Advances in Joint Replacement Surgery

Intro: MemorialCare Health System, excellence in healthcare, presents Weekly Dose of Wellness. Here is your host, Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Trong Nguyen, a board-certified orthopedic surgeon with MemorialCare Joint Replacement Center at Orange Coast Medical Center. He received his bachelor's degree at the University of California, Los Angeles, and attained his medical degree at the University of California, San Diego. He completed his residency at Albert Einstein Hospital in New York and was fellow-trained at MemorialCare Long Beach Medical Center. Dr. Nguyen specializes in sports medicine and joint reconstruction and started his private practice, the Center for Bone and Joint Care, in 2008. During his free time, he enjoys outdoor activities, going to the beach, as well as watching and playing sports. Welcome to you, Dr. Nguyen.

Trong Nguyen, MD: Hi, thank you for having me.

Deborah Howell (Host): You're most welcome. Anything for a fellow Wildcat. I went to Northwestern as well. So who typically needs joint replacement surgery?

Trong Nguyen, MD: Joint replacement surgery usually is reserved for people who have pretty severe arthritis of the hip or knee or shoulder. And typically those patients have failed non-operative management of their arthritis, and there could be various forms of arthritis, including rheumatoid arthritis and osteoarthritis.

Deborah Howell (Host): Okay, so lots of elements there going on. So what are some of the symptoms that may occur that would be a signal for somebody to see their doctor about possible joint replacement?

Trong Nguyen, MD: Well, depending on the joint, if it's in the hip or the knee, most patients who have severe osteoarthritis will have significant pain with walking, pain with activities of daily living such as getting out of bed, going to the bathroom, not being able to lift or kneel or squat or bend over to pick up objects. And usually they're pretty debilitating pain to the point where people see a significant decrease in their quality of life. And usually when someone is, when their quality of life is affected by the arthritis, that's when patients are good candidates for joint replacement surgeries.

Deborah Howell (Host): Okay, so I mean if you're having pains like this, it's certainly time to see your primary physician, and at that point, he'll make the determination whether you need to see a specialist.

Trong Nguyen, MD: Yeah, definitely, definitely. Usually when patients come to me, they're already kind of exhausted a lot of their non-operative means of managing arthritis, such as anti-inflammatory medications, exercise, therapy, injections into the knee, and those sorts of treatments. And so when those fail or when patients have exhausted that and they no longer respond to those non-operative management means, then the joint replacement is one of their options.

Deborah Howell (Host): Okay, I am interested in something you just said. You said injections into the knees. You hear radio commercials and TV commercials about new techniques where they sort of, they say it's almost like injecting a new meniscus into your knee. I'd love to just hear you speak to that.

Trong Nguyen, MD: Well, there are certain types of injections that have had a good track record. The main one is a cortisone injection, that's mostly an anti-inflammatory pain injection into the knee. There are other what we call quote-unquote lubrication injections, which is essentially an injection of hyaluronic acid, which is a natural lubricant in the knee. And it's kind of like going and getting your oil changed. You put oil in your engine, you get oil and lubrication in your knee, and that significantly improves people's symptoms depending on how severe their arthritis is. It's more effective for mild to moderate arthritis. When the arthritis gets more and more severe, those lubrication injections tend to be less effective. But it's not a cure, but it does help with patients' symptoms.

Deborah Howell (Host): Sure. So early is always better. See your doctor if you're having any of these symptoms. So what recent advancements in technology and care after surgery have helped in aiding faster recoveries for joint replacement patients?

Trong Nguyen, MD: Well, there are a few technology advances in the joint itself, the implant itself. There's also been advances in the cutting guides that we use as part of the surgery. Some are patient-specific, especially if patients have any significant deformity or abnormal bone structure, then the patient-specific guides that are custom-made can help with providing a better outcome for patients. But a lot of the advances have been made in the pre and post-operative care for joint replacements, including the therapy program and the rehabilitation protocols that we use to help patients get up and going faster after surgery with less pain and less complications risk.

Deborah Howell (Host): Physical therapy, PT. President Clinton called it his pain and torture team, but boy did they get him back up and running.

Trong Nguyen, MD: Yes. A necessary evil. Well, the therapists that we use are fantastic, so. But what I usually tell patients is therapy is 50% of your recovery. I can do 50%, you know, I'll do my part with the surgery, but patients require the therapy in order to get a full recovery. And so motivation is a very key factor in how people recover, as well as having a great positive attitude.

Deborah Howell (Host): Sure. Has to be a little frustrating for you as a surgeon to do this incredibly complex surgery, have a successful outcome surgically, and then have the patient do nothing afterwards.

Trong Nguyen, MD: Yeah, and I really try to motivate people. And one of the nice things that we do in therapy at the hospital is that we actually get people into group therapy with their own individual coaches.

Deborah Howell (Host): Oh, that's wonderful.

Trong Nguyen, MD: We actually coach the coach to help the patient guide them through the therapy, as well as doing group therapy after the surgery so that there's a kind of a sense of camaraderie during the therapy. So patients feel like they're not doing it alone. And then for even some people, they get competitive. So if you've done surgery the day before with somebody else who's one day after surgery, they'll start saying, "Well, he walked 50 feet, I'm going to try to walk 55 feet."

Deborah Howell (Host): Good. Yeah.

Trong Nguyen, MD: So it kind of pushes people a little bit, and that's one of the things that we've been kind of changing with our joint replacement center, getting people to walk faster, do more therapy so that they recover faster.

Deborah Howell (Host): Makes it a little more fun too, not to be doing it all on your own. About how long can a typical patient expect to be healing after surgery?

Trong Nguyen, MD: For a hip replacement, well, for both surgeries, hip and knee replacements, we get people up and going on day zero, which means the same day of the surgery. So typically we'll do the surgeries in the morning, and we'll get people up and out of bed that afternoon. And with adequate pain control, people are able to walk a little bit, you know, obviously going to be baby steps, but the earlier we start, the better. For short-term recovery for a hip, it can depend on the patient, it can be anywhere between four to six weeks. For a knee, I would say four to eight weeks depending on their pre-operative function and how well they were doing before the surgery. Long-term recovery, meaning significant improvement in their lifestyle and movement and being able to walk long distances, can take anywhere between one to three to four months depending on how they recover. But typically it's anywhere between four to six weeks for early recovery.

Deborah Howell (Host): And then it's back to those burpees.

Trong Nguyen, MD: Back to them, right? No rest.

Deborah Howell (Host): What are some of the other components to an expedited recovery after surgery, aside from movement and physical therapy?

Trong Nguyen, MD: One of the things that I've helped, or that I've seen a lot of patients do really well with, are these cold therapy units that we use to help patients. Like if it's a knee replacement, I use an ice machine that actually circulates cold water and actually provides a little bit of a compression and essentially massages the knee while providing an anti-inflammatory effect, reducing the swelling with the ice. Patients love it, it reduces the swelling, reduces the pain after the surgery, and it also reduces the need for narcotic medications or pain medications afterwards because those are always, you know, you always worry about side effects and long-term addiction to those medications. Usually people don't need them for long term, but this helps reduce their need for those medications. And the machine I highly recommend it to everybody who does my knee replacements or joint replacements, whether their insurance covers it or not is a completely different story.

Deborah Howell (Host): Just ask for cold therapy and ask your insurance company. Okay, well we have 60 seconds left. We've talked a little bit about hyaluronic acid and it's very important. And one last question, how does group support and group therapy fit in?

Trong Nguyen, MD: Well, like I talked about earlier, group support, group therapy is fantastic. Patients get really good responses from it, or we get really good responses from patients with the group therapy because it motivates people, helps people talk, and kind of spreads that positive attitude. And it makes people competitive. Who doesn't want to do better than their neighbors?

Deborah Howell (Host): That's right.

Trong Nguyen, MD: When it comes to joint replacements.

Deborah Howell (Host): That's right. Yeah, thank you so much Dr. Nguyen for finding the time to talk to us today about the exciting advances in joint replacement surgery. We hope to have you back when we have some more time. It's been a pleasure to have you on today.

Trong Nguyen, MD: Thank you very much.

Deborah Howell (Host): For more info or to listen to a podcast of this show, please visit memorialcare.org/podcasts. That's memorialcare.org/podcasts. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.