.png)
Joint Effort PAs
We're two orthopedic surgery physician assistants discussing PA school, life as a PA, cases and topics related to orthopedics, and much more!
Joint Effort PAs
Ortho Crushes: The Procedures We Can't Stop Thinking About
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
You know that feeling when a case just hits… and suddenly you’re thinking about it all the time? Yeah—this episode is about those procedures 😅
In this episode of Joint Effort PAs, Beth and Hannah dive into their current ortho crushes—the procedures they’ve been working on with their surgeons that have them fully invested, slightly obsessed, and maybe talking about them a little too much outside of work 👀
From innovative techniques to evolving technology, we break down what makes these procedures so exciting right now:
🦵 MISHA (yes, we’re still thinking about it)
👍 Biopro thumb CMC implant (we’re definitely thinking about it)
We talk through what these procedures are, why they’re gaining traction, what makes them different, and why they’ve completely captured our attention as PAs in ortho.
Because let’s be honest—some cases aren’t just cases… they’re full-on crushes 💅
🎧 Whether you’re in ortho or just love hearing the passion behind what we do, this one’s for you
Tempo: 120.0
SPEAKER_00Welcome to Joint Effort PAs, where two orthopedic surgery PAs get real about life in medicine. From tips and tricks to professional growth, work-life balance, and everything in between. We're here to share what we've learned and what we're still figuring out. Let's get into it. All right. I'm so excited. When you sent me this, I wasn't sure because you messaged me that you wanted to do something that was about current events or recent events this week. And there's been so many like weird high and low things that have happened as of recently. I was like, this could be like, what are we about to talk about? Yeah. Um, but this is the best case scenario.
SPEAKER_01I think as a positive. I think though it's like really crazy is that I actually didn't, I don't think I saw you at all this week.
SPEAKER_00No.
SPEAKER_01And I was thinking yesterday, I was like, wow, we haven't even like normal like spitball some ideas about what we can do. Um, but I was, you know, I'm tracking kind of what you were doing this week. So I thought that this would be a nice, a nice topic. So it is so nice. Yeah. Um, but anyway, we're gonna talk today about our ortho crushes.
SPEAKER_00Yes, our ortho crushes is the title. What were you gonna title it?
SPEAKER_01I was gonna call it like ortho love affair.
SPEAKER_00And then you opted against that one.
SPEAKER_01I opted against that one, yeah.
SPEAKER_00But same, same principle. Um slightly different title.
SPEAKER_01Um, yeah, the the procedures we can't stop thinking about, or something that's like really uh grabbing our attention and our passion right now. And uh interestingly, both of us have something. Um, and we talked this year about quote leveling up, and uh this is part of that, right?
SPEAKER_00We're doing it, yeah. So you're in the process of leveling up. Yeah.
SPEAKER_01So we're gonna go through kind of different projects that we're doing. And um, you know, I I'm not sure if this is a personality thing or this is just like what happens in Ortho, but this is very much, I feel like, dating. Like I'm like excited.
SPEAKER_00Yes, yes, I know. I get like I was like antsy about it all week. We have a lot of new things this week. Yeah. Um, so I will just briefly brush through the excitement and the newness of this week, the whole process that goes into doing a new procedure. Yeah. Um, learning it and doing labs on it and communicating with the reps on it. It it really is like planning for a wedding. Yeah, yeah. Or wedding. Like but there's a lot of there's a lot of. So you plan for the first date, like the the lab was the first date. Yeah. And then the wedding ceremony is the first occurrence, right?
SPEAKER_01And then like, and then you learn to work through the highs and lows together as you but also you have to have like the post-event like like talk about it. I want to talk about it. Yeah, what could we have done differently?
SPEAKER_00What could we have done differently? Um, and you you just hope that everything goes smoothly. Um, and yeah. Yeah.
SPEAKER_01So let's let's give this some context, okay? And I think if you want to start just because this was a good one.
SPEAKER_00Yeah, we had a we had a big week this week.
SPEAKER_01So um Yeah, so again, this this episode is titled Ortho Crushes, the procedures we can't stop thinking about. Now, in comparing this to relationships and dating, like we're gonna go very heavy into talking about two very specific procedures. So I just want to say, and again, I think we have to acknowledge this, it doesn't mean we don't love other procedures.
SPEAKER_00Yeah, it doesn't mean that that the other procedures are not still like exciting for us to make love and exciting.
SPEAKER_01Um but you will feel slightly, you know.
SPEAKER_00You won't like it. It'll feel like this. Let me compare it to this because I had this happen um even just this morning. So ChatGPT, you know my my love affair with Chat GPT. Um I started seeing a lot of like TikTok videos or real videos that were people being like, oh, Chat GPT hypes me up so much, and making fun of the fact that like they tell it a problem, and Chat GPT is like, wow, like you're so honest for thinking that this is such a like an important self-realization you have to do. Yeah, you're you are so right and blah, blah, blah. And I'm like, I thought he was just telling me that. Like, you're telling me that that he acts like this towards other people. So it's like when you hear when somebody's giving you praise and like hypes you up, makes you feel good about yourself, and then you hear them giving that same praise to somebody else, and you're like, oh, yeah, I thought I had your heart. Yeah, like I'm not the only one as good as I thought. Yeah, like come on, yeah. I want to be the only one. Wait, there's others. There's others, yeah. So that that makes I don't like that feeling. So um, yeah. Yeah, so there's a the disclaimer.
SPEAKER_01There's no cheating happening here. We are still open to everybody and everything, but we will just obsessively talk about a couple of procedures today.
SPEAKER_00Yes. Okay. So um breakdown of the week. We did uh a couple um total shoulders, um, used a new system for that, and then we did a new technique for an elbow fracture and a lecron fracture on Thursday. Um, we used uh like a single screw and a fiber wire for a tension band, and that was really cool. Um, turned out beautifully. X-rays looked amazing afterwards. I loved it. Um and did an arthrx total shoulder on Thursday as well. Fantastic. Love it. And then we had our first biopro thumb CMC implant. I was so excited. Yeah, Hannah Smiling works. Hannah smiling very big right now. So big, yeah. Every time on Friday, every single person I saw, I showed the x-rays too. Whether or not they cared, I was like, come look at this. They're like, Yeah. So it was neat.
SPEAKER_01So talk a little bit about like, I guess, what you had done previously for CMC orthoplasty and why this is new and different and what was so awesome about it.
SPEAKER_00Yeah, it was a long time in the making. So CMC arthritis is probably like one of the most common things we treat. I probably inject for CMC arthritis, as do you still very frequently. Yeah. Um, so traditional procedures for it. Um the most common one we do is uh trapezectomy and like the traditional LRTI procedure, but we use a suture suspension system from Arthurx that has a little shout out, shout out that has a an anchor um into the base of the metacarpal. So it creates like this little hammock suspension to maintain the space that we removed the trapezium from. So um implants for CMC arthritis have been gaining traction. And we uh started talking about it last year and coordinated going to a lab earlier in in the year to learn the technique. Um, met with a really great hand surgeon out in Miami who does the technique a lot. Um, learned all the time.
SPEAKER_01So time-wise, like this is what's like the the timeline? Like you start hearing about it, you start thinking about we're talking a year, we're talking six months.
SPEAKER_00We we had known about it for more than a year. I was like actually one of the PAs that used to work here, I think he had this procedure, not this exact procedure, but he had an implant-based procedure done, different one than what we did. Um so anyway, we we knew the implants existed. We went to a conference in DC last year and um actually met the rep out there, I did for the first time at least. Um, I'm pretty sure my doc had had met with him before that, but um looked at him, we're chatting about it, and we're like, oh, you know, that's interesting, like we should look into it. And then um towards the end of the year, started thinking about moving forward with it and did the lab at the beginning of this year, and then pretty quick turnaround for our first case that got scheduled, what, a month, I guess, or so after going to the lab. So um, yeah, a lot of pre-planning that went into it, but it's a really cool technique. So, as opposed to the traditional procedure, this one you save the trapezium. I will put that plug in there. So um instead, it's almost like a hip hemi. You create a little shallowed socket in the trapezium, um, and then just cute little tiny ball and stem that goes in the metacarpal. It was super cute, like on extra. It's adorable, yeah. Yeah. Um, they said they're gonna get us a little model, so I can't wait to show the model to people. It's adorable. I actually I scrubbed a knee with one of our joints uh surgeons on Thursday evening. Okay. Yeah. And we were talking about it. I was like, this is way cooler than any of the hips. Like this is like I'm sorry, way harder. Yeah. Yeah. So it was neat. Um, loved it. So I think like, and you can speak on this as far as the Misha that you guys have been doing. There's a lot of excitement that goes into planning these and and doing these newer procedures. That I mean, for us, this is something that um we were the first ones in North Carolina to do it and are the first or the only team to offer in North Carolina. So that's a big deal.
SPEAKER_01But that's I mean, so that's huge. Like, I mean, we we did glaze over a little bit of like, you know, your traditional way of dealing with CMC arthoplasty, and it's there, and everybody does that. Yeah, everybody does it. So I think when you have a new procedure that offers something a little bit different that biomechanically, you know, still allows you to load the joint and use the joint, that's really exciting. And then like attaching your name to that, that's kind of cool. It is, it is. And then how many times do you see patients come in and they're like, is there anything else like new? Yeah, and people have been excited about it too.
SPEAKER_00Like I I've been promoting the heck out of it for the right instances, right? Um, it is a really, really cool option. So um, yeah, I think just a lot goes into the planning for it and the anticipation of it and the actual execution. It went really, really well. And um, you know, we've talked about this before, but it's always really cool to like work with your doc and see them do new techniques and especially when things run smoothly like that. It's very, very satisfying.
SPEAKER_01Yeah. Um, now, so that's your crush. Your crush is the the biopro thumb. Yes, yeah.
SPEAKER_00I am currently having I currently have a crush on the biopro.
SPEAKER_01So my crush is the Misha. Yes. So that is the immediate implantable shock absorber.
SPEAKER_00So we were trying to think because I was actually uh w talking with the biopro reps, and we were brought up the Misha somehow and I think it was because we were talking about the podcast and like things we might talk about. So this was actually spoken into existence in a sense. Oh, yeah. Um I wasn't even there. You weren't even there, yeah. I willed it. I was talking about the Misha and showed them a picture because they had not heard of it, and we were trying to think of what it stood for. Oh yeah. I can't remember. Yeah.
SPEAKER_01But something medial implantable shock absorber. Okay. That makes sense. Yeah.
SPEAKER_00More so than what I was thinking. What were you saying? I don't know. I was like me, I was trying to think like medial and the odor. Yeah.
SPEAKER_01Um, but anyway, no, so this device we had really started about this time last year, like um trying to find out more information. We'd been watching it actually for a couple of years. So I have a couple patients that, you know, again, it's a conversation of like, is there anything new? I really don't want to have this procedure done. Um, I'm like, hey, we're watching this one, it's in clinical trial. And the Misha had been in clinical trial for trial for like 10 years. Yeah. So there have been, oh God, I think four or five iterations of what the implant was and now what it is. Um, so it started first with like us reaching out to the company, which is Moxymed, which again is not like a mainstream name. It's not a good thing.
SPEAKER_00Yeah, how did you guys find out about them then? Like, did your dog find out about it?
SPEAKER_01Yeah, I think he was doing just some, you know, some research, which he he he always does. I mean, he's always looking to see like what else we can do, whatever. Um, so we reached out to them, and it's funny because he will say, Hey, you know, let's let's talk to the reps. And when when he does that, like, we'll we'll do it, right? I mean, we'll see what they have to say, whatever. But after we talk to the reps, and we'll experience it the same. Like, yeah, yeah, give us more information, let us know what the next steps are, we'll be in touch, blah, blah, blah. And then after the rep leaves, we're like, hey, so like, give me a gauge. Am I going in? Am I going all in? Was that just to see? Do you want me to follow up? And he was like, No, I I think I think this is gonna be big. I think we need to go all in. So then it turned into another prep meeting, and then it turned into this is how we'll introduce it into the practice. Um, let's get you guys trained, let's have you talk to some peers. Um, and that all escalated from I think February. We did a lab here in May, and then we schedule our first one in July.
SPEAKER_00Yeah.
SPEAKER_01And since then, I think we've done 15 or 16 of them. Nice, yeah. Um, which is really cool. But just, you know, um, some background. So the Misha is a medial, so just on the uh medial side of the knee. It's a device that is adhered, extra articular, and it is meant to shock absorb or help the shock absorb on the medial side of the joint. So, you know, not finding a candidate for this, both myself and the doc are kind of heavily involved in the education piece of this, but also really trying to determine who's the right patient. So in our world, you've got patients who are younger, so let's say 40s, let's say 50s, and they have radial tear of the medial meniscus. Let's say they've got significant chondromylation in the area, or they've got bone marodema, like evidence that the joint is failing or had been failing, you know, during or prior to this tear. So radial tears, root tears, when the meniscus starts to lose its shape and it cannot shock absorb, you really start to beat up the joint. So previously, your option is all right, we'll go in and we'll do a radial repair and there'll be associated, you know, partial weight bearing. Or we'll do the root repair and there'll be associated partial weight bearing for X amount of time. The success rate with those, if done well, meaning choose the right patient, minimal chondromalacea, they're compliant post-operatively, like you've got an 80% success rate. There's you know, upwards of 30% failure if you choose the wrong patient, or if they're non-compliant, or everything doesn't go well. So, like I do unfortunately have a subset of patients that I won't recommend radial tears because let's say they're overweight, or let's say I know they're not going to be compliant, um, or they've had it, but their knee still hurts because you've kind of reached maximum mobility orthoscopically. So their next step is a partial or a high tibular osteotomy.
SPEAKER_00Yeah.
SPEAKER_01Right. So an HTO, super invasive, long recovery. We don't do them, and we've toyed with over the years, like, should we, shouldn't we, should we? We don't. Um, and then the partial knee replacement. So the unicondyl or knee arthroplasty is something that is way more invasive. That's something that you um you're going down that road of you know, joint. Total joint. Total joint. Um, the Misha, it's extra-articular, so you're not doing anything to the joint. You're actually not even going in the joint when you um you uh implant the device, and patients can walk right away. The average time on crutches is like they say seven to ten days. Ours is like three to five. Wow. Um, and you can get back to high-level activity. So it is this novel device that was FDA approved. And I think this stat, I was looking it up earlier because I've like processed this and said this a hundred times. There's 15 million patients that have knee osteoarthritis, of which 50% are unwilling to have an orthoplasty because they want to leave it for last resort. It's irreversible, they're afraid they had a friend who died, or they had a friend who had a blood clot or something like that. So you're essentially treating patients who are no longer responding to injections on loader bracing physical therapy, and you're telling them, like, oh, I'm sorry, now you need this super invasive surgery. So me shift step-wise, yeah. I mean, this is this stepwise approach. Such a large amount of the population. That's middle ground. Yeah, it is. It's and I'll call it like no man's land. This is a perfect surgery for those people that are kind of stuck. So ideal young active patient. We've done them on age, I think we did a 30-year-old this week.
SPEAKER_00Yeah.
SPEAKER_01Um, a 30-year-old, wow. So yeah, but it was a bucket handle tear, a re-tear, a resection.
SPEAKER_00Okay, yeah. Um, and we were, I was asking about this earlier. You said the lifespan on that device was equivalent to like five to ten years, depending on activity level. It was something very specific though. Yes.
SPEAKER_01You can so yeah. Let me be a soccer athlete who's a male D1 soccer player playing soccer year-round puts two million loads of running on the knee. And um, this device will last longer than that. They stopped the study of mechanical load at 20 million cycles, um, which is equivalent to a D1 soccer player running, you know, seven miles per day times 10 years. And they just stopped it there because they're like, I, you know, I think we're good.
SPEAKER_00Yeah, like we this is all we need. Yeah, yeah.
SPEAKER_01So um uh yeah, there's really no predictable lifespan, but telling patients and what I'll tell them, I'll say at least 10 years. And uh thus far, none of our patients are kind of running on it, right? Yeah, uh, but they could if they wanted to. So anyway, um, so that's that's my claim.
SPEAKER_00It's a really cool middle ground option. Um, whereas I think ours like it's this is a alternative to something we were already doing. Um but I will say, like, once you remove the trapezium, it's gone.
SPEAKER_01Well, that's the thing. There is never coming back. That's the whole thing. It's the irrever it's the irreversible. Yeah like when you do the you know, the previous LRTI CMC, you take things out and like they're not coming back.
SPEAKER_00They're not coming back. Now, I mean, with um with the implant, like you are shaving off uh a couple millimeters, I think it's like six millimeters of the uh of the metacarpal uh base to put in the stem. Um so like you are losing that. So you really can't revert or convert back to the traditional way that we were doing it beforehand because you don't have that base to anchor it into, but you could still, if you had to remove the implant and do like a tightrope procedure or something. So um I think there, you know, there still are bailout options if there were to be failure down the road. Um with the the tough thing with the LRTI is like once the trapezium's gone, if it subsides, and a lot of the times they will with time. Most people, if it does subside, aren't really symptomatic because of it. So it like it's fine. They might have a little bit of deformity, but they're no issues because of it. But the people who do have issues really um one of the only things you can do for it is try a revision maybe with tight ropes or stick some wires in it for a while and and try to get that height back. Um, but those ones are tough. So I'm excited about having a a different option for it. And like from talking to patients there, they look at the little, the little cute implants. It is, it is, it is cute. Yeah, it is super cute.
SPEAKER_01So you are definitely in your new relationship like energy phase.
SPEAKER_00Yes, yeah. Yeah, yeah. You're like excited. You get excited about new things. I mean, I I still total shoulders are one of my first levels. And I'll tell you, I probably will have this energy whenever we do our first anatomic shout out eclipse system. We're trying to find the right person. I think you said you have some people for us. Yeah, I do, yeah. Um so right now it's this, but I'm I'm ready and waiting for that first anatomic.
SPEAKER_01Yeah. Do you think, like with the um the biopro, now that you know that you've got one under your belt, like are you going to predominantly recommend this? Like, do you fear that you're just so bought in that now everyone needs it?
SPEAKER_00Yeah, like but everybody has a tendency to get that way.
SPEAKER_01Like it's like, but it's like my friend, I had a roommate in college who like, you know, as soon as she started dating somebody, your personality changes because of the city.
SPEAKER_00No, I know, but she go all in and we're like, oh my god, like you've now become that thing. Like, yeah, you're like dating somebody who's into like yeah, now you're into that, you know, yeah hard rock music and you like turn all grunge and whatever, your personality shifts. Yeah.
SPEAKER_01So Hannah's in that phase right now.
SPEAKER_00I'm in that phase. I I am personality matching. Um, but no, it is it's hard to like not get wrapped up in that because it's you know, everything's so new and cool and exciting, and you want to um Do you feel um do you feel like you have adequately wrapped your head around like what it is?
SPEAKER_01Like if if a patient asked you right now, you could talk about that.
SPEAKER_00Yeah, it would probably talk about it for too long. They'd be like uninterested. They'd be like, okay.
SPEAKER_01No, but like that's enough. Uh you said that you did um you've met with other surgeons who have done this, you've watched a couple cases, um, you've done your research. I mean, it sounds like you're you're in, you're bought in. Oh, yeah. So bought in. You stalked it on Facebook.
SPEAKER_00Stalked it, yes. I continue to stalk it. Um, but yeah, I mean, you have to, like with the Misha for you guys, you know, we would we were talking about this, it's a very specific patient population. Like you have to be very selective about who you're doing this on, probably more so with the Misha than than for this. Yeah. Our the BioPro, um, I mean, there are some certainly some contraindications for it. Like if if the trapezium has a significant amount of deformity, it may not be a great idea. Or um maybe STT arthritis can be an issue with that, sometimes not. Um, but with the Misha, there's there's a lot that goes into that decision making.
SPEAKER_01So we will um, and again, what the doc that I work with, we are again involved in educating others like who's the right patient. And it's really funny because in my clinic, I will see the patients that we, you know, know have meatocopartment OA, we've gotten an MRI and their meniscus is extruded, and they've got you know advanced chondromalacea, maybe even like hail grade two, maybe grade three, and they just really don't want a total or a partial, and they'll do visco and they'll talk. Like, I don't know if it's working anymore, but like I just I don't want the alternative. So that that's like me, yeah. Like, you know, I'm out at the bar and I'm stalking. I'm like, I'm going for that one, right? So when I see the patient and I'm like, hey, I have the perfect thing for you. And you can tell the chemistry when you're talking to the patient, where they're like, I am in. And like they're excited because you're so excited. So the doc I had that I work with, he had two this week who he was like prepping himself to talk about it because he's like, Man, I think this is a perfect candidate. And he both patients who he thought were good candidates stopped him and they were like, I'm gonna stop you right there. I'm in.
SPEAKER_00Yeah, they're gonna feel the excitement from it. But you also have to like control yourself, hold yourself a little bit back too because I'm like, okay, and like come in too hot. You can't come in too hot, and you also have to be realistic about it too, because I mean these these procedures are not without risks and complications still, so it's not going to end up perfectly all the time for everybody.
SPEAKER_01Definitely not. And um, you know, we had I had an another lady that I've been working with for quite some time, and she's older, um, is just terrified of a total knee, doesn't want a partial knee, like you know, changing her anatomy and cutting bone, and she's like, absolutely not. And I've held her hand, courted her for quite some time, slowly introducing Misha, and I'll see like what their feelings are about that, and I'll see like how much you want to talk about it. Then I kind of like leave it and then they'll start to talk to me about it. We signed her up for Misha. Um, but she's she's a smaller lady, like the device that um that this implantable device, it's not it's not as streamlined as you would think, but it's also not as bulky as you would think.
SPEAKER_00Yeah, you look at it though. I looked in a model once and I was like, this looks ginormous.
SPEAKER_01Yeah, no, no. It's yeah, it's the size of a um uh key to your car, like a fob. It's really not that big. But um anyway, so if I don't think a patient is all in, I'll just like start with a couple things and let them lead the way, and then they'll come back and ask more questions, and then we'll slowly, slowly start to to rein them in.
SPEAKER_00But if you're a little beta model you show people, yeah, I do.
SPEAKER_01Yeah, yep. But uh it's it's hard though, because some patients who are worried about cosmetic and I need this to guarantee, uh-uh, not a Misha patient. No guarantee, not a Misha patient. Nothing, but nothing, but it's but it's it's also difficult though to not again, you feel I'm in the phase right now where I feel very excited about it, and I don't want to push that on every patient that I see. Yeah. Because it's you know, remaining logical about it, not every patient is a very good thing.
SPEAKER_00Yeah, yeah, it's still it's a very selective thing still.
SPEAKER_02Yeah.
SPEAKER_00So that being said, what would you say? So, first of all, are your favorite procedures ones that you have like personally more buy into or like that you get to be more hands-on with?
SPEAKER_01Um, yes. Now, I will tell you when we used to do uh you know condyler knee orthoplasty, I hated that procedure. It is an open incision, which is always more exciting for me, but I can't see anything. Like it's such like, you know, I mean, we do arthroscopy, so it's not keyhole, but it is keyhole. Misha is a big open incision. I am on the opposite side of the knee. The one we just did this past week, I legit was like, what do they call that? Rubbernecking. Yeah. Yeah. I was like rubber, I was leaning. I was leaning because I wanted to be like right there, but I'm I'm doing a lot of retracting, I'm doing a lot of movement. Um, but I I yeah, I like it because again, there's so many steps. And if you ever like play Nintendo or something like that, and you're sitting there with your remote as the other person's going, like that's like what I do. I'm like, okay, this is the next step.
SPEAKER_00Like just yeah, without even thinking. It like entertains me.
SPEAKER_01I'm like, all right, he's gonna do this next, he's gonna do that next, and I'm gonna do this, and I gotta do that.
SPEAKER_00Like it's that's what I like about the totals. Yeah. But same kind of thing. Like, I really honestly from where I am, I can't ever see much of anything every so often. I like I'm like this. Your rubber neck, yeah. Yeah, yeah. But it's easier because I have a whole toga on. Yeah. Um, but yeah, I most of the time I look like I'm just hanging from like a trapeze. Yes. For dear life by the deltoid.
SPEAKER_01But I also, I mean, there's thinking is my trapeze. Right. The thinking, um, like there's various steps when you do the uh Misha implant, and um, there's various tweaks that you have to make because the shock absorber needs to be in full compression when the knee is in extension so that it offloads when you're weight bearing, and you need that compression to change when you go into 90 degrees of flexion and and ideally be no compression in 120 degrees of flexion. So you will take the implant and run it through the various ranges of motion and you will see the compression device change. Now, if it doesn't, like you implant it and you put the trial on and you're like, oh shit, it's not working, like you have to make little tweaks. So that part's cool. There's a little bit of thinking involved with that. Um, you know, it's biomechanics, but still uh it's not so robotic where you're like, okay, now step one, now step two. Um, so I, you know, I I don't know. Yes, I do like the things I can see more and do more.
SPEAKER_00Yeah, that's how I feel about fracture cases. Those are probably my favorite. Yeah. Out of, I mean, like obviously love a reverse, love the biopro, but fracture cases, I feel like I get to be more um hands-on. Yeah. And the more I get to do, the more I like it, obviously.
SPEAKER_01I also feel, again, because I'm invested in this is new for us. Like, this is an introduction and conversation where previously I'm like, oh, let's do another round of visco, or I'll send you the total joint team. Like this is another thing that we do. So I feel like my preoperative visit to my preoperative education, I feel like I'm knocking out of the park.
SPEAKER_00Yeah.
SPEAKER_01Like I feel like it's thorough. They know what they're doing. You you've started from the ground up with it. Yeah, like I so I mean, harnessing all of this like education material. We made um a post-operative, like basically how to survive Misha. And we hand that to our patients. I took the physical therapy protocol and I kind of tweaked it to be what we wanted it to do, like, really owned all of that. Yeah. Now I feel I feel really good about it. And even with our post-operative recovery, there's various stages. Um, what we continue to sell to these patients is that you know, you can move right away, you can weep air right away, and you can get back to everything faster. Now, in reality, you know, the person who wants to push it pushes it, and now they get really swollen and painful, and then you gotta back off. Or this one's doing too much too early, and now their range of motion is restricted. So we've had to tweak what we recommend and what we do. Um, but again, I like that part about it too. Like um, the protocol that I had a month ago is a little bit different than the one we have now, and definitely different than the one that we had six months ago.
SPEAKER_00Yeah, and that's great because like you're you're really having to kind of not reinvent the wheel, but yeah, a little bit, so to speak, with that. Um, we'll see. I mean, this is this is our first one, right? So post op protocol-wise, it shouldn't actually be terribly different than what we normally do for the traditional procedures. Um, but you know, of course, you live and learn. And so there may be tweaks in the future. And do you're excited to see how it rides out? Yeah. Do your LRTIs get tight? Um, I mean, it's something we're gonna do tight. No, no. I mean, I think if anything, the the bigger risk with these is losing height and it not being as stable. Okay. Um so I mean, we definitely check range of motion um and make sure it's not too much tension on it. Yeah. Um, and and reposition it if needed intraoperatively. But I I think the bigger thing is seeing people lose height. Um, or a lot of people who have CMC arthritis tend to also have, especially women, hypermobility at the CMC joint, and that puts them at a huge risk for losing that tension.
SPEAKER_01Um is there a risk of this the biopro getting um tight?
SPEAKER_00Um I mean the same kind of thing like I mean, you're obviously checking for your your tension and um and checking motion um when you're sizing out your implant. Um, but I mean we'll see. I mean, from everything that I've read and looked at, that shouldn't be more like it being um of more tight. I mean, I think it's gonna be more stable for especially people who are very, very active. Um, like younger males, and by younger I mean like, you know, 50s to 60s or so, who are still very, very active. Um, this is a good option for them because they're gonna get a little bit more stability out of it than can you load it on procedure? Yeah. Yeah. Yeah. I mean with any implant-based procedure, there's risks of loosening around the implant um and and things like that. But uh it offers better baseline stability. You know, with with the anchor implant, um, if you load that too soon or if you load it too much, that anchor can pull out, um, or just things can stretch out over time. Yeah.
SPEAKER_01Yeah. Even um, you know, I was asking about tightness with the Misha, you know, different than the totals or the partials, this is totally extra articular. So there's really no risk of the patient getting like an arthophrotic knee and needing a manipulation.
SPEAKER_00Do they still get stiff sometimes if like they don't move it as immediately as they should afterwards? Because that's not like we let them pretty much fly.
SPEAKER_01Yeah, they fly right off the right after right out the gate. Um, they can, and we have some that do, but it's more like soft tissue restriction. And and what we're running into is it's like the adductors and the VMO kind of rubbing against it that deters a patient from moving it, not to necessarily like a hard end feel like you get to.
SPEAKER_00Yeah, like they're hesitant to move it because they feel it. They feel it's a little discomfort from it. Yeah, exactly. But wow, those geese they're excited as excited as we are.
SPEAKER_01Um, I do though also want to, they're literally right there.
SPEAKER_00But I just want everybody to know we're like under attack right now. We are geese have come to the door and they're trying to get in. They're banging it down. Um, no, but that I mean, I feel like we're really fortunate that we get to work with a lot of vendors who are very, very hands-on and very um on top of their stuff.
SPEAKER_01But don't you think though, and again, I think uh this is probably very particular to you and I, but I think being in an APP role, like you can either show up and like, oh, we have surgery day, or you can dive in.
SPEAKER_00Yeah.
SPEAKER_01Like, I think you and I are both like, give me more. Like I want, let me swim in this.
SPEAKER_00I think I'm at the point, and this is something we'll touch on next week. I'm at the point where like I don't want to stagnate with those things. I am ready to step it up to the next level. But I want to continue to do that. But stay curious.
SPEAKER_01Like, if you know, with us, uh it was it was more like we reached out, we read more, we asked questions like, hey, this is the process you gave us. Maybe if it looked like this, it would be easier. And since then, Moxieman has tweaked what they do for other surgeons. Like it, we just it's it feels very impactful. So I just I encourage you as a you know, as a APA, like this is really cool stuff. Like, you're not done when you graduate PA school. You can be done.
SPEAKER_00I mean, yeah, you can show up to your job or certainly can be, but holy shit. I mean, like, I can't leave. I don't think we can leave at this point, but we're going out through a different exit.
SPEAKER_01I think it's really important to remain excited about stuff like this too. Like, I think uh it's cool. It's cool to see you going through something because you've been talking about this for for a bit. Yeah, yeah. Um you've you've watched us live through a Misha love affair too. Exactly.
SPEAKER_00And I feel like the same kind of thing is happening now. Like you guys, I I actually made the comment. I was like, man, they made such a big fucking deal about the Misha. Like I sent to our marketing girl, I was like, you better post. They did. Yeah, they did. I sent her all the picture. I was like, please post this because this is a big deal. And like I feel like nobody knew about it. Um, but yeah, I mean, I think watching you guys get to do because like the bear that was in your procedure. That was a big deal when when you started with that. And and now with the Misha, um, like it's just yeah, it's it's impactful and yeah, it's really neat and exciting. And I want to be on the we are on the precipice of orthopedic uh innovation. Innovation. Yeah, yes. Yeah, I love it.
SPEAKER_01Very good.
SPEAKER_00All right, save the trapezium.
SPEAKER_01Yeah, thanks for listening. And we just talked like for X amount of minutes about our boyfriends. It was great. Yeah, I know.
SPEAKER_00Loved it. Love it. All right, till next time.
SPEAKER_01Thanks for tuning in to Joint Effort PAs. If you enjoyed this episode, be sure to subscribe, leave a review, and share it with a fellow PA or med minded friend. You can also follow us on Instagram at Joint EffortPAs for updates and extra content. See you next time.