between thereand the Health Tracks building, and like
I said, between four to eight, just walk in. You don't need
an appointment, and wow, andwith the pedic injury will get you seen
and get you treated. That's fantastic, What a great idea and what a
(07:42):
great service for so many people.So you know, if you do need
if you are seen in the officeand and you're having let's say we'll start
with the knee and you're having this, you know, persistent pain or swelling,
is it do you need to goto an MRI next? Or is
a plane X ray good? Oris it kind of a judgment call.
I guess it's a judgment call.I mean, you know, my practice
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is mostly older patients, you know, with our beat arthritis needing hip knee
replacements, so I rarely get anMRI. It's really not going to tell
me very much that I can't seeon a regular X ray. Some of
my sports medicine guys who are seeing, you know, much usually much younger
patients with sports injuries where there maybe much more of a soft tissue component
(08:24):
as opposed to a bone problem.They'll typically get MRIs because they want to
see the ligaments they want to see, you know, what's going on the
soft tissue. What are the muscleslook like? What do the tendon attachments
look like? So there, thesoft tissue becomes more important, and so
an MRI is much better for helpingmake that diagnosis as opposed to a bone
problem, where an X ray isa really much more sensitive test. Yeah,
(08:50):
it seems to me, you know, just as an observer in the
OAR schedule, that the number ofjoint replacements both in hip and he seems
to have been are very common tobe done these days. I remember training
as a resident was a big deal. It was very rare. It was
a lot of complications. And sowhat's going on now. Is it just
(09:13):
easier to do with the technology.Do we just know more, or we
can select paper more or a combinationof all of that. Yeah, well
it's a combination of a lot ofthings. I mean, it's definitely a
much more common operation. You know, we're definitely seeing an aging population in
our country. You know, thenumber they banter around is ten thousand people
a day turning sixty five. Andthat's the whole baby boomer ere that you
(09:37):
know, ran from forty six tofifty six with you know, birth dates
in that range, and so allof those people are starting to turn sixty
five now, and that's a hugenumber of people. I think people are
way more active than they used tobe. You know, it's not a
common to see you know, eightyand nine year olds coming in playing tennis
or obviously the latest rage is pickleball, you know. And so there's more
(10:03):
injuries, is more abuse to thejoints, so that has a lot to
do with it. And people areliving longer, so the joints wear out
over time. And you know,when people weren't living as long, there
were less people, you know,reaching an age where joints would wear out.
So it's become a much more commonoperation. And like you said,
I remember years ago, you know, if you did two joints a day
(10:24):
in a room, it was alot. It was an all day procedure.
The complication rates were not low.Thankfully, that is all turned around
nicely, and you know, we'redoing these joints much quicker than we're used
to. People are going home sameday. When I was a resident,
you stayed twenty one days. Wow, you came in three days before the
surgery. We did testing and scrubbingand whatever we did. And then you
(10:48):
stayed eighteen days after some people weregetting their mail sent to the hospital at
that point. Wow. And nowyou go home with the next day and
I to go home, you know, not even eighteen hours. I mean,
you know, we do the operation, you're in the recovery room for
a few hours, and we getyou home. So that's amazing, that's
extraordinary. We're not even staying sowe'll get them home same day. And
(11:13):
I know you've been so involved inyou know, in getting not only patients
into the operating room, but improvingthe quality and the efficiency and the turnover
of the rooms and the nursing staff. You're done. It just an incredible
job with that, you know.I must say always take my hat off
to you there. Let me askyou what, so what are you know
who would be a candidate for afor a joint replacement for the knee right.
(11:37):
Well, again, typically they're olderpatients. They don't always have to
be, you know, we dosee unfortunately, some very young patients to
be the head a childhood problem ora congenital problem, or we're in a
bad accident and you know, thejoint is destroyed. But thankfully that's rare.
You know, most of the patientswe see are probably somewhere in the
fifty to eighty five range. Typically, the joint is wearing out. And
(12:01):
by wearing out, I mean thatyou know, if you look at a
joint, a joint is where twobones come together and it's a moving part.
Those moving parts are covered by cartilage. Cattilage is that white stuff that
you see when you eat a pieceof chicken. If you look at the
chicken leg, you'll see that white, shining stuff on the end of the
leg. That's cartilage. And whathappens over time with wear and tear and
(12:22):
aging is that cartilage starts to wearaway and peel away and chip and crack,
and then over time when it wearsaway completely, the bones are rubbing
bone on bone and that can beyou know, a very painful process with
a lot of grinding and pain anddeformity and things like that. And that's
when we consider the joint replacement.Okay, and you know I've heard also
(12:46):
about robotic surgery. Some surgeons doit robotically. Certainly, we have a
big robotic surgery program here at thehospital for various conditions especially for in urology,
for oncology and gyn and general surgeryusing it for hernias and gallbladders and
for bariatric surgery. I know it'sa different type of robot, but is
(13:09):
that taken off? Is that somethingthat you see as in advancement. Yeah,
it's certainly taken off. You know, Like you said, the robots
are very different than what's you usedin your field and in general surgery and
in kintecology, where those are morerobotic arms that are helping you get access
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to spots that you can't typically getaccess to without a very large incision and
a lot of moving things around.All robots are more of a navigation type
system, where it's really the robotis really helping you get orientation to where
the joint is, where the bonesare, and what angles those components should
(13:52):
be put in place, and thenmaking the bone cuts to match what the
robot is showing you is a goodangle to approximate the joint that you're taking
out. Remember, like in aknee replacement, the knee is basically a
hinge joint. So just like ahinge on your door, you know,
if you put it in a crookedif the door's not going to work so
well. So you know, themore accurate we can get these joints and
(14:15):
these hinges in place, the longerthey'll last, the left pain patients will
have, the better they'll function.So the roadblots slash navigation systems are really
you know, to help with thatprocess of getting these things in nice and
straight, getting the bone straightened outwhen we're done making the appropriate cuts,
so that all of those things comeinto play. And when you take an
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x RA at the end, itlooks really nice and straight and say,
wow, that's a nice looking joint. If you're just waking up in the
morning. Here on Katsas Corner,we're talking with doctor Jim Carposi, who's
the chairman and the Department of OrthopedicSurgery and professor at NYU grossmand Long Island
School of Medicine. And we've beentalking about knee replacements and some of the
new advances and indications, and youknow, what can you tell us,
(14:58):
Jim, about ifations need to havethis done, this joint replacement of the
knee, what is their recovery likein terms of you know, obviously it's
going to be dependent upon different patientsand there are other maybe comorbid factors and
things. But generally speaking, whenyou're seeing someone that's let's say, let's
say they're sixty five or seventy yearsold, you know, what can you
(15:20):
tell them broadly about their expected recoveryfor this from you? Sure, great
question, Eric, You know youbrought it up before, a little bit
about it. You know when wewere all training, how different fees were,
and I think a lot of thechanges in recovery have to do with
even before the operation starts. Youknow, years ago, we bought patients
in the hospital, they stayed forthree days, we did blood work on
(15:43):
them, and we did whatever wehad to do and got them ready for
surgery and did surgery. You know, now we spend so much time before
the surgery preparing these patients and what'scalled optimizing these patients, getting them in
the best possible shape before surgery,things that we never thought of in the
past that really become important and makethe recovery so much better. So we're
(16:06):
much more focused on getting the patientand the best possible shape. And you
know that includes out of the medicalconditions that we would check their sugars,
we make sure the diabetes is incontrol. Make sure that if they are
diabetic, if they've been in goodcontrol for a long time. We send
all our patients to the dentists tomake sure that their teeth are in good
shape and there's no dental infections orgerms in the mouth of abscessies. We
(16:30):
get them shape weight wise, sowe really if we see a patient who's
significantly overweight, we'll get them intoa weight program and get them down to
a weight where it's much safer todo the operation. And all of these
things have really led to a saferoperation and a much faster recovery. You
know. We even send the patientsfor physical fabry before the surgery, which
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we never thought of before, toget them into better shape. So after
you have the operation, your recoveryis much quicker. We can get them
home same day. We get themup walking in the recovery room. Now,
I mean years ago, our patientsstayed in bed for days before we
got them up. So I thinkthe patients recover much faster and in much
(17:14):
less pain than they did in thepast because we do so much before the
surgery to really get them ready andget them prepared for the operation. Yeah,
I think you know, you bringup some excellent points, and something
you know that I've observed is thatyou and your department and what you've done
is all about education and managing patientsexpectations, and not only after the procedure,
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but before, as you pointed out, and you know, I know
that you've had classes and you givethem instructions and you have physical therapy.
It must take a really large teamof you know, your PA's, your
nurses, your physical therapists of coursethe doctor's anesthesia team to really manage this
and get patients in and out anda quick recovery. And you know,
(17:59):
I think that you guys have reallydone a wonderful job there in terms of
you know, preoperative education and lettingpatients know what they can expect. Then
this way, if they're having anissue, they're like, well, you
know, you know, maybe it'sa little painful. Okay, well the
doctor told me it's going to be, but I still need to get out
of bed. I still need topush through this. I'm not going to
lie in bed and you know,and and wait around. And that I
(18:21):
think has really made a big differencein the recovery. What do you think
there? Yeah, it has.I mean, that's a great observation,
you know, and thanks for thanksfor recognizing that it really is a team.
And I tell patients from the firsttime I meet them in the office,
if they're coming in for a jointingplace, I said, listen,
we work as a team. You'regoing to meet the whole team during your
stay before you stay. I can'tdo this alone. And it's funny years
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ago when we looked at really changingthe whole joint program, when I got
out to what was Winthrop now NYU, we looked at changing the entire joint
program. We said, you know, if we're going to do this right,
every single person who meets the patientfrom the time they're in the office
to the time they've done with theirlast you know, physical therapy visit,
(19:07):
everybody has to be on board withwhat we're doing. So we got everybody
in one auditorium to present to themwhat the plan was. We had sixty
two different people in the auditorium.I'm not surprised. Yeah, you know,
touch the patient, so to speak, because if one person in that
in that wheel was a little bitoff, and if they sent the wrong
(19:30):
message or a different message, thepatient's going to get very confused. That's
to wait a minute, this personsaid this, and now this person's telling
her this. So you know,like you said, you need the entire
team on board and everybody needs toknow what the whole process is because you
know, one or two people sayingsomething different and the patient's going to be
totally confused and you'll derail the wholeprocess. So that's been a fun part
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actor putting the whole team together andgetting everybody on board with what we're doing.
And I think that's made a hugedifference in you know, patient satisfaction,
post operative pain, post opertive.Absolutely, absolutely absolutely. And if
you missed the phone number, I'mgoing to give it out one more so
I'll give it out of the endof the show where we have a few
minutes left, But the number forthe orthopedic department under doctor Caposi's direction is
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five one six seven four seven eightynine hundred five one six seven four seven
eight nine zero zero. And ifyou've been listening to the show, they
also have hours in the afternoon whereyou don't even need an appointment if you're
having an acute injury, rather thangoing to an urgent care or an emergency
room or or even a primary carego right to our specialist team here out
(20:40):
on Long Island in beautiful Garden City. I think it's thirteen hundred Franklin Avenue
is the address in Garden City.And that phone number again is five one
six seven four seven eight nine zerozero. I know that the show is
almost finished, but I did wantto talk about some hip replacement that we
didn't We talked mostly about n Whatcan you tell us, doctor Koposi,
(21:02):
about what's new in the area ofhip replacement surgery probably the biggest thing in
hips. And it's funny you putit the question that way. It's a
great way to put in it.Not so much it's new. But I
think what people are coming and mostasking about is the approach to the hip.
Keep hearing about anterior approach? Whatdoes that mean? I want an
antior aproach. I want to posterapproach. You know, people are coming
(21:22):
in with having read some information abouthips and come in asking about that,
And you know, I just wantedto help clarify that a little bit because
I think that's the most often askedquestions we get about hip replacements. Is
you know what approach you use andwhy and things like that. And you
know, the hip is a balland socket joint. It's located on the
side of the top of your thigh. There the hip joint itself is actually
(21:45):
in your groin. So when peoplesay they have hip pain, they come
in holding their back. That's notwhere we're the hip that sit back.
But if you're having groin pain,that's where your hip is. And there's
lots of different ways to get intothe hip. You can go from the
front, which is called an anteriorproach, which you can go from the
side, which is called a lateralapproach, or you can go from behind
the ball, which is called aposterior approach. And the thing I wanted
(22:07):
to point out, because I thinkthis is the most confusion, is that
there's really no studies out there overall of the years that we've been doing
these approaches that show that one issignificantly better than the other. It's just
a different way to get into thehip. And no matter which approach you
you choose to have or your surgeondoes routinely, just keep in mind that
there are pros and cons with everysingle approach. No matter what approach you
(22:33):
have, there will be certain precautionsof things you can and can't do.
There will be certain, you know, things that you want to watch for
and different approaches. But it's notlike one is better than the other.
It's not like if you have oneyou can you know, do anything you
want. If you have another one, you have to be careful. You
know, there are certain precautions withany approach you have to the hip,
(22:53):
and it's really you know, upto you and your surgeon to decide,
you know, what approach they thinkis best you and what approached the surgeons
most comfortable with. Yeah, Ithink that's really sound advice. And people
come in with preconceived notions and you'vegot to look at the x rays.
You've got to look at where theinjury is and and and look at the
physical well being of the patient andsee what's what's best. And sometimes you
(23:15):
know, the surgeon who's been onethousands of them as I know you have,
can certainly offer expert advice. Whatis the most common today? Do
you think reason why people are undergoinga hip replacement? Is it? Is
it trauma? Is it is itosteoporosis? Is it just age? I
mean ostroporosis won't wear down the joint. Most of it, I think is
(23:37):
the aging process. I mean,the biggest component for this is genetics.
You know, if you are peoplewho come in with a bad hip or
a bad needs, almost always youknow grandma had something or their parent had
something. Oh yeah, my dadhad both his hips done when he was
young, or my grandfather had hisknees on. There's usually some family history
(23:57):
and some genetic component to why certainjoints wear out in some people and not
in others. And then there's alwaysa you know, some activity or trauma
related. You know, Oh,I had a car accident when I was
thirty. I really messed up myknee and they had to take out a
meniscus and they told me it wouldwear out, you know when I got
older. Things like that. SoI think most of it is aging and
(24:19):
you know, some history of traumasomewhere along the way. Any any recommendations
for prevention. Let's say you knowyou have a family history or maybe you
did have that injury years ago,and you're like, oh, what can
I do to prevent myself from undergoinga hip replacement? What would you advise
those patients? Well, the easiestthing is they tell them to get new
parents, so they have different genetics. But that's not gonna work. That's
(24:41):
hard. Yeah, right, Maybeif someone adopts them it will change.
Yeah, yeah, I mean,you know, common sense things. If
you know there's a family history,then obviously you know, treat the joint
with some respect. If I knewI had a strong family history of arthritis
in the family, I probably wouldnot go out and say, hey,
let me see how many marathons Ican run. You know, you want
(25:03):
to do you know, light impacttype workouts. You want to not be
overly stressful to the joint. Icertainly recommend cross training. People who do
the same sport every day are muchmore likely to wear out joints than people
who cross train. And you know, maybe they'll they'll run or walk on
one day and then one day they'lldo a little bicycle and one day they'll
(25:23):
do some elliptical. I know,when I was in the city, we
used to see a lot of youknow, high powered athletes who were marathon
as a triathlons, and I wouldsee a lot more injuries in the marathon
runners who were just running, running, running, running every day, versus
the trathletes who would run some daysbike, some days, swim some days,
(25:44):
you know, so even though theywere pushing incredible distances, they were
kind of mixing it up. Thenwe would see a lot less of that
repetitive stress injury of doing the samething over and over. I'm sure.
Also, you know your body massindex, if you're overweight, that probably
would put pressure on the hip,just imagine. And maybe a poor diet,
and as you mentioned earlier very brieflyabout you know, diabetes and getting
(26:07):
your sugars under control. I'm sureall those things can help any well,
listen, we're at the end ofthe show. I want to thank you
again so much. You've been onthe show before and as always you are
an outstanding, wonderful guest and Ialways learn a lot from you. The
number again for the Orthopedic Department anddoctor Caposi is the chairman at five one
six seven four seven eight nine hundredfive one six seven four seven eighty nine
(26:30):
hundred. Jim, thanks so muchfor coming on. We'll have you on
again and really gave us a greateducation this morning. Really appreciate that.
Thank you. Aaron. Thanks,it's always a lot of fun. You
with great a great host, andit's always very easy talking to you.
Thank you very much, my pleasure. Well that's the end of the show.
Everyone tune in every Sunday here onkats this Corner. We'll be back
next week with a great show.This is doctor Aaron Katz. You've been
(26:51):
listening to Katzer's Corner. Come backevery week to hear more straight talk on
a wide range of men's health topicsand advice son how to live your healthiest
life. The proceeding was a paidpodcast. iHeartRadio's hosting of this podcast constitutes
neither an endorsement of the products offeredor the ideas expressed.
The following is a paid podcast.iHeartRadio's hosting of this podcast constitutes neither an
endorsement of the products offered or theideas expressed. The following program is brought
to you by NYU Land Going Health. It's Katz's Corner with doctor Aaron Katz.
You're trusted expert in men's health,providing straight talk on a wide range
(00:21):
of men's health topics and advice onhow to live your healthiest life. Now
on seven ten woor. It's theChairman of Urology at NYU Land Gone Hospital,
Long Island. Here is doctor AaronKatz. Good morning everybody, and
welcome again to Kats's Corner here onwr iHeartRadio. So glad you could join
(00:42):
us this morning. We have awonderful show for you today, not just
for men, but for everyone,mostly adults, I would say, but
this particular topic, we'll be talkingabout what is new in knee replacement surgery
and how to evaluate, you know, if you have problems with your knee
as well as if we have timehip surgery, because these are very common
(01:03):
orthopedic procedures that we do here atthe NYU Land Going Health System out on
Long Island. And to help uswith this discussion, I've asked a dear
friend, a wonderful colleague I've knownhere since I've been chair of the Urology
Department for the past twelve years,Doctor James Caposi. Jim is the chairman
in the Department of Orthopedic Surgery andprofessor at NYU Grossman Long Island School of
(01:25):
Medicine, and he's also the SurgicalDirector of Perioperative Surgical Services here. He's
been the chair of the Operating RoomCommittee and has done a tremendous job and
quality and efficiency of improvements over thepast a few years and making sure all
our time starts promptly at seven o'clockin the morning. And we were just
(01:48):
together yesterday for a wonderful celebration ofthe third commencement of our medical school.
And I know doctor CARPOSEI and Iare super proud of the Dean and actually
the found Dean was also there,Doctor Sheloff yesterday, and a wonderful day.
Yesterday wasn't a gym And thanks forcoming on to the show this morning.
Thank you, Aaron, thanks forhaving me. It was a great
day. It was really it wasa nice day that the students were excited.
(02:12):
The parents were more excited. Andit's always like, you know,
young students starting their career in medicine. Yeah, it really is wonderful.
And it's only three year medical schoolprogram. I believe in the country that's
truly dedicated three years and you know, for people young people that want to
go into primary care medicine. Butwe certainly have a lot of interest in
(02:35):
other areas as well. And Iknow you've been extraordinarily busy and you're building
up your wonderful orthopedic department here atNYU and Long Island and super busy with
procedures in the hospital for patients thatrequire knee replacement hip operations. We're going
to get into all of that.Maybe you can just start out by telling
(02:58):
us. You know, I'm sureyou see is quite a bit or hear
this. You know, someone callsyou, they call the office. You
know, I have been my kneehurts. You know, I'm not so
sure. Should I go to thedoctor, Should I wait a few days?
Advil, rest ice heat? Idon't know what do I call?
When? When? Should people getconcerned and see someone like yourself an orthopedic,
(03:19):
a specialist. Sure, well,thanks for the question, Aaron,
and also just before we get started, want to you know, congratulate your
department is absolutely awesome. I knowwe started close to the same time in
our positions. Yes, him,and it's been fun to watch both our
departments grow together, to watch theresidency programs grow. So yes, you
know, it's exciting stuff. Thankyou. I appreciate that, Jim,
(03:40):
thank you, Oh anytime. Yeah, So, you know, people often
have joined symptoms, especially as weget older. You know, it's like
if you don't wake up in themorning with something hurting, you want to
be really alive. As we getolder, so something's always hurting, you
know. I think it's not unusualto treat these things symptomatic at first.
(04:00):
If you see some swelling of thelice on it, you know, if
you've been doing a lot of gardeningthe day before, or you're you know,
tried to play football or hockey withyour kids or grandkids and things are
aching, that's not unusual. Ifyou can take some addible or some motrin
or some talent all put some iceon it. If it's swollen, then
you know, give it a littlebit of time, give it a day
or two or three see if thething's quiet down, if you see that
(04:24):
things are not getting better, orit's persistent swelling, or especially if there's
redness or something that's concerning, thenyou really should get yourself either you know,
to your interns to take a quicklook at it, or if not,
to an orthopedic surgeon so we canreally evaluate it and make sure it's
not something more serious. Yeah,and not necessarily need to go to an
urgent care or emergency room for somethinglike that and knee pain. Again,
(04:46):
you don't typically have to for somethingthat seems relatively minor and seems sort of
an ache and pain. I mean, obviously, if you're playing something vigorous
and you had a collision or somethingdoesn't seem right, or something seems a
skew, well not quite the positionit was in before, yeah, you
may want to head over to anurgent care or to an emergency room just
(05:06):
to get an X ray make sureyou didn't break something or pop something out
of a joint. But usually thoseare much much more painful than your typical
aches and pains that we all getfrom, you know, being a little
over vigorous. Yeah, I mean, I know, you know it must
be difficult to get into. Youknow, your practice, you're extraordinarily busy
if someone has pain. I mean, do you have you extended hours or
(05:29):
do you see patients on the weekend. I mean that you personally, but
your practice or somewhere where patients canyou know, get easier access to to
your guys. Yeah, we have. Actually, you know, that was
a big complaint is that all ofus have specialties and so it becomes very
hard to see a specialist and weall had several weeks waiting time, things
like that. So several years ago, we're probably going on maybe four or
(05:54):
five years now, we started inorthopedic urgic care after hours where people can
just walk in anytime between four andeight pm. They don't need an appointment,
and if they're having an orthopedic complaintor an injury, you know,
they can see one of the orthopedicPA's, they can get an X ray
right there, they can get treatmentright there, and if it's something more
(06:15):
serious, we can get them pluggedinto the system, get them an appointment
with one of the pond is,get them set up for an MRI if
they need it, or things likethat. It's kind of a nice clinic
it's busy, and it's funny whenwhen I'm leaving the office, usually somewhere
in the you know, six sixthirty range for seeing patients all day,
I'll see the waiting room typically filledwith high school kids in gym shorts who
(06:36):
are at a practice or tryout orsomething, and they're usually sitting in there
with mom with a bag of icearound their knee or the ankle of their
wrist. So it's been nice insteadof having to wait in an emergency room
for a long time exactly. Yeah, be able to pop over and see
somebody with orthopedic training. That's wonderful. You can get the treatment going,
(06:58):
yeah, and is wonderful. I'mgonna just take a pause there and give
people a phone number that you hadgiven me before the show, just to
let people know that that is available. It's five one six seven four seven
eighty nine hundred five one six sevenfour seven eight nine hundred and that is
in Minneola, Jim, that thatwe here. That's the Goden City Office,
(07:18):
Garden City officeteen hundred, Franklin.They're having us the Garden City Office.
It's right between the police headquarters andwhat used to be Lord and Taylor
is in the building right between thereand the Health Tracks building, and like
I said, between four to eight, just walk in. You don't need
an appointment, and wow, andwith the pedic injury will get you seen
and get you treated. That's fantastic, What a great idea and what a
(07:42):
great service for so many people.So you know, if you do need
if you are seen in the officeand and you're having let's say we'll start
with the knee and you're having this, you know, persistent pain or swelling,
is it do you need to goto an MRI next? Or is
a plane X ray good? Oris it kind of a judgment call.
I guess it's a judgment call.I mean, you know, my practice
(08:03):
is mostly older patients, you know, with our beat arthritis needing hip knee
replacements, so I rarely get anMRI. It's really not going to tell
me very much that I can't seeon a regular X ray. Some of
my sports medicine guys who are seeing, you know, much usually much younger
patients with sports injuries where there maybe much more of a soft tissue component
(08:24):
as opposed to a bone problem.They'll typically get MRIs because they want to
see the ligaments they want to see, you know, what's going on the
soft tissue. What are the muscleslook like? What do the tendon attachments
look like? So there, thesoft tissue becomes more important, and so
an MRI is much better for helpingmake that diagnosis as opposed to a bone
problem, where an X ray isa really much more sensitive test. Yeah,
(08:50):
it seems to me, you know, just as an observer in the
OAR schedule, that the number ofjoint replacements both in hip and he seems
to have been are very common tobe done these days. I remember training
as a resident was a big deal. It was very rare. It was
a lot of complications. And sowhat's going on now. Is it just
(09:13):
easier to do with the technology.Do we just know more, or we
can select paper more or a combinationof all of that. Yeah, well
it's a combination of a lot ofthings. I mean, it's definitely a
much more common operation. You know, we're definitely seeing an aging population in
our country. You know, thenumber they banter around is ten thousand people
a day turning sixty five. Andthat's the whole baby boomer ere that you
(09:37):
know, ran from forty six tofifty six with you know, birth dates
in that range, and so allof those people are starting to turn sixty
five now, and that's a hugenumber of people. I think people are
way more active than they used tobe. You know, it's not a
common to see you know, eightyand nine year olds coming in playing tennis
or obviously the latest rage is pickleball, you know. And so there's more
(10:03):
injuries, is more abuse to thejoints, so that has a lot to
do with it. And people areliving longer, so the joints wear out
over time. And you know,when people weren't living as long, there
were less people, you know,reaching an age where joints would wear out.
So it's become a much more commonoperation. And like you said,
I remember years ago, you know, if you did two joints a day
(10:24):
in a room, it was alot. It was an all day procedure.
The complication rates were not low.Thankfully, that is all turned around
nicely, and you know, we'redoing these joints much quicker than we're used
to. People are going home sameday. When I was a resident,
you stayed twenty one days. Wow, you came in three days before the
surgery. We did testing and scrubbingand whatever we did. And then you
(10:48):
stayed eighteen days after some people weregetting their mail sent to the hospital at
that point. Wow. And nowyou go home with the next day and
I to go home, you know, not even eighteen hours. I mean,
you know, we do the operation, you're in the recovery room for
a few hours, and we getyou home. So that's amazing, that's
extraordinary. We're not even staying sowe'll get them home same day. And
(11:13):
I know you've been so involved inyou know, in getting not only patients
into the operating room, but improvingthe quality and the efficiency and the turnover
of the rooms and the nursing staff. You're done. It just an incredible
job with that, you know.I must say always take my hat off
to you there. Let me askyou what, so what are you know
who would be a candidate for afor a joint replacement for the knee right.
(11:37):
Well, again, typically they're olderpatients. They don't always have to
be, you know, we dosee unfortunately, some very young patients to
be the head a childhood problem ora congenital problem, or we're in a
bad accident and you know, thejoint is destroyed. But thankfully that's rare.
You know, most of the patientswe see are probably somewhere in the
fifty to eighty five range. Typically, the joint is wearing out. And
(12:01):
by wearing out, I mean thatyou know, if you look at a
joint, a joint is where twobones come together and it's a moving part.
Those moving parts are covered by cartilage. Cattilage is that white stuff that
you see when you eat a pieceof chicken. If you look at the
chicken leg, you'll see that white, shining stuff on the end of the
leg. That's cartilage. And whathappens over time with wear and tear and
(12:22):
aging is that cartilage starts to wearaway and peel away and chip and crack,
and then over time when it wearsaway completely, the bones are rubbing
bone on bone and that can beyou know, a very painful process with
a lot of grinding and pain anddeformity and things like that. And that's
when we consider the joint replacement.Okay, and you know I've heard also
(12:46):
about robotic surgery. Some surgeons doit robotically. Certainly, we have a
big robotic surgery program here at thehospital for various conditions especially for in urology,
for oncology and gyn and general surgeryusing it for hernias and gallbladders and
for bariatric surgery. I know it'sa different type of robot, but is
(13:09):
that taken off? Is that somethingthat you see as in advancement. Yeah,
it's certainly taken off. You know, Like you said, the robots
are very different than what's you usedin your field and in general surgery and
in kintecology, where those are morerobotic arms that are helping you get access
(13:30):
to spots that you can't typically getaccess to without a very large incision and
a lot of moving things around.All robots are more of a navigation type
system, where it's really the robotis really helping you get orientation to where
the joint is, where the bonesare, and what angles those components should
(13:52):
be put in place, and thenmaking the bone cuts to match what the
robot is showing you is a goodangle to approximate the joint that you're taking
out. Remember, like in aknee replacement, the knee is basically a
hinge joint. So just like ahinge on your door, you know,
if you put it in a crookedif the door's not going to work so
well. So you know, themore accurate we can get these joints and
(14:15):
these hinges in place, the longerthey'll last, the left pain patients will
have, the better they'll function.So the roadblots slash navigation systems are really
you know, to help with thatprocess of getting these things in nice and
straight, getting the bone straightened outwhen we're done making the appropriate cuts,
so that all of those things comeinto play. And when you take an
(14:37):
x RA at the end, itlooks really nice and straight and say,
wow, that's a nice looking joint. If you're just waking up in the
morning. Here on Katsas Corner,we're talking with doctor Jim Carposi, who's
the chairman and the Department of OrthopedicSurgery and professor at NYU grossmand Long Island
School of Medicine. And we've beentalking about knee replacements and some of the
new advances and indications, and youknow, what can you tell us,
(14:58):
Jim, about ifations need to havethis done, this joint replacement of the
knee, what is their recovery likein terms of you know, obviously it's
going to be dependent upon different patientsand there are other maybe comorbid factors and
things. But generally speaking, whenyou're seeing someone that's let's say, let's
say they're sixty five or seventy yearsold, you know, what can you
(15:20):
tell them broadly about their expected recoveryfor this from you? Sure, great
question, Eric, You know youbrought it up before, a little bit
about it. You know when wewere all training, how different fees were,
and I think a lot of thechanges in recovery have to do with
even before the operation starts. Youknow, years ago, we bought patients
in the hospital, they stayed forthree days, we did blood work on
(15:43):
them, and we did whatever wehad to do and got them ready for
surgery and did surgery. You know, now we spend so much time before
the surgery preparing these patients and what'scalled optimizing these patients, getting them in
the best possible shape before surgery,things that we never thought of in the
past that really become important and makethe recovery so much better. So we're
(16:06):
much more focused on getting the patientand the best possible shape. And you
know that includes out of the medicalconditions that we would check their sugars,
we make sure the diabetes is incontrol. Make sure that if they are
diabetic, if they've been in goodcontrol for a long time. We send
all our patients to the dentists tomake sure that their teeth are in good
shape and there's no dental infections orgerms in the mouth of abscessies. We
(16:30):
get them shape weight wise, sowe really if we see a patient who's
significantly overweight, we'll get them intoa weight program and get them down to
a weight where it's much safer todo the operation. And all of these
things have really led to a saferoperation and a much faster recovery. You
know. We even send the patientsfor physical fabry before the surgery, which
(16:52):
we never thought of before, toget them into better shape. So after
you have the operation, your recoveryis much quicker. We can get them
home same day. We get themup walking in the recovery room. Now,
I mean years ago, our patientsstayed in bed for days before we
got them up. So I thinkthe patients recover much faster and in much
(17:14):
less pain than they did in thepast because we do so much before the
surgery to really get them ready andget them prepared for the operation. Yeah,
I think you know, you bringup some excellent points, and something
you know that I've observed is thatyou and your department and what you've done
is all about education and managing patientsexpectations, and not only after the procedure,
(17:36):
but before, as you pointed out, and you know, I know
that you've had classes and you givethem instructions and you have physical therapy.
It must take a really large teamof you know, your PA's, your
nurses, your physical therapists of coursethe doctor's anesthesia team to really manage this
and get patients in and out anda quick recovery. And you know,
(17:59):
I think that you guys have reallydone a wonderful job there in terms of
you know, preoperative education and lettingpatients know what they can expect. Then
this way, if they're having anissue, they're like, well, you
know, you know, maybe it'sa little painful. Okay, well the
doctor told me it's going to be, but I still need to get out
of bed. I still need topush through this. I'm not going to
lie in bed and you know,and and wait around. And that I
(18:21):
think has really made a big differencein the recovery. What do you think
there? Yeah, it has.I mean, that's a great observation,
you know, and thanks for thanksfor recognizing that it really is a team.
And I tell patients from the firsttime I meet them in the office,
if they're coming in for a jointingplace, I said, listen,
we work as a team. You'regoing to meet the whole team during your
stay before you stay. I can'tdo this alone. And it's funny years
(18:45):
ago when we looked at really changingthe whole joint program, when I got
out to what was Winthrop now NYU, we looked at changing the entire joint
program. We said, you know, if we're going to do this right,
every single person who meets the patientfrom the time they're in the office
to the time they've done with theirlast you know, physical therapy visit,
(19:07):
everybody has to be on board withwhat we're doing. So we got everybody
in one auditorium to present to themwhat the plan was. We had sixty
two different people in the auditorium.I'm not surprised. Yeah, you know,
touch the patient, so to speak, because if one person in that
in that wheel was a little bitoff, and if they sent the wrong
(19:30):
message or a different message, thepatient's going to get very confused. That's
to wait a minute, this personsaid this, and now this person's telling
her this. So you know,like you said, you need the entire
team on board and everybody needs toknow what the whole process is because you
know, one or two people sayingsomething different and the patient's going to be
totally confused and you'll derail the wholeprocess. So that's been a fun part
(19:52):
actor putting the whole team together andgetting everybody on board with what we're doing.
And I think that's made a hugedifference in you know, patient satisfaction,
post operative pain, post opertive.Absolutely, absolutely absolutely. And if
you missed the phone number, I'mgoing to give it out one more so
I'll give it out of the endof the show where we have a few
minutes left, But the number forthe orthopedic department under doctor Caposi's direction is
(20:18):
five one six seven four seven eightynine hundred five one six seven four seven
eight nine zero zero. And ifyou've been listening to the show, they
also have hours in the afternoon whereyou don't even need an appointment if you're
having an acute injury, rather thangoing to an urgent care or an emergency
room or or even a primary carego right to our specialist team here out
(20:40):
on Long Island in beautiful Garden City. I think it's thirteen hundred Franklin Avenue
is the address in Garden City.And that phone number again is five one
six seven four seven eight nine zerozero. I know that the show is
almost finished, but I did wantto talk about some hip replacement that we
didn't We talked mostly about n Whatcan you tell us, doctor Koposi,
(21:02):
about what's new in the area ofhip replacement surgery probably the biggest thing in
hips. And it's funny you putit the question that way. It's a
great way to put in it.Not so much it's new. But I
think what people are coming and mostasking about is the approach to the hip.
Keep hearing about anterior approach? Whatdoes that mean? I want an
antior aproach. I want to posterapproach. You know, people are coming
(21:22):
in with having read some information abouthips and come in asking about that,
And you know, I just wantedto help clarify that a little bit because
I think that's the most often askedquestions we get about hip replacements. Is
you know what approach you use andwhy and things like that. And you
know, the hip is a balland socket joint. It's located on the
side of the top of your thigh. There the hip joint itself is actually
(21:45):
in your groin. So when peoplesay they have hip pain, they come
in holding their back. That's notwhere we're the hip that sit back.
But if you're having groin pain,that's where your hip is. And there's
lots of different ways to get intothe hip. You can go from the
front, which is called an anteriorproach, which you can go from the
side, which is called a lateralapproach, or you can go from behind
the ball, which is called aposterior approach. And the thing I wanted
(22:07):
to point out, because I thinkthis is the most confusion, is that
there's really no studies out there overall of the years that we've been doing
these approaches that show that one issignificantly better than the other. It's just
a different way to get into thehip. And no matter which approach you
you choose to have or your surgeondoes routinely, just keep in mind that
there are pros and cons with everysingle approach. No matter what approach you
(22:33):
have, there will be certain precautionsof things you can and can't do.
There will be certain, you know, things that you want to watch for
and different approaches. But it's notlike one is better than the other.
It's not like if you have oneyou can you know, do anything you
want. If you have another one, you have to be careful. You
know, there are certain precautions withany approach you have to the hip,
(22:53):
and it's really you know, upto you and your surgeon to decide,
you know, what approach they thinkis best you and what approached the surgeons
most comfortable with. Yeah, Ithink that's really sound advice. And people
come in with preconceived notions and you'vegot to look at the x rays.
You've got to look at where theinjury is and and and look at the
physical well being of the patient andsee what's what's best. And sometimes you
(23:15):
know, the surgeon who's been onethousands of them as I know you have,
can certainly offer expert advice. Whatis the most common today? Do
you think reason why people are undergoinga hip replacement? Is it? Is
it trauma? Is it is itosteoporosis? Is it just age? I
mean ostroporosis won't wear down the joint. Most of it, I think is
(23:37):
the aging process. I mean,the biggest component for this is genetics.
You know, if you are peoplewho come in with a bad hip or
a bad needs, almost always youknow grandma had something or their parent had
something. Oh yeah, my dadhad both his hips done when he was
young, or my grandfather had hisknees on. There's usually some family history
(23:57):
and some genetic component to why certainjoints wear out in some people and not
in others. And then there's alwaysa you know, some activity or trauma
related. You know, Oh,I had a car accident when I was
thirty. I really messed up myknee and they had to take out a
meniscus and they told me it wouldwear out, you know when I got
older. Things like that. SoI think most of it is aging and
(24:19):
you know, some history of traumasomewhere along the way. Any any recommendations
for prevention. Let's say you knowyou have a family history or maybe you
did have that injury years ago,and you're like, oh, what can
I do to prevent myself from undergoinga hip replacement? What would you advise
those patients? Well, the easiestthing is they tell them to get new
parents, so they have different genetics. But that's not gonna work. That's
(24:41):
hard. Yeah, right, Maybeif someone adopts them it will change.
Yeah, yeah, I mean,you know, common sense things. If
you know there's a family history,then obviously you know, treat the joint
with some respect. If I knewI had a strong family history of arthritis
in the family, I probably wouldnot go out and say, hey,
let me see how many marathons Ican run. You know, you want
(25:03):
to do you know, light impacttype workouts. You want to not be
overly stressful to the joint. Icertainly recommend cross training. People who do
the same sport every day are muchmore likely to wear out joints than people
who cross train. And you know, maybe they'll they'll run or walk on
one day and then one day they'lldo a little bicycle and one day they'll
(25:23):
do some elliptical. I know,when I was in the city, we
used to see a lot of youknow, high powered athletes who were marathon
as a triathlons, and I wouldsee a lot more injuries in the marathon
runners who were just running, running, running, running every day, versus
the trathletes who would run some daysbike, some days, swim some days,
(25:44):
you know, so even though theywere pushing incredible distances, they were
kind of mixing it up. Thenwe would see a lot less of that
repetitive stress injury of doing the samething over and over. I'm sure.
Also, you know your body massindex, if you're overweight, that probably
would put pressure on the hip,just imagine. And maybe a poor diet,
and as you mentioned earlier very brieflyabout you know, diabetes and getting
(26:07):
your sugars under control. I'm sureall those things can help any well,
listen, we're at the end ofthe show. I want to thank you
again so much. You've been onthe show before and as always you are
an outstanding, wonderful guest and Ialways learn a lot from you. The
number again for the Orthopedic Department anddoctor Caposi is the chairman at five one
six seven four seven eight nine hundredfive one six seven four seven eighty nine
(26:30):
hundred. Jim, thanks so muchfor coming on. We'll have you on
again and really gave us a greateducation this morning. Really appreciate that.
Thank you. Aaron. Thanks,it's always a lot of fun. You
with great a great host, andit's always very easy talking to you.
Thank you very much, my pleasure. Well that's the end of the show.
Everyone tune in every Sunday here onkats this Corner. We'll be back
next week with a great show.This is doctor Aaron Katz. You've been
(26:51):
listening to Katzer's Corner. Come backevery week to hear more straight talk on
a wide range of men's health topicsand advice son how to live your healthiest
life. The proceeding was a paidpodcast. iHeartRadio's hosting of this podcast constitutes
neither an endorsement of the products offeredor the ideas expressed.
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