Januari 03, 2017
>> hi. i'm patrick dunican. at gibbons, we believe that citizens need to be informed about the complex issues that affect their lives. that's why we're proud to support the programming produced by the caucus educational corporation and their partners in public
television. >> bone health and joint replacement, next on "caucus new jersey." >> funding for this edition of "caucus new jersey" has been provided by virtua, south jersey's comprehensive health care system; sun national bank;
and by pse&g, committed to improving new jersey's economy and strengthening its communities. >> welcome to "caucus new jersey." i'm steve adubato. you know, joint replacement is more common than you think. get this number: about 773,000 americans
have a hip or a knee replaced each year. joining us here in the studio to talk about this very important topic are dr. scott schoifet, orthopedic surgeon and medical director of joint replacement services at virtua, located in south jersey. michael balabon had
both knees replaced, one with traditional surgery and the other using minimally invasive technique that we'll talk about a little later. dr. andrea johnson davis, a physical therapist and clinical director at star physical therapy down in mount laurel, new jersey.
and finally, he's been with us before, doctor elliot rosenstein, director for the institute for rheumatic and autoimmune disease at overlook medical center. i want to thank all of you for joining us. listen. we're talking about bone health, joint replacement.
doctor, very complex, but one of the most interesting things is, in your situation, right, you had two different--both knees--one traditional, one of minimally invasive. >> correct. >> and minimally invasive can mean different things to
different people, right? let's break this down right away. well, by the way, we don't just bring in--we don't have guests bring in props like this without using them. this is very important. take this, doctor, and show us what traditional versus minimally
invasive and having to do with the knee replacement. and this is big having to do with the quadricep muscles, right? >> talk to us. i think we have a shot of it, right, guys? >> sure. minimally invasive can mean many things--a smaller skin incision and cutting less
tissue, but what we're talking about is quadricep sparing. the quadriceps being the biggest tendon in the body. and this is a knee joint. so when we replace a knee joint, we have to replace the aligning surface of the knee, and the only way to get in there is to get this
kneecap out of the way. so traditionally, we'd split the tendon and flip the kneecap out of the way and then bend the knee back. >> that's traditional? >> that's traditional. >> ok. >> and that gives you access to
the knee to put the knee replacement in. but then you're rehabbing a knee replacement and a cut tendon. so theoretically, if you can not cut the tendon-- >> go back for a second. that rehab--on average, doctor, how long?
>> well, the entire recovery is about 3 months, but most people would say that when you don't cut the tendon, it speeds things about 2 to 3 times. >> got it. now you're gonna switch gears, talk about some improvements here? >> exactly. if you're not gonna
cut the tendon, then you need to be able to get this kneecap out of the way, and the way you would do that would be sequentially cutting bones. as the joint gets close together, it relaxes the muscle. so you can actually get the tendon out of the way. so the procedure
becomes a very big part of getting a knee replacement in, but what you find is that post-operatively, not only is the patient moving better, but you're not trying to bend a tendon that was recently cut. so pain management is easier, physical therapy becomes easier,
and the patients seem to do better. >> point of clarification: minimally invasive, as i said in the introduction, means different things to different people. is that the same as laparoscopic surgery?
>> no, laparoscopic surgery and arthroscopic surgery, using fiber optic cameras to get into the joint. this is we're actually physically getting into the joint because we need to align these prostheses properly and put it in the proper orientation
to get the knee to function well. so you can do that by not cutting the tendon. so you get the same benefits from the knee replacement, but hopefully as mike will tell you, you can see a difference in the recovery. if you can get somebody through the process faster and get them out
in the workforce-- >> let's do that, by the way. and by the way, log onto our website. we'll link onto our partners down at virtua who are providing great information in this area. let me ask you, when did you have--go back. which one's--right, left?
>> right was traditional. >> right traditional. >> 3 years ago. >> got it. >> a year ago, i had minimally invasive surgery on the left. >> got it. describe the rehab on each. >> rehab on the first one was
about a 3-month process, two months on the first knee totally devoted to physical therapy. wasn't driving, was managing pain with, you know, high doses of pain medication, was going to physical therapy 3 times a week for two months. >> doing it by the book? and by
the way, why did you need that knee replacement? what's your sport? >> i played basketball. >> too long? >> too long. >> no, never too long, but-- >> but also, you know, other activities and arthritis in the
knee. and i was very knock kneed as well. so i had-- >> what does that mean? >> that means that i couldn't put my feet together. my knees came together first. i couldn't put my feet together. >> is that--you're verifying this, doctor?
>> i am verifying it's true. >> ok. it did not look good? how does it look now? >> they go together. >> oh, that works. now talk about the other knee, the minimally invasive. that was the surgery that dr. schoifet just described.
>> that's correct. that was the one that he first described, and the minimally invasive surgery was a totally different experience. i was driving within two weeks. i went into the hospital at 6:00 in the morning. by 9:30 that day, i was walking and doing steps. by
6:00 pm that evening, i walked out of the hospital. and the difference was that, you know, i won't say that--i would say that if you have a joint replaced, it's a year-long recovery no matter which joint it is. >> but?
>> but your lifestyle and the change that is made by having the minimally invasive procedure not only jump-starts you, but you also get to sort of a better place all throughout, more active. >> i'm sorry for jumping in. go ahead. what are you hearing
here? typical? >> typical. it is typical. and knee replacement recovery, period, is surgery recovery. so it's uncomfortable. traditional versus minimal invasive, are there differences? well, sure, because the procedure itself is different. you're replacing the
joint in both knees, but what you have to worry about after the fact post-rehab, you can do a little bit more with the minimal invasive sooner. so what michael is talking about is your quality of life comes back a little bit faster than it would. they're done for pain
relief, mostly. usually you have an arthritic knee that's bothering you, it's limiting your activities, really, really restricting your lifestyle. >> doctor, who is a candidate? >> that's a good question. one of the things i think we need to address is what predisposes
people to developing arthritis in the knee, and what we really have to do is define what we mean by arthritis. there are 120 different conditions that can cause joint pain, and for the most part, we're talking about two of the major conditions, one being
osteoarthritis-- >> osteoarthritis? >> osteoarthritis. >> not osteoporosis--completely different condition. >> go ahead. >> osteoarthritis primarily being a biomechanical disturbance of a joint,
contributed to by various mechanical considerations--in particular, obesity being one of the risk factors; prior injury being another risk factor. and they're something that it's almost universal. most of us give it to some extent or another as we get
older. the other major type of arthritis, rheumatoid arthritis, very different--autoimmune condition. the body's immune system makes a mistake and starts attacking its tissues inappropriately. most patients who have this surgery are going
to have osteoarthritis, because we really don't have very good medications that can interfere with the osteoarthritic process. >> dr. schoifet, as we get older, and as people simply live longer, are we going to see more and more of this?
>> well, the american academy of orthopedic surgeons actually looked at those numbers, and you quoted some of the knee replacements alone--500,000 were done in 2005, and it's projected in 2030 that 3 million in the u.s. alone, just by--
>> hold on. you're saying our numbers are wrong? >> no, your numbers are correct. you forgot the hips. 270 hips. >> do it again. >> ok. 500,000 knees. >> 500,000 knees. >> 270,000 hips. those were
2005 numbers. >> dead on. you didn't miss a beat with that. it was perfect. >> ha ha ha! >> but knee replacements are more common than hips, and so-- >> knee more common? >> knee is more common. and what were seeing is not only
the baby boomers, which are coming in, but of course we have all our athletes, all the athletics going on. all the injuries, the sports injuries occurring in the younger people are translating into osteoarthritic conditions or post-traumatic arthritis later
on. so it's projected that that number is going to go up by over 600% in 20 years. so you're talking about a huge volume and of course a shrinking health care dollar pool. you know, how are we going to be able to do these procedures, quality outcomes, get the patients out,
and do something that's gonna change people's lives? >> let's talk about patient expectations because i had shoulder surgery, a bicep tendon tear, and i had to get 3 different surgeries because it very simply didn't work the first couple times. i
should've come down to your place. but here's the thing: i remember the rehab, which was excruciating because it's--and a great rehab operation up in north jersey, where i am. but my expectations as to what i was going to be able to do and when, i began to see, were very
unrealistic. let's talk about managing expectations. >> i mean, we actually just had that conversation before we came here-- >> in the green room, which isn't green, but go ahead. >> and exactly that. it really is managing expectations
because the expectations of a 75-year-old versus a much younger patient in their late 40s or early 50s are a little bit different. it's all-- >> should they--here's the thing: i kept thinking--i don't mean to make this about me at all because--which i'm capable
of--but just make it about anyone who says, "i want to be tough. i want to be strong. i want to work through it." not that simple? >> it's not that simple because, again, we were discussing, the body only heals so fast. so regardless of what your
mentality is going in, which is always beneficial if you're educated properly and you understand what to expect--the body is only going to heal so fast. so i don't care if you want to just tough it out and you want to just do it, it's still only gonna heal so fast,
so you're still looking at a-- >> and your attitude--i'm sorry for interrupting--describe your attitude, michael, because you're an athlete. >> well, yes, but-- >> yes, but once 50 happens, trust me--yeah, i get you. >> no, but i was actually the
one that brought up the conversation about expectations. >> oh, it was you? >> because i think that as a patient, you have to understand what's ahead of you. you need to understand that your--what you're getting involved with, what the commitment is that
and you also have to understand that, yeah, you're not gonna get a magical pill that's gonna fix everything all at once. so what you're really getting out of the procedure is the ability to get on with the rest of your life, and what you don't want to do is set yourself back by
rushing into physical therapy because, "hey i feel so much better that i'm gonna go out and i'm gonna get on the stair stepper for 4 hours." that's not the thing to do. >> how much were you managing his expectations? >> we try to manage the
expectations before surgery. i actually asked him that question, "did i tell you enough before surgery, you know, to educate you?" so, you know, if they know what's coming and they know what to expect, it's gonna make the process much easier. but you
also sometimes have to find patients you hold back because just because 10 is good doesn't mean 40 is better, and the body does need to heal, so physical therapy is crucial, patient education is crucial to get the patient through in a right timeframe so they don't end up
with tendinitis and a lot of inflammation. >> tell me, doctor, help us on this. someone watching right now--and listen. the purpose of this show very simply is to educate people, inform you, so that if you're thinking about it or you've dealt with it or a
loved one that you know should be dealing with this directly, that's why we're doing it. so the question is, say you want to go in to see a physician. what should you be asking if you're concerned about your hip, your knee, whatever it is? what kinds of questions?
>> the first question is to make sure that an accurate diagnosis is made, because there are lots of conditions that can cause hip pain, lots of conditions that can cause knee pain. they're all not necessarily arthritis. they all don't necessarily need surgery.
so accurate diagnosis. depending on what the diagnosis is, making sure that the appropriate therapy is instituted, which may include anti-inflammatory medications, may include physical therapy, appropriate exercise, orthotic devices to correct some
anatomic disturbance. we heard about the knock knees. they can be helped sometimes with inserts in the shoes. so the key is diagnosis and then a treatment plan appropriate for that diagnosis. >> let's talk about men and women, differences. why did you
make that face when i said that? >> of course there's differences. but it's just interesting you said that, because 50% of all hips are men, 50% are women, but it's about two thirds women for knees and one third men. >> because?
>> there's a lot of becauses, and no one really quite knows the answer. >> what do you think? >> a lot of it has to do with the anatomy, and it also--it's thought that some of it is social, meaning that a lot of men who are 55 or so in the
workforce, 60 years old, may have a bad knee and may not want to take the time to get it done. more women may not necessarily be in the workforce and have the availability. women are sustaining a lot more sports-related injuries because they're doing a lot more
athletics and division i sports, and you're seeing a lot more anterior cruciate ligament injuries, which can then lead to arthritis. so there's a combination of reasons. is part of it anatomic? is part of it social? the answer is not quite out there, but the data
shows, and it's in my practice, something like 65% women are knees and 35% men. >> do you see any differences, and does the research bear out that there are any differences, in terms of how men versus women deal with rehab process?
>> it's a very interesting question, actually. >> i have interesting questions. i have no answers, but i have interesting questions. >> well, it's interesting in the fact that just in casual observations in the clinic and
in my practice, both do very well. women, for whatever reason, seem to do a little bit better with the pain management aspects of it early on. men recover faster, just in my humble opinion... >> is that right? >> as far as returning to
activities and whatnot. does the research support that? not anything that i have read at this point. >> can we talk prevention? and i'll tell you why. seriously, one of the things that i realize, and when i go to the gym, i happen to work with
someone who helps me with my lack of flexibility--i just put it out there. i don't stretch enough. i do not stretch enough. as much as i work out, i don't stretch enough, and i pay the price, you know, and i haven't paid the price to the degree they were talking about
with knees and hips or whatever, but the shoulder thing--and i don't know if it had anything to do with that--what is the role of being flexible enough and stretching enough before and after exercise? exercise, first of all, is part of it, dealing
with the obesity issue, weight management, right? is a risk factor? but go back to the issue of flexibility. am i making too much of the stretching, doctor? >> you may be making too much of the stretching, but the strengthening is crucial
because it's gonna-- >> give me an example. you get the knee replacement. you get the knee replacement. are you saying--i'm sorry for jumping ahead. >> this is post surgery we're talk--after surgery or before? >> ok. you know, do before.
>> are you telling me the more quadricep work someone does, the more work they're doing leg extensions--could you pull back a little bit, steve? the more leg extension work you do, ok? the stronger you get your quadriceps--are you saying you're protecting your knee
more? >> i'm saying it's gonna help with your pain management of your knee. what i like to--and this is my description when i'm trying to describe arthritis, osteoarthritis, i describe it as the wear and tear, like wearing the tread off the tire
of your car. >> all right? so we were born with our tread in our knee, and in time, we're wearing it out. it's not being attacked in an autoimmune disorder, but-- >> and it's getting closer to bone on bone? >> it's getting closer to bone
on bone. so when you're wearing that tread off, you can't exercise it back. you can't put a medicine in and inject it back. you can't take a pill and make it recover. but what you can do is manage the symptoms. so if you build up your strength, you can take more of
the load off of the joint. so you're not--it's like taking a weight off of a car with a bad tire, ok? it's not having to work as hard. so by strengthening that extremity, you can mitigate the pain. >> now, post surgery, now what? >> well, post surgery, again,
it becomes very important to get his strength back quickly. it helps manage the pain. again, that's why not cutting the quadriceps tendon allows you to get your strength back quicker, allows you to manage those symptoms and return to function. so--
>> i'm sorry. so-- >> that's ok. i was gonna say it is equally important post-operatively as pre-operatively. >> now let's talk the hip thing. hip thing. i know it's--it's more than a hip thing. is the hip surgery "a,"
more complicated than the knee--i know it depends upon the particular case--in terms of--i'm thinking about what advancements are out there, and also is the rehab harder? anyone jump in here. you only know the knee thing, right? >> i only know the...
>> fortunately. >> good deal. let's keep it that way, ok? >> well, the knee, as we described, is a resurfacing, but a hip replacement is a ball and socket. that's a hinge joint, works like a door hinge. the hip is a ball and socket
joint. so, again, the flexibility is completely different. so when you do a hip, you actually remove the ball, put a new ball in there and a new socket. >> you don't happen to have a hip hanging around, do you? >> if you would've told me
ahead of time, i would've come in with a whole-- >> no, you're thing is primarily--ok. you would've come with the whole pelvis? >> the whole thing, would've had, a cadaver and everything-- >> good. listen. this is pbs. >> for the sake of a small
studio, i left that out. >> yeah, we got a cheap budget, but go ahead. but you would've brought the whole thing. >> but interesting you point out that when you actually poll patients, and this has been done, about does it feel like a more normal joint? how do you
feel post-op as you do pre-op? hips feel much more normal than knees, all right? and there's multiple factors. i mean, there's a lot more different parts, we do more ligament replacements. but interestingly enough, when you remove that ball and the socket, the hips
feel more normal. people don't think that they have a hip replacement when they're done, but you can talk to a lot of patients who had knee replacements, and they actually--they feel better, they function better, but they don't forget about it sometimes.
now, maybe that's gonna change with quadricep sparing technique, maybe it's gonna change with the newer prostheses, but there's a definite difference in patient perception post-operatively at >> let's talk patient rehab with the hip. go and go.
>> no. i mean, rehab, it's different. there are restrictions following a total joint--for a hip. there are restrictions on movement initially that can last anywhere from 4 to whatever the particular surgeon's restrictions--
>> what are you doing? >> you don't want to dislocate the hip, is what-- >> ok, hold on. i ask you what we're doing, and the first thing you say is what you don't want to do, right? is that--that's important? >> it's very important,
actually. >> is that--that can happen? >> that absolutely can happen, and it does happen for patients that are not cognitive enough to understand what their restrictions are, and that's one of the big things first session in physical therapy
that we go through. do you know what you can't do? let's not talk about what we can do. let's talk about what we can't do. >> you got to go real slow here. jump in, doctor, on this whole--the rehab piece of this on the hip piece. from your
experience, from what you've seen, is it that much more difficult and complicated? >> i'm not sure it's that much more difficult and complicated. it's just that there are other considerations, and the mechanics of the hip are completely different than the
mechanics of the knee. >> by the way, what causes it? >> again, it is a wear and tear kind of process. it's something that tends to happen to us all to some extent-- >> tied to arthritis again? >> i'm sorry? >> tied to arthritis?
>> osteoarthritis. so, primary cause for hip replacements. >> could it be autoimmune-related issues? >> rheumatoid arthritis can affect the hip. there's a lot of overlap in the joint distribution, but most hip replacements are done for
osteoarthritis. >> interesting. let me ask you something, because i--i'm glad you didn't jump into the hip thing because it's... >> me, too. >> yeah, exactly. what advice would you have for someone watching right now? because,
again, the point of doing this show is to inform and hopefully inspire people to get more information. that's why all the websites are up there. what would you say, michael, to someone that says, "geez, it's been 2, 3 years. i'm having a hard time getting up
the stairs." forget about playing a 3-on-3 pickup game, right, basketball? "nah, i'll let it go. i'll live with it." you say? they're watching right now. >> well, i'll say you don't have to live with that pain. it becomes an issue, really, about
pain management. i think that that's one of the key things that we should really talk about is pain management from start to finish with the whole procedure, because, you know, i started in my early 40s. i'm on the other side of 50. i started in my early 40s managing knee
pain, managing knee pain in one knee and really eventually having it in both. i started with injections. i started with vioxx, which was to me a wonder drug that went off the market. and then, you know, once that really--once i got on the north side of 50, i couldn't manage
the pain anymore, and there were things i physically couldn't do. could mow the lawn anymore. couldn't walk for hours on hours. and i think that what you need to do is really discuss the issues with your doctor, what the alternatives are, and really get the most
information you can. you said it starting out--what's the information you give them? to get the information-- >> and you don't want to live that way? >> i did not want to live that way, and i am back to a normal lifestyle, as i would call it,
because i have both of my knees replaced. >> i always notice that once you hit 50, you start calling it the north side of 50. i notice that. i'm going to go with the same thing. finally, doctor, this whole question of someone saying, "i'll live with it,"
can someone convince themselves? i mean, is that what they're doing, convincing themselves that this is just the way it is, they don't even know what it could--listen. i don't want to say it's a panacea. science is changing all the time. the rehab is not
easy. i want to make it clear to that--on that. but you don't always have--not everyone has to be living with tremendous pain all the time. >> that's correct. there are people who come in like you described who you'll get an x-ray, you'll see severe
arthritis, and they'll go, "it doesn't hurt, it doesn't bother me." >> and by the way, real quick, sometimes people can be treated without surgery. i just want to be clear. but go ahead, doctor. >> there is a lot of treatment before surgery.
>> go ahead. i'm sorry. >> but we're talking at the end, i'm glad you brought that up. but they'll come in and they've reached the end stage or they're having these issues, but they'll be saying, "it doesn't hurt. maybe it's stiff." so what i'll do is i'll
inject their joint. i'll put in a long-acting novocain in there called marcaine, and i'll say, "well, walk around." and it numbs up the knee, it kind of mimics a knee replacement. and they'll all of a sudden realize what it feels like to have a knee that doesn't hurt.
>> by the way, we'll keep talking. we've got about another 15 seconds. i want to thank all of you for providing great information. you do the novocain. they're walking around. it mimics-- >> it mimics the knee. the pain disappears, and they realize
that for 10, 15 years, they've gotten so used to the pain, they forgot what it was like to have a pain-free knee. >> isn't that something? it could change their whole perspective. >> the preceding program has been a production of the caucus
educational corporation, celebrating over 20 years of broadcast excellence; and thirteen for wnet, njtv, and whyy. funding for this edition of promotional support provided by njbiz--all business, all new jersey--and the star-ledger and
nj.com--everything jersey. transportation provided by air brook limousine, serving the metropolitan new york/new jersey area. "caucus new jersey" has been produced in partnership with tri-star studios. >> i'm john campbell, berkeley
college, class of' 98, associate's degree in paralegal studies. >> i'm boussie matiko anden, berkeley college, class of 2004, bachelor's degree in business administration. >> melvin montavo, class of '91 and 2003, degrees in accounting
and management. >> simmy papachin, class of 2001, bachelors degree in >> from different walks of life, our students succeed in different ways, yet their first step is exactly the same: berkeley college. >> don't miss steve adubato and
co-host rafael pi roman each week on "new jersey capitol report," airing on njtv, thirteen, and whyy. check your local listings.
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