May 6, 2024 • 28 mins
When traditional medicine meets cutting-edge surgery, the results can be life-changing. That's exactly what my wife discovered under the care of Dr. Jimmy Chow, an expert in hip and knee surgery, and the centerpiece of our latest episode. We traverse the collaborative landscape of chiropractic care and orthopedic surgery, where Dr. Chow's skilled hands and sharp insights brought to light my wife's hip condition through the revealing lens of MRI technology. The chapter unfolds a story of diagnosis and the revelation of hidden ailments, such as labral tears and arthritis, showcasing the power of cross-specialty cooperation in healthcare.
Recovery from surgery is a marathon, not a sprint, an adage Dr. Chow and I explore thoroughly as we focus on the underestimated but pivotal gluteus medius muscle. It's this deep dive into the post-operative journey that illuminates the common pitfalls for patients who rush back into activity, risking further injury. We also engage in a conversation about the evolving landscape of medical treatments, turning away from quick fixes like cortisone shots and embracing the painstaking but fruitful path of regenerative medicine.
And what does the horizon hold for orthopedic innovation? Our episode peers into the future of 3D printed collagen scaffolds and the potential for groundbreaking stem cell therapies. We celebrate the quantum leaps from lengthy hospital stays to patients bouncing back into action, with the caveat that such progress must be balanced with patient safety. As Dr. Chow and I close the conversation, we do so with a nod of appreciation for the healthcare professionals whose dedication underpins every success story. This episode is a tribute to the advancements and collaborative spirit that are reshaping the orthopedic realm.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Hello, I'm Arlen Foer .
I'm the chairman and thefounder of Activator Methods
International.
Welcome to Activate yourPractice podcast.
Today I am honored to have ahighly respected orthopedic
surgeon from the Phoenix areaand, as you know, phoenix is
known as the hip replacementcapital of the world.
And so today we have Dr JimmyChow MD, who is an orthopedic
(00:28):
surgeon and one of the best inthe city, if not the best.
He's very humble, so he willsay that he's one of the best.
So but good afternoon Dr Chow,good afternoon Arlen.
Thanks for having me.
You're welcome.
I really got to know him because, I'm going to tell you right up
front, I had a patient that wasvery dear to me it's my wife
(00:50):
and she started out last summerwith some point hip pain and so
I did all the activator analysison her and everything and just
wasn't finding anything and itwasn't getting well.
So when we got back to theValley and from the summer, she
said I need to go see somebodyto find out what's going on.
I said I totally agree.
(01:11):
So we ended up in Dr Chow'soffice and we walked in and were
met by his PA, and that'sShelly Kuhn, and she did an
examination and she goteverything looked at and she
said you need an MRI.
And it was really funny becauseI had just looked in the Dynamic
(01:33):
Chiropractic Journal and DrMark Studen from the University
of Bridgeport had just writtenan article on why chiropractors
don't look at MRIs and theyshould, and so when the MRI came
back and we can put that MRI up, it was very obvious that she
had a problem.
And I'm going to let Dr Chowjust tell you what the problem
(01:58):
was when the MRI came back.
Speaker 2 (02:01):
Sure.
So I mean, I think I might wantto comment on something before
we start talking about the MRI,and that's simply that you know
all of these healthcareprofessions.
You know all of them, whetheryou're chiropractic, all the way
to dermatology, all the way towhat I do in hip and knee
surgery.
You know, if whatever you'redoing is not working or is not
(02:21):
improving the patient, it'ssilly to keep thinking that
doing more is going to work.
You know, and every single oneof us is going to have to change
what we do, and I see this alot in our clinic.
I mean, if I can't make thepatient better and I don't
understand what it is, I startcalling out to other people I
say like hey, is there somethingelse that I'm doing or
something else that can belooked at?
Mri is a perfect example becauseit is not, as you know, not
(02:41):
classically a study that youwould get for routine arthritis
or routine.
You know muscle sprain aroundthe hip.
You know it's something that'sjust minor or even something
major, but it would be operative.
Most people would resort tox-ray.
Ok, in Judy's case specifically, as she's walking, there was a
(03:04):
deficit in a certain musclegroup in her hip and that
deficit led us to thinkimmediately or especially in my
PA, a very astute practitionerto recognize that hey, I think
there might be a muscleincongruity here, something
that's not actually working.
So the MRI is up here and ifyou look at the MRI, this is an
MRI not so much of the jointspace but of the outside part of
(03:26):
the hip For those otherpractitioners listening to this
podcast, you can see thetrochanter there and this is
what's known as a T2-weightedMRI.
T2 means that fluid shows up aswhite space or light space, and
solid structures and more densestructures, less watery
structures, show up as dark, andso right on the side of this
(03:47):
area this would be the left sideof the screen you can see a lot
of white coming out of themuscle that's going to the
greater trochanter, and thatwhite in the greater trochanter
area is fluid buildup andactually retracted tendon.
So the muscle was torn off ofthe greater trochanter.
So the muscle was, not was tornoff of the greater trochanter.
(04:07):
We call that a deltoid injuryor it's been erroneously but
affectionately called therotator cuff tear of the hip,
and so that's essentially themain significant complaint that
she had, along with underlyingarthritis that you could see a
little bit on x-ray and more onthe MRI as well.
Speaker 1 (04:26):
I think you said at that time that it looked like
she had a labrum that wasinvolved, correct?
Speaker 2 (04:30):
Yeah, so the labrum is the soft tissue gasket around
the acetabulum, around the cupof the joint, and the labrum
becomes degenerative as thejoint wears out.
It can also be acutelydegenerative or acutely injured
by extreme forced motion.
But you know, I'm going toguess that she was not in a
recent football injury.
So you know, usually over time,as many decades go by, labral
(04:55):
tears are pretty common.
But it is a sign of underlyingdegeneration and it becomes very
symptomatic as well, very, verypainful very symptomatic as
well, Very, very painful.
Speaker 1 (05:05):
That's probably why you said let's just put a whole
new hip in.
So you don't have to go throughthat again while we're having
you in surgery.
And that made sense to me.
Yeah, I mean.
Speaker 2 (05:14):
So we know very clearly that after so many
decades and most people afterthe age of 50 or 60, if you
start having a labral tear andyou start seeing signs of
arthritis the true term ischondromalacia or cartilage wear
you start seeing signs of thatin the same form as, or the same
studies as, degenerative labrum, then you know it's part of the
(05:34):
same process.
You know it's not an acuteinjury, it's not a quick tear,
that happened because of extrememotion and so because of that,
you also know that your body isgoing to compensate for those
problems.
And so if the body is going tocompensate for those problems,
one of the main compensationmethods is to deactivate if you
want to use a good term for thispodcast, to deactivate the
(05:56):
gluteus medius muscle, which isattached directly to the greater
trochanter.
So if that's gettingdeactivated naturally because of
an arthritic process that'sgoing on, if we repair it or fix
it by itself, it's going tohinder that reactivation process
over time.
So not only will it, you know,may not heal so well, but it
might not become verycoordinated with the rest of
your hip and we may be backseveral years later having to do
(06:19):
hip replacement after goingthrough the repair process.
Speaker 1 (06:23):
And tell us a little bit about the ligament repair
process, because you had somehistory in artificial material.
I guess what would you call it?
Polymorphous tissue?
Speaker 2 (06:34):
Yeah, it's really cool stuff.
So, yeah, I wish that I did.
I wish I was actually involvedin the creation of this.
So that goes back to aninnovator in our field, dr Lars
Pedersen.
He's somewhere in Europe, Ibelieve he's outside of either
Switzerland or Germany, but Icould have that wrong.
But Lars Pedersen spent hisentire life looking at
(06:55):
artificial ligaments and he hadgone through some failures, just
like the rest of us, or maybelearned ways how to not do it,
with what's known as a Larsligament, which is a
polyethylene braided ligament.
And the problem with those isthey would fail over time,
usually after seven years ormore, and the failure would
create frayed substance, kind oflike frayed rope, and that
would cause a lot of tissueirritation and destruction.
(07:17):
So his second go at this, aftermany tries, was a polylactone
urea, which is kind of amodified polymer that absorbs or
dissolves in an aqueoussolution without an inflammatory
process, so basically your bodydoesn't have to actively react
to it to make it go away.
It's a biodegradable, if youwill.
(07:38):
Okay, rather than you know,rather than you know absorbable.
And the nice thing about it isthat it biodegrades over the
course of seven years.
It doesn't biodegrade over thecourse of like three or four
weeks.
So seven years is more thanenough time for your body to use
it as a scaffold for scartissue to come in, more than
enough time for your body tocreate new collagen.
More than enough time for yourbody to create new collagen in
(08:00):
an appropriate place, in anappropriate position.
And so we're utilizing thatinnovation in large joints where
they weren't used before.
So the surgical technique thatwe used for your wife, that was
innovated by us we actually callit the lazy paper airplane
because of the way that wefashion the artisan tissue and
(08:22):
the way that we put it on.
But essentially we reattach thestructure to the bone and then
we augment it with this materialso that it's protected while
it's healing, and we've seenamazing results with this.
And we do have a small seriesthat we put together, but it'll
be a while before I publish that, if I do.
Speaker 1 (08:43):
But I think I remember you saying there were
three tears gluteus minimusmedius, and those were the two
big tears was it.
Speaker 2 (08:51):
Those are the big tears.
The biggest one was of themedius.
The medius is the main driverof the hip.
The minimus is a harder one,because a minimus has a very
small short structure and it'sattached to the capsule and
we're not sure what thoseactually do with respect to the
hip other than tense and act asproprioceptors of the hip.
So we see a lot of dysfunctionin gluteus minimus that may or
(09:13):
may not need actualreconstruction.
When a hip replacement isplaced when a native hip is
there, we're not sure if itactually has more function.
Okay.
Speaker 1 (09:21):
But you have how many patents in this kind of work?
Speaker 2 (09:26):
Oh, I wish I had more in this kind of work.
I actually have not patentedthis.
There's some kit patentspending right now, but we have
not patented them To date.
I have just under 20 patents invarious different things.
Some are relevant, some areless relevant.
You know how this business goes, but you know, we, we like to,
we like to call ourselvescreatives in the in the process,
because we, you know, we, we,we're excited about this stuff.
(09:49):
This is what we've dedicatedour lives to.
Speaker 1 (09:51):
Well, tell them, wasn't it the ACL joint?
Isn't that where they firststarted putting?
Speaker 2 (09:56):
Yes, so they actually the the the art the art salon
is the name of the material atone point, a-r-t-e-l-o-n.
Initially it was marketed byBiomet as what's known as Sport
Mesh and they were using it toaugment ACLs and we've got about
17 years worth of data behindthat, so we know it's not
exactly a new product and it hasbeen very well shown to work.
(10:22):
It's established.
It was used in rotator cuffaugmentation and then it was
very poorly used in hand.
They are actually using it toact as an arthritic replacement
for one of the joints and thosedid very poorly because it was a
wrong application of thematerial and then they pivoted
and went right into foot andankle and they're using it in
(10:43):
foot and ankle really, reallywell on the small joints around
it and a lot of ligament repairsand augmentations there.
So we're just taking thematerial and we're using it
around larger joints, because Ionly do hips and knees and
that's where we're using quite abit of it.
Speaker 1 (10:57):
Now tell the audience how the process works, because
Judy has been on a walker nowfor she's on her sixth month.
Explain that because you know Iwill never look at a caretaker
again the same, because I havebeen a caretaker for six months
and you know when you are acaretaker to an A-type
(11:17):
personality, you know they liketo run over you with their
walker.
But explain a little bit abouthow you were very careful about
that.
Speaker 2 (11:25):
That's the hardest part of my job.
I mean, that really is so.
You know it's easy and fun tofix something, but then to do
the post-operative recoveryprocess you really have to pay
attention to the biology veryclosely and this is one of the
longest to heal things, becauseyour gluteus medius is a major
driver of your hip and youreally can't walk around, you
(11:46):
really can't do anything in lifewithout utilizing it.
It really it is the main musclethat gets pulled.
And so if you think about it ina way that you're trying to get
to heal something that was notjust torn but that does not want
to heal and you've got toprotect the work that you've
done, yet you're basicallyprotecting it from the patient's
lifestyle.
That's the hardest thing Now,on the very base.
(12:08):
You also have to know the basicscience behind it and how the
physiology works.
Bones are more simple, becausebones you can immobilize and
they'll heal, usually over thecourse of about three to four
months, is usually a bone.
Unfortunately, ligaments andtendons take twice that long.
So you're looking at a six toeight month recovery process for
(12:29):
ligaments and tendons and oneof the hardest parts of it is
that when you feel the best,it's not necessarily the
strongest.
And so we see that time andtime again with professional
athletes, especially back in the80s and early 90s, Professional
athletes would get an ACLreconstruction and then they'd
go back to play and you'd seethey'd immediately re-rupture,
They'd be out for the seasonagain and they'd have to have a
(12:50):
revision surgery.
I mean, how many players haveyou seen with that?
And the reason is is thatthey're feeling great, they're
doing all this other stuff, butthat ligament or that tendon
that they had reconstructed justis not stout and firm and
strong enough yet, even if it'sfeeling fine and grown it, so
that therein lies the biggestheadache that I've got in my
practice is convincing patientswho are motivated and have
(13:12):
problems that they want to getbetter to say, hey, wait a
minute, I know you're feelingfine, but you're not fine yet,
Okay, and I need to protect thisfor just a little bit more.
And once you get them past thatthat spot and especially if you
have a little experience withthis and you can post this ahead
of time, because when I saw youfor the first time, when I saw
her for the first time, I wasvery clear about what this would
take I said, look, I want tomake sure that you understand
(13:34):
what you're getting into this isnot an easy thing for you.
It's not horrible, but it takesa long time.
It is absolutely a test ofpatience, but when you get past
it and when you get to the endnow you've got a solution and a
fix for something thathistorically didn't actually
have a good solution.
You've got something thatactually will work.
Speaker 1 (13:51):
Well, even the medical profession, you know,
for years and years and yearsdidn't they use cortisone?
Wasn't that the preferredtreatment on that lateral, you
know, trochanter.
Speaker 2 (13:59):
Yes.
So historically speaking wemisunderstood the
pathophysiology.
So we would call it bursitis,and bursitis is you know, was
essentially under the skinblister or under the muscle
blister.
And they would say, oh, thebursa is inflamed and that's why
this is occurring, notrealizing that usually there's
degeneration of the tendonthat's causing the other muscles
(14:21):
to be utilized too heavily,namely the IT band and the glute
max, which applies pressure tothat bursa, which is why the
bursa gets inflamed.
So treating the bursa itself islike treating a blister around a
rock in your shoe.
You know the rock's still thereand it's still going to cause
problems.
So we also know that cortisoneitself is collagen destructive.
(14:44):
It will weaken tendons.
As a matter of fact, there arecertain areas of the body that
you never inject cortisonebecause you're worried about
tendon rupture, like namely theAchilles tendon, namely the
patellar tendon, where it'sreally dire if they end up
rupturing.
So you don't want that in amajor structure around your hip
and classically that was theonly tool in our bag.
(15:06):
So surgeons would or physicianswould inject greater stroke
cancer with bursa, bursa withcortisone, sometimes 20 or 30
times, causing a worsening ofthe problem and rupture, even if
they felt better immediately.
And so we now know in 2024 thatthe answer is more regenerative
medicine.
And you know, I advise mypatients, if they're going to
get cortisone, never do morethan three in their lifetime,
(15:29):
which is a very big transitionfrom where we were 20 years ago.
Speaker 1 (15:32):
Yeah, and you said something that really interested
me.
You said that Medicare came outwith a new diagnosis or a new
class now, and it was calledlateral trochanter pain syndrome
.
Speaker 2 (15:43):
Yeah, lateral trochanteric pain syndrome.
I don't know if it was Medicare, but they do have a new
classification for it, like theterm is no longer bursitis.
I mean, people do call itbursitis, but that's now become
a misnomer.
So they call it lateraltrochanteric pain syndrome, and
those of us in the industry liketo be much more specific.
We like to say a proximal ITband inflammatory process or a
(16:06):
proximal IT band contracture ormedius insertional tendinopathy,
depending on the etiology forthat lateral trachea and
tachypain syndrome.
So there's several differentthings that can cause it and
it's really this, this, uh,discoordination of muscle groups
and motors around the hip thatreally caused the problem.
Speaker 1 (16:27):
Uh, also, I've noticed just uh in, I've taken
care of her that her iliotibialband is involved.
I mean I can you know that'sgot areas in that are tender
little nodules and so forth andso on.
Is that quite common?
Speaker 2 (16:41):
Actually it's.
It's not just common, it'salmost 100% of the patients.
Oh, okay, yeah, almost everyonehas an IT band irritation with
this, which is why they call itlateral trigonometric pain
syndrome.
The IT band is your body'sfirst step in accommodating this
problem, so your body alwaysuses the bigger muscle to try to
overcome it.
And unfortunately the mechanicsof the IT band are horrible for
(17:04):
upright walking because itpulls on the side of your knee
to keep you elevated rather thandirectly on the greater
trochanter.
So even if the muscle's big,it's got a very bad mechanical
disadvantage.
Speaker 1 (17:13):
Interesting.
So she's about six months now,and how soon can she go off her
walker then?
Speaker 2 (17:23):
Well, we're going to be, we're going to be very
gentle with it.
You know, the most, the mostcritical time period is between
four to six months.
That's the most critical time.
That's when people will reinjure themselves.
Typically After that it's a I'mvery conservative.
It's a slow, slow return tofunction, mostly because I also
know that not only do wereattach a muscle and tendon to
(17:43):
their bone, but even if it'shealed, that muscle and tendon
isn't being activated well yet.
So it's still uncoordinated andwe're waiting for some of that
muscle to grow back and tore-engage, and that usually
takes several months for that tooccur too.
So, just walking aroundnormally, I think it's going to
be probably nine months or sobefore she's going to be there
minimally and I know she doesn'twant to hear that.
(18:05):
But when she gets there, onceshe turns that corner, it's a
big corner, it's prettyimpressive.
Speaker 1 (18:12):
I remember you telling about a patient you had
and it was 10 months and he wasstill having pain for 10 months
and then one day he walked inand said it's gone.
Speaker 2 (18:21):
Yeah, Almost like he woke up and he was healed.
It was almost like miraculouswhen it happened, and I hope
that's her experience too.
I mean we do see that quitefrequently, I mean in medicine.
You've seen this in yourpractice.
I'm sure Patients turn theproverbial corner.
We don't improve at a gradualrate, we improve in the stepwise
fashion.
Sometimes those steps arepretty tall.
Speaker 1 (18:41):
And you can look if you look closer.
The pin that was put in by thelateral trochanter up there,
that's where you tied the newmaterial to correct.
That's correct.
Speaker 2 (18:49):
Yeah.
So what we did was we repairedher medius back to her, to her
bone, and whatever stump wasleft of the material so that we
actually had her native tissueis reattached.
And then we know that that'sgonna pull off.
It's not strong enough.
So then we wove thispolylactone urea graft over that
(19:10):
using Kevlar suture and then wepinned that to her bone using
this titanium staple.
So it's very, very strong.
As a matter of fact, I have onefailure that I'm aware of in my
case series.
That failure was a forcibledislocation after trauma and she
did not pull through the Kevlarsuture.
She did not pull through thetitanium staple.
(19:32):
It actually required that sherip through the material itself
in order for it to occur.
Speaker 1 (19:38):
Was she in an accident?
Speaker 2 (19:39):
Yeah, she had an accident.
Speaker 1 (19:40):
Yes.
Speaker 2 (19:40):
And we went back and fixed her and she's doing well
now.
Speaker 1 (19:42):
Yes, what do you see in the future?
I mean, this is pretty well.
First of all, let me saysomething else that I was
impressed with.
You've done over 5,000 hipreplacements and 28 ligament,
reattachments or 29 or whatever.
Speaker 2 (19:59):
29 now, yeah, yeah, 29.
Speaker 1 (20:01):
So it's not an everyday thing, oh, not at all.
That happens, not at all, andso that's why I wanted to get
you on the podcast, becausethere's people around the
country here that may besuffering from that very thing,
that could fly in for anevaluation and see what they
would find out.
Speaker 2 (20:22):
I will comment on this a little bit.
So you know, just likeeverything else, if you don't
have the tool to fix something,most of them get unrecognized or
unfixed.
Okay, so up until now the adagein our field has always been if
there's metal or plastic in thearea meaning if there's an
implant there it has to be fixedwith more metal and plastic.
(20:43):
It doesn't get fixed otherwise,and I think that's a disservice
.
I would like to modify thatadage and that's what I'm trying
to do with a portion of mycareer right now, and I have
colleagues that know this aboutme.
The modification is not that itdoesn't work.
The modification is that ourhistorical ways of doing it
weren't strong enough to keep upwith metal and plastic.
(21:05):
So this is why you see thatx-ray and there's a titanium
staple there.
Why would you attach somethingwith a titanium staple?
When we fix ACL reconstructions,we use a plastic screw.
Why would you need a titaniumstaple?
Well, there's metal and plasticin there.
There's an actual total hipreplacement there.
So you need something muchstronger to hold it together,
because you know your body usesit a little bit differently.
It relies on the structures moreand, historically, any attempt
(21:28):
that we had to fix soft tissuearound a total knee replacement
or total hip replacement usuallyended in failure.
It really did.
So we resorted to, you know,for the past 30, 40 years we
resorted to techniques that werereally salvage techniques.
I mean the number one way tofix this around a total hip
replacement, that the problemthat Judy has would be a muscle
(21:49):
transfer of the glute max to thetrochanter.
That would be to take your,your, your butt muscle and
sticking it right to thetrochanter and hoping that she
learns how to use her musclemore appropriately, assuming
that it heals.
You know that's a pretty morbidprocedure and you talk about
recovery.
That's more than a yearrecovery and that was the next
closest thing we had to justfixing it directly.
Speaker 1 (22:11):
So how do you see the future?
Do you see change?
What changes do you see thatwill make it easier, better.
Speaker 2 (22:18):
There's a lot of things, okay.
So it depends on how far intothe future you want to look.
So the immediate future stuffthat I'm going to be involved in
, or at least I hope to beinvolved in, is we want to kit
this stuff for the lay surgeonout there.
So there are such things knownas kit patents, where useful to
the companies.
Really, what's useful to theprovider, namely surgeons out
(22:41):
there that need it or patientswho would be the recipient of
this, would be kits that havejust the tools needed for this
particular application.
So if you have that kit, thenyou know this is made for this
purpose.
And so, all of a sudden,surgeons out there who have to
think about this, figure it out,learn from a guy like me, have
enough chutzpah to actually doit on their own without it being
(23:03):
an established technique andthen following the patient
properly, now have the securityof having this is what this is
for.
Here you go, okay.
So that would be the maybe lessexciting but the immediate
future stuff.
If you want far more distantfuture stuff, um, you know I'm
in the hip and knee implantbusiness.
I do sports medicine around hipand knee Well.
(23:24):
I was trained in multipleaspects of orthopedics, but I
don't practice there anymore.
We have things so far as um, as3d printing on a collagen
scaffold with stem cells andtissue engineering.
Uh, we do believe that at somepoint in time in the future.
It may take 50 to 100 years toget there, but we believe that
with an artificial hip like thisyou should be able to reverse
(23:46):
it to the patient's naturalanatomy just by removing the hip
and putting in an engineeredhip made of their own bone and
soft tissue.
So it is very likely that atsome point in time in the future
, instead of artificial ligament, we'd be able to grow and
replace that stuff in vitro intoa lab and implant that.
Speaker 1 (24:04):
Well, you know, I remember when she had a knee
replaced here six, seven yearsago, they measured the implant.
And so because I, as apractitioner, when I was
examining people, I used to seesome imbalances in leg length,
inequality.
That was sickening.
Speaker 2 (24:21):
Oh yeah.
Speaker 1 (24:21):
Nobody paid any attention to, and now they were
getting it down to millimetersand I thought, wow, they're
paying attention to this, whichis a very good thing.
Speaker 2 (24:29):
Well, they need to.
I mean, we've been doing thisnow.
I mean hip implants.
Hip replacement implants areone of the oldest part of
replacement technology inorthopedics and even as such,
it's still in its infancy, Evenas such, you know, we've only
been doing it for, you know,just under a hundred years, and
even 20, even 10 years ago, weweren't paying attention to some
(24:50):
of the stuff.
Speaker 1 (24:50):
What I found interesting is that used to be
coming from the posterior.
Then the big find was come fromthe anterior.
When you did it, you came fromthe top, and I must say that if
it would have been just the hipreplacement, that would have
been over in a week.
I mean, it would have beennothing.
And even the closing personyour closer you can't even see a
(25:12):
scar on her today and within amonth it was gone.
Speaker 2 (25:17):
That's pretty cool stuff.
Yeah, very cool.
But I, you know, I often thinkwhat would happen if we could
kind of go back in time and showthe pioneers of our field back
in the eighties and seventieswhat we're doing today.
I think the jaws would be onthe floor because you know what
used to be a three week hospitalstay, riddled with all kinds of
complications, where the mostsuccessful surgery was getting
(25:38):
up of a chair and going to themailbox and back.
You know, now people areplaying professional basketball
on.
You know it's just amazing what, what can be done now compared
to where we started.
You know, even even three tofour decades ago.
Speaker 1 (25:52):
Yes, well, and I think the the professions are
opening more to you know,getting into new things.
The young kids coming out ofschool are definitely open.
I think, yeah, yeah, what's?
Speaker 2 (26:05):
new.
Speaker 1 (26:06):
Yeah.
Speaker 2 (26:07):
I mean it's, you know it's.
The profession itself is openbecause everybody is learning.
There are how do I say thisproperly?
Academic resistances to certainnewer, to certain newer
technologies, but that justthat's good, you know.
That's good to protect patientsas well, cause you don't want
some cowboy out there doingrandom stuff just because he
thinks it might be cool.
(26:27):
Yes, like you do need to have adeliberate improvement.
As you go, um and as as thosethings start becoming adopted by
patients and practitionersalike, it moves from
experimental to established, tostandard of care, and that's
(26:48):
really where we see a lot ofthis stuff, even coming from the
superior aspect of the hip.
I mean it works too well for itnot to eventually become
standard of care.
Speaker 1 (26:56):
It's just too early for that to be the case, and you
have to have somebody thatknows what's going on.
By the way, dr Chow has awaiting list of about a year now
, and so you can't just walk in.
We got lucky we were in theoffice and I pleaded Very
persistent.
Speaker 2 (27:16):
Yes.
Speaker 1 (27:17):
I think he had a cancellation, but anyway, we
were lucky to get in at areasonable time.
But just so you know thatthat's where he's at is because
he is innovative.
And the first of all, and I gotto say one thing, and I know
your office will watch this, butyour staff is outstanding, from
Ruby opening the door to sayhello to on to you know, kim and
(27:40):
all the rest of them.
They care and they're verycaring people and they look
after you and so it's no fun togo through this, but we had the
most enjoyable time you can havegoing through something like
this.
Speaker 2 (27:54):
Yeah, we.
I am very proud of our staff.
They are easily industry bestacross the board and you know
mad props to them.
I'm very proud of our staff.
They are easily industry bestacross the board and you know
mad props to them.
I'm very proud of the work thatthey do.
And you're right, nobody wantssurgery, but everyone wants the
results of surgery.
And nobody wants to haveproblems, but everyone wants
their problems fixed.
Speaker 1 (28:10):
So and on that note, I just want to thank you for
coming in.
By the way, Dr Chow is achiropractic patient and he goes
a couple of times a week, hesaid.
But you know, surgeons get invery bad positions and they are
required to be in that positionfor a period of time, and so he
has a full exercise regime andeverything.
So and we just seem to befriends and I'm really happy to
(28:33):
have you as a friend, and sothank you for coming on.
Speaker 2 (28:35):
Thank you so much for having me.
I appreciate it.
Hello, I'm Arlen Foer .
I'm the chairman and thefounder of Activator Methods
International.
Welcome to Activate yourPractice podcast.
Today I am honored to have ahighly respected orthopedic
surgeon from the Phoenix areaand, as you know, phoenix is
known as the hip replacementcapital of the world.
And so today we have Dr JimmyChow MD, who is an orthopedic
(00:28):
surgeon and one of the best inthe city, if not the best.
He's very humble, so he willsay that he's one of the best.
So but good afternoon Dr Chow,good afternoon Arlen.
Thanks for having me.
You're welcome.
I really got to know him because, I'm going to tell you right up
front, I had a patient that wasvery dear to me it's my wife
(00:50):
and she started out last summerwith some point hip pain and so
I did all the activator analysison her and everything and just
wasn't finding anything and itwasn't getting well.
So when we got back to theValley and from the summer, she
said I need to go see somebodyto find out what's going on.
I said I totally agree.
(01:11):
So we ended up in Dr Chow'soffice and we walked in and were
met by his PA, and that'sShelly Kuhn, and she did an
examination and she goteverything looked at and she
said you need an MRI.
And it was really funny becauseI had just looked in the Dynamic
(01:33):
Chiropractic Journal and DrMark Studen from the University
of Bridgeport had just writtenan article on why chiropractors
don't look at MRIs and theyshould, and so when the MRI came
back and we can put that MRI up, it was very obvious that she
had a problem.
And I'm going to let Dr Chowjust tell you what the problem
(01:58):
was when the MRI came back.
Speaker 2 (02:01):
Sure.
So I mean, I think I might wantto comment on something before
we start talking about the MRI,and that's simply that you know
all of these healthcareprofessions.
You know all of them, whetheryou're chiropractic, all the way
to dermatology, all the way towhat I do in hip and knee
surgery.
You know, if whatever you'redoing is not working or is not
(02:21):
improving the patient, it'ssilly to keep thinking that
doing more is going to work.
You know, and every single oneof us is going to have to change
what we do, and I see this alot in our clinic.
I mean, if I can't make thepatient better and I don't
understand what it is, I startcalling out to other people I
say like hey, is there somethingelse that I'm doing or
something else that can belooked at?
Mri is a perfect example becauseit is not, as you know, not
(02:41):
classically a study that youwould get for routine arthritis
or routine.
You know muscle sprain aroundthe hip.
You know it's something that'sjust minor or even something
major, but it would be operative.
Most people would resort tox-ray.
Ok, in Judy's case specifically, as she's walking, there was a
(03:04):
deficit in a certain musclegroup in her hip and that
deficit led us to thinkimmediately or especially in my
PA, a very astute practitionerto recognize that hey, I think
there might be a muscleincongruity here, something
that's not actually working.
So the MRI is up here and ifyou look at the MRI, this is an
MRI not so much of the jointspace but of the outside part of
(03:26):
the hip For those otherpractitioners listening to this
podcast, you can see thetrochanter there and this is
what's known as a T2-weightedMRI.
T2 means that fluid shows up aswhite space or light space, and
solid structures and more densestructures, less watery
structures, show up as dark, andso right on the side of this
(03:47):
area this would be the left sideof the screen you can see a lot
of white coming out of themuscle that's going to the
greater trochanter, and thatwhite in the greater trochanter
area is fluid buildup andactually retracted tendon.
So the muscle was torn off ofthe greater trochanter.
So the muscle was, not was tornoff of the greater trochanter.
(04:07):
We call that a deltoid injuryor it's been erroneously but
affectionately called therotator cuff tear of the hip,
and so that's essentially themain significant complaint that
she had, along with underlyingarthritis that you could see a
little bit on x-ray and more onthe MRI as well.
Speaker 1 (04:26):
I think you said at that time that it looked like
she had a labrum that wasinvolved, correct?
Speaker 2 (04:30):
Yeah, so the labrum is the soft tissue gasket around
the acetabulum, around the cupof the joint, and the labrum
becomes degenerative as thejoint wears out.
It can also be acutelydegenerative or acutely injured
by extreme forced motion.
But you know, I'm going toguess that she was not in a
recent football injury.
So you know, usually over time,as many decades go by, labral
(04:55):
tears are pretty common.
But it is a sign of underlyingdegeneration and it becomes very
symptomatic as well, very, verypainful very symptomatic as
well, Very, very painful.
Speaker 1 (05:05):
That's probably why you said let's just put a whole
new hip in.
So you don't have to go throughthat again while we're having
you in surgery.
And that made sense to me.
Yeah, I mean.
Speaker 2 (05:14):
So we know very clearly that after so many
decades and most people afterthe age of 50 or 60, if you
start having a labral tear andyou start seeing signs of
arthritis the true term ischondromalacia or cartilage wear
you start seeing signs of thatin the same form as, or the same
studies as, degenerative labrum, then you know it's part of the
(05:34):
same process.
You know it's not an acuteinjury, it's not a quick tear,
that happened because of extrememotion and so because of that,
you also know that your body isgoing to compensate for those
problems.
And so if the body is going tocompensate for those problems,
one of the main compensationmethods is to deactivate if you
want to use a good term for thispodcast, to deactivate the
(05:56):
gluteus medius muscle, which isattached directly to the greater
trochanter.
So if that's gettingdeactivated naturally because of
an arthritic process that'sgoing on, if we repair it or fix
it by itself, it's going tohinder that reactivation process
over time.
So not only will it, you know,may not heal so well, but it
might not become verycoordinated with the rest of
your hip and we may be backseveral years later having to do
(06:19):
hip replacement after goingthrough the repair process.
Speaker 1 (06:23):
And tell us a little bit about the ligament repair
process, because you had somehistory in artificial material.
I guess what would you call it?
Polymorphous tissue?
Speaker 2 (06:34):
Yeah, it's really cool stuff.
So, yeah, I wish that I did.
I wish I was actually involvedin the creation of this.
So that goes back to aninnovator in our field, dr Lars
Pedersen.
He's somewhere in Europe, Ibelieve he's outside of either
Switzerland or Germany, but Icould have that wrong.
But Lars Pedersen spent hisentire life looking at
(06:55):
artificial ligaments and he hadgone through some failures, just
like the rest of us, or maybelearned ways how to not do it,
with what's known as a Larsligament, which is a
polyethylene braided ligament.
And the problem with those isthey would fail over time,
usually after seven years ormore, and the failure would
create frayed substance, kind oflike frayed rope, and that
would cause a lot of tissueirritation and destruction.
(07:17):
So his second go at this, aftermany tries, was a polylactone
urea, which is kind of amodified polymer that absorbs or
dissolves in an aqueoussolution without an inflammatory
process, so basically your bodydoesn't have to actively react
to it to make it go away.
It's a biodegradable, if youwill.
(07:38):
Okay, rather than you know,rather than you know absorbable.
And the nice thing about it isthat it biodegrades over the
course of seven years.
It doesn't biodegrade over thecourse of like three or four
weeks.
So seven years is more thanenough time for your body to use
it as a scaffold for scartissue to come in, more than
enough time for your body tocreate new collagen.
More than enough time for yourbody to create new collagen in
(08:00):
an appropriate place, in anappropriate position.
And so we're utilizing thatinnovation in large joints where
they weren't used before.
So the surgical technique thatwe used for your wife, that was
innovated by us we actually callit the lazy paper airplane
because of the way that wefashion the artisan tissue and
(08:22):
the way that we put it on.
But essentially we reattach thestructure to the bone and then
we augment it with this materialso that it's protected while
it's healing, and we've seenamazing results with this.
And we do have a small seriesthat we put together, but it'll
be a while before I publish that, if I do.
Speaker 1 (08:43):
But I think I remember you saying there were
three tears gluteus minimusmedius, and those were the two
big tears was it.
Speaker 2 (08:51):
Those are the big tears.
The biggest one was of themedius.
The medius is the main driverof the hip.
The minimus is a harder one,because a minimus has a very
small short structure and it'sattached to the capsule and
we're not sure what thoseactually do with respect to the
hip other than tense and act asproprioceptors of the hip.
So we see a lot of dysfunctionin gluteus minimus that may or
(09:13):
may not need actualreconstruction.
When a hip replacement isplaced when a native hip is
there, we're not sure if itactually has more function.
Okay.
Speaker 1 (09:21):
But you have how many patents in this kind of work?
Speaker 2 (09:26):
Oh, I wish I had more in this kind of work.
I actually have not patentedthis.
There's some kit patentspending right now, but we have
not patented them To date.
I have just under 20 patents invarious different things.
Some are relevant, some areless relevant.
You know how this business goes, but you know, we, we like to,
we like to call ourselvescreatives in the in the process,
because we, you know, we, we,we're excited about this stuff.
(09:49):
This is what we've dedicatedour lives to.
Speaker 1 (09:51):
Well, tell them, wasn't it the ACL joint?
Isn't that where they firststarted putting?
Speaker 2 (09:56):
Yes, so they actually the the the art the art salon
is the name of the material atone point, a-r-t-e-l-o-n.
Initially it was marketed byBiomet as what's known as Sport
Mesh and they were using it toaugment ACLs and we've got about
17 years worth of data behindthat, so we know it's not
exactly a new product and it hasbeen very well shown to work.
(10:22):
It's established.
It was used in rotator cuffaugmentation and then it was
very poorly used in hand.
They are actually using it toact as an arthritic replacement
for one of the joints and thosedid very poorly because it was a
wrong application of thematerial and then they pivoted
and went right into foot andankle and they're using it in
(10:43):
foot and ankle really, reallywell on the small joints around
it and a lot of ligament repairsand augmentations there.
So we're just taking thematerial and we're using it
around larger joints, because Ionly do hips and knees and
that's where we're using quite abit of it.
Speaker 1 (10:57):
Now tell the audience how the process works, because
Judy has been on a walker nowfor she's on her sixth month.
Explain that because you know Iwill never look at a caretaker
again the same, because I havebeen a caretaker for six months
and you know when you are acaretaker to an A-type
(11:17):
personality, you know they liketo run over you with their
walker.
But explain a little bit abouthow you were very careful about
that.
Speaker 2 (11:25):
That's the hardest part of my job.
I mean, that really is so.
You know it's easy and fun tofix something, but then to do
the post-operative recoveryprocess you really have to pay
attention to the biology veryclosely and this is one of the
longest to heal things, becauseyour gluteus medius is a major
driver of your hip and youreally can't walk around, you
(11:46):
really can't do anything in lifewithout utilizing it.
It really it is the main musclethat gets pulled.
And so if you think about it ina way that you're trying to get
to heal something that was notjust torn but that does not want
to heal and you've got toprotect the work that you've
done, yet you're basicallyprotecting it from the patient's
lifestyle.
That's the hardest thing Now,on the very base.
(12:08):
You also have to know the basicscience behind it and how the
physiology works.
Bones are more simple, becausebones you can immobilize and
they'll heal, usually over thecourse of about three to four
months, is usually a bone.
Unfortunately, ligaments andtendons take twice that long.
So you're looking at a six toeight month recovery process for
(12:29):
ligaments and tendons and oneof the hardest parts of it is
that when you feel the best,it's not necessarily the
strongest.
And so we see that time andtime again with professional
athletes, especially back in the80s and early 90s, Professional
athletes would get an ACLreconstruction and then they'd
go back to play and you'd seethey'd immediately re-rupture,
They'd be out for the seasonagain and they'd have to have a
(12:50):
revision surgery.
I mean, how many players haveyou seen with that?
And the reason is is thatthey're feeling great, they're
doing all this other stuff, butthat ligament or that tendon
that they had reconstructed justis not stout and firm and
strong enough yet, even if it'sfeeling fine and grown it, so
that therein lies the biggestheadache that I've got in my
practice is convincing patientswho are motivated and have
(13:12):
problems that they want to getbetter to say, hey, wait a
minute, I know you're feelingfine, but you're not fine yet,
Okay, and I need to protect thisfor just a little bit more.
And once you get them past thatthat spot and especially if you
have a little experience withthis and you can post this ahead
of time, because when I saw youfor the first time, when I saw
her for the first time, I wasvery clear about what this would
take I said, look, I want tomake sure that you understand
(13:34):
what you're getting into this isnot an easy thing for you.
It's not horrible, but it takesa long time.
It is absolutely a test ofpatience, but when you get past
it and when you get to the endnow you've got a solution and a
fix for something thathistorically didn't actually
have a good solution.
You've got something thatactually will work.
Speaker 1 (13:51):
Well, even the medical profession, you know,
for years and years and yearsdidn't they use cortisone?
Wasn't that the preferredtreatment on that lateral, you
know, trochanter.
Speaker 2 (13:59):
Yes.
So historically speaking wemisunderstood the
pathophysiology.
So we would call it bursitis,and bursitis is you know, was
essentially under the skinblister or under the muscle
blister.
And they would say, oh, thebursa is inflamed and that's why
this is occurring, notrealizing that usually there's
degeneration of the tendonthat's causing the other muscles
(14:21):
to be utilized too heavily,namely the IT band and the glute
max, which applies pressure tothat bursa, which is why the
bursa gets inflamed.
So treating the bursa itself islike treating a blister around a
rock in your shoe.
You know the rock's still thereand it's still going to cause
problems.
So we also know that cortisoneitself is collagen destructive.
(14:44):
It will weaken tendons.
As a matter of fact, there arecertain areas of the body that
you never inject cortisonebecause you're worried about
tendon rupture, like namely theAchilles tendon, namely the
patellar tendon, where it'sreally dire if they end up
rupturing.
So you don't want that in amajor structure around your hip
and classically that was theonly tool in our bag.
(15:06):
So surgeons would or physicianswould inject greater stroke
cancer with bursa, bursa withcortisone, sometimes 20 or 30
times, causing a worsening ofthe problem and rupture, even if
they felt better immediately.
And so we now know in 2024 thatthe answer is more regenerative
medicine.
And you know, I advise mypatients, if they're going to
get cortisone, never do morethan three in their lifetime,
(15:29):
which is a very big transitionfrom where we were 20 years ago.
Speaker 1 (15:32):
Yeah, and you said something that really interested
me.
You said that Medicare came outwith a new diagnosis or a new
class now, and it was calledlateral trochanter pain syndrome
.
Speaker 2 (15:43):
Yeah, lateral trochanteric pain syndrome.
I don't know if it was Medicare, but they do have a new
classification for it, like theterm is no longer bursitis.
I mean, people do call itbursitis, but that's now become
a misnomer.
So they call it lateraltrochanteric pain syndrome, and
those of us in the industry liketo be much more specific.
We like to say a proximal ITband inflammatory process or a
(16:06):
proximal IT band contracture ormedius insertional tendinopathy,
depending on the etiology forthat lateral trachea and
tachypain syndrome.
So there's several differentthings that can cause it and
it's really this, this, uh,discoordination of muscle groups
and motors around the hip thatreally caused the problem.
Speaker 1 (16:27):
Uh, also, I've noticed just uh in, I've taken
care of her that her iliotibialband is involved.
I mean I can you know that'sgot areas in that are tender
little nodules and so forth andso on.
Is that quite common?
Speaker 2 (16:41):
Actually it's.
It's not just common, it'salmost 100% of the patients.
Oh, okay, yeah, almost everyonehas an IT band irritation with
this, which is why they call itlateral trigonometric pain
syndrome.
The IT band is your body'sfirst step in accommodating this
problem, so your body alwaysuses the bigger muscle to try to
overcome it.
And unfortunately the mechanicsof the IT band are horrible for
(17:04):
upright walking because itpulls on the side of your knee
to keep you elevated rather thandirectly on the greater
trochanter.
So even if the muscle's big,it's got a very bad mechanical
disadvantage.
Speaker 1 (17:13):
Interesting.
So she's about six months now,and how soon can she go off her
walker then?
Speaker 2 (17:23):
Well, we're going to be, we're going to be very
gentle with it.
You know, the most, the mostcritical time period is between
four to six months.
That's the most critical time.
That's when people will reinjure themselves.
Typically After that it's a I'mvery conservative.
It's a slow, slow return tofunction, mostly because I also
know that not only do wereattach a muscle and tendon to
(17:43):
their bone, but even if it'shealed, that muscle and tendon
isn't being activated well yet.
So it's still uncoordinated andwe're waiting for some of that
muscle to grow back and tore-engage, and that usually
takes several months for that tooccur too.
So, just walking aroundnormally, I think it's going to
be probably nine months or sobefore she's going to be there
minimally and I know she doesn'twant to hear that.
(18:05):
But when she gets there, onceshe turns that corner, it's a
big corner, it's prettyimpressive.
Speaker 1 (18:12):
I remember you telling about a patient you had
and it was 10 months and he wasstill having pain for 10 months
and then one day he walked inand said it's gone.
Speaker 2 (18:21):
Yeah, Almost like he woke up and he was healed.
It was almost like miraculouswhen it happened, and I hope
that's her experience too.
I mean we do see that quitefrequently, I mean in medicine.
You've seen this in yourpractice.
I'm sure Patients turn theproverbial corner.
We don't improve at a gradualrate, we improve in the stepwise
fashion.
Sometimes those steps arepretty tall.
Speaker 1 (18:41):
And you can look if you look closer.
The pin that was put in by thelateral trochanter up there,
that's where you tied the newmaterial to correct.
That's correct.
Speaker 2 (18:49):
Yeah.
So what we did was we repairedher medius back to her, to her
bone, and whatever stump wasleft of the material so that we
actually had her native tissueis reattached.
And then we know that that'sgonna pull off.
It's not strong enough.
So then we wove thispolylactone urea graft over that
(19:10):
using Kevlar suture and then wepinned that to her bone using
this titanium staple.
So it's very, very strong.
As a matter of fact, I have onefailure that I'm aware of in my
case series.
That failure was a forcibledislocation after trauma and she
did not pull through the Kevlarsuture.
She did not pull through thetitanium staple.
(19:32):
It actually required that sherip through the material itself
in order for it to occur.
Speaker 1 (19:38):
Was she in an accident?
Speaker 2 (19:39):
Yeah, she had an accident.
Speaker 1 (19:40):
Yes.
Speaker 2 (19:40):
And we went back and fixed her and she's doing well
now.
Speaker 1 (19:42):
Yes, what do you see in the future?
I mean, this is pretty well.
First of all, let me saysomething else that I was
impressed with.
You've done over 5,000 hipreplacements and 28 ligament,
reattachments or 29 or whatever.
Speaker 2 (19:59):
29 now, yeah, yeah, 29.
Speaker 1 (20:01):
So it's not an everyday thing, oh, not at all.
That happens, not at all, andso that's why I wanted to get
you on the podcast, becausethere's people around the
country here that may besuffering from that very thing,
that could fly in for anevaluation and see what they
would find out.
Speaker 2 (20:22):
I will comment on this a little bit.
So you know, just likeeverything else, if you don't
have the tool to fix something,most of them get unrecognized or
unfixed.
Okay, so up until now the adagein our field has always been if
there's metal or plastic in thearea meaning if there's an
implant there it has to be fixedwith more metal and plastic.
(20:43):
It doesn't get fixed otherwise,and I think that's a disservice
.
I would like to modify thatadage and that's what I'm trying
to do with a portion of mycareer right now, and I have
colleagues that know this aboutme.
The modification is not that itdoesn't work.
The modification is that ourhistorical ways of doing it
weren't strong enough to keep upwith metal and plastic.
(21:05):
So this is why you see thatx-ray and there's a titanium
staple there.
Why would you attach somethingwith a titanium staple?
When we fix ACL reconstructions,we use a plastic screw.
Why would you need a titaniumstaple?
Well, there's metal and plasticin there.
There's an actual total hipreplacement there.
So you need something muchstronger to hold it together,
because you know your body usesit a little bit differently.
It relies on the structures moreand, historically, any attempt
(21:28):
that we had to fix soft tissuearound a total knee replacement
or total hip replacement usuallyended in failure.
It really did.
So we resorted to, you know,for the past 30, 40 years we
resorted to techniques that werereally salvage techniques.
I mean the number one way tofix this around a total hip
replacement, that the problemthat Judy has would be a muscle
(21:49):
transfer of the glute max to thetrochanter.
That would be to take your,your, your butt muscle and
sticking it right to thetrochanter and hoping that she
learns how to use her musclemore appropriately, assuming
that it heals.
You know that's a pretty morbidprocedure and you talk about
recovery.
That's more than a yearrecovery and that was the next
closest thing we had to justfixing it directly.
Speaker 1 (22:11):
So how do you see the future?
Do you see change?
What changes do you see thatwill make it easier, better.
Speaker 2 (22:18):
There's a lot of things, okay.
So it depends on how far intothe future you want to look.
So the immediate future stuffthat I'm going to be involved in
, or at least I hope to beinvolved in, is we want to kit
this stuff for the lay surgeonout there.
So there are such things knownas kit patents, where useful to
the companies.
Really, what's useful to theprovider, namely surgeons out
(22:41):
there that need it or patientswho would be the recipient of
this, would be kits that havejust the tools needed for this
particular application.
So if you have that kit, thenyou know this is made for this
purpose.
And so, all of a sudden,surgeons out there who have to
think about this, figure it out,learn from a guy like me, have
enough chutzpah to actually doit on their own without it being
(23:03):
an established technique andthen following the patient
properly, now have the securityof having this is what this is
for.
Here you go, okay.
So that would be the maybe lessexciting but the immediate
future stuff.
If you want far more distantfuture stuff, um, you know I'm
in the hip and knee implantbusiness.
I do sports medicine around hipand knee Well.
(23:24):
I was trained in multipleaspects of orthopedics, but I
don't practice there anymore.
We have things so far as um, as3d printing on a collagen
scaffold with stem cells andtissue engineering.
Uh, we do believe that at somepoint in time in the future.
It may take 50 to 100 years toget there, but we believe that
with an artificial hip like thisyou should be able to reverse
(23:46):
it to the patient's naturalanatomy just by removing the hip
and putting in an engineeredhip made of their own bone and
soft tissue.
So it is very likely that atsome point in time in the future
, instead of artificial ligament, we'd be able to grow and
replace that stuff in vitro intoa lab and implant that.
Speaker 1 (24:04):
Well, you know, I remember when she had a knee
replaced here six, seven yearsago, they measured the implant.
And so because I, as apractitioner, when I was
examining people, I used to seesome imbalances in leg length,
inequality.
That was sickening.
Speaker 2 (24:21):
Oh yeah.
Speaker 1 (24:21):
Nobody paid any attention to, and now they were
getting it down to millimetersand I thought, wow, they're
paying attention to this, whichis a very good thing.
Speaker 2 (24:29):
Well, they need to.
I mean, we've been doing thisnow.
I mean hip implants.
Hip replacement implants areone of the oldest part of
replacement technology inorthopedics and even as such,
it's still in its infancy, Evenas such, you know, we've only
been doing it for, you know,just under a hundred years, and
even 20, even 10 years ago, weweren't paying attention to some
(24:50):
of the stuff.
Speaker 1 (24:50):
What I found interesting is that used to be
coming from the posterior.
Then the big find was come fromthe anterior.
When you did it, you came fromthe top, and I must say that if
it would have been just the hipreplacement, that would have
been over in a week.
I mean, it would have beennothing.
And even the closing personyour closer you can't even see a
(25:12):
scar on her today and within amonth it was gone.
Speaker 2 (25:17):
That's pretty cool stuff.
Yeah, very cool.
But I, you know, I often thinkwhat would happen if we could
kind of go back in time and showthe pioneers of our field back
in the eighties and seventieswhat we're doing today.
I think the jaws would be onthe floor because you know what
used to be a three week hospitalstay, riddled with all kinds of
complications, where the mostsuccessful surgery was getting
(25:38):
up of a chair and going to themailbox and back.
You know, now people areplaying professional basketball
on.
You know it's just amazing what, what can be done now compared
to where we started.
You know, even even three tofour decades ago.
Speaker 1 (25:52):
Yes, well, and I think the the professions are
opening more to you know,getting into new things.
The young kids coming out ofschool are definitely open.
I think, yeah, yeah, what's?
Speaker 2 (26:05):
new.
Speaker 1 (26:06):
Yeah.
Speaker 2 (26:07):
I mean it's, you know it's.
The profession itself is openbecause everybody is learning.
There are how do I say thisproperly?
Academic resistances to certainnewer, to certain newer
technologies, but that justthat's good, you know.
That's good to protect patientsas well, cause you don't want
some cowboy out there doingrandom stuff just because he
thinks it might be cool.
(26:27):
Yes, like you do need to have adeliberate improvement.
As you go, um and as as thosethings start becoming adopted by
patients and practitionersalike, it moves from
experimental to established, tostandard of care, and that's
(26:48):
really where we see a lot ofthis stuff, even coming from the
superior aspect of the hip.
I mean it works too well for itnot to eventually become
standard of care.
Speaker 1 (26:56):
It's just too early for that to be the case, and you
have to have somebody thatknows what's going on.
By the way, dr Chow has awaiting list of about a year now
, and so you can't just walk in.
We got lucky we were in theoffice and I pleaded Very
persistent.
Speaker 2 (27:16):
Yes.
Speaker 1 (27:17):
I think he had a cancellation, but anyway, we
were lucky to get in at areasonable time.
But just so you know thatthat's where he's at is because
he is innovative.
And the first of all, and I gotto say one thing, and I know
your office will watch this, butyour staff is outstanding, from
Ruby opening the door to sayhello to on to you know, kim and
(27:40):
all the rest of them.
They care and they're verycaring people and they look
after you and so it's no fun togo through this, but we had the
most enjoyable time you can havegoing through something like
this.
Speaker 2 (27:54):
Yeah, we.
I am very proud of our staff.
They are easily industry bestacross the board and you know
mad props to them.
I'm very proud of our staff.
They are easily industry bestacross the board and you know
mad props to them.
I'm very proud of the work thatthey do.
And you're right, nobody wantssurgery, but everyone wants the
results of surgery.
And nobody wants to haveproblems, but everyone wants
their problems fixed.
Speaker 1 (28:10):
So and on that note, I just want to thank you for
coming in.
By the way, Dr Chow is achiropractic patient and he goes
a couple of times a week, hesaid.
But you know, surgeons get invery bad positions and they are
required to be in that positionfor a period of time, and so he
has a full exercise regime andeverything.
So and we just seem to befriends and I'm really happy to
(28:33):
have you as a friend, and sothank you for coming on.
Speaker 2 (28:35):
Thank you so much for having me.
I appreciate it.
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