The Joint Effort Podcast

Before the Operating Room: Building Stronger Bones and Joints

• Dr. Noelle DiGioia Guthrie & Tiffany Belculfine, PA • Episode 7

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Leading Up To Surgery, How Does The Patient Optimize Bone And Joint Health? 

The path to a great joint replacement starts long before the first incision. We dig into what truly improves outcomes: stronger bones, smarter prehab, targeted nutrition, and a calm, realistic plan for recovery. We unpack the difference between osteoarthritis and osteoporosis, why bone density matters for implants, and how vitamin D, calcium, and protein support healing and reduce inflammation. We also talk candidly about who is ready for surgery, when to wait, and how to use weight management, smoking cessation, and alcohol moderation to lower risk.

Prehab takes center stage as we explain how pre-op range of motion predicts post-op range of motion, especially for knee replacement. You’ll hear practical, clinic-tested strategies to strengthen quads and hamstrings, stabilize the core, and improve gait mechanics so the first weeks after surgery move faster and hurt less. We address a frequent fear among active people: did years of sports cause the problem? Our take is balanced—lifelong movement is a net positive, though extreme mileage and prior injuries can accelerate wear. The upside is that athletes often thrive in rehab because they know how to train, pace, and recover.

We also highlight gender-specific care that respects the reality women face: later presentation, stiffer joints, and higher osteoporosis risk. Tailored rehab that accounts for hip-to-knee alignment and ligament laxity can speed stability gains and confidence. Finally, we tackle anxiety and expectations with clear milestones, layered pain control, and home setup tips, from stairs to support. If you’re planning a knee or hip replacement—or helping someone who is—this conversation gives you a focused, evidence-informed plan for a safer surgery and a stronger comeback.

If this helped you get ready for surgery, follow the show, share it with a friend who’s on the same path, and leave a quick review so more listeners can find it. Your feedback shapes future topics and helps us help you move better.

To learn more about The Bone and Joint Center at Magee-Womens Hospital visit: https://www.pghbjc.com
Dr. Noelle DiGioia Guthrie
300 Halket St.
Pittsburgh, PA, 15213
412-683-7272

To learn more about The Wellness Center for Bone and Joint Health visit: https://www.boneandjointhealth.org
Tiffany Belculfine
300 Halket St., Suite 1601
Pittsburgh, PA, 15213
412-641-8594

SPEAKER_00:

Welcome to the Joint Effort Podcast, where mobility meets reality and your future self says thank you. Your host, Dr. Noel DeJoy Guthrie of the Bowman Joint Center of the Game Women's Hopket. And Tiffany Elkafi, position assistant at the Wellness Center of the Bone Joint House, serving adults across Western California. If you're the sound like you're putting on stop weird side there, you're in the right place. Every day, they'll break it down and build you back up with a personalized plan for real life. The show is information without a substitute talking to the clinician. Now, let's get you moving. Here are Dr. Noelle and Tiffany.

SPEAKER_02:

Preparing for surgery is not just about the procedure. It's about setting your body up for the strongest possible recovery. Welcome everyone. I'm Julie Schwenzer, co-host and producer in the studio with Dr. Noel DeJoya Guthrie of the Bone and Joint Center at McGee Women's Hospital, and Tiffany Belkefine, physician assistant at the Wellness Center for Bone and Joint Health. It's so good to be back with you, ladies.

SPEAKER_01:

Hi again. Thanks for having us.

SPEAKER_02:

I know it's a tongue teaser, those names. Yeah, yeah. Nice long names and very nice established organizations. Um, so let's get right into it. So leading up to surgery, Dr. Noel, how does the patient optimize bone and joint health?

SPEAKER_01:

Very good question. Um, well, first and foremost, I always tell my patients surgery is a big commitment. Um, you know, obviously you have to be a candidate as far as your arthritis and um, you know, medically and stuff like that. But another big piece of it is that the patient, it's elective. They have to be ready to have surgery because preoperatively it's a big deal, post intraoperatively and post-operatively, you know, those big three steps are huge. And a lot of things that we can control in each step, too. So I think preoperatively, there's a few things that we maximize. Obviously, um osteoporosis, osteopenia is a big thing that we've talked about. Um, that does not prohibit people from having a joint replacement, I think is really important. Um, but if you can um maximize the treatments you have to increase your bone health, which is great, vitamin D, calcium, healthy diet, um, exercise, movement. Also, there's even medications. If you do have osteoporosis that's that severe, that can help build bone. Um, so that's definitely a conversation that we have in our office and we um encourage patients to have with our primary care doctors. Another thing is is movement, exercise, being in good shape. I think a lot of um particularly for knee replacements, your pre-op range of motion really dictates your post-op range of motion. So we kind of encourage people to do something we call prehab, meaning even going to PT before surgery to help with your range of motion, to help strengthen your quadriceps, your hamstrings, your low back, your core, all those things help your gait, help your post-op recovery. We've also talked extensively in our last episode about optimizing uh weight management, uh nicotine, smoking cessation, alcohol use, um, those kind of things, definitely controllable that we help try to help patients optimize before surgery, before proceeding to surgery.

SPEAKER_02:

And you mentioned too osteopenia and osteoarthritis. Could you please expand again on the difference between those two?

SPEAKER_01:

Sure. So osteoarthritis is basically the wear and tear of your joints. So just with, you know, movement, exercise, putting pressure on your joints, your cartilage starts to wear down on the ends of particularly in your knee and your female tibia, and then in your hip, on your in your um as tabulum and your femoral head. Um, so basically it's just as we get older, as you, it's kind of like the treads on a tire. As you use them more, they just start to wear down. That's really good analogy that we use. And then osteopenia is the precursor to osteoporosis. So they kind of are in the same family. Um, that's basically just that your bone becomes weaker. Um, you know, as we, you know, nutritional deficits, women, particularly with um hormonal changes, are put at increased risk for osteopenia and osteoporosis.

SPEAKER_02:

And what about people that you will not operate on? What happens when you decide like we just can't do this with you because it's too risky?

SPEAKER_01:

Yeah, I mean, like we said, joint replacement's elective. Um, so meaning number one, we make sure patients are healthy to have surgery. Um, if a patient's have a significant like heart history, um, you know, lung history, we always, you know, refer them and work with their primary care doctors and the cardiologists and other specialists to make sure that they're healthy. I think, you know, we don't want to put anyone through a knee or a hip surgery and then the outcome be poor because they're medically unfit before. Um, and then there's patients who, you know, they might have to lose some weight. You know, we always kind of try to optimize weight, smoking cessation. We do that before. So we work really, we work well with patients. We give them resources to help them get ready before surgery for those kind of things that we can change. Um, and then, you know, it might take a little bit longer to for them to have surgery. Um, and there are is a subset of patients who just medically can't have surgery. Um, I would like to say I don't think age prohibits having a joint replacement. You know, some people think they're 90 and above and just can't have joint replacement, but there are a lot of patients in that age subset who are healthy, active, and that's the f the only thing that's really keeping them from doing things is their joint. Um, so I think that's important to know too. But for the patients a subset who, you know, just medically can't have surgery, we definitely work with them to um, you know, for non-op things to help control their pain. Um, it's a difficult situation, but we we try to do the best that we can.

SPEAKER_02:

And can you also speak to nutrition and protein intake and how that supports bone strength and tissue repair?

SPEAKER_01:

Yeah, no, I think, I mean, obviously protein and um having a good healthy diet helps your muscle mass, um helps you generally be fit and um ready. Like we said before, you know, surgery is a stressor and we want you to be optimized before surgery so that you can recover well. But um protein intake, you know, having a healthy diet helps decrease inflammation afterwards and also helps you, you know, obviously joint replacement causes a lot of inflammation. So it helps you recover from that quickly. Everyone's gonna have pain and inflammation, swelling afterwards. But, you know, some people who are more fit prior to surgery can recover quicker.

SPEAKER_02:

And you know, I know a lot of runners and people that have been involved in a lot of activities or sports throughout their whole life into you know middle age and stuff like that, but they still need a replacement. So is it also body structure and you know, things that are out of their control?

SPEAKER_01:

Yeah, I mean, we have tons of patients who were like, you know, I was so active when I was young. Was that bad to do when I was young? Should I have not, you know, run that much or played volleyball or whatnot? And and I I say no. I mean, I think when you're growing up and and exercise and movement is so important, you know, it helps you be active, it helps you be healthy, it helps you, you know, create communities. Yeah, it's fun. So I think um I would not change that. And there's some people who have, you know, if you have an injury, that's a little bit different because it sometimes accelerates your arthritis. And um, but I'd say to people, there's no you shouldn't, you know, regret what you did younger. Um, it might ex, you know, I think if you're marathon runner, they're doing multiple marathons a year or, you know, more long distance running, it's just the sheer force that's putting on your joints, it accelerates it a little bit. So um that's different from you know being a casual runner or ex, you know, exercising, playing sports when you're younger. Um, and we have tons of patients like that who who come in, need joint replacements and do really well. I think, I mean, like we talked before, athletes are really in tune to their body. They, you know, obviously you kind of are used to that sort of training and pushing your body where you need to afterwards and you know, healing and stuff like that. But no, it's not uncommon for athletes to be in our office for sure.

SPEAKER_02:

And what is uh gender-specific care and how does it influence surgical planning? Because I I actually didn't hear about this term. I didn't know that this was something until I spoke to you ladies, you know, before our interviews.

SPEAKER_01:

Yeah. I mean, it's there's been a lot of research shown that um women have wait longer to have be evaluated for the osteoarthritis. They have a, I mean, I don't want to say higher pain tolerance, which com is very, you know, anecdotally common, but um, so for that reason, they wait longer, their arthritis is worse, they're stiffer because they wait longer. So talking about, you know, the prehab is really important with those patients, like patients who I have, you know, particularly with knees that are really stiff, I really encourage them to go to physical therapy before. Like we talked about too, osteoporosis is more common in women just because of our hormonal changes. Um, so we optimize, and like I said, it's not doesn't prohibit you from having a joint replacement. We try to optimize it before. Um, also, there's gender-specific uh rehab that we do post-op. Um just physiological women are um structured differently as far as like their hips to knees angle and your your hamstrings and quadriceps kind of um work differently than the males. So we we actually have one of our physical therapists upstairs really developed a gender-specific post-op rehab care for women, particularly. Um and also, you know, I was an athlete growing up and it was ACL injuries are are huge in female. I mean, they happen in male, but if you think about it, every ACL injury you hear is in in females, and that also has to do because our ligaments are a little bit more lax because of our hormones. Um, so it's important, you know, when I was an athlete, we actually, when we were younger, we did certain exercises that help strengthen your quadriceps and hamstring muscles around your knee to prevent that kind of thing. Um, so even, you know, thinking this is talking to like, you know, coaches and athletic trainers and stuff, but that's important too.

SPEAKER_02:

Um, so I have a last question for the both of you. And, you know, we always appreciate that your job goes beyond, you know, the health care and and what happens in the office. How do you help patients manage their expectations and their anxiety before surgery?

SPEAKER_01:

Like I said, working with, you know, it's a big deal for the patient. And I just I tell patients that and I say, you know, we give them the most support we can pre-operatively to help manage our expectations post-op. Um, you know, we have a lot of good resources from our team, from, you know, us all the way, you know, around in the operating room, in our pre-op nurses, in our office, you know, everyone is there to provide support, answer questions, um, do it quickly too. I think that's important. Um, there's a lot of anxiety around joint replacement, particularly related to pain too. Um, so we definitely address that. We come at your pain all different ways, which I, you know, a lot of programs do. Um, but I think the biggest thing is that knowing that every touch point in the process is there to help you and support you and help you through this pre-operatively and post-operatively.

SPEAKER_03:

And definitely again, letting people know what those expectations are. Um, if their expectation is that they are going to go out dancing with their spouse a week after surgery, you know, we need to educate them and let them know that that's probably not going to be the case. And if people aren't thinking about those things, you know, they things come up like, well, how am I going to do this? How am I going to do this? What's this going to look like? Well, how am I going to get around my house? Well, what if I don't have anybody to help me? What if I have stairs? You know, kind of preparing them for all of those things that are going to come up if they have a procedure done. And just kind of letting them know that whole process, letting them know that, you know, it's a mental stressor for them too to go through that. And it's it's a stress on their body, it's a stress on their mental, you know, things they used to just do without thinking. Now maybe they have to think a little differently. It's a lot, it really is. But it's nice to educate patients and let them know realistically, like, hey, these are the things that can happen. Because if they don't ask, you know, they're not gonna know. And if we don't ask, we're not gonna know what their concerns are.

SPEAKER_01:

And I always tell patients, we're doing, we're doing joint replacements to get you back to what you were doing before. Like we want to get you back to playing tennis, back to, you know, to playing with your grandkids, going for walks, walking your dogs, stuff like that. So I mean, it like Tiffany said, you know, I think managing expectations to get there is important. Um, but I think the end goal, that's you know, our goal.

SPEAKER_02:

Okay, well, thank you both so much. This has been very informative. I hope a lot of people listening or watching, um, you know, feel more prepared if this is something they have to go into. So we appreciate your guidance.

unknown:

Okay.

SPEAKER_01:

Yeah, thank you. Thank you.

SPEAKER_00:

That's today's dose of strength, balance, and better movement from the Joint Effort Podcast. Ready for care that fits your life and gets you moving? To schedule an appointment with Dr. Noel for your surgical and injection needs, call 412-683-7272, or visit PGHBJC.com. Or if you are looking for lifestyle changes that are not certain, contact Tiffany Belgifine. Call 412-641-8594 or visit bone at jointhealth.org. Healthy bones and happy joints make every day better. Until next time, keep moving, stay steady, and take care of yourself.