The Bone and Joint Playbook, Tips for pain-free aging. Presented by Dr. John Urse
The latest orthopedic topics for pain free aging with the nations best doctors and topical experts.
The Bone and Joint Playbook, Tips for pain-free aging. Presented by Dr. John Urse
Can a Robotic Joint Replacement Provide Better Results?
In this episode, Dr. Urse talks with Dr. Chad Weber who has performed over 1000 Robotic joint replacements in the greater Dayton area. They talk about the different types of robotic surgeries, the pros and cons and what people should expect before, during and after the surgery. This year over 700,000 knee replacements will occur, so you need make sure you have all the facts before you select your doctor.
Dr. Chad Weber, DO, FAOAO. Orthopedic Associates of SW Ohio. Orthopedics: Surgery, Robotic Assisted Surgery, Trauma. Centerville, Dayton, Greenville.
Connect, foot Bone Connect, connect Ankle, ankle connect.
Speaker 2:Hello and welcome to the Bone and Joint Playbook with Dr. John Earth. Tips for pain-free aging. Dr. John S is a board certified orthopedic surgeon with over 35 years experience in the Dayton, Ohio area. He is also a clinical fellowship trained surgeon in total joint replacement from Harvard. Today's topic is our Robotic Joint replacements Better with special guest Dr. Chad Weber, who has done over 1000 robotic joint replacements in the greater Dayton area. This episode is brought to you by
Speaker 3:Ted's authentic Greek salad dressing and marinade. It's healthy, gluten-free, and delicious. You can find ted's in Dayton, Ohio at Dorothy Lane Markets Health Foods Unlimited and Dots markets. That's Ted's authentic Greek dressing and marinade. Thanks Ted.
Speaker 4:Well, hello folks. It's Terry O'Brien here, tri-Level Records. And we're back with another episode of the Bone and Joint Playbook with Dr. John ERs. Today's topic is our robotic joint replacements better. That's gonna be the question and I'm gonna let j Dr. John Urs introduce his special guest. Dr, take it away.
Speaker 5:Well thanks Terry. Um, we've got another, uh, cutting edge topic today talking about robotics in total joint surgery. Um, we have a guest, my partner Dr. Chad Weber. He's a board certified orthopedic surgeon. He's also got a fellowship, uh, training in adult and reconstructive surgery. So he is also one of the pioneers in the, uh, southwestern Ohio area in robotic surgery having just hit the 1000 mark on total joint replacements, which is quite an accomplishment.
Speaker 4:That's a lot of joint replacements. Okay, so Hello Dr. Webber.
Speaker 5:How are you?
Speaker 6:Good, thank you. Great to be here.
Speaker 5:Well, Terry, let me talk a little bit about our topic today. First of all, robotics and artificial intelligence help people do their jobs better. In orthopedics, robotics help improve the way surgeries are done. The robot is controlled by the doctor and allows the doctor to combine their knowledge, experience, and judgment with the precision of a robot in orthopedics. The use of robotics, including partial and total knee replacements, hip replacements, and some leg realignment procedures for deformities are what we'll be talking about today. So Dr. Weber, I'm just gonna call you Chad cause it's a podcast. What are the benefits of using robotics for total knee and total hip replacement surgeries?
Speaker 6:I, I think the main reason I started really doing, um, robotics was a lot of the implants are the same. Um, in today's society, in medicine we're operating on larger people and you're trying to somewhat look for a way to separate yourself and get good outcomes, um, somewhat better than some of the other guys that are doing practice. I mainly started doing robotics because I wanted my patients to do better, faster. Everybody wants to be better faster. Um, and using these implants in larger people, we gotta make sure that we put'em in. Right. So simply in, in general with robotics, it allows more reproducible placement of implants, both in total knees, partial knees, and total hips. Um, I think that's really, really important with the patients that we're doing today. No one wants early failures and I would say from the research that we have up to this point with robotics, it does show that there's less early failures and better reproducible placement of the implants on basically total knees, partial knees, and total hips.
Speaker 5:Well, and again, I guess the big take home points would be does this improve accuracy? Which it sounds like it might. Yep. Does it improve speed, which gets people off the table sooner, less bleeding, less complications with, you know, a, a more expeditious surgery and has improved patient outcomes? So I think we wanted to wonder why are we interested in doing anything better? Well, the numbers in the United States are a little different for hips and knees. Most people like their hip replacements. They get up, walk on'em pretty quickly, and they're pretty thrilled with a stiff hip how quickly they can move it better and get around better. Knees are a little different. In fact, in the United States we do over 700,000 total knee replacements, but over 20% of people are dissatisfied with their knee replacement. And what do you think some of those reasons are, Chad?
Speaker 6:Uh, I think it's the rehab is often harder than what they anticipated. It's continued pain. Uh, I think doing a primary total knee replacement and somebody who has had previous trauma and has had previous surgery on that joint, uh, may be a little bit different patient than somebody who just comes in with regular arthritis versus post-traumatic arthritis
Speaker 5:Because they may have what scar tissue or scar tissue, we do tissue. It's kind of like that that knee's already had trauma to it and it's having more surgery, which is more
Speaker 6:Trauma. Correct. Sometimes it's post-operative lack of physical therapy where the patient's not necessarily motivated enough to go do the therapy. I would say, when I think of total hips and total knees, therapy's important in both, but much more important and much more grueling and total knees and partial knees than total hips.
Speaker 5:Well, I'll take the patient's side of this equation then, because those are things the patient's not doing that they should do. Uh, but I think the surgeons have some fault also, if there's that many being done, maybe some of these are too tight, maybe they're a little loose, people feel like they're knee wobbles, maybe it's, uh, not sized correctly to fit them. I tell people, if you have eight and a half shoes and you have to go around with eight or nines, it's not really an eight and a half and maybe your sizes on your implants may not be as accurate as they could be. And there are some, some specialized components that are made to be patient specific and made to fit your knee perfectly. So I think that the doctor has some responsibility, but I think the patient has some responsibility and a combination of those two um, factors give you either a good or maybe a less than optimal outcome. But I think that makes all of us wonder is there room for improvement in trying to get that number down. And unfortunately with uh, the trends we see in the United States because of baby boomers, obesity and the aging population, it's anticipated by 2030 we'll be doing 170% more total knee replacements, which means if 20% of 2 million people are unhappy, that's a whole lot of dissatisfied people. Yeah. So I think that maybe using accuracy and some of these robotic technologies might be a way that we put it in a little better, it feels better, and then we have to kind of encourage our patients to soldier through that post-operative therapy.
Speaker 6:I agree with you a hundred percent. I think there is, there's patient factors, there's position factors, um, whether you're using a robot or not, there's an art to putting in a total hip or a total knee. Um, going through training, you know, we get to see various people put total knees and total hips in. I think that that is part of the art of doing a total hip and a total knee. Some people like them really, really, really loose. Some put'em in a lot tighter than others where they almost, you know, really, really squeak when they're moving through the range of motion. Those people are obviously have a little bit harder time getting their motion back. But I think finding that perfect knee is something that I've looked for for a long, long, long time. And I think like when I'm done with the end of a case, when I'm done with a robotic case, I'm much closer if not there after doing a robotic knee than I ever was not using the robotic stuff. It feels balanced, it tracks better, it just seems like a better total knee. And I would say I feel like my results when I did 50 patients with one and 50 patients without one, the people who I did robotically far and above recovered much quicker. The range of motion was if in a total knee that I didn't use robotics zone, I would say it was probably at two weeks, somewhere between 70 and 80 degrees I thought was great. With robotics, I would say it's not uncommon for people to come in at 9,500 above a hundred degrees range of motion, and that has to do with just better biomechanics. Number one, putting them in perfectly or better. And then two, I think using the robot, there's much less soft tissue trauma during the case. Less retractors in, less retractors out, not necessarily shorter time of surgery. I think that comes with doing more and more cases, but I think that those two things together, um, really lead to a much better type of,
Speaker 4:So let, let me jump in here real quick because I, I think we've gone pretty far into this, but as an, as somebody who's not a doctor, I'm always curious, is a robot conducting this surgery? How does this thing work? Right? What, what is going on? And can, can you explain that a little bit? Because I think, you know, some, a robot's taking over and, and you're just kind of sitting in the background, that's not necessarily the case. Is that true?
Speaker 6:There's really three types of robotics involved with total joint replacements. There's passive systems where you basically do everything. It's like a guide system, um, where human error can still occur during the case. There are semi-active cases which are kind of like the Mako, which is the one that I use. It's, it uses haptics. So it's a saw attached to the end of a robotic arm. Going into the case, you take registration, we do get a preoperative CT scan in the surgery, you actually confirm the position of the patient with that ctt. So they merge. And then what that does is, is when you're going to make your cuts, those cuts are planned, you know, the size is going in, you may not know the exact thickness of the plastic, but it prevents you from cutting the M mcl. I don't really put any retractors at all when I do that case because the robot will not let me go outside of those lines. So that's the semi-active ones versus the active ones are where you sit in the corner and you push a button and you observe what it does. But the robot really does all of the surgery. So most of the, I would say most of the robotic systems that we currently use in orthopedics are either passive or semi-active. We're still doing the surgery, we're in there, we have control of the arm. And unless we pull the trigger, then it's not cutting. But if we pull the trigger, it's only gonna let us cut the perfect cut.
Speaker 4:So it's, it's, it is more or less a safety guide, just, it's not gonna let you stray. It's gonna give you exactly what you wanted.
Speaker 6:If you want to cut it one degree, it cuts at one degree. It does not cut at three. It does not cut at four. Um, it cuts at one degree. So it's important for alignment. And you know, when we do that with the replacements, we do two things. We take out the arthritis and often we realign them because they've developed a bow leg or a no knee. And we don't want those things to allow the implants to wear out quickly because if we don't correct, if we take out the arthritis but we don't correct a deformity, they will fail and they will usually fail fast. So the realignment is just as an important part of the surgery as taken out the arthritis.
Speaker 4:All right. Sorry to interrupt. I'll let you guys continue.
Speaker 5:So, and I'll, and I'll talk a little bit about why, um, we talk about what's called a well-balanced knee or a knee that, um, feels like it's moving well in being a straight or a bent position. So as you know, when you take your knee from a fully straight position to a bent position, it's, it's got a, it's gotta move through that arc of motion smoothly. And if it's wobbly when your knee's bent and you go to stand up, then that little piece of plastic between the end of the thighbone metal and the upper shin bone metal isn't thick enough. And therefore we can adjust that by putting a thicker thing, much like we put a shim underneath a short table leg. So the, uh, the ability to see that before we make the cuts is what the robot lets us do. And I use a different robot that Dr. Webber uses and it uses a different company's implants, but they all look pretty similar, just like a Chevy and a Ford carburetor look pretty similar. They get you where you need to go when you go to the store. So when we, when we do our preoperative or intraoperative planning, we see, well this looks like it's gonna be too tight when they bend their knee. So we move the, the, the implant up away from the other bone to make more room when they bend it or we turn it a little. Some people who are really bow-legged and you know, you've seen the cowboys get off a horse, looks like you could throw a football between their legs. Those people, we used to put their knee perfectly straight after surgery and we didn't have the robots, but we knew it was lined up perfectly. Guess what? They all weren't perfectly happy. Correct. Because then when the robot showed us how the knee would bend and straighten in a person with a bow knees arc of movement, we found out that a degree or two, just a little bit of bend was actually perfect for that person's mechanics. And when he says a balanced knee is a happy knee, that means as you straighten and bend it, it's not too tight, it's not too loose, and it feels as good as it can. Now these are not normal knees, they're fake joints, right? So part of your kneecap, if you feel the bone on the, on the top of your knee, the underside of that kneecap gets replaced with a piece of plastic. Cuz most kneecaps have arthritis underneath them. So it may feel unusual to we to kneel or do gardening on your knees. We allow people to do it, but if they don't want to, we tell people, you know, they don't have to. So again, what we're getting from the robot is that data before we dial in how to make those bone cuts so that we have optimal balance between bending and straightening. And that was what, at least my therapist tell me what Dr. Weber's eyes are telling him that hey, your, your people with the robotics are, are doing better. They're, they're like further along, they seem happier. Um, they still hurt when they bend and we, we don't sugarcoat that postoperative pain that they're gonna have. We use ice, we use what is called multimodal medicine control. We give them inflammation medicines or some of the, um, pain medicines if you need'em. And, you know, people need'em for a while. So let's go to a, another, um, topic here. Um, so, so if you were to tell the patient, is there anything extra I'm gonna need for this surgery? Am I gonna have these pins sticking out where you're putting the markers in with your antennas? Or what happens with, with the process of doing a robotic joint replacement?
Speaker 6:So with the system that I currently use, and I think it's different from system to system, is with a total knee we can do all of the, we have to find a way for your knee and the position to be able to able to talk to the robot. And most of those things are, are translated through arrays. That usually requires us to put some sort of pins either in your tibia and or your femur, um, for a total knee or partial knee and into your pelvic bone so that we find a way to communicate the position of your joint and space preoperatively. We do a CT scan, which I think for, uh, my system is important again, for the one that you use, I don't think that you have to have preoperative imaging besides x-rays. We use a CT scan. So when people ask me do I have to do anything different, I would say number one, we get a CT scan of every hip or knee prior to surgery because that's what we use to do our preoperative planning. And that's what we also load on the robot so that in surgery when we're doing those specific points on your knee, on your femur, on your tibia, on your hip, that it matches up with the, with the CT scan. And when those two things match with enough accuracy, that's where the accuracy kind of occurs. If it's garbage in, if you put garbage in and you're not matching it up, it'll never match up and you, it won't let you proceed. So it makes you the, it, it brings in the precision. Um, as far as intraoperatively and hips, I tell people they're gonna have two incisions, a small one up on their, uh, like hip, top of their hip by their iliac wing or their pelvic wing bone, that's about a centimeter or two. And then their regular surgical incision on the front or side of their hip. One is for the pelvic array and one is for to do the surgery. And
Speaker 5:An arrays just a little antenna. It's like a little antenna. It's, it's got little correct, um, things sticking up like uh, ETS ears. Yep. And those things see the robot and then the robot has a, a little camera that is getting those bony anatomy points registered in the program, which lets Dr. Weber adjust how he puts that hip or knee in the proper position he wants for that patient. And each patient may have some different anatomy. Some of the hips are shallow hips, they're born with a shallow hip, they call hip dysplasia. Other hips are are born with a deeper socket. And whatever we see, we look at those, um, what are called anatomical variants beforehand and we can adjust how we place what we need to do so the hip doesn't pop out of place or dislocate. We can adjust the leg lengths. I know people really hate it when they're hips aren't even after surgery and we never want the hip to be loose enough to pop out. But we certainly, um, wanna keep the leg lengths as even as possible. Um, and if they're off just a little on one side and you have to do the other side, usually we can adjust it to match'em up. But they're usually pretty darn, even when we have this type of accuracy, which then prevents two of the biggest problems with hips, which is, uh, a hip popping out or dislocating. And the second thing would be a leg length inequality. And trust me, people don't like walking in the shower with one leg longer than the other or significantly longer. So, um, if you said, boy, is that something that, uh, prevents a lot of problems in the, the future? I say that's, that's definitely a, a, a, a major advantage, especially on larger patients cuz absolutely we talk about their, their bodies kind of roll a little bit side to side more than we try to hold'em on the table. But, uh, sometimes they win and we lose.
Speaker 6:I think bigger patients, more obese patients, it's super important and definitely improves the accuracy. Another thing in my practice is I used to do a lot of trauma. So people have a ton of hardware in their knees from plates and screws, nails, uh, also in their hip from acetabular or hip socket fractures or fe like hip fractures. So how do we replace that hip without having to take out all that hardware? So it allows me to know going in, I'm gonna have to take out this screw that screw. And a lot of times there's not necessarily normal anatomy like you said with hardware in there. So what's normal sometimes defining when you're in there and you're just looking, sometimes there's not any normal anatomy to go off of. So the normal anatomy is based off the CT scan and often they're opposite side. And if you didn't have the robot, I mean, it allows me to do surgeries that are a much higher level advanced and that I would probably shy away from doing
Speaker 5:Without the
Speaker 6:Guidance, without the guidance of it. Right. It allows me to walk into a case with preoperative CT scan doing the plan is this versus, uh, we may have to do this, we may have to do that going in there. I know we got, we're gonna have to do this if that doesn't work, we're gonna have to do this if we're gonna have to. It's just a much better plan going into the surgery. So as a surgeon, a much more competent and at ease to go in there and do the surgery that the patient's gonna have a good outcome. Yeah, because the last thing you want is somebody to have a bad outcome.
Speaker 5:Right? And we always, um, we always compare this to sailing. If you had a chart and you said, I'm going from this island to that island, you know, the old saying is, if you don't know where you're going, you're bound to end up somewhere else. And we like to have plans. We like the, the mystique and the surprise out of a surgery as much as possible, we want to go in with an idea of what we're gonna do. We have to adjust things a little bit. We always talk about kids on training wheels a little to the right, a little to the left. There are things that we always encounter in surgery that, that we have to think on our feet. But for the most part, it's much of it we can have ahead of time planned just like that, that captain on the ship who can put the thing on autopilot. It's gonna take me how we safely avoid the, the, the shoals and the, and the coral reefs. So I think the other thing I think patients want to know is when we put in a hip or a knee, can they walk on it right away? Is this bonded with cement? Is it something where I can't, I'm, I'm afraid to put my weight down. Is it gonna fall apart? Are these pretty sturdy and are they ready for me to use right away? And what kind of precautions would I have after surgery?
Speaker 6:I don't necess, I don't necessarily change any of my weightbearing all my patients, I let them weight bears tolerated unless their bone is super bad in surgery or something occurs. Do
Speaker 5:You mean like soft or osteoporosis, that kind of thing?
Speaker 6:Yeah. Um, but I would say 99% of my people I let weight bears tolerate. Do
Speaker 5:They need a crud or a cane or a walker or
Speaker 6:For
Speaker 5:Hips, just get up and go. Or
Speaker 6:For hips and knees, I would say most people are on a walker or a cane for anywhere between two to four weeks. That is the normal Now I would say I've had people come
Speaker 5:Two weeks. Really the goal is don't fall. And so that's correct. You know, we did a podcast on having surgery and you know, moving your, your dog leashes, your throw rugs, getting a grab bar in the shower, having your home ready for a procedure that you're gonna be, you know, in the house for a little bit. Where am I gonna sleep? Am I gonna have to go up and down steps to get to bed? Can I outfit my downstairs to sleep for a week or two? Who's gonna help me? All these things have to do with things we try to front load on, on the preoperative, um, office visits. Uh, some of the educational materials we give people, we're sending text messages now to tell people about how to clean their area before the surgery and what kind of nutritionals they may need, what kind of, um, uh, environment they want to be, um, recovering in. You know, we don't want 10 cats in the room to get a wound problem around your incision. So there's a lot of factors that we control and then there's some we don't control. So, um, it's a big surgery whether you have your hip or knee replaced. So we want people to plan for it. Just like you plan a trip to Octoberfest in Germany, you'd, you'd find a place to stay, you'd find who's gonna help. You'd find your, um, transportation or your, your medicines and all the things you need to get something like this done. And these are elective problems. You have arthritis, most of the time that's not an emergency. So we have time for you and us to plan these in an optimal fashion. So
Speaker 4:Let me, let me ask one question that I popped in my mind with a robotic knee, knee replacement mm-hmm.<affirmative>, if I recall, are the manufacturer reps in the room with you to make sure all the technologies going correct? Is that, is that, how many people are in the room during a robotic?
Speaker 6:So I would say there's for, again, the robot that I use, there's always an mps, which is a person who takes care of the robot, runs the robot, any problems with the robot, they can help with that solution. They are, they've been trained, they've specifically work with that robot. So they help with doing the balancing. When we talked about balancing the knee earlier, like making it feel right, there's certain things that we move the implants, they are the ones that makes that move on the screen and they help us bring those numbers to where we want'em in order to put'em in. So there's an NPS in my room, there's one rep, there's a surgical scrub myself and usually one of my PAs and then the anesthesiologist. Okay.
Speaker 4:If, if again, remind me if I'm using a striker, uh, robotic Yep. Then I'm using Stryker components for my replacements. Is that true?
Speaker 5:That's correct, yeah. And there's other
Speaker 6:Companies at this point
Speaker 5:Yes. Yeah. That have their robots. I use a Rosa robot, which uses a Zimmer bio product and they're, they have different ways they do it. He talked about how um, some of them actually cut a saw and they remove the part that's not, um, favorable or the bone spurs and the arthritis, the type of robotic knee replacement I do uses a cutting guide that places that over the bone to take away the arthritic portion of the knee to balance the knee in the proper alignment that we talked about. And there's different ways to get to the end of the, uh, surgery. Um, and so how we get to grandma's house might be this road or that, but the goal was to get there with a, a well-balanced knee that's ready to be walked on and is, um, you know, comfortable for the patient and feels good to the surgeon as they place it through a motion. And that's part of the art of medicine. When surgeons have the experience of doing a lot of these, they've felt what the knee should be like if it's too loose or too tight and you want your surgeons, and that's where the patients have to do some of their homework. Again, if you're gonna have a simple tonsil surgery, you might go see any ear, nose and throat doctor because everybody does tonsil surgeries. Not everybody does robotic joint replacements. Not everybody does some heart valve surgeries. So when you do a more experienced surgery, um, or more in depth surgery, I think it's worth doing your homework as a patient or a consumer to say, Hey, are you comfortable with these, uh, outcomes? How many of these have you done? What's your, you know, you know, talk to your friends about who they did, um, their surgeries with. It's much like getting a recommendation for a restaurant or a, or anything else. It's word of mouth helps. Certainly a lot of people know Dr. Weber's work because of the volume he's done. And I think the, um, the proof we like to see is in our, um, outcomes after we see our patients. And when patients say, you know, I feel really good and I'm only two weeks from surgery, he's going, boy, that's a good knee and I like that. Whatever I did on that, I think I wanna do on the next one. And we get that feedback. Conversely, we have some patients that are, you know, using some designs or perhaps we felt this was really tight in surgery from old scar tissue and we know that knee's gonna be hard to move, then they don't wanna move it. And all of a sudden we have a stiff knee that we have to manipulate or push through with, um, um, an extra procedure later. And there are reasons that every surgery isn't gonna be perfect. We know that. So we don't want to say we're going from 20% dissatisfied patients to zero. Right. But we certainly want to knock that number into single digits. We want to do everything on our end to make that knee as happy as it can be to last as long as it can. Alright,
Speaker 4:So if I'm looking for, doctor says I got knee replacement, are there ways of finding a robotic knee surgeon? And then follow up question is, should I be worried about what technology they use? Are they all the same or is there one better than the the other? Maybe you can't say because of who you're doing, but is that something I should worry about?
Speaker 6:I think you wanna look for somebody who is doing robotics in some form or fashion. At the end of the day, you want whoever doing your surgery to be comfortable with the way that they do it. Whether, whether you one system thinks that it's better than the other, I think that you're using technology that's giving people better results and recovering faster. Um, I think you go talk to the surgeon and you just talk to'em. I mean, I think a lot of it has to do with their thought processes. For me, I tell people I try to learn from every case. Um, I'm in, there's no doubt that the needs that I put in this year are better than the ones I put in two years ago and I was using robotics two years ago. But that's just the learning process and you keep on looking for that perfect knee or that perfect hip. And I think we've been close, close and I think our people do well. I still think there's things that we can improve on. Some of that may be through increased use of robotics, um, or it may be through some of the approaches and stuff that are, have been established for a long time, but just doing things a little bit differently. It's little things that sometimes make the difference.
Speaker 4:All right. So, uh, Dr. ERs, I know we're coming to the end or close to the end of this podcast. Are there things that we haven't got to that are important messages we wanna talk about?
Speaker 5:I I would tell people that, um, as Dr. Webers said, you want to do your, your homework on the front end to the right doctor to do your surgery the night, the right hospital system, plan your recovery and plan to do your therapy plan to realize there is gonna be, uh, an effort on your part to get a good result. The second thing I'd say is that we want this to last a long time. So a hip and knee replacement shouldn't be run on or jumped on. Um, they're fake joints. So you can walk, you can golf, you can swim, you can do a lot of things. You don't wanna fall out of a tree. You don't want to hit a hit, a hit a, a group of skiers that when you're going down the hill you collide with and now you've broken your thighbone below your total hip replacement. That's a mess for everybody. Um, Dr. Weber's trained to fix that. So, uh, the other thing I would say is that these are procedures that are still surgeon centered. They're accurate, they're efficient, and, and we feel they need to continue to be data driven. And data driven means we look at our dirty laundry, we say, are patients happy? How are the two year to five year results? They're encouraging. That doesn't mean they couldn't fail at seven years, then we might not be as happy about robotics. But for now, the short term results are good. They need to continue to be analyzed. Uh, they need to be reported and, and anything we do needs to stay in the test of time. So, um, we always want people to tell us if they have any allergies to nickel or metal. Uh, these are metal implants and there's a small group of people who have earrings that break out their ears. Some of the partial dental implants are made of nickel, but if you have an allergy to that type of metal and we put it in your knee or hip, you'll never be happy. Um, because it'll always be a little swollen, a little sore. We won't know if it's infected or not. And you'll be dissatisfied and we'll wonder, or someone else will wonder why it's not doing as well as it could. So, um, try to think about the things you can tell us and then we'll all try to work together to get you the best hip or knee replacement.
Speaker 4:Well, all right. Sounds like a a a relatively in, um, good approach. One of the questions that I had, and we'll have to save it for another podcast, was as a guy who doesn't know much about the medical world, I don't know how to pick up a good doctor. I don't know how to pick a good surgeon. I would not have the first clue that you just go to the, your, your primary doctor tells you to go to. I don't know if that's, so that's a whole nother podcast we can get to, but I I think it's worth talking about.
Speaker 5:Yeah, I think there's, there's certainly your, your primary care providers are a good start. They've had other patients have these surgeries done. Um, you may have had someone in your family have, uh, another procedure by Dr. Weber or one of our partners. I mean, our, our group is, is rather diverse. And if you, if you like the way our practice took care of that other problem, that would give you, uh, an opportunity to look at some of the doctors who do, uh, something specialized in the form of a joint replacement. Um, and again, there are online and review options for people to look at. And word of mouth, I mean word of mouth is, is just like that restaurant we talked about that you're looking to take, um, someone on Valentine's Day a couple days ago. But<laugh>, good luck getting into that on a, on a busy night. Um, remember these, uh, podcasts are all available on, uh, any place you listen to podcasts on Apple, Spotify farm.
Speaker 4:That is true.
Speaker 5:Yep. Uh, Spotify or, or iHeartRadio and, uh, on the website with dr john ers.com. But, um, we appreciate having Dr. Weber come and, uh, spend some time and, uh, Terry and as usual, a great job with
Speaker 4:Well, thanks, Senator Doc, I appreciate. This is Terry O'Brien. We're trial level productions here with the Bone and Joint Playbook with Dr. John. We'll see you again soon.
Speaker 7:Thank you for joining us today on this episode of The Bone and Joint Playbook with Dr. John Earth, tips for PainFREE Aging. Please join us again for another episode. This has been a production of Doctors Unmasked, produced by Terry O'Brien.