Not Too Young for Joint Replacement

Intro: We're talking wellness at MemorialCare Health System. It's time for Weekly Dose of Wellness. Here's Deborah Howell.

Deborah Howell (Host): Well, hello, and welcome to the show. Glad to have you along. I'm Deborah Howell, and today we'll be talking about age and joint replacement. Our guest is Dr. Andrew Wassef, Medical Director and Orthopedic Surgeon at MemorialCare Joint Replacement Center, Long Beach Medical Center. Welcome, Dr. Wassef.

Andrew Wassef, MD: Thank you. Good morning, Deborah. Appreciate the invitation.

Deborah Howell (Host): Always great to have you on the show.

Andrew Wassef, MD: Thank you very much.

Deborah Howell (Host): Now, in the past, many people younger than 50 interested in joint replacement surgery were told to wait, despite the fact that their quality of life suffered as a result of joint pain. But advancements in joint replacement technology are now allowing a growing number of younger people to become candidates for joint replacement surgery. So, Dr. Wassef, across all ages, how can chronic joint pain affect someone's quality of life?

Andrew Wassef, MD: Well, chronic joint pain can really be a debilitating issue. We have so many patients now that have injuries at a young age, many of them are sports-related. And it creates a situation where they have knee or hip pain that can really decrease the amount of activities that they're able to do as they continue to try to enjoy the normal activities that they really like to do in their life. Unfortunately, there really is no way to stop joint pain because our joints are moving every time we take a step. And our job is to really try to decrease the symptoms, and if we cannot decrease the symptoms with medications and other options, then we start discussing surgery.

Deborah Howell (Host): Got it. Now, in the past, the majority of people seeking out joint replacement surgery were over the age of 65. How has that changed today?

Andrew Wassef, MD: Well, Deborah, we're seeing a real paradigm shift. As I said before, there's so many young patients now that we're seeing with pretty severe joint problems. And really, people are not willing to live in pain, and we really want to keep people active because we know so many other medical problems can occur if you do not stay active. Now we have technology that allows us to be so much more precise, and we're much more comfortable really offering our new surgical techniques with total joint replacements to younger candidates.

Deborah Howell (Host): Yeah, like the woman who cuts my hair. She's been on her feet, you know, for so many years, but she's only in her 40s, and she just had her hip replaced, and she is so, so happy now.

Andrew Wassef, MD: Well, you know, when you take a patient who has a really bad hip or knee and you do a joint replacement that's successful, it's a very, very rewarding thing to see how much pain relief they get and to see them really get back to their normal life and enjoy life again.

Deborah Howell (Host): Absolutely. Now, why would someone who is 65 or younger need a joint replacement surgery?

Andrew Wassef, MD: Well, there's really several reasons. First of all, some people are unfortunately genetically predisposed to arthritis. There's different types of arthritis, rheumatoid arthritis, and just the normal wear and tear arthritis. Other people have had injuries. Some people have broken their leg or broken their hip. Some people have had prior ACL reconstructions or tears in their cartilage or their meniscus that may predispose them to having arthritis at an earlier age.

Deborah Howell (Host): You just mentioned both of my surgeries that I've had. So I may be coming to you very soon.

Andrew Wassef, MD: [Laughs]

Deborah Howell (Host): Now, what are some of the advancements in joint replacement surgeries that are changing the culture of joint replacement surgery?

Andrew Wassef, MD: Well, really, the technology that we are using now in our MemorialCare system is the Mako Robotic-Arm Assisted arm, and that has really, really changed the way we look at joint replacements. It allows us to be so much more precise, and it allows us to create a surgical plan that is specific for each individual. Prior to this, we really didn't have the capabilities to fully understand what needs to be done in terms of a joint replacement. And so, this technology has just really made us so much more comfortable in ensuring that our patients are going to have good outcomes.

Deborah Howell (Host): That is awesome. So how does Mako technology improve surgical outcomes?

Andrew Wassef, MD: Well, prior to surgery, we obtain a CT scan, and the CT scan does not just go through the affected joint. So if we're doing a total knee replacement, we get a CT scan of the knee, and that CT scan also goes through the hip and the ankle, and it allows us to really, truly see the patient's normal anatomy. It gives us the ability to change the mechanical axis and to really see what their anatomy is prior to surgery so that we can give them the best surgical plan, we can size the implants perfectly, and we can put them in exactly how we want to. So it really allows us to accomplish our preoperative plan, which, prior to this, there was no technology that allowed us to be so precise.

Deborah Howell (Host): Absolutely. And just as an example, if I may, my brother-in-law, Jim, had hip replacement surgery, this is, you know, 10 years ago. And they guessed as well as they could, but they got the wrong size hip, so he had to have it redone. Had they had the Mako, and they could have seen the exact measurements before, they would have had a better result, and he wouldn't have had to have a second surgery.

Andrew Wassef, MD: That is very true. Unfortunately, there are many patients that may not have the most optimal outcome because we really were not in the position to have the information available to us. Now, with this new technology, the information is right there in front of us, and we can make much more educated decisions and really get it perfect.

Deborah Howell (Host): It's all about the math, isn't it?

Andrew Wassef, MD: That it is. Being able to accomplish our preoperative plan is what we all really strive to do. And for a surgeon to have technology that allows us to get it right every single time, it's really a game changer for us.

Deborah Howell (Host): It's absolutely fabulous. Now, how is this new technology, like Mako, improving the overall joint replacement experience for patients?

Andrew Wassef, MD: Well, I will tell you, I've had many patients of my personal patients who I've done their total knee replacement on one side normally prior to having the robotic-assisted technology, and have done their other side using the robot. And time and time again, they come back and say this is just so much easier. They're getting their motion much earlier, they're getting their strength back, and they're stopping using a cane, and they're just happier much sooner.

Deborah Howell (Host): I love it. How is Mako contributing to the growing trend of a younger patient population?

Andrew Wassef, MD: Well, younger patients obviously seek out the best technology because they want to make sure that they have obviously the best outcomes. For us, it gives us the extra assurance that we're going to give a young patient the best total joint possible, and that's going to give it the best longevity. We know now in our literature that really, if you put in a total hip or a total knee correctly and it's well-balanced, people will have a much longer lifespan with that joint. So it's really critical that we put the implants in correctly, and with the Mako Robotic-Arm Assisted technology, it really gives us the ability to put it in the correct mechanical position every time.

Deborah Howell (Host): Beautiful. Do you also do shoulders, or is it mainly hips and knees?

Andrew Wassef, MD: At this time, it's hips and knees, and partial knee replacements. The shoulder replacement with the Mako Robotic-Arm Assisted technology will be coming in the future, but we do have many great surgeons doing total shoulder replacements.

Deborah Howell (Host): Got it. Dr. Wassef, can you share a patient success story where a younger patient's quality of life was positively impacted thanks to their joint replacement surgery?

Andrew Wassef, MD: Yes, definitely. I've had many young patients, and these are more extreme cases, the one that really sticks out in my mind is a younger patient in his young 20s, I think he was 24, and he had what was called avascular necrosis, where the blood supply to the hip was interrupted causing the hip to die. When that happens, unfortunately, the head tends to collapse, and you tend to have very aggressive, severe arthritis. So he was a very young kid, and it was so debilitating that he was on chronic pain medications, and very, very high dose pain medications. He was also not walking normally. He was requiring a wheelchair, and he was requiring crutches, and he was unable to even complete his normal schooling as a student. And it was really traumatic for him. After his hip replacement, which thankfully went very, very successfully using the Mako Robotic-Arm Assisted technology, he really, really turned his life around. He's completely off of all the pain medications. He's just completely changed in every way, and it's really been a great, great journey and a great thing to see. And his family is so appreciative of him being able to actually be a normal member of their family again.

Deborah Howell (Host): That's absolutely wonderful, and probably one of the main reasons you became a doctor in the first place, right?

Andrew Wassef, MD: Definitely. Stories like that are really the most rewarding, and that's why we do this.

Deborah Howell (Host): Well, you just made my morning. How can people learn more about joint replacement surgery options at Long Beach Medical Center?

Andrew Wassef, MD: Well, if you go online and you look at memorialcare.org, there's a link there, it's actually memorialcare.org/lbjointreplacement, and you can get all the information on the Mako Robotic-Assisted technology and the surgeons that offer it.

Deborah Howell (Host): Well, thank you so much, Dr. Wassef, for all the good news and all the good work you're doing.

Andrew Wassef, MD: Thank you very much, Deborah. It's a pleasure.

Deborah Howell (Host): Wonderful to have you on the show. Very informative. And if you want more information or to listen to a podcast of this show, again, please visit memorialcare.org. That's memorialcare.org. I'm Deborah Howell. Thank you for listening, and have yourself a wonderful day.