Orthopedic Replacements

Stan and Clarence chat with Dr. David Fischer about orthopedic replacements.

Dr. Fischer - a retired faculty member of the Department of Orthopedic Surgery at the University of Minnesota - spent his career specializing in knee and joint replacement surgery along with sports medicine. He brings a wide breadth of knowledge to this topic.

Join the conversation at healthchatterpodcast.com

Brought to you in support of Hue-MAN, who is Creating Healthy Communities through Innovative Partnerships. More about their work can be found at http://huemanpartnership.org/

Research 

• Why do we replace knees?
• Osteoarthritis (most common cause)
• Rheumatoid arthritis
• Haemophilia
• Gout 
• Knee injury 
• When do we replace knees? NHS Inform.
• you have severe pain, swelling and stiffness in your knee joint and your mobility is reduced
• your knee pain is so severe that it interferes with your quality of life and sleep
• everyday tasks, such as shopping or getting out of the bath, are difficult or impossible
• you cannot work or have a normal social life
• Average age is between 60 and 80 years old 
• How do we replace knees?
• Explain partial vs full knee replacements (the type types)
• What are they made of?
• cobalt chromium (metal alloy)
• titanium (metal alloy)
• polyethylene (plastic)
• What is the average recovery time? 
• Outpatient vs inpatient? 
• How long is the procedure?
• Disparities in orthopedics?
• Insurance
• Is this procedure covered under their insurance? 
• Yes, in most cases. For most health insurance plans sponsored by employers or purchased through healthcare.gov, knee replacement surgery is covered by health insurance when recommended by your doctor. Despite this, you may still be responsible for a large out-of-pocket cost. For example, if your co-insurance is 20% and your yearly out-of-pocket maximum is $7,200, you would be liable for a $7,200 bill after your surgery and recovery. kneereplacement.com
• Cost 
• Can people afford the procedure? Do people usually pay out of pocket?
• Time off work 
• The average cost of knee replacement surgery (without complications) is $29,300, according to a study by the Journal of Orthopaedic Surgery and Research. Can vary from $15,000 to $70,000. 
• Is this an inpatient procedure? 
• Accessibility 
• Similar to insurance problems, do they have access to a surgeon?
• Time 
• Recovery time 
• Time off work
• Caretaker needed?
• Outpatient or inpatient?
• Race
• Black individuals are at least as likely as White individuals to experience advanced arthritis but are >30% less likely to undergo total hip or knee replacement than White individuals, after adjusting for age and sex1,2. J of Bone &Joint Surgery.
• Other Considerations
• The importance of an understanding by both the patient and surgeon of expectations of the surgery as a decision is made
• Vast majority of patients are seniors and although pain, stiffness, etc. are their symptoms, the result is a quality of life issue
• What are the functional losses and improvements the patient would like, are they reasonable, etc.?  
• There is a difference between hoping to resume walking, shopping, travel and light activities than looking forward to being able to again train for a marathon or singles tennis.....Reasonable expectations result in a smoother recovery and more consistently happy patients......