ON THIS EPISODE OF CYCLE OF HEALTH, JOINT REPLACEMENT.

HEAR FROM A MAN JUST OFF KNEE REPLACEMENT SURGERY PUSHING HIMSELF TO GET BACK TO DOING THE THINGS HE LOVES MOST.

LEARN THE INS-AND-OUTS OF THIS SURGERY FROM THE DOCTORS WHO PERFORM IT.

AND TRAVEL DOWN THE ROAD TO RECOVERY WITH THE PHYSICAL THERAPISTS TREATING THESE PATIENTS EACH AND EVERY DAY.

WE HOPE YOU'LL JOIN US FOR THIS CONVERSATION, COMING UP ON CYCLE OF HEALTH.

♪ ♪ ♪ ♪ HELLO AND WELCOME TO CYCLE OF HEALTH, I'M DR. RICH O'NEILL.

ON TONIGHT'S SHOW, WE'RE TALKING ABOUT JOINT REPLACEMENT.

ALSO KNOWN AS ARTHROPLASTY, IT IS ESTIMATED THAT MORE THAN ONE MILLION TOTAL JOINT REPLACEMENT SURGERIES ARE PERFORMED ANNUALLY.

CHANCES ARE, YOU KNOW SOMEONE WHO'S GOTTEN A "NEW HIP" OR A "NEW KNEE," BUT WHAT EXACTLY DOES THAT MEAN?

TONIGHT, WE WANT TO EXPLORE THIS TOPIC FROM INJURY TO RECOVERY AND WE HAVE A GREAT GROUP OF GUESTS TO HELP US DO JUST THAT.

THEY ARE: DR. KEVIN KOPKO, JOINT REPLACEMENT SURGEON AT SYRACUSE ORTHOPEDIC SPECIALISTS DR. ROBERT SHERMAN, JOINT REPLACEMENT SURGEON AT SUNY UPSTATE MEDICAL MR. STACY GRIFFITH, PHYSICAL THERAPIST AT SYRACUSE ORTHOPEDIC SPECIALISTS AND DR. KERRY WALSH, PHYSICAL THERAPIST AT SUNY UPSTATE MEDICAL THANK YOU ALL FOR BEING HERE.

Dr. SHERMAN, WHAT ARE SOME OF THE THINGS THAT CAN LEAD TO JOINT REPLACEMENT?

>> SO THE MOST IMPORTANT THING AND THE REASON WE DO JOINT REPLACEMENT IS PAIN.

SO THERE IS A WHOLE SERIES OF REASONS WHY PEOPLE MAY HAVE PAIN IN THEIR JOINTS.

MOST COMMON JOINTS REPLACED ARE HIPS, KNEES AND SHOULDER.

WE ARE GOING TO TALK ABOUT HIPS AND KNEES ATTORNEY AND THE UNDER LYING CONDITION IS SOME FORM OF ARTHRITIS, WHICH IS THE WEAR AND TEAR OF A JOINT.

>> SO IF MY KID IS IN PAIN, I CAN'T GO TO AN ORTHOPEDIC SURGEON?

[LAUGHTER] WELL, WHAT IS ARTS ARTHRITIS?

>> IT'S WEAR AND TEAR ON A JOINT.

IT IS THE CARTILAGE WEARING AWAY AND RESULTING IN THINNING OF THE CARTILAGE OR CARTILAGE HOLES AND THAT RESULTS IN PROGRESSION OF ARTHRITIS.

TWO MAIN KINDS.

OSTEOARTHRITIS AND RHEUMATOID ARTHRITIS.

OSTEOARTHRITIS IS WEAR AND TEAR, RHEUMATOID IS THE AUTOIMMUNE DISEASE THAT LEADS TO DESTRUCTION OF THE JOINTS FROM INFLAMMATORY RESPONSES FROM THE IMMUNE SYSTEM.

>> HOW COMMON IS ARTHRITIS OF THE KNEE OR HIP?

>> EXTREMELY COMMON.

MOST AMERICANS OVER THE AGE OF 60 ARE GOING TO HAVE SOME FORM OF ARTHRITIS THAT AFFECTS ONE OF THEIR LOWER EXTREMITY JOINTS HIPS, KNEE OR ANKLE.

EXTREMELY PREVALENT ACROSS THE WORLD IN ALL SPECIES.

IT DOESN'T JUST AFFECT HUMANS.

IT AFFECTS ANIMALS AS WELL.

>> OUR DOG USED TO HOBBLE UP THE STAIRS.

IT WAS VERY PAINFUL TO WATCH.

SO AGE, IT SOUNDS LIKE, IS ONE OF THE FACTORS THAT CONTRIBUTES TO ARTHRITIS.

WHAT ABOUT OTHER THINGS.

DIET.

>> I THINK THE MAJOR THING IS AGE, ACTIVITY LEVEL, WEAR AND WEAR, PRIOR TRAUMA, WEIGHT AND FORCE ON THE JOINTS.

THERE IS A NUMBER OF THINGS THAT LEAD TO ARTHRITIS AND I THINK EVERYBODY HAS THEIR OWN REASON WHY THEY HAVE IT.

THERE IS GENETIC COMPONENTS WE DON'T FULLY UNDERSTAND.

AND THEN THERE IS POST TRAUMATIC ARTHRITIS AND GENERAL WEAR AND TEAR, THE VAST MAJORITY OF THEM.

MOST PATIENTS WITH RHEUMATOID ARTHRITIS ARE USUALLY DIAGNOSED EARLIER IN LIFE AND MEDICALLY TREATED AND HAVE DONE MUCH BETTER IN THE LAST DECADE WITH THE DISEASE MODIFYING ANTIRHEUMATIC DRUGS THAT HAVE CHANGED THE FACE OF WHAT WE SEE WITH RHEUMATOID ARTHRITIS.

>> WHEN WE GET INVOLVED AS SURGEONS, PATIENTS HAVE LOSS OF THE CARTILAGE, REGARDLESS WHETHER IT'S BECAUSE OF A PREVIOUS INJURY, INFECTION, RHEUMATOID ARTHRITIS, BAD LUCK, BAD GENES, EVENTUALLY YOU GET TO A POINT WHERE THERE IS VERY LITTLE CARTILAGE LEFT IN THE JOINT AND YOU COME TO SEE THE ORTHOPEDIC SURGEON BECAUSE YOUR KNEE HURTS, IT SWELLS, CLICKS, STICKS, POPS.

MOST IMPORTANTLY, YOU CAN'T GET THROUGH YOUR DAY.

THE THINGS YOU WANT TO DO, I WANT TO RUN A MARATHON EVERY DAY, BUT HEY, I WANT TO GO SHOPPING, GO ON A TRIP, I WANT TO DO A GENTLE HIKE.

I WANT TO BE ABLE TO GO PLAY WITH THE GRANDKIDS.

I WANT TO BE ABLE TO, YOU KNOW, DO REASONABLE GOALS, YOU CAN'T DO THAT ANYMORE BECAUSE YOUR JOINTS HURT.

THEY SWELL AND THEY PREVENT YOU FROM DOING THOSE ACTIVITIES.

>> YOU KNOW, I'VE ACTUALLY RUN A COUPLE OF MARATHONS.

I'M A RUNNER AND BIKER AND I USED TO BE WORRIED THAT WHEN I RAN A LOT, I WOULD WEAR OUT MY JOINTS BUT THEN I READ SOME RESEARCH THAT SAID THAT IS NOT TRUE.

SO CAN SOMEBODY COMMENT ON THAT?

>> ARTHRITIS IS REALLY A DISEASE OF WHAT YOU MAKE OF IT.

GENERALLY IT'S NOT SOMETHING THAT'S GOING TO KILL YOU, BUT THERE IS RESEARCH THAT SHOWS THE MORE YOU DO THINGS, THE MORE ACTIVE YOU ARE, IT'S HEALTHY FOR YOUR JOINTS.

I TELL MOST OF MY PATIENTS SUFFERING FROM ARTHRITIS.

USE IT OR LOSE IT SITUATION.

WHEN WE DO JOINT REPLACEMENT, WE AREY PLACE THE SURFACE OF THE BONE AND A LITTLE CARTILAGE, THE MUSCLE TENDONS AND I WILLING AMOUNTS ARE YOURS.

UNTIL YOU START RUNNING MORE THAN 27 OR 30 MILES A WEEK, THERE IS NO NEGATIVE EFFECT ON YOUR KNEES.

EVEN WHEN WE HAVE PATIENTS WITH ADVANCED ARTHRITIS, WE GET THEM TO THERAPY COLLEAGUES, GO TO LOWER IMPACT AND TRY TO DO HIGH REPETITION LOW WEIGHT LOW IMPACT AND THAT'S PROTECTIVE FOR THE JOINTS.

THE MORE MOBILE AND STRETCHED OUT YOU ARE, THE EASIER SURGERY IS GOING TO BE WHEN YOU GET TO THAT POINT.

SO I THINK THE MORE YOU DO AND THE MORE ACTIVE YOU ARE IN ENJ, THE BETTER YOU ARE GOING TO FAIR WHEN YOU GET TO THE POINT OF SURGERY.

>> WE RECENTLY SPOKE TO A MAN JUST A MONTH REMOVED FROM KNEE REPLACEMENT.

HIS NAME IS DANIEL VARGA AND HE'S CURRENTLY ON THE ROAD TO RECOVERY.

LET'S TAKE A LOOK.

>> MY NAME IS DANIEL VARGA I JUST HAD A KNEE REPLACEMENT ABOUT FOUR WEEKS AGO AT THE SURGICAL CENTER AT S.O.S.

MY LIFE BEFORE SURGERY, YOU KNOW, MY GENERAL PHYSICAL CAN BE PROBABLY WASN'T AS GOOD AS IT COULD HAVE BEEN BECAUSE I JUST COULDN'T EXERCISE AND THINGS LIKE THAT.

IT WAS JUST TOO PAINFUL.

>> PREDOMINANTLY MOST OF MY PATIENTS WHEN THEY COME INTO THE OFFICE WITH SIGNIFICANT ARTHRITIS IN THEIR KNEE, THEY REALLY HAVE PAIN WITH ALMOST ALL THE THINGS THEY DO.

WE REFER TO THEM AS ACTIVITIES OF DAILY LIVING.

DANIEL HAD THE BREAD AND BUTTER CHRONIC DEGENERATIVE CHANGES WHERE JUST OVER THE COURSE OF TIME HE WORE DOWN A LOT OF THE CARTILAGE ON THE ENDS OF THE BONES IN HIS KNEE JOINT.

>> I LIKE TO PLAY TENNIS AND I LIKE TO GOLF AND I LIKE TO SKI.

THOSE THINGS ALL KIND OF SUFFERED.

I WASN'T ABLE TO DO THEM.

SOME NIGHTS COULDN'T SLEEP BECAUSE OF THE PAIN.

YEAH, THE PAIN WAS PRETTY STEADY.

>> PATIENTS AND PEOPLE ARE LIVING LONGER, MORE ACTIVE LIVES.

AND AS A RESULT OF THAT, THEIR HIPS AND THEIR KNEES ARE BEARING THE BURDEN OF DOING THOSE THINGS.

BEFORE THE SURGERY, WE TRIED TO DO SOME INJECTIONS INTO THE KNEE.

THEY OFFERED SOME RELIEF FOR A TIME, BUT, YOU KNOW, OVER TIME, THEY WOULD WEAR OFF AND I NEVER-- THE BIGGEST THING WAS I NEVER GOT ANY MOBILITY BACK.

COULD I NEVER REALLY BEND THAT KNEE.

>> THE INJECTION DIDN'T PROVIDE ANY RELIEF OF THEIR SYMPTOMS AND THEY'RE HAVING PAIN EVERY DAY WITH THEIR ACTIVITIES OF DAILY LIVING, WE THEN START DISCUSSIONS TO SEE IF SURGERY IS SOMETHING THAT THEY'RE ULTIMATELY INTERESTED IN PROCEEDING WITH.

>> HE BASICALLY SAID YOU ARE KIND OF AT THE END OF THE LINE WITH THIS.

YOU CAN EITHER LIVE WITH IT OR DO THE KNEE REPLACEMENT.

SO WE DECIDED TO DO THE KNEE REPLACEMENT.

MY BIGGEST CONCERN WAS RECOVERY TIME, YOU KNOW, HOW LONG WAS IT GOING TO TAKE ME TO GET BACK ON MY FEET AND GET WALKING AGAIN.

BUT THE IMMEDIATE RECOVERY WAS SURPRISINGLY MUCH BETTER THAN I THOUGHT IT WAS GOING TO BE.

I MEAN I WAS UP AND WALKING IMMEDIATELY.

AS SOON AS I GOT OUT OF RECOVERY, I GOT UP AND WALKED AROUND THE WARD AND DID SOME STAIRS AND YOU KNOW, WALKED OUT TO THE CAR AND WENT HOME AND WAS WALKING AT HOME.

>> THE GOAL OF SURGERY IS TO ELIMINATE THE PAIN THAT THE ARTHRITIS HAS CAUSED.

SO BY ELIMINATING THE PAIN, WE ARE ALLOWING THEM TO GET BACK TO THE THINGS THAT THEY WANT TO DO.

>> FROM DAY ONE OF THE SURGERY, MY KNEE PAIN WAS LESS, ACTUALLY, THAN IT HAD BEEN PRIOR.

YOU KNOW, AND EVERY DAY IT SEEMED TO GET A LITTLE BIT BETTER.

>> WE DO THE PROCEDURE IN THE OPERATING ROOM BUT THAT'S JUST THE START OF IT AND IN THE SENSE THAT THERE TENDS TO BE A PROCESS AFTER THE SURGERY, AFTER SURGERY, ESPECIALLY WITH A JOINT REPLACEMENT, THERE IS A LOT OF DEFICITS BESIDE THE PAIN THAT ARTHRITIS CAUSES SO THEY'LL HAVE A LOSS OF MOTION, A LOT OF STRENGTH.

THEY'LL HAVE AN ALTERED GATE, LISTENING A LOT AND FAVORING THAT.

MANY MONTHS OR EVEN YEARS BEFORE THEIR SURGERY.

PHYSICAL THERAPY IS REALLY IMPORTANT TO FIX EVERYTHING ELSE THAT THE SURGERY, THE JOINT REPLACEMENT FIXES AS FAR AS PAIN GOES.

>> IT'S ONLY FOUR WEEKS OUT BUT THE INDICATIONS ARE THAT I SHOULD BE A LOT MORE MOBILE.

I MEAN I'M DOING STEPS IN A NORMAL FASHION NOW WHEREAS BEFORE I WAS ALWAYS DEPENDING ON MY GOOD LEG, IF YOU WILL, TO GET UP AND DOWN THE STEPS.

NOW I'M WALKING UP AND DOWN THE STEPS MORE NORMALLY.

>> DAN IS A MONTH OUT OF THE SURGERY TODAY.

SO HE IS DOING FANTASTIC.

HE IS PROBABLY ALMOST DONE WITH PHYSICAL THERAPY FROM OUR STANDPOINT.

HE PUT IN A LOT OF HARD WORK BEFORE THE SURGERY DOING EXERCISES PRESCRIBED TO HIM AND THAT HELPED HIM ACCELERATE AND HE IS REALLY MOTIVATED.

HE DID WHAT HE WAS SUPPOSED TO DO BEFORE AND HAS DONE WHAT HE IS SUPPOSED TO DO AFTERWARDS.

>> PHYSICAL THERAPY IS KEY, NO DOUBT ABOUT IT.

I MEAN IF YOU STICK WITH IT AND DO THE EXERCISES EVEN THOUGH THEY'RE PAINFUL SOMETIMES, YOU FEEL BETTER AFTERWARDS.

>> USED TO BE PRETTY DREADED, YOU KNOW, JOINT REPLACEMENT.

BUT WITH THE RESULTS THAT WE HAVE SEEN OVER THE LAST FIVE OR SIX YEARS, ADVANCEMENTS IN THE PROCEDURES, THE TECHNOLOGY, OUR DOCTOR SKILLS, IT'S REALLY, YOU KNOW, WE ARE SEEING A LOT MORE PATIENTS LIKE DAN, WHO IS PRETTY MUCH DONE IN A MONTH, AFTER KNEE REPLACEMENT.

>> IT ALLOWS THEM TO GET BACK TO DOING THE THINGS THAT THE ARTHRITIS HAS PREVENTED THEM FROM BEING ABLE TO PERFORM.

>> THE KNEE PAIN IS GONE FOR THE MOST PART.

NOBODY WANTS THE SURGERY BUT THIS IS THE BEST OUTCOME, I THINK YOU COULD ASK FOR.

MY EXPECTATION IS THAT I WILL BE BACK IN THE SUMMER HOPEFULLY TO DO MY REGULAR ROUTINE.

>> SO, GUYS, AS I SAID, I'M A RUNNER AND BIKER.

I HAVE HAD AN UNENDING LIST OF KINDS OF MINOR INJURIES WHERE I THINK OH MY GOD, I'M GOING HAVE TO HAVE MY KNEE REPLACED OR, YOU KNOW, AND I GO TO P.T.

AND YOU GUYS HAVE HELPED ME NOT YOU PERSONALLY, BUT YOU AS A PROFESSION HAVE HELPED ME ENDLESSLY.

YOU KNOW, WHEN SOMEBODY COMES INTO YOU AND THEY SAY I GOT A KNEE PROBLEM, HOW DO YOU KNOW THE DIFFERENCE BETWEEN SOMETHING THAT'S NOT SERIOUS AND SOMETHING THAT'S MIGHT NEED TO GO TO THE ORTHO GUYS.

>> ONE OF THE CRITERIA TO HAVE A KNEE REPLACEMENT IS THAT YOU'VE TRIED ALL THE OTHER THINGS AND EXHAUSTED THE POSSIBILITIES.

I THINKITIS REALLY IMPORTANT TO REMEMBER THAT YOU ARE NOT HAVING A KNEE REPLACEMENT BECAUSE YOU HAVE A DIAGNOSIS OF ARTHRITIS.

ALMOST ALL OF US THAT LIVE INTO MIDDLE AGE AND OLDER AGE, IF WE X-RAYED OUR JOINTS, YOU ARE GOING TO FIND ARTHRITIS AND THE INDICATION IS THAT SEVERE PAIN THAT'S NOT RELIEVED BY DOING ALL THE OTHER CONSERVATIVE MEASURES, AND THAT STIFFNESS THAT DOESN'T GET BETTER.

SO THE FIRST LINE OF TREATMENT IS GOING TO BE TO, YOU KNOW, START SOME EXERCISE.

WHAT ARE YOUR PROBLEMS?

SO IF YOU ARE WEAK, WE ARE GOING TO STRENGTHEN THE MUSCLES.

IF YOUR JOINT IS STIFF, WE ARE GOING TO WORK ON THAT.

EVEN IF YOU ULTIMATELY END UP NEEDING A JOINT REPLACEMENT DOWN THE ROAD, YOU ARE GOING TO BE BETTER FOR IT, BETTER PREPARED FOR THE SURGERY AND HAVE A BETTER OUTCOME.

IT'S NEVER WASTED TIME OR EFFORT.

>> AS WE TALK ABOUT THIS CONSERVATIVE MEASURES, EVERYBODY IN OUR OFFICE GETS TOLD THE SAME THINGS.

AT THE END OF THE DAY, THERE ARE ONLY TWO RECOMMENDED STRONG RECOMMENDATIONS FOR TREATMENT OF OSTEOARTHRITIS FROM THE AMERICAN ASSOCIATION OF ORTHOPEDIC SURGEONS.

THERAPY, ACTIVITY MODIFICATION AND THEN WEIGHT LOSS.

SO THOSE ARE THE TWO THINGS I TALK TO ALL MY PATIENTS ABOUT.

THE OTHER TWO THINGS WE GENERALLY RECOMMEND ARE ANTIINFLAMMATORIES SO IBUPROFEN OR ALEVE OR PRESCRIPTION ANTIINFLAMMATORIES OR INJECTIONS LIKE CORTIZONE OR JEL SHOTS ARE OPTIONS AND THE EFFICACY OF THEM ARE VARIABLE BUT THOSE ARE THE FOUR RECOMMENDED TREATMENTS OF ORTH RIGHTS BEFORE WE GET TO SURGICAL OPTIONS.

>> WE GET A LOT OF THINGS ABOUT, YOU KNOW, SHOULD I LOOK ONLINE AND DO THIS EXERCISE PROGRAM OR WHAT DOES Dr. GOOGLE SAY I SHOULD DO AS FAR AS MY KNEE PAIN.

WE DO A LOT OF EDUCATION OF WHAT TO DO BUT ALSO WHAT NOT TO DO.

YOU KNOW, PROBABLY NOT DO A LOT OF STAIRMASTER.

MAYBE MORE SWIMMING.

MAYBE ELLIPTICAL VERSUS RUNNING ON THE TREAD MILL.

A LOT OF THAT IS EDUCATION THAT THERAPISTS DO FOR PATIENTS TO PROLONG THAT, IF THEY CAN.

REALLY GIVE THEM MORE TIME TO DECIDE IF THEY WANT TO GO THROUGH THE JOINT REPLACEMENT OR NOT.

>> THE OTHER THING I FIND REALLY IMPORTANT IS ONCE THAT DECISION TO DO A JOINT REPLACEMENT IS MADE, TO HAVE THE PATIENT GO TO PHYSICAL THERAPY BEFORE SURGERY.

IT'S A LOT EASIER TO LEARN EXERCISES, TO LEARN TREATMENT WHEN THE KNEE DOESN'T HURT.

IT'S CLEARLY GOING TO HURT IN THE WEEK AFTER SURGERY.

SO TO EDUCATE PATIENTS, TO HAVE REALIST IX EXPECTATIONS OF WHAT THEY'RE GOING TO EXPERIENCE AFTER SURGERY, AND TO GET THEM AS MUCH MOTION AND STRENGTH GOING INTO THE OPERATION TO MAKE THEM THE BEST CANDIDATE SO THAT THEY'RE QUICKER TO RECOVERY AND FEEL BETTER AND I CERTAINLY THINK THAT SINCE WE HAVE BEEN DOING THIS, PATIENTS GO HOME QUICKER, FEEL BETTER, GET THEIR MOTION BETTER AND PHYSICAL THERAPY BOTH BEFORE AND AFTER SURGERY ARE CRUCIAL.

>> ABSOLUTELY.

>> PRE-HAB HAS RESULTED, YOU ARE RIGHT, IN THE EDUCATION, BEFORE SURGERY, IT'S EDUCATIONAL, THERAPEUTIC AND PROBABLY THE BIGGEST DRIVER IN REDUCED LENGTH OF STAY AND TRANSITION TO THE OUTPATIENT SURGERY WORLD IS KNOWING WHAT YOU ARE DOING BEFORE SURGERY.

YOU ARE NOT LEARNING IT FOR TWO DAYS IN THE HOSPITAL.

YOU ARE GOING HOME SIX OR EIGHT HOURS OFF SURGERY UNLESS PEOPLE SPEND THE NIGHT, WE ARE DOING SO MUCH MORE INVASIVE OR LESS DURATION OF HOSPITALIZATION NOW AND IT ALL STARTS IN THE OFFICE BEFORE SURGERY.

>> SO Dr. KOPKO, YOU GUYS BROUGHT THESE MODELS HERE.

CAN YOU TAKE THAT MODEL AND SHOW US-- YEAH, WHAT IS GOING ON WHEN YOU HAVE ARTHRITIS IN THE JOINT?

WHERE IS IT AND... >> IN GENERAL THIS IS THE REPLACED KNEE, THE FEMUR, TIBIA, LONG BONE AND SHIN.

THIS IS A REPLACED KNEE.

YOU CAN'T SEE THE ARTHRITIS BUT ANYTHING THAT IS SHILL VER OR WHITE WHAT IS WE AREY PLACED.

WHEN YOU LOOK AT KNEE REPLACEMENT, WE DON'T REPLACE THAT MUCH BONE.

IT'S NOT LIKE THERE IS A BIG CUT AT THE TOP OR BOTTOM.

WE ARE GENERALLY REPLACING 10 MILL MILLIMETERS OF BONE ALL THE WAY AROUND.

INCREASED SURFACE AREA WHERE THE IMPLANT ARE CEMENTED OR GROW INTO THE BONE.

TIBIA CUT GETS A HORIZONTAL CUT AND BETWEEN THE TWO THERE IS A PLASTIC LINER WHICH IS A POLYETHYLENE BEARING.

THE IMPLANTS UTILIZED IS A METAL PEOPLER, BASE PLATE AND PLASTIC LINER BETWEEN THEM AND MOST PATIENTS THE KNEE CAP IS REMOVED AND THERE IS A PLASTIC KNEE CAP TO THE PATELLA.

>> YOU SUPER GLUE IT?

>> IT IS BASICALLY DENTAL CEMENT.

WHEN IT WAS FIRST DESIGNED, IT WAS A DENTIST WHO DESIGNED BONE CEMENT.

HE TRIED TO SELL IT AND NOBODY WABLED TO USE IT-- NOBODY WANTED TO USE IT AND IT WAS MARKETED FOR JOINT REPLACEMENT AND IMPLANTS.

IT'S MORE A GROUT THAN A CEMENT.

IT DOESN'T ACT LIKE A CEMENT DOES TYPICALLY.

BUT THAT'S WHAT THE I AM PLANTS USE.

THEY HAVE A CEMENT BONE INTERFACE WHERE YOU CEMENT IT OR IMPLANTS DESIGNED MORE COMMONLY IN THE HIP THAN THE KNEE WHERE WHERE THE BONE GROWS INTO THEM, PRINTED AT A 3D STRUCTURE OF BONE AND IT GROWS INTO THE IMPLANTS.

>> I WANT TO SHOI YOU A CLIP FROM MY BROTHER, CHARLIE LIVES IN RURAL ALASKA IN THE MIDDLE OF NOWHERE AND HE HAD A LOT OF PAIN IN HIS HIP FOR A LONG TIME AND HAD A HIP REPLACEMENT ABOUT EIGHT MONTHS AGO.

NOW LIVING IN RURAL ALASKA HAS ITS CHALLENGES, BELIEVE ME.

AND I'M AMAZED THAT HE IS BACK TO DOING HIS EVERYDAY ROUTINE.

WAIT UNTIL YOU SEE THIS.

>> CHARLIE O'NEILL, Dr. RICH O'NEILL'S BROTHER WHO LIVES IN ALASKA.

YOU MIGHT BE ABLE TO TELL BY MY OUTFIT HERE THAT I LIVE IN ALASKA.

IT'S 30 BELOW ZERO TODAY AND HE ASKED ME TO SHOW YOU A COUPLE THINGS ABOUT MY HIP MOBILITY.

NO PAIN EVER, UNBELIEVABLE INCREASE IN RANGE OF MOTION.

>> DOWN TO THE SNOW MACHINE.

GETTING READY TO GO HARVEST WOOD TO GIVE YOU AN IDEA WHAT I'M WALKING THROUGH ROUTINELY.

I'M GOING TO POINT THIS CAMERA DOWN TO MY FEET.

THESE ARE MY KNEES YOU CAN SEE RIGHT AT SNOW LINE.

GIVES YOU AN IDEA.

I HAVE NO PROBLEM WITH MY HIPS.

>> LIFE IS PHYSICAL, ICY.

THIS IS ONE OF MY HEAVIER TASKS GETTING FIREWOOD ALMOST ON A DAILY BASIS.

THIS IS THE TERRITORY I LIVE IN.

A GLACIER, THE BIG WHITE THING IN THE FOREGROUND IS A GLACIER.

IT'S THE MIDDLE OF WINTER.

AND GETTING AROUND EVEN WITH A NORMAL HIP WOULD BE CHALLENGE.

I HAD INTERIOR REPLACEMENT IN JUNE.

I'M LIKE A NEW MAN.

THAT'S ALL I CAN TELL YOU.

>> Dr. SHERMAN.

SHOW ME WHAT YOU GUYS DID TO MY POOR BROTHER.

>> THERE ARE A LOT OF DIFFERENT THINGS WHEN IT COMES TO HIPS.

THE HIP IS A SIMPLER JOINT THAN THE KNEE BUT THE HIP IS A BALL AND SOCKET.

THIS IS A AREY PLACED HIP BUT IN THE NATURAL 4EU7 YOU ARE GOING TO HAVE BONE CONTINUE UP AND IT FORMS A BALL AND SITS IN A SOCKET.

AND WHAT WE DO IN A HIP REPLACEMENT IS WE CUT THE NECK OF THE FEMUR AND REMOVE THAT BALL BECAUSE THE BALL IS ALL WORN OUT AND WE CLEAN A LITTLE BIT OF BONE OUT OF THE SOCKET AND WE PUT A TITANIUM SOCKET INTO THE PELVIS AND TAKE ANOTHER PIECE OF TITANIUM AND WEDGE IT INTO THE SHAFT OF THE FEMUR AND PUT A NEW BALL AND LINER IN AND WE GIVE SOMEBODY A NEW BALL AND SOCKET JOINT.

THERE ARE DIFFERENT OPTIONS AS FAR AS MATERIALS.

IS IT A CERAMIC ON PLASTIC, CERAMIC ON CERAMIC.

AND THIS IS A LOT OF FACTORS GO INTO THE DECISION OF WHAT WE USE.

BUT AT THE END OF THE DAY, ALL HIP REPLACEMENTS ARE GOING TO BE A REPLACEMENT WITH BALL AND SOCKET.

>> SO MY BROTHER IS ONE OF THOSE GUYS WHO SETS OFF THE ALARM WHEN HE GOES THROUGH THE THING AT THE AIRPORT, RIGHT?

>> ABSOLUTELY.

>> WHAT IS HARDER TO RECOVER FROM?

THE KNEE OR THE HIP?

>> I WILL SAY THE MORE CHALLENGING IS THE KNEE REPLACEMENT THAN COMPARED TO HIP REPLACEMENT.

AND I THINK THAT'S BECAUSE IT'S A MORE PAINFUL JOINT REPLACEMENT BECAUSE OF THE LOCATION OF THE INCISION.

THERE IS A LOT OF MANUAL THERAPY INVOLVED RIGHT FROM DAY ONE WHEN WE SEE OUR PATIENTS ABOUT THREE DAYS AFTER SURGERY, WE ARE MAINLY STRETCHING.

AND I THINK THAT'S CRUCIAL TO A KNEE REPLACEMENT WHEREAS THEY DON'T HAVE TO DO SO MUCH OF THAT WITH HIP REPLACEMENT.

WITH THEIR OWN STRETCHING IN THE HIP, THEY GET THE MOTION BACK ON THEIR OWN.

KNEE, THEY NEED A LITTLE HELP FROM THE THERAPIST AND THAT'S USUALLY WHAT IS THE MOST APPREHENSION FOR PATIENTS WHEN THEY COME INTO THE OFFICE.

WE START WITH THE FIRST THREE OR FOUR DAYS.

>> KERRY, WHEN THEY SAY MANUAL THERAPY, I THINK THAT'S YOU GRAB THE THING AND... AND THEY'RE MAD AT YOU.

WHAT DO YOU ACTUALLY DO?

>> SORT OF.

WE CLOSE THE DOOR SO THEY CAN'T HEAR THE SCREAMING.

NO.

IT IS UNFORTUNATELY, IT CAN BE PAINFUL BUT WE WORK, WE EXPLAIN TO THE PATIENT WHAT WE ARE GOING TO DO AHEAD OF TIME, WORK WITH THEIR MEDICATIONS IF WE NEED TO.

BUT IT REALLY IS THAT HANDS ON, THAT PHYSICAL THERAPY WHERE THE THERAPIST IS WORKING ONE ON ONE PUTTING THEIR HANDS ON THE NEW JOINT TO DO TECHNIQUES TO IMPROVE THE RANGE OF MOTION.

>> I THINK THAT'S ONE OF THE BIG KEYS TO FINDING A GOOD THERAPIST AND HAVING A GOOD RELATIONSHIP WITH YOUR THERAPIST.

IF YOU DO THE PRE-HAB BEFOREHAND, MEET YOUR THERAPIST, KNOW YOUR EXPECTATIONS GOING INTO SURGERY.

BUT WE'VE GOT REALLY GOOD DATA WITH BOTH OF THE GROUPS IN TOWN THAT, YOU KNOW, PATIENTS WHO GO TO OUR THERAPISTS AND TALK TO US AND STACY IS ACROSS THE HALL FROM ME ON TUESDAY.

SHE TELLS ME WHAT PATIENTS ARE DOING WELL, WHAT PATIENTS I NEED TO PAY ATTENTION TO.

THAT'S HELPFUL.

YOU KNOW WHAT PATIENTS ARE DOING BECAUSE YOU ARE GETTING FEEDBACK RIGHT AWAY RATHER THAN WEEKS LATER WHEN YOU GET A FAX FROM ANOTHER THERAPIST.

>> AND I DON'T THINK WE WANT TO SCARE PATIENTS AND TELL THEM THAT YOU ARE GOING TO LEAVE IN TEARS EVERY DAY BECAUSE YOU ARE NOT.

IF THAT'S THE EXPERIENCE YOU HAVE, YOU PROBABLY SHOULD FIND A DIFFERENT PHYSICAL THERAPIST BUT IT'S NOT GOING TO FEEL GOOD.

BUT IF YOU PUT THE EFFORT IN, ESPECIALLY THAT FIRST FOUR WEEKS IN THE KNEE, MORE LIKE TWO OR THREE WEEKS PROBABLY WITH A HIP, YOU PUT THAT EFFORT IN AND IT WILL PAY HUGE DIVIDENDS BECAUSE YOU WILL HAVE 25, 30 YEARS OF A NEW JOINT THAT YOU ARE SO HAPPY.

>> I THINK WE TALKED EARLIER, IF YOU ASK A KNEE REPLACEMENT WITHIN A MONTH OR TWO, IF YOU WANT ANOTHER ONE DONE, THEY WOULD SAY NO BUT WITHIN SIX MONTHS THEY WOULD SAY IT WAS WORTH IT.

>> HOW LONG DOES IT TAKE TYPICALLY TO RECOVER FROM A HIP?

HOW LONG DO PEOPLE COME TO SEE YOU?

>> OUTPATIENT THERAPY AVERAGE FIVE TO SEVEN WEEKS.

NATIONAL AVERAGE IS EIGHT WEEKS.

FOR A HIP, FOUR TO SIX WEEKS.

NATIONAL AVERAGE EIGHT WEEKS.

>> Dr. SHERMAN, WHAT ADVICE WOULD YOU GIVE TO SOMEBODY WHO IS ON THE, YOU KNOW, CUSP ABOUT JOINT REPLACEMENT SURGERY?

>> I WOULD SAY KEY IS DO IT BUT MAKE SURE THAT YOUR SYMPTOMS ARE SEVERE ENOUGH TO WARRANT AN OPERATION.

NOBODY SHOULD GO INTO AN OPERATION JUST BECAUSE HEY, IT BOTHERS ME EVERY ONCE IN A BLUE MOON.

BUT WHEN YOUR QUALITY OF LIFE IS SEVERELY AFFECTED AND YOU CAN'T DO THE ACTIVITIES OF DAILY LIVINGOR CAN'T ENJOY YOURSELF BECAUSE A JOINT HURTS BECAUSE OF ARTHRITIS, ABSOLUTELY.

IT'S ONE OF THE BEST THINGS WE DO.

IT'S ONE OF THE MOST COST EFFECTIVE SURGERIES OUT THERE TO GIVE PEOPLE QUALITY OF LIFE BACK.

>> THAT'S WHAT MY BROTHER SAID.

HE SAID HE SUFFERED FOR A NUMBER OF YEARS.

HE WAS REALLY LIMITED IN WHAT HE COULD DO.

AFTER THE SURGERY A COUPLE WEEKS LATER, HE WAS BACK TO DOING EVERYTHING HE WANTED TO DO.

IT WAS A TOTAL GAME CHANGEER.

>> LIFE EXPECTANCY GOES UP AFTER JOINT REPLACEMENT.

ONE OF THE ONLY SURGERIES, IN ORTHOPAEDICS THAT YOU ARE INCREASING-- >> GLAD TO HEAR IT.

AS LONG AS THE BEARS DON'T GET HIM IN ALASKA.

THAT'S ALL THE TIME WE HAVE, BUT I WANT TO THANK OUR PANELISTS AGAIN FOR JOINING US.

DR. KEVIN KOPKO, JOINT REPLACEMENT SURGEON AT SYRACUSE ORTHOPEDIC SPECIALISTS DR. ROBERT SHERMAN, JOINT REPLACEMENT SURGEON AT SUNY UPSTATE MEDICAL MR. STACY GRIFFITH, PHYSICAL THERAPIST AT SYRACUSE ORTHOPEDIC SPECIALISTS AND DR. KERRY WALSH, PHYSICAL THERAPIST AT SUNY UPSTATE MEDICAL BE SURE TO VISIT WCNY.ORG/CYCLEOFHEALTH FOR MORE INFORMATION ABOUT THIS AND OTHER EPISODES.

FOR CYCLE OF HEALTH, I'M DR. RICH O'NEILL.

THANKS FOR CHECKING IN.

ON THE NEXT CYCLE OF HEALTH, SCHIZOPHRENIA.

JOIN ME FOR AN INTIMATE CONVERSATION WITH A MAN DIAGNOSED WITH THIS BRAIN DISORDER AS HE TALKS ABOUT HIS EXPERIENCE AND THE STEPS HE'S TAKEN TO CARE FOR HIMSELF AND OTHERS.

THEN, HEAR FROM DOCTORS WHO TREAT SCHIZOPHRENIA, AND LEARN ABOUT THE COMPLEX SCIENCE BEHIND THIS DISEASE THAT AFFECTS 1 IN 100 OF US.

WE HOPE YOU'LL JOIN US FOR THE DISCUSSION, ALL ON THE NEXT CYCLE OF HEALTH.