Total Joint Replacement at BMC
In this segment, Eric L Smith, MD, joins the show to discuss how The Department of Orthopedic Surgery at Boston Medical Center, one of the most outstanding in New England, provides comprehensive, exceptional orthopedic care to every patient, without exception.
Eric L. Smith, MD is a fellowship-trained adult reconstructive orthopedic surgeon at Boston Medical Center. Dr. Smith’s clinical interests include primary joint reconstruction, revision joint reconstruction, and arthritis. He specializes in various types of hip and knee surgery, including replacements, resurfacing, total joint replacement in bariatric patients, and total hip arthroplasty using anatomic femoral heads – replacement parts that mimic the size and shape of the actual hip joint. After receiving his Bachelor of Science degree in biology from the University of California at Davis, he earned his medical degree at Tulane University School of Medicine in New Orleans, LA and completed his residency training at Tripler Army Medical Center in Honolulu, HI. Dr. Smith served ten years on active duty, during which time he was deployed to Afghanistan as an orthopedic surgeon in support of Operation Enduring Freedom. He also completed a specialized fellowship in adult reconstructive surgery at New England Baptist Hospital in Boston.
Melanie Cole (Host): More than 15 million Americans suffer from osteoarthritis according to the American Academy of Orthopedic Surgeons. This disease can affect the cartilage in joints and may cause pain, stiffness, swelling, and limited range of motion in the knees and hips. Surgery to replace or resurface joints becomes an option if your quality of life is greatly diminished by the disease and you have difficulty carrying activities of daily living. My guest today, is Dr. Eric Smith. He’s an orthopedic surgeon and the Section Chief of Total Joint Replacement at Boston Medical Center. Welcome to the show, Dr. Smith. Let’s first talk about some of the most common causes of joint pain, and specifically, in the knees and the hips, what do you see when people come in complaining of pain?
Dr. Eric Smith (Guest): Melanie, thank you, for having me. This is a very common scenario for patients to present to their doctor, their primary car physician, even the Emergency Room, complaining of pain in their hip or their knee that affects their quality of life and their daily activities. The most common causes of the pain that the patient is experiencing is osteoarthritis. Osteoarthritis is, essentially, the condition where the smooth, cartilage surface of the joint – either the hip or the knee – starts to wear itself out, and when it becomes degenerative, which -- kind of like cobblestone, becomes very bumpy and causes the patient to have pain.
Melanie: People are walking around -- maybe it’s just from weight bearing, it develops over the years – what’s the first line of defense if they come to see you? What do you do for them first?
Dr. Smith: That’s a great question because oftentimes the journey for patients to proceed from when they first have their pain or their pain or their symptoms, as they describe, to when they see me is a journey that’s inconsistent. Some people have acute pain, which means it just started a week ago. Others have been suffering from their pain for months if not years.
When I assess the patient in the office, we want to ensure that the first-line steps have been followed so that the patient can have the best outcome. These typically start with some form of modifying their activities. For instance, if they were not using a cane, oftentimes a cane can be beneficial to help relieve their pain. Also, pain medication in the form of nonsteroidal anti-inflammatories or Tylenol can be essential to relieving their pain.
And then, oftentimes, if patients are not responding to these modalities, they might be a candidate for an injection of corticosteroid, which is a powerful anti-inflammatory into their knee or their hip. And then lastly, we may consider some form of surgical intervention. I also would point out that some form of physical therapy, to ensure that their muscles are as strong and flexible as possible, can really help to relieve their pain before the need for surgery.
Melanie: Dr. Smith, when they’re considering surgery, people hear today about partial joint replacements and total joint replacements, what’s the difference?
Dr. Smith: The difference, Melanie, is that a partial replacement – in particular, a partial knee replacement – is just that. The knee joint is actually made up of three separate joints. There's the medial or inside part of the joint, there’s the lateral or outside part of the joint, and there’s also the kneecap part of the joint. A total knee replacement replaces those three joints.
And I just have to say -- a knee replacement is not an operation that completely replaces your knee. What it does is it shaves off the damaged portion of the knee -- which is the damaged cartilage that looks like cobblestone, if you will -- and replaces it with a cap – typically, a metal cap on the femur and then a metal cap on the tibia or down the shin bone. There’s a plastic shim that goes in between those two pieces. The partial replacement is in which only one portion, such as the inside or the outside part of the knee, has this replacement. The kneecap portion can also have a partial replacement.
Melanie: Okay, so, that was a great explanation. Thank you, because it explains it so well for the listeners and the anatomy and physiology of the knee. Now, with the hip, we hear that the different types of replacements, that out of all of them that the hip seems to be the one that people recover from the quickest, or have an easier time of it. You’re seeing hips being replaced in even younger and younger patients these days. Speak about hip replacement and what’s going on in the world of hip replacement today.
Dr. Smith: Yeah, Melanie, hip replacement – I’m happy to say – has been rated as the most successful operation performed in the United States. The success rate of this operation even exceeds the benefits of an iPhone, if you can believe that. Replacements are offered to patients that have pain that affects their quality of life and their daily activities. Because the technology has improved many-fold over the last several years, this operation has been offered and performed in even younger patients. All patients, of course, are taken on a case-by-case basis to determine the optimal type of operation for them, but it is a very safe and effective operation that when someone has that condition, I feel very strongly and very confidently to offer them that procedure.
Melanie: When does it get to that decision-making process, Dr. Smith? What do you tell them that they should be asking you about that decision and making that decision together with their orthopedic surgeon?
Dr. Smith: This is very much a co-decision making. It’s described as shared decision-making between the patient and the surgeon. Those patients that have pain that affects their quality of life and their daily activities are the best candidates for undergoing a surgical procedure to help relieve that pain. I keep saying this over and over for the patient’s own quality of life and the patient’s own daily activities because each patient is different. I have a saying that I like to tell the residents, which is, “I don’t treat the X-rays. I treat the patient.” I’m really listening to the patient tell me what their symptoms are and correlating that to what their X-rays look like, what their physical examination reveals, to help come up with the best overall plan for the patient.
Melanie: And tell us about your joint replacement capabilities at Boston Medical Center.
Dr. Smith: At Boston Medical Center, we have the Boston Medical Center Total Joint Replacement Center, which specializes in advanced reconstruction of joints for patients. This is inclusive of hip and knee replacements, including hip and knee replacement revisions. Revisions are operations in which patients have a joint replacement that has failed – there’s multiple different reasons that it can fail, but we offer the services to provide and restore the patient’s quality of life through our total joint center.
In addition, we offer partial replacements of the knee for those patients that are candidates, as well as we offer really the most advanced, cutting-edge technology in total joint replacement whether it’s the bearing surfaces that we use, whether it’s the direct anterior approach to the hip replacement that we offer, computer-assisted knee replacement if needed, and also, patient-customized knee replacement and patient-specific instrumentation when needed.
Melanie: Dr. Smith, based on the materials that you use these days, how long can one expect a replacement to last?
Dr. Smith: Melanie, that’s a great question, and it’s often asked by the patient. The survivorship of total joint replacements – both total hip and total knee replacements – has greatly improved over the last several years because of the newer technology, but it is still related to the usage of the joint replacement. The analogy is always – when you buy a new car, how long does the new car last? Well, it somewhat depends on how you drive the car. There are many factors that play a role in survivorship, such as the patient’s weight, their activity level, and so forth. What I would say is that in general, joint replacements are designed to last 15 to 20 years, but again some of those factors are dependent on the patient’s age, activity level, and so forth. The newer technologies have been shown to be quite wear-resistant with time.
Melanie: What would you like listeners to know about possibly preventing the need for a joint replacement in the first place? What do you tell weekend warriors or people that might be carrying a little bit of extra weight, or who maybe even have a genetic predisposition to having certain types of – maybe rheumatoid arthritis, or something – osteoarthritis – what do you tell them about taking good care of their knees and hips?
Dr. Smith: Joint health is a very important topic because you have your joints for your entire life and it’s important to take care of them just as you would take care of other parts of your body. This includes having a well-balanced, nutritious diet that avoids fatty foods and therefore, would avoid excessive weight gain. Keeping your weight at an optimal weight is very important. Making sure that you’re taking all of the necessary vitamins and minerals for a healthy diet, as well as participating in daily activities that promote good muscular strength as well as good cardiovascular strength. I’m not advocating for people to go out and become joggers or runners, but what I am advocating for is for people to have a healthy lifestyle in which they get out with activities whether it’s riding a bike, using the elliptical machine, swimming, walking. These are all important things to maintain the healthy joint care that’s important for the long-term benefits for your health.
Melanie: Certainly good advice, so wraps it up for us, and really, what you want people to know about joint replacement. When they come to see you, what do you tell people every single day, Dr. Smith, about considering this type of surgery?
Dr. Smith: The Total Joint Center at the Boston Medical Center is part of a large, collaborative, multi-specialty group, here at Boston Medical Center that is uniquely designed to care for patients with the most complex medical, social, and physical needs, as well as physical ailments, done in the most professional and collaborative way that I have ever seen of any medical center in the Greater Boston Area.
Melanie: Wow, thank you, so much. That’s really great information. You’re listening to Boston Med Talks, and for more information on a total joint replacement at Boston Medical Center, you can call 617-414-2273, or you can go to www.bmc.org/orthopedic-surgery, that’s www.bmc.org/orthopedic-surgery. This is Melanie Cole. Thanks, so much for listening.