EP 670: Bad Joints Bringing You to Your Knees? Orthopedic Trauma Surgeon Dr. Saldanha on Complex Joint Revision and How To Prevent Life-Threatening Falls

In this segment, Dr. Mistry and Donna Lee welcome Dr. Vilas Saldanha, an Orthopedic Surgeon specializing in the treatment of serious, traumatic injuries ranging from broken ankles to botched joint replacements. While broken hips and bad falls are commonly the butt of bad jokes, orthopedic trauma is a deadly serious issue. Dr. Saldanha sees the impact of injuries sustained everywhere from the battlefields of Afghanistan to the bike trails of Austin. Listen in to learn how mobility loss, osteoporosis, and other factors may be life-threatening, particularly for seniors and those prone to instability, as well as the steps you can take to prevent such injuries. If you or someone you love is struggling after a traumatic injury or complicated joint surgery, call Texas Orthopedics at (512) 439-1000 or visit them online to schedule an evaluation with Dr. Saldanha today!  

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Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

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Transcript

Speaker 1 0:00

<silence>

Speaker 2 0:07

Welcome to the Armor Men's Health Show with Dr. Mystery and Donna Lee.

Speaker 3 0:15

Hello and welcome to the Armor Men's Health Show. I'm Dr. Mystery , board certified urologist men's health expert. Joined by my co-host Donnel Lee .

Speaker 4 0:23

That's right. I'm a board certified co-host. Welcome everybody.

Speaker 3 0:26

Donnel Lee is a professional comedian. Mm-Hmm. <affirmative> . If so funny if you were, if you were alive in the 1980s. Hey ,

Speaker 4 0:32

There it is.

Speaker 3 0:33

<laugh> . What? The seventh? You know what?

Speaker 4 0:34

Funniest ,

Speaker 3 0:35

Funniest . In America . The seventh. Funniest

Speaker 4 0:36

In America.

Speaker 3 0:37

In America, though.

Speaker 4 0:38

Not the city or

Speaker 3 0:40

State. I have a mother. She's not very funny. No, I'm not sure. This is a really difficult group to , uh,

Speaker 4 0:44

Well, Nick at Knight told me so Nick , remember Nickelodeon? Is that still around? Nickelodeon? Probably not.

Speaker 3 0:50

Nickelodeon had a Super Bowl , uh, like Oh , I saw that.

Speaker 4 0:52

It was so

Speaker 3 0:52

Funny. It was pretty funny with SpongeBob.

Speaker 4 0:54

That was awesome.

Speaker 3 0:55

Anyway, <laugh> . Well , this is a men's health show. This is brought to you by , uh, NAU Urology specialist. That's the group that I started in 2007. Uh, we are all over town. Uh , Donna, how do people get a hold of us and , uh, you know , and , and we're our offices.

Speaker 4 1:07

You can call us at (512) 238-0762. And somebody told me to slow down 'cause I talk way too fast. We're in Round Rock, north Austin, south Austin and Drooping Springs, Texas. Our website is armor mens health.com and you can check out our podcast wherever you listen to your free podcast.

Speaker 3 1:22

Hey, you got it right. Nice job. I

Speaker 4 1:23

Got it right this time. Thank you.

Speaker 3 1:25

Uh, you know what? I love me guests. Oh,

Speaker 4 1:27

<laugh> .

Speaker 3 1:28

And I love bad guests . If

Speaker 4 1:31

You could see our YouTube channel right now, this guy, he's got two races after this.

Speaker 3 1:36

I am joined by Dr. Vilas Salata. Vilas , thank you so much for joining us today.

Speaker 5 1:40

Thank you, Sonny .

Speaker 3 1:41

You are a board certified orthopedic surgeon and an all around badass. That's

Speaker 4 1:47

Right. You can tell from the outfit you

Speaker 3 1:49

Are. But, so for our listener's sake, why don't you tell us a little bit about , uh, where you went to school and what kind of training an orthopedic surgeon goes through. Sure.

Speaker 5 1:57

So I grew up in New York. I did , uh, a medical school in Philadelphia at Drexel. And then from there did my residency at Einstein , um, in North Philadelphia, which is at a level one trauma center. Uh, right after that, I , uh, entered active duty with the Air Force. And , uh, my first assignment was at Baltimore Shock Trauma. And I deployed right out of there , uh, in 2012 to Afghanistan. That was my first , uh, assignment really as an attending surgeon. Really? It was , uh, in Afghanistan. Really?

Speaker 3 2:25

Wow . Like the first time that you were in charge of people and that , that that room was yours, you were like, oh, you just got shot. And an IED just blew your leg up, huh? Yeah ,

Speaker 5 2:33

You know, interesting. It's , uh, we crossed five time zones basically to get from where I was in , uh, Naval station, Norfolk to Afghanistan. And then I show up and , uh, I put my bags down and you get to work <laugh> .

Speaker 3 2:45

Wow. <laugh> . Yeah . There's no orientation, there's a knife brief orientation.

Speaker 5 2:49

But, you know, I was blessed with the fact that the senior, I was the youngest there. I was a captain and most of the people , um, ahead of me were , you know , either major as lieutenant colonel, colonel. So I had a , a lot of good officers ahead of me, basically to show me the ropes and whatnot. And I volunteered for most of it just to, I find like you get most of your experience as a hands-on experience. And what you saw there in seven months probably won't see in this country ever. I ended up thank God doing about truly Right . Thank God. But in about seven months, I did about 650 cases.

Speaker 3 3:23

And like, these are gonna be cases of trauma, broken bones, gunshot wounds,

Speaker 5 3:28

Bla a lot of blast trauma,

Speaker 3 3:29

Blast injuries. Oh , and, and you know, the , the kind of skillset that you're gonna develop in that pressure cooker of an environment, probably, you know, 10 times the, the value that you would have in any kind of job here stateside at

Speaker 5 3:43

At least, you know, it's, you come into it because you have, you're you , what you're given is it doesn't, you know, read. It's not from any textbook. There's no Okay. Do this at this point because it's just blown apart. So you have to make, do you have to be good with improvisation within a semi austere environment with limited resources.

Speaker 3 4:05

One of the reasons that I love you is that I, I know that you love to operate. You're just like me. I mean, we sit in that lounge. We love to hang around the hospital. We love to operate because we love, we love what we do as a task. I heard that you even operated on a dog once.

Speaker 5 4:19

That is true. Wow.

Speaker 3 4:21

A blast dog. It was a bomb dog . Yeah ,

Speaker 5 4:22

It was a mine detecting , uh, it was a Belgian, me and Wal and , uh, know this. Yeah . It was a , one of the task force commanders from the , um, from nato, and he got hit by a car and broke the equivalent of our forearm. Okay. And , uh, the veterinarian there had , uh, presented it to myself and my , uh, commander with this and said , what do you think? And he said, well, it's like a , a regular forearm.

Speaker 3 4:44

It's like a regular forearm. Oh , let's just , let's just go fix that. And that dog survived beyond

Speaker 5 4:48

That <laugh> . He was , he was, we ca we fixed him a standard stainless steel plate and screws casted him. He was up and running and back on duty in a month. Yo , you

Speaker 3 4:56

Made him go back to work. <laugh> back to work . My God, I guess military, t military is a little different. So, so now that you're back stateside, a lot of what your , um, job entails is trauma , uh, and , uh, and , and , and what happens here. So, so when it comes to trauma here , uh, as part of a normal orthopedic trauma practice, what are some of the things that make up kind of the majority of your day?

Speaker 5 5:19

Well, you know, I would say that I actually see patients in the office , uh, four half days a week, but I operate five to six days a week. So in the Monday through Thursday in the morning, wait, wait , wait .

Speaker 3 5:29

How did you get nine days? Does that make you jealous ? How did he get nine days? You're jealous. I can see it . Oh, man. God gave you nine days. Mm . He only gave me eight. Oh , stop <laugh> . Okay, go ahead,

Speaker 5 5:39

<laugh> . So to answer the question, a lot of falls . Okay. Uh, upward St . David's Round Rock Medical Center is, it's the busiest , uh, level two trauma center in Williamson County. We see about 80% of the trauma for that county. A lot of falls , a lot of high speed motor vehicle accidents, transfers in from other , uh, regional hospitals , uh, that span way up north even to temple. We also created a , a regional receiving , uh, unit for complex joint replacement and revision. So the other part of my world is , uh, revision surgery . So re somebody gets a total knee or a total hip and it falls apart, gets infected, they fall, break apart around it, then they send it to us and we redo

Speaker 3 6:20

It. So when an 80-year-old person is getting up in the middle of the night to go to the bathroom, Mm-Hmm. <affirmative> trips over their carpet. This is how you're , your and my worlds collide. Okay. If, if I don't fix them from getting up at night to pee Mm-Hmm . <affirmative> , then they're gonna get up, trip on the carpet and then break their hip. Why, why is the hip so easy to break? It seems like such a huge bone

Speaker 5 6:38

Osteoporosis. Right? So as time progresses, the bone thins and it hollows out from the inside. So the cortices , or think of it as the shell gets thinner and thinner. So even a very slight moment of force can cause a crack. It could be, it could be as simple as you, you slid out of your chair , you didn't even fall, you just slid out. Wow . And then based on, it's, think of it as like a three point bend. Right. Or like, imagine a seesaw and you've got something in the middle if the two ends are pushed down on the middle or the fulcrum can create a bend a break pretty easily. And

Speaker 3 7:13

As we get older, osteoporosis and thinning bone really creates a lot of different difficulties. I I have patients that come in that say they broke an ankle stepping off a curb wrong, you know, lots of broken hips

Speaker 5 7:23

Just standing there.

Speaker 3 7:25

Just standing there and they , wow . They hurt themselves. And a broken hip can be very dangerous. Right? I mean, if you're, if you're 80 years old, isn't the mortality from a broken hip like in the 90 days, you

Speaker 5 7:35

Know , 20 to 30%? So, and you know, the , we've studied what ,

Speaker 3 7:38

What you're saying is that 20 to 30% of people that break their hip will die. Could within,

Speaker 5 7:43

If you, and there's some, they're mitigating factors, right? Right. So we've the American Academy of Orthopedic Surgeons , uh, the , uh, orthopedic Trauma Association there , there've been huge studies, tens of thousands of patients. And we've landed on, you have to get to these people very soon, like 24. Ideally we try to get to them within 24 hours. You

Speaker 3 8:04

Have to fix them quick, quickly.

Speaker 5 8:05

Right. Because then you mobilize them. That's , that's right . You get their hands away from their chest. You get them sitting up upright mobilization, you, it prevents all the untoward complications of being recumbent in a bed. Right. So, pneumonia, the delirium, the bed sores and, and just the level of pain that people feel. 'cause the hip fractures incredibly painful. Hmm . I bet So . Yeah . So if you reduce their pain scores, you reduce all the , their all comer , uh, contributors towards mortality. But it's a double-edged sword. Right. A lot of these people are very sick also. They're , they're on blood thinners. They have multiple cardiac issues. So

Speaker 3 8:44

It's not the healthiest population. Not at all. So I really emphasize in my older population, and if you're taking care of an older person or you are an older person, taking care of an older person, is that you have to make sure that your environment where you live and you know, your bedroom and your bathroom have important things that prevent you from unnecessary falls. You know, not having a lot of loose carpeting, you know, making sure you have handrails when appropriate. You know, not having a lot of obstacles on the way to the bathroom. I mean, these are things that I emphasize a lot in my office.

Speaker 5 9:12

They , they say preventative medicine is the best medicine. Right. So this dovetailing on what you're saying, adding a nightlight, even adding padding alongside the bed, lowering the bed,

Speaker 3 9:22

These are really important things that people don't think about until they break one hip <laugh> , you know? Mm-Hmm . <affirmative> .

Speaker 5 9:27

And , and the , the hard , sometimes I think the hardest conversations to have are for people that have balance issues. Right. And you say, Hey, why don't you just get a cane? Yeah . Well get a walker, a cane, or a walker. In fact, why don't get both? Yes. You know, they have the collapsed wolf styles. They have the ones in different colors.

Speaker 3 9:42

You're worried about looking old. How about being dead? Like , correct . That that's really a very, you can

Speaker 4 9:46

Bedazzle them. You can

Speaker 3 9:48

Bed ,

Speaker 5 9:48

You can bedazzle them. We should ,

Speaker 3 9:50

We should, we should offer that.

Speaker 5 9:52

You know , you can even have a little horn on there. <laugh> or race car sounds. That's what I would have . Race 40 sounds for years now.

Speaker 4 9:59

I like that. I like that.

Speaker 3 10:01

Well, you know , um, uh, well , when I, when I was in training, the orthopedic surgeons were always the busiest , uh, of the, of the surgical subspecialties. I feel like orthopedic trauma must be an incredibly exciting thing to do. The fact that you also race cars means that your , uh, need for adrenaline is pretty high. <laugh> . You know what I'm saying? <laugh> , which is pretty good. Uh, we're gonna be right back. I , I have Dr. Vela Saldana with Texas Orthopedics. He's an orthopedic trauma surgeon. Donna, how do people get ahold of us and get , get to learn more about Dr. Saldana?

Speaker 4 10:31

That's right. Dr. Saldana, who uses bigger words than Dr. Mystery , you can call us . Hey , at (512) 238-0762 and our website, armor men's health.com, where you can submit your questions and listen to our podcast wherever you check out. Free podcast. Hello

Speaker 3 10:44

And welcome back to the Armor Men's Health Show. I'm Dr. Mystery , your host, board certified urologist, and I'm joined by my co-host, Donna Lee. That's

Speaker 4 10:52

Right. Welcome to the show and our YouTube channel. So check out our YouTube channel. Armor Men's

Speaker 3 10:56

Health. Ever since you lost weight, you've been trying to get us on

Speaker 4 10:58

Camera. I cannot wait to be on camera 'cause I'm skinny. She

Speaker 3 11:02

<laugh> . She now has I think four podcasts. She does like a podcast for hairdresser.

Speaker 4 11:07

Oh, he is so pretty us. That's

Speaker 3 11:09

Right. I mean, she's trying to get a reality TV show. Not

Speaker 4 11:11

For me, for my hairdresser

Speaker 3 11:13

<laugh> . Yeah. You're hoping that, that he invites you as a, as a guest.

Speaker 4 11:15

I'll just be in the background all the time.

Speaker 3 11:16

I know how it is. Mm-Hmm . <affirmative> , this is a men's health show brought to you by NAU Urology specialist. That's the holistic Men's wellness program and urology group that I started in 2007. Donna, how do people get appointments with us, which we have lots of availability for you and , uh, and , and we're our offices

Speaker 4 11:32

Call us at (512) 238-0762 . And yes, we are a holistic urology office. One of the only ones I think in the country. So you can learn more about us at armor men's health.com. You can also submit your questions to that website, armor men's health.com, and we will answer them anonymously. You can send them to our guests like Dr. Saldana, who we have today. We're in Round Rock, north Austin. South Austin and Dripping Springs. And I think people remember the website. If I sing it omans health.com.

Speaker 3 11:58

You really are looking for that stage presence . Nice job <laugh> . Uh , we are joined . You're welcome by Dr. Vila Salana, Texas Orthopedics. He's a , uh, an all around great guy and a certified badass. So , uh, Dr. Salana , thank you so much for joining us again today. So , um, uh, one of the things that I talk about a lot on the show is how not all doctors are the same, and not all surgeons are the same, but when you're a patient and you're, you know, the , the power, we talk about power differentials often in that room, in that, in that, in that exam room is so big between the training, the experience of any surgeon and the patient that's suffering from a disease that sometimes it's hard to see, you know, the trees , uh, for the forest. But when it comes to um , you know, advanced orthopedic problems, the good hips and the good knees, you know, those guys go on living great lives. But the bad ones, those guys suffer and they tell everybody. So my father-in-law, he decided to do both knees at the same time. And I dunno , that was like 12 years ago. That sounds terrible. And he's still struggling, you know, today. And his life is obsessed with his knee and how he can't walk. And he was so active before and it went downhill in such a hurry. Mm-Hmm , <affirmative> . So , um, you take care of complicated and complex like reconstructive things. Why don't you tell me a little bit about, you know, what does that mean? Like, like when do I need a you as opposed to, you know , uh, you know , an orthopedic surgeon that just does run of the mill orthopedics?

Speaker 5 13:26

You know, I thank you for the question. I think , um, put it to you , I'll , I'll frame it to you this way. People that come see me after they've had their knee already replaced or their hip already replaced, there's a problem. And I think the devil is in the details. It's not necessarily you have to do advanced imaging, you have to do all these fancy lab tests and all that. Just listen to what the patient is saying. So I may ask the same question 10 different times in 10 different ways in my interview with a patient. And they'll start with to address the power thing. I'm actually either sitting on the exam table and they're sitting on the chair, or we're , I'm sitting on a stool a little lower than they are and we just chat. What's up? Why are you here? How's, how's life? What is your day to day like? Can you do what you're doing? Have you ever had a good day on your knee or hip, whatever joint is replaced. And then the common sense stuff. Any fevers or chills? Have you ever been sick? Has this knee ever been operated on more than once? Or hip been operated on more than once? Let's say you're sleeping in bed and you're waking up for the day and you swing your legs over. Does it take a minute to get your knee in gear or your hip in gear? And those are , uh, suggestive of instability, right? Oh , it's called startup pain. So if I can't get my knee in gear or I have to kind of shake it or like kick it around like a dog, or it takes a few minutes to warm it up because I don't feel quote unquote confident on it, there's probably a mechanical problem. One of my mentors, the guy that trained me, said that in orthopedics, the only disease , true disease is instability. Mm-Hmm . The body does not like asymmetric or abnormal motion. And to follow on with that, all things really fail in sheer force. Shear is a tangential force. It's not perpendicular to a surface.

Speaker 3 15:10

It's two things moving across each other is what you say .

Speaker 5 15:11

Exactly.

Speaker 3 15:12

So when you have , um, uh, somebody that's , uh, you know, we , we , we, we are very lucky to have so many great orthopedic surgeons on this show, and almost all of them say, don't get something replaced until it's not. You're not able to do the things you want to do. Right. And so, you know, don't do it just because you have maybe a little pain, but if you're, if you're able to still function, don't, don't get the replacement. Now what are the most common problems that occur with let's say a knee replacement?

Speaker 5 15:36

So post-surgical, you're saying? Yeah, it could be size, it could be the position of the implant.

Speaker 3 15:41

You're saying bigger is not better

Speaker 5 15:43

<laugh> in this case, it may not be. Oh boy, just urology. Okay . Okay . It could be size, position, the rotation of the implants. It could be how the soft tissues were handled because

Speaker 3 15:53

These things are put in while you're sleeping. So you're not actually physically walking on the thing where it's being put in, but you do your best to try to mimic what it's gonna do. Right, exactly.

Speaker 5 16:02

And you know, right now there's a, this is a whole rabbit hole in itself, but there's a whole debate on robotic assisted joint replacement versus conventional manual. And this is like the hotly debated thing currently in amongst orthopedic surgeons that do joint replacements. And you're either in one camp or both camps. And you know, I would tell you that regardless of the instrumentation that you use, you have to balance the knee. That you just have to think of it as two spaces. Then with the knee in extension and inflection, those spaces, or the space between the femur and the tibia has to be equal. If you can balance those and it's not moving around like a wet noodle, for lack of better words, Hey, you're gonna do, hey,

Speaker 3 16:47

I don't know , he has wet noodles in his practice too.

Speaker 5 16:50

That's so weird. <laugh> , you , you're gonna , you're gonna do okay. But again, it's, this is a , i I think that you need to take your time when you're doing a joint replacement. This is not one of those, you just slam them in. This is supposed to last somebody two decades. They're gonna be cycling this thing hundreds of thousands of times . So it better be right.

Speaker 3 17:08

It better be right. I mean, it's a mechanical thing that you're putting, I mean, you wouldn't expect like the binding on a book to last that long or anything that you were gonna open and close that much analogy . So the knee really has to like, be well positioned, get put in. So there must be a lot of people that don't have great, like knee replacements. So, so not , I mean, out there. I mean, and not, not to say that, and I think that, you know, I'm a surgeon. I know that I could do the same case a thousand times and somebody doesn't do well with something that I thought went really well. Uh, so it's not necessarily, you know, a comment on the surgeon, but, so if , if people are have had a knee replacement , uh, what are some common complaints that that let you know that that could be a pro , that it could be a problem?

Speaker 5 17:47

I, I feel like I can't get my knee in gear. I've never had a good day on it. I don't feel confident on it. My knee gives out on me. Um, I it's always hot. And this is like beyond the , um, regular Yeah . Postsurgical stuff, right? Yeah . So two years later it's super hot. Um, it drains that's, I mean, a bad sign,

Speaker 3 18:06

Really

Speaker 5 18:07

Bad sign. Mm-Hmm , <affirmative> . Um, I can't extend my leg. I can't bend my knee. It's too tight. I can't get beyond like maybe an arc of like 40, 50 degrees. It's just super stiff. Uh , my hip, it dislocates on me. It's dislocated four or five times. Um, I mean the , the list goes on. You

Speaker 3 18:26

Can , you can tell that a a a a part of your body that you've relied on for your entire life to not feel confident in it would really shake yourself in terms of your ability to , uh, feel comfortable and walking and your , and , and your normal activities.

Speaker 5 18:40

Absolutely.

Speaker 3 18:40

And so , uh, do you think that, that most orthopedic surgeons are , uh, willing and able to refer on to someone else when they have somebody who's complaining? Or do you think that a lot of them keep, keep those patients to try to fix them themselves?

Speaker 5 18:54

You know, I don't know exact percentage numbers. I, I do have , uh, there's a lot of great orthopods in town and I think that the revision surgery is, it's concentrated. There's only like two or three of us in town that do like, do them in significant volumes.

Speaker 3 19:08

And by revision you mean somebody that already had something done and then needs something, something else. Why is that harder? I mean, I, I know why it's harder. Tell our listeners why that's harder. <laugh> . Mm-Hmm . <affirmative> .

Speaker 5 19:17

Think about a house, right? And you decide one day that I love this piece of property, but I just hate the house, so I have to take a wrecking ball to the house. What's gonna happen to your foundation at the end?

Speaker 3 19:30

It's gonna get cracked and happen . It's gonna

Speaker 5 19:32

Get cracked. And so when you take, you have to redo a knee or you have to redo a hip, you have to rip it down to the studs and rebuild it. Well that foundation is

Speaker 3 19:42

Your bone,

Speaker 5 19:43

Your bone. And it is almost always compromised.

Speaker 3 19:46

Right. Because you , you cement those things in there. Yeah . And you gotta like, break the cement and like take the thing out and,

Speaker 5 19:51

And cement it destroys bone. It's amazing. Oh , like when you actually open a knee and you take a knee replacement out the cement, actually it just almost liquefies and it looks like garbage at the end. So you're left with, I could show you scores and scores of pictures of like these massive holes left in people.

Speaker 3 20:08

So this idea that, oh, the knee didn't work, why don't I just go in and like, you know, fix it up. Um , is, is is not one that people should take lightly because it, it , it requires special skill and uh, and , and things may not end up and metal and a lot of metal <laugh> , you should have seen his eyes . He lit up . He likes metal . Wow . Oh my God . Wow . Well, Dr. Saldana certified badass, you know, revisionist , uh, and trauma surgeon. I mean, you really have too many titles. Uh mm-Hmm . <affirmative> when it comes to what we do. But most importantly, a surgeon who loves to operate. I think that's the biggest compliment that I can give. Mm-Hmm . <affirmative> , uh, to you my friend. So thank you so much for joining us today. Appreciate your time very much. And Donna, how do people get ahold of us and send us a message? That's

Speaker 4 20:50

Right. You can call Dr. Saldana by visiting Texas Orthopedics. So it's Texas ortho.com.

Speaker 3 20:56

Tx ortho.com.

Speaker 4 20:57

That's right. And you can learn about your bones with him or your bone with Dr. Mystery . And call us at (512) 238-0762 and visit our website, armor men's health.com.

Speaker 2 21:06

The Armor Men's Health Show is brought to you by NAU Urology Specialist. For questions or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at armor men's health.com.