Let’s Talk Joint Surgery

Released Sept. 23, 2025

PODCAST OPEN: Thank you for tuning in to the Live Yes! With Arthritis podcast, produced as a public service by the Arthritis Foundation. You may have arthritis, but arthritis doesn’t have you. Here, you’ll get information, insights and tips you can trust — featuring volunteer hosts and guest experts who live with arthritis every day and have experience with the challenges it can bring. Their unique perspectives may help you — wherever you are in your arthritis journey. The Arthritis Foundation is committed to helping you live your best life through our wide-ranging programs, resources and services. Our podcast is made possible in part by the generous financial contributions of people like you.

This episode of the Live Yes! With Arthritis podcast is brought to you in part by Pacira BioSciences.

Trina Wilcox: Welcome back to the Live Yes! With Arthritis podcast. My name's Trina Wilcox, your host for this episode. My diagnosis came when I was 6 years old. My parents had been trying to figure out what was going on, and they finally got that at 6. And a lot of my pain started in my hands, knees, feet. And throughout the years, my fingers have really been a challenge for me. And a wrist surgery was one of the first things that I had to undergo. But like many young folks that deal with the diagnosis, you have to wait until you're fully grown. So, they waited until I was in college, I believe, before we did the wrist fusion and pretty well handled everything for a while. Recently, I guess it's been almost two years now, I had to have a tendon replacement.

So, that is just one of the things that comes along with a diagnosis of arthritis, rheumatoid arthritis specifically for me, and that's our topic today. We're going to talk about surgery, knowing when to get surgeries for arthritis, joint surgery, how to prepare for it. It can all be tricky, convoluted, stressful, and even if your doctor has told you, "Hey, it's time to get this done," you might want to put it off. There's a lot of things to consider: the unknown, the pain, the disruption in life, insurance coverage, work. It's just all so inconvenient. And we're going to talk about a lot of those that come along with joint surgery.

In this episode, hopefully you'll find some insight; tips that will help you prepare if you have a surgery coming up. I'm joined by Alan Beyer, MD. Dr. Beyer is founding member of Hoag Orthopedic Institute. He graduated from Georgetown University School of Medicine. During his residency at the Hospital for Joint Diseases in New York, he became the chief resident of orthopedics and completed Sports Medicine Fellowship at the Kerlan-Jobe Orthopedic Clinic. His passion for sports influenced his decision to pursue this specialty and his own podcast, Doctor in the Dugout. Dr. Beyer, welcome to the podcast.

Dr. Alan Beyer: Well, thank you so much for having me today. Thrilled to be here.

Trina Wilcox: That's quite a resume you have. So, tell me, what's your whole experience with arthritis? And have ever had any surgeries?

Dr. Alan Beyer: My experience with arthritis personally is that, about 12 years ago, I was diagnosed with psoriatic arthritis. This was after being in clinical practice and medical practice for 30 years and taking care of literally thousands of people who themselves had osteoarthritis, or rheumatoid arthritis like yourself, psoriatic arthritis. So, I was diagnosed based on some swelling in my hands, which isn't a great thing for a surgeon to have, and began to develop more and more hip pain. So, my arthritis was brought under control with medical treatment. I was on a number of immunobiologics, remain on them to this day, but did require a hip replacement about 12 years ago already. Hard to believe it's been that long.

So, I've seen joint replacement on both sides of the knife, holding the knife and being on the receiving end of the knife. And I've really tried to use as much as I could my own personal experience to help counsel patients who are about to undergo joint replacement as to what they can expect, what it's going to do, what it's not going to do. And I think patients who go into these kinds of things with their eyes wide open and well educated about the pitfalls, pros, cons, do much better. And it also has been a wonderful tool for me to use to just reinforce my doctor-patient relationship over the years. So, it's been a big plus, not to mention the fact that my hip is doing fabulously, and I'm able to play golf a number of times a week and haven't thought about that hip ever since the surgery. We'll get into how you pick the right place and person to do your surgery so you can get that kind of outcome as well.

Trina Wilcox: Yes, it is great when you can have that relationship and have the empathy from the other side, like you're describing. It's so helpful.

Dr. Alan Beyer: Well, people are looking for proper guidance. Unfortunately, too many people rely on Dr. Google, which I try to talk them out of, because you don't know what the source of the information you're reading about necessarily on the internet is. And the best way to deal with that is to either go to a trusted source, like Cleveland Clinic's website or the Mayo Clinic's website, or the relationship that you've developed in the course of your treatment with your rheumatologist and/or your orthopedic surgeon.

Trina Wilcox: Well, you're bringing up a great point. Knowing when to have that surgery can sometimes be confusing. Fortunately, my personal experience, I've had a doctor that's been very straightforward and said, "You know, this needs to happen at this time." Or "This can wait," I've had that, too. You know, "This can wait as long as you can ride it out and your functionality’s OK." So, how do we know we're getting the right information?

Dr. Alan Beyer: It's a very, very tough tightrope to sometime navigate. I always will tell a patient one thing: "One of the reasons I went into orthopedic surgery is because I don't save lives. I just try to make people's quality of lives better." So, very few of the surgeries that I do are life-threatening, because of a life-threatening condition. So, by definition, most of these are elective surgeries, which means the patient and the doctor together can decide when is the right time. I try to tell patients, and I'm going to focus mostly on hip and knee replacement, because that's what I did the most of, is when your activities of daily living have gotten to the point where you're cutting back and not doing the things you want to do, let's face it, it's all about quality of life.

When we're getting to the point where just over-the-counter meds like Tylenol aren't cutting the mustard, where you've had to really cut back your physical activity, not be able to play with your grandchildren… I mean, there are so many things that we get enjoyment out of. Why take those things away from you when it's something that we can fix? And it’s when you’re starting to cut back on those things, that’s when it’s time to sit down and have the serious conversation about, “OK, now’s the time.”

Trina Wilcox: Well, you mentioned hip and knee. I know those are what you're most familiar with, but can you touch on some of the other things that we need to be prepared for as arthritis patients that could come up that we may need to seriously think about in our future?

Dr. Alan Beyer: I think the most important thing to do, obviously exhaust conservative therapies. You don't rush into surgery. Even the simplest surgery in the world has 1% of people, or 1/10th of 1% of people, have a complication and an untoward result. So, don't take surgery lightly. There's no such thing as minor surgery. I'm always fond of saying, "My definition of minor surgery is surgery on anybody but me," and that should be most people's definition of minor surgery. All surgery is major. You're going to get anesthetics, you're going to have meds, you're going to have disruptions in your lifestyle. There's always the possibility of something coming up that you didn't foresee. So, don't rush into it lightly. Take it seriously.

That said, when one has made the decision that, "OK, now I'm going to go ahead and proceed with my hip, my knee, my shoulder, my hand surgery," whatever, the next step is to optimize yourself for that surgery in several different ways. One thing you have to do is do the research. Find out “Who's the doctor I’m going to? What’s the facility I’m going to? What’s their reputation? How are their outcomes? What’s their infection rate? What’s their readmission rate? How many of these has the doctor done? And am I the third case that he’s doing?” Optimize who's doing it and where you're having it done.

Second of all, optimize yourself. And what does that mean? Get yourself in a situation where you remove as many of the stresses that might be present after the surgery that could negatively impact you. That is, have some help around the house to help you that first week or two. Don't try to do it yourself. Get rid of the responsibilities that you might have in terms of the workplace or your family situation. Have somebody else take those over for a while so you can be in your recovery phase with a clear head and really just concentrate on getting yourself better. Optimize your medical conditions. If you're a diabetic, be sure that your diabetes is under good control. If you have some poor dentition, some teeth that have abscesses or things like that, get them taken care of first. Minimize the risk of these things seeding your body with an infection in the post-operative phase. Do the rehabilitation exercises that you need to do to get yourself as strong as you can be going into the surgery.

All of these things sound so minor, but when you add them all together, there's a lot. And you're going to have a better outcome, a more predictable number of times, if you take the time to do these things. Safeguard your house. Get a rail installed in the shower or the bathtub to help you in that first couple of weeks. Get rid of any throw rugs that may be around that you could slip on when you're still using a cane or a walker. And most orthopedic surgeons, most hospitals, have a guidebook that gives you the checklist for doing these things. Use it. Don't think that you know it and you've got this under control. Take the advice of the experts who've done this thousands of times.

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Trina Wilcox: I want to go back to the first thing you mentioned about checking into your doctor and making sure you're not the third surgery they've ever done. A lot of people are at the mercy of their insurance and being told where they can go. What if they're unsettled and truly uncomfortable with where their insurance is telling them where they can go and the reasons why? Do you have any tips on how to navigate that process, so they are seeing someone that they are confident in going under the knife with?

Dr. Alan Beyer: Two things. Number one, every insurance that I'm aware of allows for second opinions. If you have a confidence problem with the surgeon that you've been referred to or, for some reason, don't feel, "This is the guy or gal who I need to do my surgery," demand a second opinion. And second of all, squeaky wheels get the grease. You know, this is your health. I like to tell people, especially with things like joint replacement, you only get one chance to get it done right the first time. Put in the extra effort so you're sure you're getting it done where you want to have it done and by whom you want to have it done. And just speak up. If you feel you're being bulldozed, speak up. There's always a higher level that you can go to in terms of consumer relations/patient relations at every insurance company in the world.

Trina Wilcox: Now, I know you said when your quality of life starts plummeting, that's probably a great sign to get in there and have some surgery. It can be very confusing to someone that has dealt with pain. They wear the orthotics and they get by. They've been told, "You know, put the foot surgery off as long as possible," which is reasonable. How do you know, though, when you've actually just tipped over that line and it is time to give yourself relief, new direction, better quality of life?

Dr. Alan Beyer: As I said, first thing is: Yes, exhaust all the conservative therapies. Try conservative therapy first. That's always the best way to go. But when you're not able to do the things that give you happiness, that give you high quality of life, that make you stop taking your walk around the block a couple times a day... You know, I'm also very fond of telling people, particularly with, let's say, a knee replacement, that I might be replacing their knee and making their knee work better, but I'm probably also extending their lifespan because they're going to be able to be more active, they're going to have better cardiovascular health, they're going to be able to be more physical and do more things physically. And emotionally they're going to be happier because they're not having that pain every single day.

Pain gets to be very, very wearing when you are subject to severe pain every day and you're starting to take opioid medications and do all kinds of things that cloud your head and aren't good for you in the long run. So, I think it's a balance. Don't rush into it, as I said, but by all means, we've come so far in the last 30 years in terms of the post-operative course and the results specifically for joint replacement that I think that a lot of those fears can be booted away. Now, am I going to sit here and say that a hundred percent of the time these turn out fabulously and everybody's a 10 out of 10? No. I'm going to be forthright. There's probably about 5 to 10% of hip and knee replacements that still have some residual pain. But even if they do, it's still far less pain than they were dealing with day to day before they underwent the surgery.

Trina Wilcox: Let's talk again about research. I know you said Dr. Google is bad, but being well-informed is very important. So, what are some of the best ways the patient can be prepared, do their research, going into that feeling confident that they are well-informed and can speak with the doctor intellectually about what's about to happen?

Dr. Alan Beyer: I think go directly to the source. Go to the Hospital for Special Surgery in New York. Hoag Orthopedic Institute that I'm affiliated with out here on the West Coast; we do more joint emplacements than any hospital west of the Mississippi. The Cleveland Clinic, the Mayo Clinic, trusted places that we all know about, that's the source you should go to, not just querying Dr. Google. That, and talk to your physician and the hospital or outpatient surgery center that you're going to. These days, most quality places post their outcomes, they post what their infection rate is, they post what their readmission rate is. Many places also post the cost if somebody's paying out of pocket or has a 20% copay. So, look into those things. Don't just take for granted that, "Oh, this is going to be fine. It's not going to be any problem." Because, like I said, you get one shot at getting it done right the first time.

Trina Wilcox: Let's talk about younger patients. Is there such thing as having surgery too soon? Could they wear out joints and need surgery again?

Dr. Alan Beyer: So, the answer's yes, but the answer is a much more optimistic yes than it  used to be. Back when I first started practice over 40 years ago, we were very, very hesitant to do joint replacements in people in their 40s. We thought our joint replacements were only going to last 10 or 15 years, and we felt that that meant that that person was going to have a second and possibly a third joint replacement depending on how long they lived. And the second and third time around, quite frankly, it's a little bit more of a roll of the dice in terms of what the outcome's going to be. The quality of the bone that you're putting the implants into is not as good because it's already been violated once. And you try to get somebody through an operation like this and need it only once in their lifetime.

Subsequently, we found through years and years of having done these that our current generation in the hip and knee replacements specifically look like they're lasting 30 years or longer if everything's been done appropriately. They've been put in in a well-aligned manner, with proper surgical technique, and we're getting 30-year survival of these components. So, doing it in a 50-year-old means it's likely going to be the last time they ever need to have that joint operated on and everybody's happy. 30- and 40-year-olds, which sometimes in rheumatoid disease and other arthritic processes are bone-on-bone and do have problems, but again, you have to weigh the balance.

If this person is basically crippled in a wheelchair because their knees are bone-on-bone arthritis, and you replace their knees and they can now walk, I think most of them would say, "I'm willing to do this if 20 or 30 years from now I need to have it operated on again because I'm getting 20 or 30 years of being out of the wheelchair." So, I think that we’ve certainly loosened the criteria in terms of the age that we’ll go ahead and proceed with someone with a joint replacement because the technology and our surgical techniques have gotten so much better.

Trina Wilcox: What kind of technology do you see coming down the pipeline? I know some of us, for me, I don't have the joint replacements that are small enough and that will last long enough for me yet; the materials aren't there yet. Do you see that coming in five, 10, 15 years? Or will it ever happen?

Dr. Alan Beyer: I think it will. I think the smaller joints will be able to be replaced by things such as 3-D printing technology, which is starting to be used now in orthopedic joint replacement where a small piece can be replicated on a 3-D printer and then that's implanted. We're using more and more robotics now in our joint replacements to make sure that we get the alignment absolutely correct because the longevity of a joint replacement is 100% based on how well it's aligned when it's inserted. So, there are technological advances that are always occurring, will continue to occur. But then we're going to get into that argument of, "Well, I think I'll wait because things are getting better as time goes on."

You know, it's like the same thing when computers first came out. People always said, "Well, I think I'm going to wait till the computers get a little cheaper and get a little faster." And what happened? Every year they got cheaper and they got faster. This is the same exact thing. Yes, it's going to be better in a year than it is now, but probably at some very, very small level. It's continually evolving, it's continuous quality improvement, and that's what we should be aiming for. We should never sit on our laurels and say, “Hey, we’ve got this down pat; we can’t make it any better.”

Trina Wilcox: So, to keep up on that from the patient side, is our best option just to check in with our rheumatologist constantly? Or is there another way to be in-the-know of the new technology?

Dr. Alan Beyer: I think that developing a relationship with the orthopedic surgeon is also important. That way, he or she can also keep you apprised of what's going on technologically and how things are improving and whether he or she thinks it's time to maybe bite the bullet at this point. So, both the rheumatologist and the orthopedic surgeon are very, very important.

Now, another little aspect of this that I'll throw in there is: Back 20, 30 years ago, I used to see hundreds of rheumatoid arthritis patients who needed joint replacement. Now we see hardly any, and that's because of the development of the immunobiologics that are out there, and there are more and more of them coming down the pike all the time. So, another reason to wait until you absolutely have to, because there are medical advances as well that might obviate the need for your having surgery.

Once your joint has gotten to the point where it's bone-on-bone, there's not a drug invented yet that can fix that. Maybe stem cell someday, but we're not there yet. But the immunobiologics have done an unbelievable job of curing the autoimmune arthritic processes, which we used to see much, much more. By far, now most of our joint replacements are done in degenerative arthritis rather than in an autoimmune arthritis.

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Trina Wilcox: What are some other things that you think we should know that we haven't even thought of?

Dr. Alan Beyer: That which you always have to mention is weight. Especially in your weight-bearing joints, like your knees, your hips, your ankles, your back. If you can control your weight, and we have a lot of different new ways now which are good for some people, not good for other people that hold GLP-1 and other classes of weight management medications, which indicate… There have been some studies that have actually come out already that show that patients who are on GLP-1s and have lost weight have less pain from the arthritis in their knees. The equation I always used to like is that every pound of weight that you're carrying puts three to four pounds of force on your knees.

So, if you lose 20 pounds, you're putting 80 pounds less force on your knee with every step you take. That should help motivate people to say, "Well, 10, 20 pounds, that's not so tough, and it's going to make my knees feel better." It really does make your knees feel better. And if the pain goes away because you've lost the weight, maybe you don't need the surgery. Keep going. So, I think that's a very, very important factor for people who are considering joint replacement in any of the lower extremity joints.

Trina Wilcox: Well, and a lot of folks say, too, you know, "I'm in pain, I can't move." What do you say to that?

Dr. Alan Beyer: You know, it becomes a vicious cycle. When you don't move your joints, they get stiffer, and they get more painful, so they move less. So, I really encourage all of my patients preoperatively to start months before even, if we're planning that far ahead, to get into certain modalities that they can to improve their range of motion. Get into the jacuzzi, or get into the swimming pool, and try to do exercise in the buoyancy of the water, which is less painful, to get the motion back. Because the better motion you have before the surgery, the better motion you're going to have after the surgery.

If you have a joint which is basically almost fused, to not moving at all, that's going to be a real problem for the surgeon to get you great range of motion afterwards. So, do everything you can. We sometimes send patients to physical therapy for prehab to actually do exercise with the therapist before the surgery. And in some ways, that's more important than after the surgery, because after the surgery, they don't have the pain. They can do it themselves. So, get yourself in the best place you can be in terms of your mobility and what your pain levels are before the surgery. Because, that way, you'll need less pain medicine after the surgery, and you're going to have a better outcome.

Trina Wilcox: I don't think people talk enough about prehab. Can you go into that a little bit more, just so maybe some folks listening can start doing that?

Dr. Alan Beyer: You don't necessarily have to go to the therapist for this. There are a lot of programs that have been developed now, which are available online. Again, I'd refer people to one of the trusted websites that I mentioned, and they'll outline. We give all of our patients a booklet full of exercises for them to do before the surgery, to the best of their ability. And the time spent doing that is going to pay off bundles afterwards. So, I think preoperative prehabilitation, if you will, is a very, very valuable tool.

Trina Wilcox: Very good. So, before each episode, we post a question on social media. And for this episode, it was asked: "Do you need a joint replacement? And what's holding you back?" So, we got a few responses. I'll share some of those with you. Lynn Garrison Buck says, "Insurance." The fact that it's considered a pre-existing condition and recovery time off has been a challenge for her.

Dr. Alan Beyer: Well, there's actually two questions there for us to unpack. Pre-existing conditions was pretty much taken care of in the insurance industry with the advent of Obamacare in 2010, where insurance companies were obligated to cover pre-existing conditions. And yes, the autoimmune disease, by definition — you had your onset in childhood — are pre-existing conditions. But that doesn't let them off the hook in terms of providing you the treatment you need to care for that condition. The recovery time off is very, very variable. After a knee replacement or a hip replacement, I would typically tell people to not plan on going back to regular work for six to eight weeks. If they work from home, they can probably do work on the computer and stuff by about 10 days to two weeks. They will get back into their vigorous activities on a graded basis.

It takes a good three to four months to really forget that you had a major, lower extremity surgery. So, that takes time with your employer or in terms of how much time off you have, paid time off or going on disability, which some people do for a while, but make those arrangements ahead of time. Go into the surgery with a clear head, not worrying about, "Oh, I have to be better three weeks from now because I have such-and-such wedding to go to," or "This trip that I have planned." Don't do that. Don't have anything planned on your calendar for a number of months after the surgery. That way, you don't have an artificial deadline hanging over your head, putting pressure on you to achieve. You want to go through the postoperative course with an absolutely clear head.

Trina Wilcox: Excellent. Nat Kai says, "Doctors won't do it until I'm 50. Won't even discuss it. So, meanwhile, years of waiting." That sounds frustrating.

Dr. Alan Beyer: It is frustrating. Boy, he's somebody who wants to get older. (laughter) Who wants that, right? I think that, if this is an autoimmune arthritis, like a rheumatoid or psoriatic arthritis, and that's why it's so bad before 50, or sometimes post-traumatic, if you have a severe accident where you have a fracture in the knee joint or the hip, you can get early arthritis in that joint. I think in this case, seek out someone at a center that does a lot of joint replacement. And they'll be a lot more comfortable with possibly bumping the age earlier because of the wealth of experience they have. Rather than the orthopedic doctor or the hospital down the block, seek out a center that really specializes in joint replacement, and they'd probably loosen those restrictions somewhat.

Trina Wilcox: OK, good. Cheryl Clark says, "I need both knees replaced. Surgeon won't do it until I lose more weight. I only need to lose at least 50 pounds. I'm seriously bummed over it."

Dr. Alan Beyer: This is a great question. And I have turned away many patients who I felt exceeded what the weight limits of the components comfortably handle. Why have an operation when you know something that you can fix, and it won't be easy to fix, but you can fix it, is going make it work better and last longer? So, my advice to Cheryl would be: Lose the weight. I got burned several times early in my career when patients said to me, "Doc, replace my knee, and I promise I'll lose the weight afterwards." And they never lose the weight afterwards because their pain is gone now; they can get to the refrigerator even easier. So, they don't lose the weight afterwards. Lose the weight before the surgery. It's going to make the surgery do better.

Trina Wilcox: OK. This is another one that I can't imagine how frustrating it is. Patrice Johnson says, "Not having someone to take care of me post-surgery, and I refuse to go to a rehab facility. Not to mention a six-month recovery period. No thanks. I would rather live with my knee the way it is."

Dr. Alan Beyer: Well, my first off-the-cuff answer to that is: If you'd rather live with the knee the way your knee is, live with it. That said, let's correct a few misconceptions she has. Six months is a long time. It's not a six-month recovery. Very, very rarely does that happen, barring a major complication like an infection, which are so rare these days that it almost doesn't bear talking about it. There are ways, and I understand her hesitancy to go to some of these skilled rehab facilities, because, quite frankly, they're not many of them. There are some great ones, maybe few and far between, but most of them are not places where younger, active people really want to be.

I think that the solution for a situation like this is to get either a family member or a friend, who is strong enough aligned with you, that they'll agree to live with you for a month or two. Because I think it's going to make: A) you less lonely; B) somebody there to help you, because you're not going to be feeling like dressing yourself and preparing all your meals and cleaning the house that first week or two after a joint replacement. So, just scratch your head and figure out a family member, a cousin… Invite them to stay with you for a month or two, and that's going to help things go a lot more smoothly. These problems are sometimes difficult to fix in our social situations, but a friend or a neighbor or a relative is probably the answer for that one.

Trina Wilcox: Another social media inquiry from Eddie Williams said, and I know you said they're not usually that common, but he's worried about staph infections. "They're more common than anything else," is his thought on it. What do you have to say about that?

Dr. Alan Beyer: Well, actually, they're not that common. They're very uncommon. Well below 1% at centers that do a large number of joint replacements, but they're a catastrophe when they happen. A bad, deep infection in a joint replacement usually necessitates taking out the components, putting in a spacer, waiting six weeks, keeping the patient on antibiotics, and then bringing them back and doing it a second time. I can only speak about our experience at Hoag Orthopedic Institute. What we've been working on the last 15 years to minimize the incidence of infection. It includes things like making sure the patient's dentition is good preoperatively that I alluded to earlier; making sure there's no source of infection, urinary tract infection, other common infections that people have. And this is all part of that pre-surgical optimization that I talked about.

The other things that we do are: We have the patient treat their entire body with a sage cloth, which is a chlorhexidine-impregnated cloth that we have them wipe down their whole body with for several days before the surgery, and include some swabs in the nose to clean out the nose, which is often a source of bacteria on the patient's body. So, we are doing everything we can that way to make the person not bring something into the OR that will subsequently seed in their knee joint.

We use high-flow filtration systems in the operating room to have frequent air changes, so the air is constantly circulating at a very high rate in the operating room. We wear a space suit. The surgeon and the scrub tech and his assistant wear a space suit, which actually covers them from head to toe and has air circulating into it so they can breathe to minimize any shedding or any breathing or anything that they might do. So, we've taken a lot of precautions over the years to minimize the risk of infection. It's far less worrisome than it used to be. But again, I hate to sound like a broken record: Do the research about the facility that you're going to because different hospitals have different infection rates.

I'm used to working in an orthopedic hospital where the only surgery we do are orthopedics. So, there's never a case in the operating room that's being done before me, like a gallbladder or an infection or an intestine surgery that potentially could contaminate the field. Yes, we clean the OR, obviously, between cases, but who knows? Going to a purely orthopedic center, you don't have that risk because none of those cases are being done in our ORs. These are all little, tiny things that, if you do them all, you can really get that infection rate down to as close to zero as we're ever going to get it.

Trina Wilcox: That is very comforting. And what is something, goodness gracious, should someone get a staph infection, what are those very early signs that they should watch for? And what should they do if they think they have one?

Dr. Alan Beyer: Increased heat around the joint. There's always going to be a little heat around the joint after surgery just from blood flow and postoperative swelling, spiking the temperature. Obviously, any temperature over 100.5, call the doctor. Any kind of drainage from the wound. All of these things are early signs. And do not hesitate. Your surgeon wants to know as soon as you have any doubts about this. Because if you catch it early and hit it hard, you can often avoid the necessity of having to remove the whole component and redo it six, eight weeks later.

Trina Wilcox: Very good. Beth Carter Cox says the reason she is holding off on surgery is the expense, time off work and pain. She says she had her first surgery in 2020, and it was the most pain she's ever endured. That's horrible.

Dr. Alan Beyer: Absolutely. So, expense: I can't really comment on. That's so individual in terms of what somebody's insurance is, where they're in plan, where they're out of plan, where they have their deductible met, where they don't have their deductible met. Time off work got much shorter in the five years since she last had hers done. Of course, it depends on what kind of work you do, but for a typical office work, I'll usually tell people four to six weeks till they can be back at the office doing everything without any concern.

But let's talk about the pain though, because that's one that a lot of changes have happened. First of all, we've really gone into this mode of trying to limit as much as we can the use of opioid medications because of the obvious risks of abuse. We've really made a very, very strong effort to almost eliminate the use of opioids after joint replacement. How do we do that? There's been tremendous advances in the use of blocks that our anesthesiologist can do, right before the surgery's done, the morning of — around the hip, around the knee, around just about any area of the body. And many of these can last days and days after the surgery. So, there's very little need for strong pain medications like opioids for any protracted period of time. I think preparing the patients for the fact that, yes, there's going to be a little bit of pain. You know, the old days, 10, 12 years ago, where they made pain a vital sign and the Patient's Bill of Rights said, "You're entitled to have no pain after surgery," that's probably what brought on the opioid crisis. We were over-medicating patients, so they had no pain. I'd rather prepare the patient for, "There's going to be a little bit of pain. We're going to control it with these blocks that the anesthesiologist is doing, and some other medications that are non-opioid, and you'll do better."

The other thing is: If you can really hit them hard with these blocks that the anesthesiologists do, and they wake up without pain — they wake up from anesthesia without pain — many studies have shown that those patients have much less pain in the postoperative course. It's when they wake up with a terrible amount of pain that it's… you're always playing catch-up. You're never ahead of it, and the patient doesn't have a smoother course. So, the key is hitting it hard before it happens and letting them have a nice smooth sailing afterwards, with hopefully non-opioids; and the blocks usually last them for two, three, five days.

Trina Wilcox: Alright. And one more from Barb that says, "I fear that my RA might cripple the knee worse later."

Dr. Alan Beyer: That's a really good question, and first of all, I'd ask what kind of control is her RA under? Is it actively flared? Or is it pretty burnt-out and quieted down and it should stay that way? When you replace the knee, and you're putting in basically metal and plastic new articular surfaces that are nice and smooth, RA is a disease not of the joint or the cartilage; it's really a disease of the synovium, the lining of the joint. And in a rheumatoid or other autoimmune patient, what we'll do part and parcel of doing a knee replacement is doing what we call a synovectomy, which is removing as much of the synovium as we can, so there's much less likelihood of rheumatoid-inflamed synovium attacking where we've cemented or press-fit the knee into place. So, part and parcel of doing the surgery in a rheumatoid would include doing a partial or total synovectomy. And I think the orthopedic surgeon needs to work in conjunction with the rheumatologist to keep that rheumatoid arthritis under control postoperatively.

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Trina Wilcox: At the end of each episode, we share our top three takeaways from the episode. So, Dr. Beyer, what are your three takeaways?

 

Dr. Alan Beyer: I'd say number one is always conservative therapy first. Don't rush into surgical repair of a joint. Always try the conservative therapy first. And when that's no longer effective, that's when you start making the decisions about surgery. Second, I would say research your doctor and the facility where you're having it done, because get it right the first time is just so, so important in joint replacement surgery. So, definitely put in the time. Don't blindly trust because your neighbor had so-and-so do it. Put in the research and the time. Pick the right facility and pick the right surgeon.

And finally, I'd say optimize your care, and that's both preoperatively, and we talked about preoperative optimization in terms of weight management, diabetes control, doing some exercise preoperatively, getting your house to be nice and safe, and optimize your postoperative care. And the best way to do that is to have nothing else on your plate that's distracting for you in that period of weeks that you're in your early postoperative phase. So, those would be my three big takeaways.

Trina Wilcox: Very good. I think my takeaway is making sure I keep the line of communication with my orthopedic surgeon open, as well as my rheumatologist. I love your point about the pre and posthab. That's great information. And always, you know, doing the best you can to prevent any further damage and just, you know, do all of the care that you can to avoid surgery, or put it off as long as possible, is very important. Thank you so much, Dr. Beyer. Appreciate it. Please check out Dr. Beyer's podcast, Doctor in the Dugout. And if you want some more information and all the resources about arthritis, visit arthritis.org. Thanks so much.

Dr. Alan Beyer: Thanks for having me.

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